Postpartum Contraception Research Articles

A Descriptive Analysis of Emergency Contraception Familiarity in Postpartum People [ID: 1377163

INTRODUCTION: Ensuring access to emergency contraception (EC) is a fundamental component of comprehensive contraceptive counseling and reproductive health care. Despite this, little is known about familiarity with EC in postpartum people, a population motivated to prevent pregnancy in part because of the risk of short interpregnancy interval. This study aims to assess familiarity with EC in postpartum people. METHODS: After IRB approval, 76 participants choosing a lower-efficacy method of postpartum contraception were recruited from a large urban hospital on postpartum day 1. Most participants were between the ages of 25 and 34, married, employed, and have had multiple pregnancies. Familiarity with EC and reproductive health were assessed via surveys after attaining patient consent. Descriptive statistics were performed. RESULTS: Nearly all participants (91%) had heard of EC before. A minority of participants (18%) have brought up EC with a health care professional, while approximately half (46%) reported a health care professional bringing up EC with them. Most participants (75%) reported being at least somewhat likely to take EC if they wanted to prevent pregnancy. One-third of participants reported prior use of EC, while nearly half of participants (42%) reported having at least one unplanned pregnancy. CONCLUSION: A majority of participants were aware of and willing to use EC despite a minority of participants having discussed the option with a health care professional. For all patients but especially those who select a lower-efficacy postpartum contraceptive method, health care providers can supplement reproductive choice and reduce the risk of short interpregnancy interval through comprehensive counseling on when and how to use EC.

Increasing Contraception Options Immediately After Birth: Did Immediate Postpartum Long-Acting Reversible Contraception (IPP LARC) Utilization Increase During the COVID-19 Pandemic? [ID: 1377847

INTRODUCTION: Preliminary research indicates prenatal and postpartum care decreased during the COVID-19 pandemic. Models also indicate increases in unintended pregnancies after 2020. The goal of this study was to assess whether immediate postpartum long-acting reversible contraception (IPP LARC) insertions and desire for IPP LARC increased during COVID-19 among patients insured under TennCare Medicaid (TennCare or CoverKids) with access to coverage for this type of contraception. METHODS: Deliveries in patients insured under TennCare Medicaid Programs (n=6,922) in one East Tennessee hospital were assessed before and during the COVID-19 pandemic (January 2019 to May 2020 and June 2020 to December 2021, respectively). Data from electronic health records were securely collected in Excel and analyzed using SPSS software. Comparisons were made using chi-square tests. RESULTS: During COVID, increased uptake of IPP LARC was statistically significant: 18.0% (CI 16.9–19.1%) before the COVID-19 pandemic and 22.0% (CI 20.6–23.3%) during (P<.001). In addition, desire for IPP LARC increased significantly among patients: 20.0% (CI 19.1–21.3%) before COVID-19 and 22.3% (CI 21.0–23.7%) during COVID-19 (P=.016). Significant increases in desire for IPP LARC during the pandemic occurred among adolescent patients (<20 years of age) (P=.003), those living HRSA-defined nonrural areas (P=.024), non-Hispanic women (P=.036), and White women (P=.027). CONCLUSION: IPP LARC is a highly effective, convenient contraception option for women, especially during times with possible increased limitations in accessing postpartum care. Perhaps because of shelter-at-home orders, limitations in “nonessential” health care being practiced, or personal preferences and desires during the pandemic, IPP LARC was more highly utilized and desired by those wishing to avoid unintended pregnancy after the pandemic began.

Medicaid Payment For Postpartum Long-Acting Reversible Contraception Prompts More Equitable Use.

To increase access to highly effective contraception and improve reproductive autonomy, a growing number of state Medicaid programs pay for the provision of immediate postpartum long-acting reversible contraception (LARC) in addition to providing a global payment for maternity care. Using Pregnancy Risk Assessment Monitoring System data, we examined postpartum LARC use both overall and by race and ethnicity among respondents with Medicaid-paid births during the period 2012-18 in eight states that implemented immediate postpartum LARC payment and eight states without it. Using a quasi-experimental difference-in-differences design, we found that the policy resulted in an overall 2.1-percentage-point increase in postpartum LARC use. Our triple-differences analysis found no significant change among White mothers and a 3.7-percentage-point increase in use among Black mothers compared with White mothers. Additional research is needed to determine whether this increase was aligned with patients' preferences and whether hospitals' immediate postpartum LARC policies and practices take a patient-centered approach that supports reproductive autonomy and equity.

