Postpartum Contraceptive Choice Research Articles

Influence of pregnancy intention on postpartum contraceptive choice at an urban academic medical center.

To describe postpartum contraception preferences in the context of pregnancy intention (PI). Prospective cohort study analyzing postpartum contraceptive choice in 431 postpartum women who delivered at a single academic medical center. Postpartum contraceptive choice (PCC) in women with an unintended or mistimed pregnancy was compared to contraceptive choice in women with an intended pregnancy using the adapted National Survey of Family Growth categorization. Mistimed and unintended pregnancies were grouped for analysis. Generalized linear modeling estimated the relative influence of PI on PCC adjusting for maternal age, race, and parity. Nearly three out of four (71.9%) pregnancies were mistimed or unintended. These pregnancies were more likely in women who were non-Hispanic black (62.3%), unmarried (86.3%), 18-24 years old (51.3%), and insured by Medicaid or Medicare (82.1%), compared to women with an intended pregnancy, p-value <0.001. Women with mistimed or unintended pregnancy were 83% more likely to choose highly effective, user-independent methods compared to any other or no method, adjusted relative risk (aRR) 1.83 (95% CI 1.36, 2.47), and more likely to desire voluntary sterilization , adjRR 2.70 (95% CI 1.58, 4.59). Additionally, women with these pregnancies were 56% more likely to use user-independent methods compared to user-dependent methods, adjRR 1.56 (95% CI 1.18, 2.06). Women with mistimed or unintended pregnancies are 83% more likely to choose highly effective postpartum contraception or voluntary sterilization, and thus initiatives are necessary to increase access and affordability to these methods before hospital discharge after delivery.

Association Between Proximity to Delivery Hospital and Postpartum Contraception Choice [ID 2683622

INTRODUCTION: Proximity to prescribers may present a barrier to postpartum contraceptive care. We examine associations between postpartum contraceptive choice and residential proximity to the prescribing, delivery hospital. METHODS: After IRB approval, we collected electronic medical record data from 2020 to 2022 at an inner-city, academic hospital and used CDXGeoData to determine residential distance to the hospital. Contraceptive choice at delivery, 2 weeks, and 6 weeks postpartum, focusing on long-acting reversible contraception (LARC) versus other contraceptives, was compared across distance to hospital. RESULTS: We identified 3,705 births: 53.5% Black, 30.3% Hispanic, and 73.7% utilizing public health insurance. Residential distance to the hospital was 0–1,724 miles with 74.2% living within 10 or fewer miles. Those residing within 10 miles were more likely to be non-Black (X2 (2)=12.02; P&lt;.01), Hispanic (X2 (2)=83.91; P&lt;.001), single (X2 (3)=33.54; P&lt;.001) and primiparous (X2 (3)=13.09; P&lt;.01). Cesarean section was more frequent (32.5% versus 28.1%; X2 (2)=6.58; P&lt;.01) and gestational age shorter (U=1171108; P&lt;.05) for those living further from the hospital. Postpartum tubal ligation did not differ across groups. LARC uptake at discharge and 2 weeks postpartum trended towards being higher for women who lived further (X2 (1)=3.49; P=.06; aOR 1.15; 95% CI, 0.96–1.39). CONCLUSION: There is a trend towards increased LARC uptake if the patient resides further from their delivery hospital after controlling for confounding factors. Our findings add to understanding of patient preferences and barriers to care.

Postpartum contraceptive choice and fulfillment in patients with opioid use disorder

ObjectiveWe examined the differences in postpartum contraception between patients with and without opioid use disorder (OUD). Study DesignWe conducted a retrospective, single-institution, cohort analysis assessing differences in desired method of postpartum contraception and plan fulfillment. ResultsPatients with OUD comprised 200/8654 (2.3%) of our study cohort. After 2:1 matching, method desired (matched odds ratio [mOR] 0.86, 95% confidence interval [CI] 0.60–1.23 for highly vs. moderately effective) and receipt (mOR 0.77, 95% CI 0.53–1.12) of desired method were comparable between groups. ConclusionPatients with and without OUD were similar in their choice and fulfillment of postpartum contraception.

