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More access to contraception improves mothers’ mental health, new study suggests

A study by a team of researchers at the Texas A&M University School of Public Health suggests that low-income mothers in states with more Medicaid access to free, long-acting reversible contraception immediately following childbirth experience better mental health. The study, by Dr. Daniel Marthey, Dr. Elena Andreyeva and Dr. Hannah Rochford, School of Public Health, was published in Health Services Research

“The goal of making contraceptives cheaper and more accessible has a long history, beginning with the introduction of the federal Title X family planning program in 1970,” Rochford said. “But when the Affordable Care Act mandated that all federally approved contraceptive devices and services be made available to patients at no additional cost, this caused problems because contraceptives such as intrauterine devices and contraceptive implants can cost the provider more than the single, lump sum payment the provider receives from Medicaid to obstetric care.” 

As a result, some state Medicaid agencies began to bill separately for this form of contraception, known as immediate postpartum, long-acting reversible contraception (IPP LARC). 

For this study, the research team examined the effect of state decisions to unbundle postpartum long-acting reversible contraception on self-reported maternal mental health status using data from the 2014-2019 core component of the Behavioral Risk Factor Surveillance System, a telephone-based survey. The study provides new evidence that the change in IPP LARC payment was associated with reductions in self-reported days of not good mental health among low-income mothers.  

The researchers believe that making IPP LARC more widely available could lead women to switch from less effective contraceptive methods—or no contraceptives—which could reduce the risk of unintended pregnancy. In addition, they may choose LARC over sterilization, which would not affect the ability to conceive, but would give patients more autonomy over future reproductive decisions. They speculate that both mechanisms have direct mental health benefits.