Yale: Women who have just given birth are often motivated to prevent a rapid, repeat pregnancy. For those who prefer a contraceptive implant, getting the procedure in the hospital immediately after giving birth is more cost-effective than delaying insertion to a 6-8 week postpartum visit, according to a new study by Yale School of Medicine researchers.
online ahead of print in the July issue of Obstetrics & Gynecology,
the study compares costs associated with immediate implant insertion
with costs of unintended pregnancy. The implant is placed in the arm and
can last for three years.
The research team used data from the
published literature to model what would happen to a hypothetical group
of 1,000 women who want the contraceptive implant after a recent birth.
The computer model, referred to as a decision analysis, takes into
account all possible outcomes for each step of the process.
authors found that for every 1,000 women using an implant, immediate
contraception is expected to avert 191 unintended pregnancies and save
over $1 million in the first year compared with delayed insertion. Cost
savings would increase further for the second and third year after
insertion. Immediate insertion is cost effective because more women will
get the implant compared to a delayed insertion strategy.
can get pregnant again within four weeks of delivering a baby,” said
lead author Dr. Aileen Gariepy, assistant professor in the Department of
Obstetrics, Gynecology & Reproductive Sciences at Yale School of
Medicine. “Most women resume sexual activity before their postpartum
office visit and therefore will be at risk of pregnancy. And 35% of
women do not return for a postpartum visit.”
Gariepy said the
immediate postpartum period — after delivery but before discharge home —
is an ideal opportunity for initiating contraceptives because patients
are motivated and timing is convenient. But most insurance policies do
not provide coverage for contraceptive implant while the mother is still
in the hospital.
“Lack of reimbursement is the most significant
barrier to providing this highly effective contraceptive,” she said.
“It’s time to stop making women jump through hoops. Providing immediate
postpartum insertion helps women and insurance companies. It’s a win-win
strategy for all.”
“This is important information for policy
makers and insurance companies,” Gariepy added. “Our findings show a
strong public health benefit and should aid national organizations
advocating for insurance providers to reimburse immediate postpartum
Other authors on the study include Xiao Xu of Yale, and Dr. Jennifer Y. Duffy of University of California-Irvine.
study was funded by a Yale Clinical and Translational Science Award
(CTSA) grant from the National Center for Advancing Translational
Sciences (NCATS) at the National Institutes of Health (UL 1 TR000140).