Virtual Antenatal Group Contraception Counseling: A Pilot Study [ID: 1346753

INTRODUCTION: This pilot study examines the feasibility, patient satisfaction, and knowledge after a novel virtual Group Contraception Counseling (GCC) session. METHODS: At an urban academic hospital, we recruited English-speaking pregnant women aged 15–49 who had access to a video-enabled electronic device. Participants engaged in a standardized 45-minute educational session about contraceptive methods in groups of two to five persons conducted over a video conferencing platform. The primary outcome was patient satisfaction measured by the Person-Centered Contraception Counseling (PCCC) scale. The secondary outcome was knowledge change before and after counseling. We used a nonparametric test of ranks to analyze satisfaction scores. A paired-sample t test and independent t tests were used to compare knowledge scores. RESULTS: Nineteen participants completed the study. Participants identified primarily as Black (47%), in a partnership (52%), having completed college (61%), and having an annual income of less than $50,000 (78%). The mean PCCC score was 19.21 out of 20 (SD 1.12, range 13–20) with no difference in satisfaction based on demographics or knowledge change score (r−0.296, P=.218). There was a significant difference between knowledge test scores pre- and post-GCC sessions (t 18=−3.229, P<.01), with post scores being 12% higher than pre scores (range 16–40%). Age, race, partnership status, and employment did not differentiate scores, whereas education was predictive of mean change of score after the GCC session (t 15=−2.93, P<.01). CONCLUSION: Our preliminary findings suggest antenatal contraception counseling in small virtual groups is a feasible option with high satisfaction and increased contraceptive knowledge for postpartum contraception choices.

Postpartum Insurance Discontinuity and Use of Prescription Contraceptive Methods [ID: 1377734

INTRODUCTION: Medicaid eligibility income thresholds increase during pregnancy and historically ended 60 days postpartum. Thus, this postpartum period is especially vulnerable to insurance discontinuity, which may decrease access to contraception. METHODS: We used Pregnancy Risk Assessment Monitoring System survey data (2012–2020) in 42 states. Exposure, assessed 2 or more months after childbirth, was categorized as continuous insurance, insurance loss, discontinuous Medicaid-to-private, and discontinuous private-to-Medicaid. We used modified Poisson regression to estimate risk ratios (RRs) with 95% CIs for using contraception methods requiring prescriptions compared to nonprescription methods/none, adjusted for race and ethnicity, language, education, age, marital status, federal poverty level, and year. We then stratified by Medicaid expansion status at time of delivery. RESULTS: Of 246,088 respondents, 76.4% held continuous insurance from childbirth to 2 or more months postpartum, 11.9% lost insurance, 7.6% experienced discontinuity from Medicaid-to-private insurance, and 4.1% from private-to-Medicaid. Compared to continuous insurance, the adjusted RR for prescription postpartum contraception was 0.88 (CI 0.86–0.89) for loss of insurance, 0.99 (0.97–1.01) for discontinuous Medicaid-to-private, and 0.96 (0.93–0.98) for discontinuous private-to-Medicaid. Stratification by Medicaid expansion status yielded similar results. Of respondents in states or time periods without Medicaid expansion, 16.2% experienced insurance loss compared to 7.9% of those with Medicaid expansion. CONCLUSION: Insurance loss 2 or more months after childbirth was associated with decreased likelihood of prescription postpartum contraception, with a higher proportion of respondents without Medicaid expansion vulnerable to such insurance loss. Increased state adoption of the federal 12-month postpartum Medicaid extension option could improve access to prescription postpartum contraception.

Interbirth Intervals of Immigrant and Refugee Women in the United States: A Cross-Sectional Study.

