Objective

To determine whether Bedsider text message and e-mail reminders increase family planning contraceptive continuation and appointment rates.

Material and methods

We trained staff at three high-volume Family Planning, Access, Care, and Treatment (Family PACT) clinics to enroll women through a special portal to receive text message or e-mail reminders for contraceptive refills and clinic appointments. Women were matched by contraceptive method, time frame of index visit, age group, and language preference to Family PACT clients at comparison sites that did not use the Bedsider program. Family PACT claims data was used to assess the contraceptive coverage of Bedsider and comparison women over 12 months. We assessed differences in contraceptive coverage between the two groups using McNemar's test of matched comparisons. Clinic records from one clinic were available to assess impact on kept appointment rates.

Results

Of the 488 women enrolled, 370 had a claim for a hormonal method (oral contraceptive, patch, ring, contraceptive injection) in the Family PACT database. Matching resulted in 365 matched pairs. The median length of enrollment in the reminder system was 115 days (16 weeks). A greater percentage of Bedsider women returned on time for contraceptive injections than women in the comparison group. However, McNemar's test showed no differences in contraceptive coverage between the intervention and comparison groups. Kept appointment rates showed a statistically significant increase after the intervention at the clinic providing data.

Conclusion

Contraceptive injection users showed a positive impact from receiving reminders, but overall there was no impact of the Bedsider reminders on return on time for contraceptive refills and injections. We were able to measure a significant increase in kept appointment rates at one clinic using the Bedsider text message and e-mail reminder system.

Background

Previous studies have shown that contraceptive provision generates significant public sector cost-savings by preventing health care and social service expenditures on unintended pregnancies. Over the past decade, women's contraceptive options have expanded considerably, calling for the need to better understand the relative cost-benefit of new contraceptive methods.

Methods

We estimated the number of pregnancies averted by each specific contraceptive method by subtracting the total number of pregnancies expected under Family PACT from the total number of pregnancies that would be expected if the program were not available. The cost of providing each method was compared with the savings in reduced public expenditures from averted pregnancies. A resultant cost-benefit ratio was calculated for 11 specific contraceptive methods provided to women under Family PACT.

Results

Every contraceptive method studied saved more in public expenditures for unintended pregnancy than it costs to provide. Over half (51%) of the pregnancies averted in 2009 were attributable to the most commonly used method, oral contraceptives. Injectable methods accounted for 13% of averted pregnancies, followed by intrauterine contraceptives (12%), and barrier methods (9%). Intrauterine contraception and contraceptive implants had the highest cost-savings with approximately $5.00 of savings for every dollar spent for users of these methods.

Conclusions

Because no single method is recommended clinically for every woman, it is medically and fiscally advisable to offer women all contraceptive methods to enable them to choose methods that best meet their needs, increasing the likelihood of compliance with the method chosen and prevention of unintended pregnancies.

Background

Considerable racial and ethnic disparities have been identified in maternal and infant health in the United States, and access to postpartum care likely contributes to these disparities. Contraception is an important component of postpartum care that helps women and their families achieve optimal interpregnancy intervals and avoid rapid repeat pregnancies and preterm births. National quality measurements to assess postpartum contraception are being developed and piloted.

Objective

To assess racial/ethnic variation in receipt of postpartum care and contraception among low-income women in California.

Study design

We conducted a prospective cohort study of 199,860 Californian women aged 15-44 with a Medicaid-funded delivery in 2012. We examined racial/ethnic variation of postpartum care and contraception using multivariable logistic regression to control for maternal age, language, cesarean delivery, Medicaid program, and residence in a primary care shortage area (PCSA).

Results

Only one-half of mothers attended a postpartum visit (49.4%) or received contraception (47.5%). Compared with white women, black women attended postpartum visits less often (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], 0.71-0.76), were less likely to receive any contraception (aOR, 0.83; 95% CI, 0.78-0.89) and were less likely to receive highly effective contraception (aOR, 0.64; 95% CI, 0.58-0.71). Women with Spanish as their primary language were more likely to get any contraception (aOR, 1.15; 95% CI, 1.11-1.19) but had significantly lower odds of receiving a highly effective method (aOR, 0.94; 95% CI, 0.90-0.99) compared with women with English as their primary language. Similarly, women in PCSAs had a greater odds of getting any contraception (aOR, 1.06; 95% CI, 1.03-1.09), but 24% lower odds of getting highly effective contraception than women not living in PCSAs (aOR, 0.76; 95% CI, 0.73-0.79).

Conclusion

Significant racial/ethnic disparities exist among low-income Californian mothers' likelihood of attending postpartum visits and receiving postpartum contraception as well as receiving highly effective contraception.