Hi Phyllis,

I am wondering if you are speaking about the indigent, pregnant US
population not covered by Medicaid, which is mostly undocumented
immigrants. These folks get Emergency Medicaid to cover just their delivery
time period, and you are correct that their postpartum checkup /
contraception appt is not covered.

However, for citizens and a few other types of folks who have actual
Medicaid for Pregnant Women, in my state they get at least two (and
sometimes closer to three) months of insurance coverage postpartum. Their
postpartum appt and birth control is covered 100% during that time period.
So in theory they could be offered a first depo injection either
immediately postpartum or at their postpartum checkup appt - around six
weeks postpartum.

For me, this is a tricky and discouraging topic overall. I work with these
populations prenatally/postpartum, and do let moms know prenatally about
the risks of depo given immediately postpartum in terms of milk supply.
However, most of these moms are not at all convinced about the importance
of breastfeeding and/or do not have adequate breastfeeding support, and
many plan to do a combo of breast and formula from the get-go.
Additionally, many say they are planning to breastfeed but yet do not even
attempt to nurse or express at the hospital. In these common scenarios, I'm
not sure how much the potential supply dip from early depo matters...

Debbie Farb, RN, BSN, MPH, IBCLC

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