Perception of coercion during contraceptive counseling among individuals with HIV

ObjectiveHistorically, individuals with HIV have reported feeling coerced during contraceptive counseling or experienced forced sterilization. The purpose of this study was to assess perceptions of coercion related to counseling and influence on postpartum contraceptive choice among individuals with HIV. MethodsThis is a mixed methods study conducted in Georgia, North Carolina, Pennsylvania, and South Carolina between March 2020 and June 2021. Participants completed a survey to assess their experiences with contraception counseling and perceived coercion. An Interpersonal Quality of Family Planning (IQFP) care score was calculated to assess quality of counseling. Qualitative analyses were performed on narrative responses. Bivariate and regression analyses were used to evaluate factors associated with perceived coercion and IQFP scores. Results100 surveys were collected. The median age of respondents was 29 (IQR 24–35). The median IQFP score was 53 (IQR 44–55) and 45 % of individuals had a maximum IQFP score of 55. Most individuals (96 %) report that a provider “did a good job” explaining contraceptive options and 26 % report their provider’s preference affected their contraceptive choice to some degree. Few (11 %) respondents felt pressured to use long-acting reversible contraception postpartum. This perceived coercion was more likely when a provider suggested a specific contraceptive method, aOR 6.1 [95 % CI 1.1–33.1] and such specific provider suggestions were reported by one-third of respondents. ConclusionWhile perceived coercion was reported by few individuals with HIV, it was strongly associated with the provider making a specific method suggestion. Disproportionate provider influence in the final contraceptive decision occurred in one-quarter of individuals. More research is needed to discern to what extent provider preference compromises patient autonomy in shared decision-making.

Future Pregnancy Considerations after Premature Birth of an Infant Requiring Intensive Care: A Qualitative Study.

Postpartum contraception counseling and method use vary widely among patients who had a preterm birth. We performed this study to explore what issues and concerns individuals with preterm infants requiring intensive care describe as influencing their postpartum contraceptive choices. We conducted a qualitative study using semi-structured interviews with participants who gave birth to a singleton preterm infant admitted to the neonatal intensive care unit (NICU). We explored pregnancy, childbirth, postpartum care, and NICU experiences, as well as future reproductive plans and postpartum contraceptive choices. Two coders used a constant-comparative approach to code transcripts and identify themes. We interviewed 26 participants: 4 (15%) gave birth at less than 26, 6 (23%) at 26 to 27 6/7, 8 (31%) at 28 to 31 6/7, and 8 (31%) at 32 to 36 6/7weeks of gestation. We identified three main themes related to future pregnancy plans and contraception choice. First, participants frequently described their preterm birth and their infants' NICU hospitalization as traumatic experiences that affected plans for future pregnancies. The loss of control in predicting or preventing a future preterm birth and uncertainty about their premature child's future medical needs resulted in participants wanting to avoid going through the same experience with another child. Second, participants chose contraception based on previous personal experiences, desired method features, and advice from others. Last, having a preterm birth did not result in any ambivalence among those who desired permanent contraception. Preterm birth influences future pregnancy plans. When discussing reproductive goals with patients, clinicians should be aware of potential trauma associated with a premature birth, assess for whether patients want to discuss contraception, and center the conversation around individual needs if patients do desire contraceptive counseling.

The Impact of the COVID-19 Pandemic on Postpartum LARC: A Retrospective Cohort Study [A20

INTRODUCTION: At the onset of the COVID-19 pandemic, providers were encouraged to counsel patients interested in long-acting reversible contraception (LARC) about immediate postpartum placement to decrease in-person postpartum visits. We assessed the impact of this COVID-related hospital policy on postpartum LARC uptake. METHODS: In this retrospective cohort study, we compared patients who delivered a live born infant(s) during two periods, one immediately prior to the COVID pandemic (“pre-COVID cohort” (December 16, 2019 to March 1, 2020)), and one at the onset of the pandemic (“COVID cohort” (March 16-May 31, 2020)). We collected electronic medical record data, including sociodemographic characteristics and contraception choices, in the antenatal and postpartum periods for 649 patients. Odds ratios were adjusted for age and race. RESULTS: We found an increase in immediate postpartum LARC use during COVID (13% vs. 9%, P=.12, aOR 1.44, CI 0.87-2.39). The etonogestrel implant was the most placed form of immediate postpartum LARC in both cohorts (67% and 71% in pre- and during COVID cohorts, respectively). In general, contraceptive choices at discharge differed between the cohorts (P=.01), with fewer patients desiring LARC placement at the postpartum visit during COVID (13% vs. 6% in pre- and during COVID cohorts). There was no difference between the average number of postpartum visits attended in each cohort (OR 0.93, CI 0.68-1.28). CONCLUSION: Changes in contraceptive counseling during COVID were accompanied by differences in postpartum contraceptive choices at discharge. Targeted contraceptive counseling can influence patient choices in the setting of expected barriers to routine postpartum care.

