Short-Interval Pregnancy Following Delivery in Catholic-Affiliated Versus Non-Catholic-Affiliated Hospitals Among Patients Insured Through the Medicaid Program.

Abstract

Background: As the number of U.S. Catholic-affiliated hospitals increases, more patients who receive care at Catholic hospitals may face restrictions to reproductive healthcare services, including postpartum contraception and sterilization. Little is known about how Catholic hospital affiliation affects the likelihood of a short-interval pregnancy following a delivery. A short interpregnancy interval is associated with poor obstetric outcomes in subsequent pregnancies.

Methods: In this retrospective study of Medicaid claims data, we examined if an index delivery at a Catholic-affiliated hospital was associated with a short-interval pregnancy among patients in nine states (2010-2014). We used Cox proportional hazards regression to compare the time to subsequent pregnancy for those who delivered at Catholic-affiliated hospitals versus non-Catholic-affiliated hospitals. We also estimated the likelihood of a subsequent pregnancy by 6, 12, and 18 months following an index delivery.

Results: We matched 1,197,898 index births to a provider and the religious affiliation of the delivery hospital. Across all nine states, 20.9% (249,764) of deliveries were at Catholic hospitals. After adjusting for maternal age, maternal race and ethnicity, and rural residence, subjects who delivered in a Catholic hospital had a 5% increased adjusted odds of conception by 18 months (95% confidence interval: 1.04-1.07; adjusted odds ratio: 1.07, 95% confidence interval: 1.05-1.10 by 6 months and adjusted odds ratio: 1.06, 95% confidence interval: 1.05-1.08 by 12 months for Catholic vs. non-Catholic hospitals).

Discussion: Medicaid enrollees who deliver at Catholic hospitals are at increased risk for short-interval pregnancies.