Letter: Impact of a Novel, Postpartum Contraception Decision Aid Distributed Antenatally at a Canadian Urban, Tertiary Care Centre: A Prospective, Pre- and Post-Intervention Study

Abstract

To develop a postpartum contraception decision aid and evaluate its acceptability and impact on postpartum contraception choices, when distributed antenatally, at an urban, tertiary care hospital. This was a prospective pre- and post-intervention study of postpartum patients in two obstetrical practices. During baseline (January-February 2021) and intervention phases (March-April 2021), patients' contraceptive choices were recorded at the start and end of their postpartum visit. Intervention phase participants received a novel contraception decision tool at 36 weeks gestation. Baseline participants were asked whether a hypothetical decision tool would have been helpful in making contraceptive choices, while intervention phase participants completed a validated acceptability questionnaire regarding the previously distributed tool. Age, gravidity, parity and visit type (telephone/in-person) were collected. Data were analyzed using the Wilcoxon rank-sum test for continuous variables and Fisher's exact test for categorical data. Baseline and intervention phases had 63 and 53 participants, respectively. Compared to baseline participants, intervention phase participants were less likely to be undecided at both the start (13/53 (24.5%) vs. 35/63 (55.6%), p=0.001) and conclusion (4/53 (7.5%) vs. 16/63 (25.4%), p=0.01) of their postpartum visit. Acceptability of our contraception handout was high, with 48/53 (90.6%) of people reporting it helpful in guiding decision making. Our decision aid was acceptable to patients and decreased the rate of contraception indecision among postpartum people.