Improving Birth Outcomes Through Increasing Access to Long-acting Reversible Contraception: An Impact Analysis of a State-funded Program in North Carolina

OBJECTIVE: To examine the association between a state-funded program in North Carolina (NC) to increase access to long-acting reversible contraception (LARC) through local health departments and to reduce preterm birth (PTB) and low birthweight (LBW). DESIGN: This population-based cohort study used a difference-in-differences approach to determine if PTB and LBW in the postintervention period (2018-2019) differed from the preintervention period (2013-2015) comparing treatment to comparator counties. SETTING AND INTERVENTION: Improving Community Outcomes for Maternal and Child Health funding began in June 2016 in 13 counties to improve access to LARC. OUTCOME MEASURES: PTB and LBW data came from the NC Consolidated Linked Birth File, live birth certificate data probabilistically linked with other public health sources. RESULTS: Our sample included 150 045 births from 13 treatment counties grouped into three treatment groups and 249 173 births from 56 comparator counties. There was no statistically significant decrease in PTB, and a 0.4 percentage point decrease in LBW (95% CI, -0.7, -0.1) comparing all ICO4MCH counties to comparators. We observed a one-percentage point decrease in PTB in two of the three ICO4MCH groups compared to comparator counties [Durham: -1.0 (95% CI, -1.7, -0.2) and High Country-Robeson-Sandhills: -0.9 (95% CI, -1.5, -0.4)]. For LBW, in the more rural treatment counties, there was a 1.2 percentage point difference (95% CI, -1.7, -0.8) in average predicted prevalence comparing the post- to preintervention period compared to the comparator counties. There was a statistically significant reduction in LBW for White and Black mothers in the more rural treatment counties compared to counterparts in comparator counties. CONCLUSIONS: Findings from this evaluation showed a small reduction in PTB and LBW at the population level, particularly in rural counties and among Black or African American women residing in rural counties.