Despite guidelines recommending an interval of at least 18-24 months between a live birth and the conception of the next pregnancy, nearly one-third of pregnancies in the United States are conceived within 18 months of a previous live birth. The purpose of this study was to examine the associations between multiple immigration-related variables and interbirth intervals among reproductive-aged immigrant and refugee women living in the United States. This was a cross-sectional, quantitative study on the sexual and reproductive health (SRH) of reproductive-aged immigrant and refugee women in the United States. The data were collected via an online survey administered by Lucid LLC. We included data on women who had complete information on nativity and birth history in the descriptive analysis (n = 653). The exposure variables were immigration pathway, length of time since immigration, and country/region of birth. The outcome variable was interbirth interval (≤18, 19-35, or ≥36 months). We used multivariable ordinal logistic regression, adjusted for confounders, to determine the factors associated with having a longer interbirth interval among women with second- or higher-order births (n = 245). Approximately 37.4% of study participants had a short interbirth interval. Women who immigrated to the United States for educational (aOR = 4.57; 95% CI, 1.57-9.58) or employment opportunities (aOR = 2.27; 95% CI, 1.07-5.31) had higher odds of reporting a longer interbirth interval (19-35 or ≥36 months) than women born in the United States. Women born in an African country had 0.79 times the odds (aOR = 0.79; 95% CI, 0.02-0.98) of being in a higher category of interbirth interval. Although all birthing women should be counseled on optimal birth spacing through the use of postpartum contraception, immigrant and refugee women would benefit from further research and policy and program interventions to help them in achieving optimal birth spacing. SRH research in African immigrant and refugee communities is especially important for identifying ameliorable factors for improving birth spacing.

Strategies for Improving Postpartum Contraception Compared With Routine Maternal Care: A Systematic Review and Meta-Analysis.

Objectives: This study aimed to systematically review the effectiveness of service interventions for improving postpartum contraception, including contraceptive use, prevention of repeat pregnancies and induced abortions. Methods: A systematic literature search was conducted in three databases until June 2022 (PROSPERO registration CRD42022328349). Estimates of intervention effects from meta-analyses were represented as odds ratios (OR) with 95% confidence intervals (CI). Results: 16 studies with 14,289 participants were included, with four kinds of interventions recognized. Interventions effect in increasing use of contraceptives and decreasing rates of repeated pregnancy for up to 6months postpartum (OR = 2.24, 0.06, 95% CI = 1.46-3.44, 0.02-0.22, respectively), with no significant associations with contraceptive use at 12months postpartum, prevention of postpartum repeat pregnancies and induced abortions during 1year after childbirth. Conclusion: We concluded that interventions impact the initiation of postpartum contraceptive use and prevention of repeat pregnancy with an overall certainty from low to moderate. These findings highlight the need for additional studies to integrate the beneficial effect of several interventions and then design more feasible strategies, which is important for the maternal and child healthcare systems.

An assessment of postpartum contraception rates with evolving care during the COVID-19 pandemic

ObjectiveThe COVID-19 pandemic presented new care delivery obstacles in the form of scheduling procedures and safe presentation to in-person visits. Contraception provision is an indispensable component of postpartum care that was not immune to these challenges. Given the barriers to care during the initial months of the pandemic, we sought to examine how postpartum contraception, sterilization, and visit attendance were affected during this period.Study Design.We performed a retrospective chart review to examine contraception initiation, sterilization, and postpartum virtual and in-person visit attendance rates during the first six months (March 15 to September 7, 2020) of the COVID-19 pandemic compared to the rates in the same period in the year prior at a single tertiary academic care center. We abstracted data from the first prenatal visit through twelve weeks postpartum. ResultsWith the initiation of virtual appointments, postpartum visit attendance significantly increased (94.6 % vs 88.4 %, p < 0.001) during the pandemic with no difference in overall contraception uptake (51 % vs 54.1 %, p = 0.2) or sterilization (11.0 % vs 11.5 %, p = 0.88). During the pandemic, contraception prescribed differed significantly with a trend towards patient-administered methods including pills, patches, and rings (21 % vs 16 %, p = 0.02). In both periods, there was a significantly younger mean age (p < 0.001), higher proportion of non-White and non-Asian race (p < 0.001), public insurance (p = 0.003, 0.004), and an established contraceptive plan prenatally (p < 0.001) in the group that received contraception. ConclusionAs virtual postpartum visits were instituted, contraception initiation and sterilization were maintained at pre-pandemic rates and visit attendance rose despite the obstacles to care presented by the COVID-19 pandemic. Provision of virtual postpartum visits may be a driver to maintain contraception and sterilization rates at a time, such as early in the COVID-19 pandemic, when patient care is at risk to be disrupted by social distancing, isolation, and avoidance of medical campuses.

