Mexico’s family-planning initiative, launched in the 1980s, made postpartum placement of the Intra-Uterine Device (IUD) widely available to women at no cost.
Recently, there has been considerable interest in increasing postpartum access to highly effective contraception such as the IUD in Texas.
In a research paper that was recently published online, my colleagues and I at the Texas Policy Evaluation Project (TxPEP) show that while more than half of Mexican-born women in Austin and El Paso preferred to use an IUD or implant after delivery, less than 10 percent were actually using these methods. Nearly half were relying on less effective methods such as condoms or withdrawal, or no method at all, but very few had a preference for these methods.
The results shown in the paper are based on a 2013 survey of postpartum Mexican-born women who delivered in these two cities, as well as reanalysis of surveys conducted in Mexico between 1987 and 2014. They underscore the contrast between the highly effective types of contraception Mexican women living in the U.S. would like to use and could easily access if they were living in Mexico, and the less effective methods they are actually able to access in the U.S. Immediate postpartum access to long-acting contraceptive methods (LARC) is not yet available in either Austin or El Paso, although it has been in Mexico for more than 30 years.
There is a vast difference between the proportion of women in Mexico and the U.S. who use IUDs and implants in the first several months following delivery. In 2014, 19 percent of women in Mexico had an IUD or implant placed immediately following delivery, whereas less than 0.1 percent of women in the U.S. began using these methods before they left the hospital.
The transformative impact of Mexico’s national family-planning initiative is not well known in the U.S. Some of the strategies used by Mexico’s health authorities in the 1980s, including training physicians in immediate postpartum insertion of IUDs and subsidizing the cost of devices, provided widespread access to postpartum LARC among women throughout the public healthcare system, and could be emulated on this side of the border.
Only recently, Texas revised its Medicaid policy to reimburse hospitals for the cost of devices and postpartum insertion, effective January 1, 2016. The extent to which Medicaid policy changes will increase women’s access to LARC following delivery depends on future efforts to facilitate prenatal counseling about this option at clinics and hospitals throughout the state. Increasing access also hinges on resolving the logistical and administrative obstacles to provision of immediate postpartum LARC at Texas hospitals. It will also be important to ensure that this option is open to two groups that have often been excluded by state-funded family programs: teens and undocumented migrants. Together they account for a substantial proportion of the children born each year in our state.
Our study points to the paradox for Mexican migrants who have left a country in which all birth control methods are available at no cost to all women. In the U.S., these women find themselves in a very different situation where there is ample public support for their newborn children, but little or no support for helping mothers accomplish their strongly felt goals for limiting or spacing future childbearing.