Maryland, my (current) state! Maryland's IUD/LARC push (assuming we are referring to the same thing) is particularly troubling because of the way it was carried out - but is also a good cautionary tale. Maryland's LARC push was part of an HHS grant program that funds home visitors to low income/vulnerable women during the prenatal and postpartum period. TL;DR lengthening interbirth intervals was one of the grants' goals and states had to choose their own metric. Maryland was the only state to choose LARC usage as their metric - some states measured the use of contraception generally, others measured whether or not women gave birth within a certain interval after their previous birth (usually ~12 months), and some states (such as Connecticut) chose to measure whether women were provided information about the risks of short interbirth interval. Personally, that last one is my preferred approach. What particularly concerned me about MD's program was that 1) it was targeted towards low income women, often on Medicaid 2) LARCs generally require medical assistance to discontinue 3) home visitors were advocating for these devices in mothers' homes - a particularly vulnerable area. (end tl;dr) I've done some data deep dives on this grant program more broadly and it's quite interesting - for example, HHS wants programs to be evidence-based, and privileges grant money going towards interventions that have been studied, but the most effective programs tend to be ones where the home visitor is a nurse Paraprofessional home visitors were no more effective than the control group in many studies, but many states turn to them because they are more cost effective. I imagine there are all sorts of difficulties with doing reliable studies in this area, but that facet stood out to me. I have links and articles buried on my hard drive if anyone wants to know about their state program and chosen metrics.
Maryland, my (current) state! Maryland's IUD/LARC push (assuming we are referring to the same thing) is particularly troubling because of the way it was carried out - but is also a good cautionary tale. Maryland's LARC push was part of an HHS grant program that funds home visitors to low income/vulnerable women during the prenatal and postpartum period. TL;DR lengthening interbirth intervals was one of the grants' goals and states had to choose their own metric. Maryland was the only state to choose LARC usage as their metric - some states measured the use of contraception generally, others measured whether or not women gave birth within a certain interval after their previous birth (usually ~12 months), and some states (such as Connecticut) chose to measure whether women were provided information about the risks of short interbirth interval. Personally, that last one is my preferred approach. What particularly concerned me about MD's program was that 1) it was targeted towards low income women, often on Medicaid 2) LARCs generally require medical assistance to discontinue 3) home visitors were advocating for these devices in mothers' homes - a particularly vulnerable area. (end tl;dr) I've done some data deep dives on this grant program more broadly and it's quite interesting - for example, HHS wants programs to be evidence-based, and privileges grant money going towards interventions that have been studied, but the most effective programs tend to be ones where the home visitor is a nurse Paraprofessional home visitors were no more effective than the control group in many studies, but many states turn to them because they are more cost effective. I imagine there are all sorts of difficulties with doing reliable studies in this area, but that facet stood out to me. I have links and articles buried on my hard drive if anyone wants to know about their state program and chosen metrics.