The direct and indirect effects of community beliefs and attitudes on postpartum contraceptive method choice among young women ages 15–24 in Nigeria

The direct and indirect effects of community beliefs and attitudes on postpartum contraceptive method choice among young women ages 15–24 in Nigeria

Differences in postpartum contraceptive choices and patterns following low- and high-risk pregnancy

ObjectiveTo assess the impact of a high-risk pregnancy on postpartum contraceptive planning and use. MethodsWe conducted a retrospective cohort study of women who gave birth in a teaching hospital in 2020. We classified women into 2 groups based on their risk status according to the Society for Maternal-Fetal Medicine. The World Health Organization (WHO) tiers of contraceptive efficacy were used to categorize contraceptive planning and administration. The primary outcome was the utilization rate of Tier 1contraceptive methods at their postpartum visit in women with prior high-risk pregnancy. Univariate and multivariate analyses were carried out to determine the relationships between risk status, characteristics, contraceptive preference, and actual utilization. ResultsThis study included 788 low-risk and 482 high-risk postpartum women. High risk women indicated greater interest in (43.5% low-risk vs 52.2% high-risk, p < 0.01) and usage rates of (45.7% low-risk vs 54.3% high-risk, p = 0.01) Tier 1 contraception. The most commonly chosen contraceptive methods among low- and high-risk women were progestin-only pills (30.6%) and tubal ligation (36.4%), respectively. Uptake rates of immediate postpartum contraceptive implants did not differ between low (9.3%) and high-risk (11%) women (p = 0.32). Few patients adopted intrauterine devices (1.1%). ConclusionHigh-risk status was associated with intention to use and uptake of effective contraceptive methods, which persisted through the postpartum period. ImplicationsTo assist women in achieving the recommended interpregnancy intervals, counseling tailored to their individual risks and needs should be provided. Reasons for low intrauterine devices uptake should be explored. Postnatal care should include immediate postpartum long-acting reversible contraception (LARC) services.

542 Postpartum contraceptive choice and fulfilment in patients with opioid use disorder

Rates of unintended pregnancy in women with opioid use disorder (OUD) are higher than the general population, which may be explained by lower utilization of postpartum contraception. Therefore, we sought to examine the differences in postpartum contraceptive outcomes in women with and without OUD. A retrospective cohort analysis of deliveries occurring from 2012-2014 at an urban tertiary care institution. Clinical and demographic data were obtained from individual chart review and differences between patients with and without OUD were compared. Outcomes included tier of efficacy for planned method of contraception, plan fulfillment within 90 days postpartum, postpartum visit attendance, and subsequent pregnancy within 365 days of the index delivery. Tests of differences, univariable and multivariable logistic regression, and propensity score matched samples using genetic matching algorithm was used to analyze outcomes. Of 8,654 deliveries during the study period, 200 (2.3%) were complicated by OUD. Women with OUD were significantly more likely to be white and not receive adequate prenatal care (Table 1). After propensity matching, women with OUD were less likely to choose a highly effective vs moderately effective method than women without OUD (matched odds ratio [mOR] 0.24, 95% confidence interval [CI] 0.05-0.93) and were less likely to have their contraceptive plan fulfilled (mOR 0.64, 95% CI 0.42-0.99) (Table 2). There was no difference in postpartum visit attendance (mOR 1.08, 95% CI 0.73-1.61) or the rate of short interval pregnancy (mOR 1.15, 95% CI 0.73-1.80). Clinical and demographic characteristics were similar between women with and without OUD in our urban tertiary care center. System level barriers may account for less frequent fulfilment of contraceptive plans among women with OUD in pregnancy. Clinicians should be mindful of addressing the contraceptive needs of these patients prior to and after delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Association of race and ethnicity with postpartum contraceptive method choice, receipt, and subsequent pregnancy

BackgroundWe sought to assess racial/ethnic differences in choice of postpartum contraceptive method after accounting for clinical and demographic correlates of contraceptive use.MethodsThis is a secondary analysis of a single-center retrospective cohort study examining postpartum women from 2012 to 2014. We determined the association between self-identified race/ethnicity and desired postpartum contraception, receipt, time to receipt, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery.ResultsOf the 8649 deliveries in this study, 46% were by Black women, 36% White women, 12% Hispanic, and 6% by women of other races. Compared with White women, Black and Hispanic women were more likely to have a postpartum contraception plan for all methods. After multivariable analysis, Hispanic women (relative to White women) were less likely to receive their chosen method (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.64–0.87). Women of races other than Black or Hispanic were less likely to experience a delay in receipt of their desired highly-effective method compared to White women (hazard ratio [HR] = 0.70, 95% CI 0.52–0.94). There were no differences between racial/ethnic groups in terms of postpartum visit adherence. Black women were more likely to be diagnosed with a subsequent pregnancy compared to White women (OR 1.17, 95% CI 1.04–1.32).ConclusionRacial/ethnic variation in postpartum contraceptive outcomes persists after accounting for clinical and demographic differences. While intrinsic patient-level differences in contraceptive preferences should be better understood and respected, clinicians should take steps to ensure that the observed differences in postpartum contraceptive plan methods between racial/ethnic groups are not due to biased counseling.