415 Impact of Pennsylvania Medicaid payment policy change on rural versus non-rural hospital implementation of immediate postpartum long-acting reversible contraception

OBJECTIVES/GOALS: To apply implementation science strategies to evaluate the impact of the 2016 Pennsylvania (PA) Medicaid payment policy change on hospital-level access to immediate postpartum long-acting reversible contraception (IPP LARC), an evidence-based strategy to increase contraceptive access; to identify differences by rurality and academic status. METHODS/STUDY POPULATION: We conducted a web-based, IRB-exempt survey of Labor and Delivery (L&amp;D) leaders at all PA hospitals in Summer-Fall 2022, assessing hospital characteristics, contraceptive practices, and facilitators/barriers to IPP LARC implementation, using concepts from health services studies of small subsets of implementing hospitals; we translate these concepts into policy evaluation by sampling the complete population of Pennsylvania hospitals with active L&amp;D units. L&amp;D hospitals were characterized as sustainers if they implemented by 2019 and continued to provide IPP LARC, as implementers if they implemented IPP LARC in 2020-22, and non-implementers if they had not started the process. We use the Center for Rural Pennsylvania definition of rural: counties with RESULTS/ANTICIPATED RESULTS: We collected data from 48/74 (64.9%) hospitals with L&amp;D units. Hospitals were heterogenous with 18/48 (37.5%) in rural counties and 15/48 (31.3%) identifying as academic. A minority of hospitals provide IPP LARC, with 17/48 (35.4%) offering implants and 16/48 (33.3%) offering intrauterine devices (IUD) immediately postpartum. Before the PA Medicaid payment policy change, few offered implants [4/48 (8.3%)] or IUDs [1/48 (2.1%)]. Non-rural hospitals implemented IPP LARC more often and on an earlier timeline than rural hospitals: [7/30 (23.3%) v 3/18 (16.7%)] sustainers, [5/30 (16.6%) v 2/18 (11.1%)] implementers. Common facilitators include clinical champions, meeting patient needs, and adequate knowledge. Planned analyses include implementation barriers, and impact of external implementation support. DISCUSSION/SIGNIFICANCE: Despite unmet need in rural populations for evidence-based contraception, rural hospitals were less likely to implement IPP LARC. Implementation support should be designed to meet the needs of rural hospitals. Implementation science methods can be translated to evaluate the impact of healthcare policy on access to care.

The Effect of Balanced Counseling Strategy and Audiovisual on Postpartum Mother's Interest in Using Postpartum Contraception at the Samboja Health Center

Postpartum contraceptive coverage rates are still low in both Indonesia and East Kalimantan. The coverage of postnatal family planning at the Samboja Health Center in 2022 is 43.2% and in 2021 it is 47.86%. Methods: This research method is a Quasi experimental design with a one group pretest and post test design. Results: Most of the mothers' interest in using postpartum contraception before being given a balanced counseling strategy along with audiovisuals had a low interest of 88.5%, after the intervention the respondents' interest increased to a high of 92.3% in postpartum mothers at the Samboja Health Center. Discussion: the use of audiovisual in the Balanced Counseling Strategy has the advantage that audiovisual can provide complete and easily accepted information so that it can encourage mothers' interest in using postpartum family planning. Conclusion: Balanced Counseling Strategy with Audiovisual in increasing postpartum women's interest in using postpartum contraception.

Trends in Postpartum Contraceptive Use in 20 U.S. States and Jurisdictions: The Pregnancy Risk Assessment Monitoring System, 2015-2018.

In the last decade, state and national programs and policies aimed to increase access to postpartum contraception; however, recent data on population-based estimates of postpartum contraception is limited. Using Pregnancy Risk Assessment Monitoring System data from 20 sites, we conducted multivariable-adjusted weighted multinomial regression to assess variation in method use by insurance status and geographic setting (urban/rural) among people with a recent live birth in 2018. We analyzed trends in contraceptive method use from 2015 to 2018 overall and within subgroups using weighted multinomial logistic regression. In 2018, those without insurance had lower odds of using permanent methods (adjusted odds ratio [AOR], 0.72; 95% confidence interval [CI], 0.53-0.98), long-acting reversible contraception (LARC) (AOR, 0.67; 95% CI, 0.51-0.89), and short-acting reversible contraception (SARC) (AOR, 0.61; 95% CI, 0.47-0.81) than those with private insurance. There were no significant differences in these method categories between public and private insurance. Rural respondents had greater odds than urban respondents of using all method categories: permanent (AOR, 2.15; 95% CI, 1.67-2.77), LARC (AOR, 1.31; 95% CI, 1.04-1.65), SARC (AOR, 1.42; 95% CI, 1.15-1.76), and less effective methods (AOR, 1.38; 95% CI, 1.11-1.72). From 2015 to 2018, there was an increase in LARC use (odds ratio [OR], 1.03; 95% CI, 1.01-1.05) and use of no method (OR, 1.05; 95% CI, 1.02-1.07) and a decrease in SARC use (OR, 0.97; 95% CI, 0.95-0.99). LARC use increased among those with private insurance (OR, 1.05; 95% CI, 1.02-1.08) and in urban settings (OR, 1.04; 95% CI, 1.02-1.07), but not in other subgroups. We found that those without insurance had lower odds of using effective contraception and that LARC use increased among those who had private insurance and lived in urban areas. Strategies to increase access to contraception, including increasing insurance coverage and investigating whether effectiveness of existing initiatives varies by geographic setting, may increase postpartum contraceptive use and address these differences.

