Reducing short interval pregnancies: Mica Bumpus, Program Director, ACOG

Mica and her team are focused on helping ob-gyns and other women’s healthcare providers around the country get the resources needed to offer LARC immediately postpartum to women who want them.

“It is vital to remember that the U.S. has a history and current reality of discriminatory care and contraceptive coercion, including forced sterilization, which has disproportionately impacted communities of color. All contraceptive counseling and any programs aimed at increasing access to contraception, especially LARC, must be sensitive and responsive to this history.”

Q: What kind of work do you do on the Postpartum Contraceptive Access Initiative (PCAI) at the American College of Obstetricians and Gynecologists (ACOG)?

A. Through PCAI, our team prepares ob-gyns and other women’s health care providers to offer the full range of contraceptive methods to women after delivery through comprehensive, individualized training plans, including education, onsite support, and capacity building. Expanding access to the immediate postpartum initiation of effective contraception, including LARC, can empower women to choose the method that’s right for them and reduce short interval pregnancies.

Q: Why is your focus on increasing access to immediate postpartum LARC?

A. The immediate postpartum period can be a particularly favorable time to provide LARC and research shows that LARC provision is safe and effective. There are unique barriers to providing LARC that can make it challenging for health care providers and institutions to offer them routinely in the immediate postpartum setting. Our work helps to overcome those unique barriers. One benefit of increasing access to LARC immediately postpartum is that it can decrease short interval pregnancies. Short interval pregnancies, defined as pregnancy within one year of a previous delivery, are an independent risk factor for preterm delivery and adverse neonatal outcomes. Almost half of women discharged after delivery without having a desired postpartum tubal ligation will be pregnant within one year. These women know with certainty that they do not want to become pregnant and voice the need for highly effective contraception. It is a true failure of our healthcare system not to value these requests or offer another option for highly effective contraception when postpartum tubal ligation is unavailable. LARC offered immediately postpartum can serve as a bridge method for these patients after childbirth and can help support a woman’s choice of if and when she wants to get pregnant again.

Q: What are your guiding principles?

A. We believe that LARC is not the right choice for everyone and increasing access to LARC in the immediate postpartum setting is just one piece of the puzzle to ensure access to the full range of contraceptive methods whenever a patient desires it. Most importantly, we believe that women know what is best for them and their health.

Q: What barriers exist for postpartum LARC?

A. Research tells us that the biggest barrier to access for LARC immediately postpartum is the lack of insurance coverage. In most states today, significant insurance coverage gaps still exist for folks covered by Medicaid and commercial payers alike.

Q: What role can communities play?

A. Women are smart and know what is best for them and their health. The same applies to communities: communities know what’s best for them. When doing this work, it’s crucial to partner with the communities you’re trying to serve and ensure they’re at the table from beginning to end. Partnering with these communities will help ensure their voices and needs are at the center of the work.