This study has identified unmet demand for long-acting reversible contraception (LARC)—(IUDs and implants) and permanent contraception (sterilization and vasectomy). This study assessed the types of contraception publicly insured women would prefer to use after delivery, and found a much higher percentage of women prefer LARC and sterilization than the percentage of women who actually use these methods.

Of the eight hospitals that participated in the study, only one provided LARC methods immediately after delivery. Women at this hospital were much more likely to use implants and IUDs than women at the other hospitals in the study.

The research, based on interviews with 1,700 women who delivered healthy babies at eight Texas hospitals, was published in Obstetrics & Gynecology. “These results show that preference for IUDs, implants and female sterilization is high among public patients in Texas, but that these low-income women often have trouble accessing their preferred method of contraception after delivery,” said Joseph Potter, lead author of the study. “This study suggests that one way to improve access to IUDs and implants, in particular, is by making these methods available to women who want them immediately after giving birth.”

Other findings point to barriers that women in Texas encounter when seeking highly effective contraception. Women who received prenatal care from a public clinic were more likely to use a LARC or permanent method than those who obtained care from a provider in a private practice.

Another finding with policy implications for Texas and other states with large immigrant populations is the disadvantage that foreign-born women experience when it comes to accessing their preferred method—implant, IUD, or sterilization. The likely explanation is undocumented immigrants’ lack of insurance coverage for contraception after delivery. In Texas, contraception is not a covered benefit of the CHIP Perinatal program for which undocumented women may be eligible.