UAMS Implements Statewide Initiative to Prevent Unintended Pregnancies

By Linda Satter

The Arkansas Immediate Postpartum Long-acting Reversible Contraceptive (LRAC) Initiative is a UAMS-led effort to provide training and support for administrators, clinical providers and billing personnel at delivering hospitals across Arkansas so they can begin offering long-acting reversible contraceptives in the immediate postpartum period and obtain reimbursement.

Intrauterine devices and birth-control implants are highly effective in preventing pregnancy, without element of user error and last for three to eight years depending on device. They can also easily be removed at any time if a woman wants to become pregnant.

A private philanthropic grant awarded to the UAMS Department of Obstetrics and Gynecology “helps us support all other delivering hospitals in our state in improving access to long-acting reversible contraception, which allows women more choices in contraceptive options,” said Nirvana Manning, M.D., professor and chair of the department.

Manning said unplanned and closely spaced pregnancies can contribute to poor maternal and neonatal health and can have a negative impact on families.

Following a pilot program in which UAMS provided the devices to more than 700 women in Little Rock and Fort Smith, the Arkansas General Assembly passed Act 581 of 2023, which allows birthing hospitals to obtain Medicaid reimbursement for postpartum patients who receive either device while still in the hospital.

Insertions can cost more than $3,000. Until passage of the new legislation, the procedures were not reimbursable by the state Medicaid program during the immediate postpartum period.

The department began implementing the initiative April 25 when it delivered a toolkit containing documents and other information necessary to implement the program to a hospital in Fort Smith.

Manning said she hopes that by increasing access to contraception immediately after delivery, women will be empowered to decide if, when and under what circumstances to have another child.

Immediate and early postpartum is an ideal time to begin contraception because women are accessing the health care system and are known not to be pregnant, Manning said.

While percentages vary, upwards of 60% of women in Arkansas don’t return to their provider for their six-week postpartum visit.

For several years Arkansas has ranked as one of the worst states in America for maternal mortality.

The U.S. Centers for Disease Control and Prevention (CDC) reported last year that in 2019, about 35% of all pregnancies in the United States were unintended. In 2022, the Arkansas Department of Health said that 54% of women in Arkansas reported that they were not trying to get pregnant when they did.

The financial burden on state and federal governments from unintended pregnancies is more than $21 billion, according to a 2022 report from the U.S. Congressional Joint Economic Committee.

The LARC initiative has been endorsed by the American Congress of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP) and the CDC as among the most effective family planning methods.

Clinical practice guidelines from the CDC and ACOG support immediate postpartum insertions for both IUDs and implants, with few contraindications.