Postpartum Contraception by Pregnancy Intent in a Cohort of Women at an Urban Academic Health Center [22J

Abstract

INTRODUCTION: Nearly half of all pregnancies are unintended. We aim to understand postpartum contraceptive preferences in the context of pregnancy intention (PI). METHODS: Prospective cohort study analyzing postpartum contraceptive behaviors in 431 postpartum women who delivered at the University of Cincinnati Medical Center. Postpartum contraceptive choice (PCC) was compared between women with intended and mistimed/unintended pregnancies, classified using an adapted National Survey of Family Growth construct. Regression analysis estimated the influence of PI on PCC. RESULTS: 71.9% of all pregnancies were unintended. They are more likely in women who are non-Hispanic black (62.3%), unmarried (86.3%), between 18 and 24 years old (51.3%), and use Medicaid (80.1%), compared to intended pregnancies, p-value<0.001. The most popular choices of postpartum contraception overall were IUDs (21.4%), BTL (20.7%), and Depo-Provera (20.2%). Women with unintended pregnancy were 83% more likely to choose highly effective, user-independent methods compared to any other or no method, RR 1.83 (95% CI 1.36, 2.47), and especially more likely to desire sterilization BTL, RR 2.7 (95% CI 1.58, 4.59). Among women sure of their PCC, those with unintended pregnancy were still >50% more likely to use highly effective, user-independent methods compared to user-dependent methods, RR 1.56 (95% CI 1.18, 2.06). CONCLUSION: Women with unintended pregnancy are significantly more likely to choose highly effective postpartum contraception but are also more likely to be medically underserved. Public health initiatives to improve access to family planning services and PPC are important areas of focus to address the high rate of unintended pregnancy.