The transformative role of postpartum contraception

Despite an uptick in awareness and concerted efforts, Arkansas continues to face a serious maternal health crisis. Its vast rural footprint limits access to healthcare, and high rates of unplanned pregnancies contribute to poor outcomes for women and families.

At the University of Arkansas for Medical Sciences (UAMS), we’re working to improve these outcomes by increasing access to contraceptive options, particularly long-acting reversible contraceptives (LARC), which include intra-uterine devices (IUDs) and Nexplanon implants. Thanks to a recent grant, we were able to provide postpartum LARC devices in Little Rock and Fort Smith regardless of whether insurance covered some, all, or none of the cost of these forms of contraception. This gave women the opportunity to choose convenient and effective long-term contraception immediately after childbirth.

Data from these grants assisted in passing ACT 581, which required Medicaid to reimburse IUD and Nexplanon placement in the immediate postpartum period. We are now traveling throughout the state to train delivering hospitals on the billing, coding, and best practices for immediate postpartum LARC placement. We have currently provided this service to seven delivering hospitals and aim to provide to any facility that would like to offer this to their patients.  

According to a recent ACHI study, about a quarter of the 18- to 19-year-olds in Arkansas who gave birth in the years 2019-2021 were pregnant again less than 18 months later. Research shows that providing LARC directly after birth can dramatically reduce unplanned pregnancies and help women space pregnancies more effectively, positively impacting both maternal and child health. Many women who may not initially seek out contraception will still make use of it when offered in the hospital setting. 

By offering these devices at the point of care, we’re addressing practical barriers like missed follow-up visits, lapses in coverage, early resumption of sexual activity, transportation, and time away from work or family responsibilities — challenges that disproportionately affect Arkansas’ rural and low-income populations. Women who receive contraception immediately after delivery are better equipped to plan their pregnancies and protect their health in the critical postpartum period.

The benefits of LARC are not limited to convenience and accessibility. LARCs, such as IUDs and implants, are more than 99% effective and can last anywhere from three to 10 years, depending on the device, without requiring maintenance or daily attention. This “set it and forget it” approach is especially valuable for women juggling work, child care, and financial challenges. Those women often do not have the flexibility to prioritize routine contraceptive appointments or remember to take a pill daily. Studies demonstrate that women who choose LARC methods are significantly less likely to experience unintended pregnancies and are able to achieve optimal pregnancy spacing, which is critical for their health and that of their children.

In a state where maternal mortality rates are alarmingly high, making contraceptive access easier could have far-reaching impacts. According to data from the Guttmacher Institute, ensuring easy access to effective contraception — without pressure or coercion — empowers women to make informed decisions for themselves and their families. The aim is not to promote any single method of contraception but to support women’s individual choices in a way that meets their needs. We at UAMS are dedicated to providing the full range of contraceptive options so that each patient can make a choice that aligns with her life, plans and health.

The work we’re doing at UAMS through our postpartum LARC program and mobile health units highlights the importance of a community-focused approach to healthcare, particularly in rural areas where access to specialists and comprehensive health services is often limited. This focus on accessibility and personalized care enables us to play a key role in reducing maternal health disparities statewide.

Providing women with the means to control the timing of their pregnancies is critical, especially when addressing Arkansas’ maternal health challenges. All of these individual programs and initiatives we hope will give women and families the support they need to make the best decisions about their health care and plan their families in ways that will lead to a healthier Arkansas.

Editor’s note: Nirvana Manning, MD, NCMP, FACOG is chairman and professor of Obstetrics and Gynecology at the University of Arkansas for Medical Sciences (UAMS). She is also a member of the Arkansas Maternal Mortality Review Committee. The opinions expressed are those of the author.