Impact of Prenatal Group Healthy Relationship Education on Postpartum Contraception.

We aimed to evaluate the impact of an antenatal group healthy relationship education program on the postpartum use of long-acting reversible contraception (LARC). This is a planned subgroup analysis of a larger randomized controlled trial. Pregnant and newly parenting women were randomized to either group healthy relationship education, "MotherWise," or no additional services. An evidence-based healthy relationship education program and individual case management sessions were provided. The program did not include any prenatal care or contraception counseling. This subgroup analysis included those participants with a nonanomalous gestation randomized at <40 weeks who received care and delivered at a single safety-net hospital and were discharged home with a live infant(s). From September 2, 2016 to December 21, 2018, 953 women were randomized in the larger trial; 507 met inclusion criteria for this study; 278 randomized to program and 229 controls. Participants were mostly young, parous, Hispanic, publicly insured women. Participants randomized to program were more likely to take a prescription medicine and be delivered through cesarean; there were not any other significant differences in baseline, antenatal, or perinatal outcomes. Those randomized to program were more likely to be discharged home with immediate postpartum LARC in place (odds ratio [OR] 1.87; confidence interval [CI] 1.17-3.00), and more likely to be using LARC at the postpartum visit (OR 2.19; CI 1.34-3.56). Antenatal group healthy relationship education provided separately from prenatal care is associated with a twofold increase in the use of postpartum LARC. ClinicalTrials.gov NCT02792309; https://clinicaltrials.gov/ct2/show/NCT02792309?term=NCT02792309&draw=2&rank=1.

SUSTAINABLE MIDWIFERY CARE IN Mrs. “P” FROM PREGNANCY UNTIL THE POSTPARTUM PERIOD AT POLINDES SUKOREJO BOJONEGORO 2019

Pregnancy with a distance of children &lt;2 years is the distance between one pregnancy and the next less than 2 years. Pregnancy with a distance of children &lt;2 years is one of the complications / causes of high cases of maternal and infant mortality. Pregnancy and childbirth require professional services by skilled health personnel. Solving maternal health problems needs to use an ongoing health care approach from before pregnancy, pregnancy, childbirth, childbirth, and contraception. This Final Project Report method uses varney management by documenting SOAP. The subjects of this study were third trimester pregnant women, labor, postpartum, contraception, and newborns (BBL). Data collection was carried out with history, physical examination, investigation, analyzed according to midwifery care diagnosis. The results of the study showed that the care given ended with physiological results. Care is given focus on trimester III pregnancy, care provided with a standard 10 T, delivery with 60 steps APN, childbirth with 4 visits, BBL with 3 visits, and midwifery care for postpartum contraception services with the results of mothers using postpartum contraception. There was no gaps in the application of midwifery care between the theory and practice of midwifery care that is on the ground, and must be maintained to improve the degree of maternal and child health services and be able to detect early complications that can reduce high maternal and infant mortality and morbidity.

Is enhanced, structured prenatal counseling in third trimester associated with postpartum contraceptive uptake?

