INTRODUCTION:: Hospitals across the country are implementing immediate postpartum long-acting reversible contraceptive (LARC) programs. Our objective was to qualitatively evaluate representative services through the lens of clinical ethics. METHODS:: We conducted a multiple case study using a literature review to identify academic hospitals providing immediate postpartum LARC. We conducted in-person, semi-structured interviews with 66 key informants across 11 facilities. Two authors independently analyzed data using a framework analysis based on the Armstrong Clinical Ethics Coding System. Authors obtained IRB exemption. RESULTS:: Analysis revealed three significant ethical considerations. First, we found that most sites do not offer immediate postpartum LARC to all patients, instead offering it only to patients with insurance coverage for this care-generally Medicaid recipients. Service delivery thus leads to disparities in LARC access and the potential targeting of LARC to marginalized populations. Second, we identified challenges with informed consent processes: providers struggled to promote both LARC access and patient autonomy (e.g., providers grappled with the appropriateness of newly offering LARC to a laboring woman versus the paternalism of not offering LARC at all). Third, while patient needs and preferences were a major motivating factor in establishing immediate postpartum LARC programs, no site had corresponding provisions to enhance access to subsequent LARC removal. CONCLUSION:: Hospitals offering immediate postpartum LARC contend with important ethical issues, including providing equitable access to contraceptive care, creating robust informed consent processes, and ensuring access to LARC removal. Engaging with patients and a reproductive justice framework when designing these programs may help hospitals adopt safeguards to promote patient-centered care.