Prospective Longitudinal Analysis of Contraceptive Adherence in a Diverse Postpartum Population [249

Abstract

INTRODUCTION: To describe contraceptive method adherence at 12 months postpartum in an ethnically diverse primiparous population. METHODS: Primiparous women delivering at greater than 35 weeks of gestation with the nurse–midwifery service at an academic center were followed for 12 months postpartum. Women's self-reported contraceptive choice was collected immediately postpartum and continuation was queried at 1.5, 6, and 12 months. Ethnicity was self-identified. Three contraceptive groups were defined by the woman's choice of immediate postpartum contraception: 1) condoms; 2) intrauterine device or implant (long-acting reversible contraception [LARC]); or 3) oral contraceptive pills, patch, ring, or depot medroxyprogesterone acetate. Our primary outcome measure was time to contraceptive method change and was compared between groups using Kaplan-Meier survival analysis. Individual times were censored if the participant dropped out without method change or had no method change at 12 months. RESULTS: Of 109 women enrolled, 99 were included in the analytic sample based on contraceptive choice. Mean population age was 25.2±5.0 years; 50% were non-Hispanic white, 40% Hispanic, and 9% Native American. Forty-four percent changed their contraceptive method over the course of the year. Kaplan-Meier survival curves were different among the three groups (P=.005). Marginal survival (no change in contraceptive method) at 12 months was 69.1% for LARC compared with 43.8% for condoms and 35.7% for oral contraceptive pills, patch, ring, or depot medroxyprogesterone acetate (overall P=.008). Post hoc testing indicated LARC survival was longer than oral contraceptive pills, patch, ring, or depot medroxyprogesterone acetate (P=.005). CONCLUSION: Women were more likely to continue utilization of LARC methods at 1 year postpartum compared with other methods. Postpartum women frequently change their contraceptive method within 12 months after delivery.