IntroductionContraception is key for maternal well-being in the postpartum period. This study aims to evaluate the impact of prenatal counseling on postpartum contraception uptake. MethodsThis cohort study assessed pregnant patients who received their prenatal care at our outpatient obstetrics clinic in 2021–2022. The intervention group received counseling at their 28- and 36-week prenatal visits with a language-congruent paper handout and a review of methods by the provider. The non-intervention group was seen in the outpatient clinic prior to implementation. Intervention patients were surveyed on postpartum days 1–3 to evaluate recollection of counseling and intent to start contraception. Data on uptake and type of contraception chosen was collected for both groups at 6- and 12-weeks postpartum. Our primary outcome was uptake of any type of contraception at the 6-week postpartum visit. ResultsA total of 126 patients over two five-month intervals (64 intervention and 62 non-intervention) were included in analysis. Baseline patient characteristics were similar between the groups, including predominance of public insurance. Groups differed by race/ethnicity, with higher rates of Hispanic patients in the intervention group. Patients in the intervention group had higher contraception uptake within six weeks of delivery (OR 2.61, p = 0.0287). Forty-three patients in the intervention group desired postpartum contraception (including permanent methods, such as tubal ligation), although only 21 (48.8 %) received their desired method. There were no differences in method chosen between the non-intervention and intervention groups (p = 0.15). ConclusionsStructured prenatal counseling regarding contraceptive options can improve the timely initiation of contraception.

A Prospective Multi-centric Study of Acceptance, Insertion and Follow-Up of Postpartum Insertions of IUCD.

The unmet need for contraception in the postpartum period is a major challenge in our country. Unintended pregnancies are highest in the first year after birth, and postpartum IUCD insertion is an effective way to counter this problem. This study was planned to build up data for acceptance and follow-up of postpartum IUCD insertions. The present study has included data of PPIUCD insertions and follow-up from seven institutions over a period of 6months. The case recruitment lasted for 3months, including only those who had PPIUCD insertions in this period, and they were followed up for a period of 6months. The follow-up of patients was at 6weeks and 6months. All issues were addressed including side effects, expulsions, myths surrounding the device, etc., along with routine postnatal care. There were 5227 deliveries and 1895 insertions. The acceptance rate was 36%, and a follow-up at 6weeks and 6months showed up an expulsion rate of approximately 4% and a removal rate of 5%. Overall, at the end of 6months we have a continuation rate of 90%. This shows that a dedicated approach to postpartum contraception will definitely bring down incidence of unintended pregnancies.

Continuous quality improvement strategy for increasing immediate postpartum long-acting reversible contraceptive use at Jimma University Medical Center, Jimma, Ethiopia

BackgroundEven though the immediate postpartum period is a golden time and a great opportunity to provide long-acting reversible contraceptives to prevent unintended pregnancy, its utilisation is very low in Ethiopia....

Abstract TP201: The Role Cardiovascular And Non-cardiovascular Risk Factors In The Development Of Strokes Among Young Adults

Background: We examined the effect of CV and non-CV risk factors on the development of strokes in young adults 18-55 years old. Methods: This case-control study, using the Colorado All Payer Claims Database (APCD), identified young adults with index stroke admissions and assigned them(1:3) to controls matched on age/sex/insurance type(commercial or public)/enrollment duration. Controls were assigned a proxy stroke date based on their matched case. CV and non-CV risk factors occurring from enrollment until 1 day prior to stroke date were included. Pregnancy, postpartum, and oral contraceptives were separated from other non-CV risk factors in women. To assess whether there was a differential effect of the risk factors by age in each sex, conditional logistic regression models were fit separately for men and women with an interaction between age and risk factor. Results: Between 2012-2018, 2735 index stroke admissions were identified (52.3% women) and matched to 8,178 controls. In men with stroke, 53.4% and 27.7% had at least one CV and non-CV risk factor, respectively. In women with stroke, 57.6%, 41.0%, and 12.1% had at least one CV, non-CV and hormonal risk factor, respectively. The most common CV risk factors were hypertension(27.8%), hyperlipidemia(26.8%), tobacco use(20.9%) in men and hypertension(25.5%), tobacco use(22.9%), obesity(22.6%) in women. The most common non-CV risk factors were migraines (14.3%), renal failure(6.9%), thrombophilia(6.1%) in men and migraines(29.1%), malignancy(9.5%), thrombophilia(6.7%) in women. Having one or more CV or non-CV risk factors significantly contributed to the development of strokes(Figure). Controlling for CV risk factors, having at least one non-CV risk factor had the highest risk among men and women &lt;45. Hormonal risk factors significantly contribute to strokes in women ≥35. Conclusions: Non-CV risk factors play a significant role in the development of strokes among young adults and warrants further study.

Determinant Factors of Post-Partum Contraception among Women during COVID-19 in West Java Province, Indonesia.

