Prevalence of Postpartum Permanent Contraception Requests and Fulfillment Among Incarcerated Individuals and Individuals in the Community

Abstract

Objective: To describe the prevalence of requests and frequency of fulfillment of postpartum permanent contraception among patients receiving prenatal care in a state prison system, compared with a multistate community population.

Methods: We abstracted contraceptive preferences from electronic prenatal and delivery records among patients accessing prenatal care within the North Carolina Department of Adult Correction from 2016 to 2021 and compared it with previously abstracted data from a community sample of patients with Medicaid insurance who delivered in 2018 and 2019. We chose this comparison group because most incarcerated patients are Medicaid-eligible. Further, incarcerated patients would be excluded from the community sample because Medicaid coverage is suspended or terminated during incarceration. We described demographics, pregnancy and delivery characteristics, prevalence of permanent contraception requests, and fulfillment of requests.

Results: Among the samples, 15.1% (128/890) of patients in the prison clinic sample had a documented plan for permanent contraception, compared with 23.5% (2,307/9,837) of patients in the community sample ( P <.0001, standardized mean difference [SMD] 0.21). Of prison clinic patients who requested permanent contraception and delivered while incarcerated, 25 of 86 (29.1%) received permanent contraception, compared with 1,096 of 2,076 (52.8%) in the community sample ( P <.0001, SMD 0.48).

Conclusion: Incarcerated patients request postpartum permanent contraception at lower frequencies than patients in the community; however, substantially fewer incarcerated patients received permanent contraception. Further study is needed to better understand the contraceptive goals and experiences of incarcerated individuals to promote reproductive justice and reduce health disparities.