OBJECTIVES: Obese women face a greater risk of unintended pregnancy (UIP), and Medicaid enrollees experience disproportionate burden of obesity and UIP. The objectives of this study were to evaluate prescription contraceptive (all types including long-acting reversible contraceptive [LARC]) use patterns among obese women covered by Medicaid.

METHODS: We identified 18–45-year-old newly diagnosed obese women covered by Medicaid between January 2017 and September 2021 from the Merative MarketScan Research Databases (index date is the date of initial obesity diagnosis). We used CPT, HCPCS, ICD-10, and NDC codes to identify prescription contraceptives. Age-based subgroup analysis was conducted, and McNemar test was used for statistical testing of differences.

RESULTS: Among 312,411 newly identified obese women, we found no evidence of prescription contraception fill for 70% in the 1-year period prior to, and 60% in the 1-year period after the index date (pre-index versus post-index; p<0.01). LARC use modestly increased: 11% prior to and 16% after (p<0.01) the index date. Among the remaining subjects, oral contraceptives were the most frequently used options accounting for 12% and 14% of the total subjects prior to and after the index date (p<0.01). Across three age groups, contraceptives were most often used among the 18–25-year-old group and least often used among the 36–45-year-old group (55% versus 21%, p<0.01). Furthermore, 23% of the 18–25-year-olds chose LARCs.

CONCLUSIONS: Most obese women covered by Medicaid were not using prescription contraceptives in the year before or after their diagnosis. While a greater proportion of women received prescribed contraception in the year following obesity diagnosis, the relative lack of effective contraception may help explain previously reported positive correlations between obesity and UIP. The older group of obese women had the lowest rate of contraceptive use and may have a greater relative risk of UIP.