Popular with new moms, critics say South Carolina birth control option targets minorities – Charleston Post Courier

COLUMBIA Six days past her due date and 36 hours of labor later, Reigna Griffin was welcomed into world on July 1 by way of an operating room at Palmetto Health Richland.

"I just felt a bunch of tugging," said Treana Parrish, 23, who gave birth to her first child by C-section. "Then it was over."

Months earlier, during one of her first prenatal appointments, Parrish decided that she wanted an intrauterine device inserted immediately after Reigna was born because she doesn't want any more children.

"I knew I wanted that when I first found out about it," said Parrish, who works at Target stocking shelves.

The small T-shaped IUD, a so-called "long-acting reversible contraceptive," will prevent future pregnancies by secreting a hormone into the uterus that prevents the egg from becoming fertilized. The device may remain in place up to five years.

Parrish is far from alone. Five years ago, South Carolina's Medicaid program became the first in the country to offer this free service to women while they were still in the hospital after giving birth. Since then, 25 other states have adopted similar policies, and thousandsof women covered by the South Carolina Medicaid program and BlueCross BlueShield of South Carolina have decided to get an IUD or a similar long-acting reversible contraceptive while they're still in the hospital.

"We think most women are really happy about it," said Dr. Judy Burgis, an OB-GYN at Palmetto Health. "We try to offer it universally to everyone."

Long-acting reversible contraceptives, commonly called LARCs, have become increasingly popular in recent years because they are considered more effective than oral contraception and require no daily effort on the patient's part. Birth control pills, by contrast, are less reliable because they're subject to human error. Patients must remember to take the pills at the same time every day to maximize their efficacy. Failing to do so may result in an unwanted pregnancy.

Traditionally, new moms who want an IUD have opted to receive one during the recommended postpartum visit at their gynecologist's office about six weeks after they've had a baby. But Melanie Giese, the director of the S.C. Birth Outcomes Initiative, said 55 percent of moms don't show up for that visit. When her group began discussing the possibility of making these LARCs more widely available, Giese wanted to reach these moms where she knew she could find them in the hospital.

To date, 12 South Carolina hospitals, including Palmetto Health Richland and Medical University Hospital in Charleston, offer patients this service. Some doctors won't insert an IUD after birth because about 15 percent of patients will expel the device if their cervix is still dilated. Still, since 2012, at least 5,000 moms covered by Medicaid have received an IUD in these hospitals.

Medicaid, which pays for more than half of all births in the state each year, reimburses the hospitals for the full cost of these expensive implants, about $923 per device. The patients pay nothing.

Giese estimated the state has saved at least $1.8 million in preventing unintended pregnancies.

"There's a passion for it," Giese said. "It's a very hot topic."

Meanwhile, some public health experts have expressed concern that LARCs have been marketed mainly to poor, minority patients. In South Carolina, for example, 53 percent of Medicaid beneficiaries are black or Hispanic.

"It borders on population control," said Lynn Roberts, an assistant professor of public health at the City University of New York and a reproductive justice expert. "We think its wrong to over-promote (long-acting reversible contraceptives) to particular groups, and particularly to poor women of color, because of the history of sterilization."

During the eugenics movement of the 1920s and '30s, several states, including South Carolina, passed sterilization laws that disproportionately impacted poor, disabled and minority women. Proponents of the movement believed that controlled breeding would prevent overpopulation and would improve the genetic makeup of the human race. Likewise, in Puerto Rico during the 1950s, the first large-scale human trial for birth control subjected women there to very high dosages of hormones.

Few women in the United States have been forcibly sterilized in modern times, but in an editorial published in the medical journal Contraception, Jenny Higgins, a gender and women's studies professor at the University of Wisconsin, Madison, points out that minority women are much more likely to have their "tubes tied" to prevent further pregnancies and that in the 1990s, a birth control implant called Norplant was "aggressively marketed to poor women and women of color, especially to young, urban, African American and Latina girls."

Higgins acknowledged that long-acting reversible contraceptives offer "compelling advantages," but that health care professionals also run the risk of alienating patients.

A spokeswoman for the Medicaid agency said she could not provide demographic data about Medicaid beneficiaries who have opted to receive a LARC in the hospital.

Dr. Drew Mather, an OB-GYN at Palmetto Health, said he discusses birth control options with his pregnant patients during their first prenatal visit and during at least two other appointments over the course of their pregnancies.

"We present them with all their options," he said.

Parrish, for one, said she never felt pressured to make a decision one way or another. She talked to her doctor, did some research on her own and chose an IUD called Mirena. She said it had fewer side effects than some of the others.

Her doctor inserted the device about 10 minutes after Reigna's delivery.

"I don't like pain, so I said, 'Go ahead and do it while the epidural is in,' " she said. "That was great."

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Popular with new moms, critics say South Carolina birth control option targets minorities - Charleston Post Courier