Associations Between Prenatal Intention and Postpartum Choice: Infant Feeding and Contraception Decisions Among Inner-City Women.

Abstract

Purpose: We sought to understand how women's prenatal infant feeding and contraception intentions were related to postpartum choices. Materials and Methods: Expectant women ≥14 years of age receiving care at MacDonald Women's Hospital, Cleveland Ohio were previously surveyed regarding feeding and contraceptive intentions. Here, we asked: (1) What were postpartum feeding choices, and did prenatal intention predict postpartum choice?, (2) What were postpartum contraceptive choices, and did prenatal intention predict postpartum choice?, and (3) What was the relationship of postpartum contraceptive choice to postpartum feeding choice? Results: Of 223 women interviewed prenatally, 214 (96%) were followed to postpartum in-hospital, and 119 out of 214 (56%) were followed to the postpartum visit. The mean age was 25 years, 185 out of 206 (89.8%) were African American, and 149 out of 200 (75.0%) were multiparous. Prenatal feeding and contraceptive intent were significantly associated with postpartum feeding and contraceptive choices, respectively (both p < 0.0001). More women who initiated breastfeeding chose no contraception (54.5% for any breastfeeding versus 32.2% for exclusive formula feeding) versus long-acting reversible contraception (LARC), tubal ligation, or other contraceptive types (χ2 = 9.28, p = 0.03). After adjusting for known confounders, only receipt of other contraceptive types (not LARC, not tubal ligation) was significantly associated with decreased odds of any breastfeeding (p = 0.02). Conclusions: Among low-income predominantly African American inner-city women, prenatal intentions were significantly associated with postnatal choices for infant feeding and contraception. After controlling for confounders, women receiving less effective types of contraception (not LARC and not tubal ligation) had reduced odds of any breastfeeding (p = 0.02).