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Recording available 2/16-5/2

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Abstract Award

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Poster Session 2

Category: Obstetric Quality and Safety

Poster Session 2

(544) The impact of an immediate postpartum LARC program on short-interval birth rates in Tennessee

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Coauthor(s)

KR

Kaylee Ramage, MSc, PhD

Assistant Professor
University of Tennessee, Knoxville
Knoxville, Tennessee, United States
Megan L. Young, MPH (she/her/hers)

Process Improvement and Quality Review Manager
University of Tennessee Medical Center
Knoxville, Tennessee, United States
AM

Alicia Mastronardi, MPH

University of Tennessee Graduate School of Medicine
Knoxville, Tennessee, United States
SH

Sam Havron

University of Tennessee Graduate School of Medicine
Knoxville, Tennessee, United States
Jill M. Maples, PhD

Associate Professor
University of Tennessee Health Science Center COM Knoxville
Knoxville, Tennessee, United States

Submitting Author(s)

Jordan E. Lewis, MPH

Researcher
University of Tennessee Graduate School of Medicine
Knoxville, Tennessee, United States

Coauthor(s)

Mary G. Herndon, MD

OB/GYN Resident
University of Tennessee Graduate School of Medicine
Knoxville, Tennessee, United States

Presenting Author(s)

Katherine B. Kaak, MD (she/her/hers)

Resident
University of Tennessee Medical Center
Knoxville, Tennessee, United States

Coauthor(s)

NZ

Nikki B. Zite, MD, MPH

Professor, Vice Chair of Education and Advocacy
University of Tennessee Graduate School of Medicine
Knoxville, Tennessee, United States

Objective:
In Nov 2017, a Tennessee-wide policy change (i.e., the immediate postpartum long-acting reversible contraception (IPP LARC) program) occurred, which allowed reimbursement for IPP LARC among patients receiving Tennessee Medicaid; however, few hospitals adopted this program. To understand its impact, this study assessed rates of short-interval births (SIB) among institutions who implemented the IPP LARC program compared to those who did not.

Study Design:
Birth certificate data from Tennessee Medicaid patients who had a live birth between Jan 2015-Dec 2021 were abstracted, excluding nulliparas. The 3 major hospitals who implemented the IPP LARC program were identified (1 in each of West, Middle, and East TN). We applied an interrupted time-series design to assess the impact of the IPP LARC program implementation on average (avg) monthly rates of SIB at institutions who did and did not implement the program. The intervention effect was assessed at 9 months post-implementation (Aug 2018). SIB was classified as a birth interval < 24 months.

Results:
Implementation of the IPP LARC program had differential impacts on SIB among the 3 hospitals who implemented this program. The hospital in West TN had higher than avg monthly SIB rates pre-implementation (33%), compared to non-implementing hospitals. They had an avg decrease of 0.16% of births classified as SIB/month (p=0.046) post-implementation (Fig 1). The pre-implementation monthly SIB rates in the Middle and East TN implementation hospitals had less than avg SIB rates compared to non-implementing hospitals (25.8% in Middle TN and 23.1% in East TN vs 28.6% in non-implementing hospitals). A significant decline in SIB was not seen post-implementation (Middle TN: avg decline of 0.07% of births classified as SIB/month (p=0.546); East TN: avg increase of 0.06% of births classified as SIB/month (p=0.565) (Fig 2).

Conclusion:
Implementation of IPP LARC programs may help to reduce rates of SIB. Expansion of IPP LARC programs could increase access to and uptake of IPP LARC, potentially reducing adverse neonatal and maternal outcomes associated with SIB.