Hospital stakeholder knowledge and attitudes about immediate postpartum long-acting reversible contraceptive (LARC) methods

Abstract

Listen

Translate article

Objectives: While research exists on office-based and postabortion placement of long-acting reversible contraceptive (LARC) methods, little is known regarding perceptions about immediate postpartum LARC method provision. This study sought to understand the knowledge and attitudes about immediate postpartum LARC methods among key stakeholders in hospitals implementing immediate postpartum LARC methods in Georgia. Methods: We interviewed 32 key stakeholders from 10 Georgia hospitals undertaking immediate postpartum LARC method implementation. A codebook developed from a theory-based interview guide was used for initial analysis, followed by analysis of emerging inductive themes and finally interpretation and integration of deductive and inductive themes. Results: Key stakeholders included physicians, nursing administrators, pharmacists, billing personnel and lactation consultants. More than half reported no training, education or familiarity with LARC devices despite being integral to immediate postpartum LARC method implementation at their institution. Many stakeholders viewed immediate postpartum LARC method placement as a lesser alternative to office-based LARC method placement. Although attitudes toward LARC method effectiveness were positive overall, most stakeholders mentioned higher risk of IUD expulsion immediately postpartum. Patient selection and trust factored into stakeholders' opinions about ideal timing for LARC method placement. Concerns that stakeholders raised about immediate postpartum placement of a method's potential negative effects on patients included decreased condom use, infection and lost motivation for women to return for postpartum visits. Conclusions: These findings highlight a considerable need for LARC method education among hospital staff involved in immediate postpartum LARC method placement programs. Accurate information addressing commonly raised concerns is critical for stakeholder buy-in to create sustainable immediate postpartum LARC method placement programs. Immediate postpartum LARC method placement should be contextualized as a valuable opportunity for all postpartum women to access contraception.