How South Carolina became a model for reproductive options

South Carolina is not generally thought of as a leader in reproductive choices, but that’s exactly what we are when it comes to making contraceptives readily available to women who are still in the hospital after giving birth. This policy change not only had a positive impact on the women of South Carolina but also has influenced at least 17 other states to follow suit, as well as the federal government.

As a mother and an obstetrician/gynecologist, I am so grateful for the health-care workers who led the way to provide IUDs and contraceptive implants — the most effective, safe and convenient contraceptives available to women. In 2012, South Carolina was the first state that passed a law to provide Medicaid coverage so women could receive an IUD or contraceptive implant in the hospital, at the time of delivery, instead of having to wait until the six-week postpartum appointment.

The results of the change were quickly evident: the use of long-acting reversible contraceptives rose steadily as more women had more accessible options to choose from.

The state Department of Health and Human Services estimates that this policy change saved South Carolina’s Medicaid agency $1.7 million in the first two years by preventing unintended births.

The federal government and another 17 states all changed their policies as well to unbundle the costs and reap the benefits for these super forms of contraception for women just when they need it most: right after having a baby. This is often the best, or only, opportunity many women have for a face-to-face discussion with doctors about which forms of contraception are best for them given their values and needs.

A perfect picture of how this changed the life of a real person is a patient I met in late 2012, when she was a 29-year-old mother of three. She came to see me because she was newly pregnant with her fourth child.

With all of her previous pregnancies, she had recurrent life-threatening health problems. She had previously been unable to return to the clinic for her postpartum visits and receive effective contraceptive counseling due to the challenge and cost of finding child care, especially for her special-needs child.

Now that she was pregnant again, she was concerned for her health and family. She wanted to get an IUD, and postpartum placement in the hospital would have been perfect for her.

However, it was not was not yet covered under Medicaid, as the new law would not go into effect until 2013. I remember her telling me: “My heart sank every time I learned I was pregnant again. I love my kids, but I get worried about having more and about what the risks are with my medical history.”

I was dismayed and surprised that she had not been able to have an IUD placed after her previous pregnancies due a variety of factors including job changes and residency changes, and she and I both knew that a postpartum placement would be so beneficial for her and her family.

My patient gave birth in early 2013, just as postpartum placements became covered, and she was able to receive an IUD at the time of delivery; she has been enjoying her IUD for more than two years, pregnancy free.

I am passionate about making sure women have control of their reproductive capacity in order to fulfill their potential in all aspects of their life, not just motherhood. It was important for my patient to have reliable, safe birth control so she could care for her family and continue her online studies.

For all the women who now can receive their inpatient postpartum contraceptives, I am thankful to the health-care leaders in South Carolina who made this important access a reality.

This story was originally published December 4, 2017 at 5:23 PM with the headline "How South Carolina became a model for reproductive options."