One of the manifestations of family development is pregnancy planning, where this method is applied 0-42 days after childbirth. Post-partum contraception is an effort to avoid pregnancy by using contraceptive medicine from 42 days to 84 days after childbirth. This research aims to analyze the attitudes of fertile couples who use contraceptive devices after childbirth during the COVID-19 pandemic and the factors that influence it. This research uses a quantitative method approach. The sampling technique was random sampling with proportional sampling so that 280 respondents were obtained from 3 regencies/cities in West Java with high fertility rates and low post-partum contraceptive participation rates. Quantitative data analysis used univariate, bivariate, and multivariate methods. The results showed that the final model of the analysis of the most determining factors for post-partum contraception during a pandemic were family support, healthcare staff support, counselling with healthcare staff, attitudes, and age at first marriage. Fertile couples with the highest amount of family support are more likely to use post-partum contraceptive devices during COVID-19. The results of this study can be used as material for consideration in making decisions about post-partum contraception, especially during the COVID-19 pandemic.

Effect of one-to-one versus group counseling on uptake of postpartum contraception in selected hospitals in Ghana: A prospective cohort study.

To compare the effect of one provider to one client counseling and one provider to a group client counseling on the uptake of postpartum contraception. This was a hospital-based prospective cohort study among women attending a postpartum clinic at Korle-Bu Teaching Hospital and Greater Accra Regional Hospital. Postpartum mothers were recruited daily from April 1, 2017 to November 28, 2017. Mothers from this cohort that used a contraceptive method within a year postpartum were determined at 3, 6, 9, and 12 months after recruitment. A P value of less than 0.05 was considered statistically significant for all analyses. Of 982 women surveyed, contraceptive uptake among women who received one-to-one counseling was 306/600 (51.0%) and that for women who received group counseling was 48/382 (12.6%) (P< 0.001). Factors associated with contraceptive uptake during postpartum period were: one-to-one counseling (adjusted odds ratio [aOR] 7.05, 95% confidence interval [CI] 4.94-10.07), mothers' age (aOR 0.95, 95% CI 0.91-0.98), being single (aOR 0.54, 95% CI 0.35-0.85), cohabiting (aOR 0.39, 95% CI 0.22-0.69), and previous use of contraception (aOR 1.55, 95% CI 1.12-2.15). One-to-one counseling was associated with a significantly greater uptake of contraception during the postpartum period compared with group counseling. Other factors associated with uptake were age, marital status, and history of contraceptive use.

Catholic sole community hospitals are associated with decreased receipt of postpartum permanent contraception among Medicaid recipients

ObjectivesTo examine the association of Catholic hospitals with receipt of postpartum tubal ligation and long acting, reversible contraception among Medicaid recipients. Study designWe conducted a retrospective cohort study of live births from January 1, 2016 to October 31, 2016 to female Medicaid beneficiaries in the United States between ages 21 and 44. Our main exposure was the presence of a Catholic-affiliated sole community hospital, and our primary outcome was highly effective postpartum contraception. We examined rates of postpartum permanent contraception, along with the use of a long acting, reversible form of contraception (LARC) at 3 and 60 days are postpartum. We compared counties that had only a Catholic-affiliated hospital with counties with only a non-Catholic hospital. ResultsOur study population included 14,545 postpartum Medicaid beneficiaries. Study participants came from 88 counties across 10 United States states. Only 7.7% of women in counties with Catholic sole community hospitals received permanent contraception by 3 days postpartum, compared to 11.3% in counties with non-Catholic sole community hospitals (RD: -3.92%; 95% CI: -6.01%, -1.83%). This difference was not mitigated by receipt of outpatient procedures or long-acting, reversible contraception. Importantly, women residing in counties with Catholic sole community hospitals were much less likely to return postpartum for an outpatient visit between 8 and 60 days postpartum than women in counties with non-Catholic sole community hospitals (35.4% vs 45.4%, RD: -9.29%; 95% CI: -16.71%, -1.86%). ConclusionsIn counties where the only hospital was Catholic, Medicaid recipients giving birth were significantly less likely to receive permanent contraception and to return for postpartum care. ImplicationsCatholic hospitals are increasing in the United States, which may restrict access to postpartum contraception, particularly in rural areas. We found that Medicaid recipients giving birth at a Catholic sole community hospital were less likely to receive permanent contraception and to return for care.