Change in Postpartum Visit and Contraception Rates Pre-COVID-19 to Post-Lockdown in Six U.S. Federally Qualified Health Centers.

Abstract

Background: Postpartum care, including contraception, benefits maternal health and decreases mortality, which increased in the United States with COVID-19. Pandemic disruptions to postpartum health care access in vulnerable populations are not well understood. We utilize electronic health record (EHR) data for prenatal patients (n = 2,265) at six urban Federally Qualified Health Centers (FQHCs) from one year prepandemic (January 1, 2019) through one year after the first stay-at-home orders ("lockdown") (March 31, 2021). Objective: We investigated (1) changes in rates of postpartum visit (PPV) and postpartum contraception receipt in the post-lockdown versus prepandemic periods and (2) characteristics predictive of differential changes in PPV and contraception rates. Materials and Methods: Visit and prescription records from EHR were used to classify if patients received PPV and most/moderately effective contraception within 60 days postpartum, analyzed separately and as a composite variable: PPV and contraception, PPV only, or no PPV. Risk differences comparing post-lockdown with pre-COVID-19 pandemic were estimated using binomial regression and generalized logistic regression models adjusted for age, race/ethnicity, language, and clinical site. Effect modification by sociodemographic and clinical covariates was examined. Results: Total patient volume fell 21% in the post-lockdown versus pre-COVID-19 period. Rates of PPV decreased in absolute terms by 9.6 (95% confidence interval: -13.6, -5.6) and contraception by 8.1 (-13.3, -2.8) percentage points. After adjustment, PPV and contraception decreased by 9.3 percentage points (-13.1, -5.4), while PPV only was stable (-0.4 [-4.3, 3.6]). Conclusions: These findings suggest a substantial impact of the COVID-19 pandemic on postpartum care in FQHCs and community health centers. Supply and demand drivers require further examination to inform strategies to improve postpartum care access and subsequent maternal health outcomes.