Association of Trust and Locus of Control with Postpartum Contraception Choice.

Objective: In this study, we explored associations of trust in the healthcare system, health locus of control, and patient factors with choice of effective postpartum contraception. Methods: For this observational study, we measured trust in the healthcare system and health locus of control using validated scales. The primary outcome was postpartum contraceptive choice. We defined effective contraception as methods with failure rate ≤ 10%. We used bivariate and multivariate analyses to determine associated variables. Results: Neither trust in the healthcare system nor health locus of control were associated with effective contraceptive choice. Black women were more likely to report choice of effective contraception compared to white women (OR = 4.26, 95% CI 1.43, 12.68). Choice of effective contraception did not differ between women who intended to become pregnant again in less than 2 years versus greater than 2 years although women with no desire for future pregnancy were more likely to choose effective methods (OR = 4.78, 95% CI 1.56, 14.64). Conclusions: Neither trust nor health locus of control were associated with choice of effective postpartum contraception. The increased likelihood of effective post-partum contraception in black women suggests coercion and bias in counseling and provision.

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

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&lt;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 &gt;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.

Investigating the quality of family planning counselling as part of routine antenatal care and its effect on intended postpartum contraceptive method choice among women in Nepal

BackgroundThough modern contraceptive use among married women in Nepal has increased from 26% in 1996 to 43% in 2016, it remains low among postpartum women. Integration of counselling on family planning (FP) at the time of antenatal care (ANC) and delivery has the potential to increase post-partum contraceptive use. This study investigates the quality of FP counselling services provided during ANC visits and women’s perceptions of its effectiveness in assisting them to make a post-partum family planning (PPFP) decision.MethodsIn-depth interviews (IDIs) were conducted with 24 pregnant women who had attended at least two ANC visits in one of the six public hospitals that had received an intervention that sought to integrate FP counselling in maternity care services and introduce postpartum intrauterine device insertion in the immediate postpartum period. IDIs data were collected as part of a process evaluation of this intervention. Women were selected using maximum variation sampling to represent different socio-demographic characteristics. IDIs were audio recorded, transcribed verbatim in Nepali, and translated into English. Data were organized using Bruce-Jain quality of care framework and analyzed thematically.ResultsOverall, the quality of FP counselling during ANC was unsatisfactory based on patient expectations and experience of interactions with providers, as well as FP methods offered. Despite their interest, most women reported that they did not receive thorough information about FP, and about a third of them said that they did not receive any counselling services on PPFP. Reasons for dissatisfaction with counselling services included very crowded environment, short time with the provider, non-availability of provider, long waiting times, limited number of days for ANC services, and lack of comprehensive FP-related information, education and counselling (IEC) materials. Women visiting hospitals with a dedicated FP counselor reported higher quality of FP counselling.ConclusionsThere is an urgent need to re-visit the format of counselling on PPFP during ANC visits, corresponding IEC materials, counselling setting, and to strengthen availability and interaction with providers in order to improve quality, experience and satisfaction with FP counselling during ANC visits. Improvements in infrastructure and human resources are also needed to adequately meet women’s needs.

Associations Between Prenatal Intention and Postpartum Choice: Infant Feeding and Contraception Decisions Among Inner-City Women.

Purpose: We sought to understand how women's prenatal infant feeding and contraception intentions were related to postpartum choices. Materials and Methods: Expectant women ≥14 years of age receiving care at MacDonald Women's Hospital, Cleveland Ohio were previously surveyed regarding feeding and contraceptive intentions. Here, we asked: (1) What were postpartum feeding choices, and did prenatal intention predict postpartum choice?, (2) What were postpartum contraceptive choices, and did prenatal intention predict postpartum choice?, and (3) What was the relationship of postpartum contraceptive choice to postpartum feeding choice? Results: Of 223 women interviewed prenatally, 214 (96%) were followed to postpartum in-hospital, and 119 out of 214 (56%) were followed to the postpartum visit. The mean age was 25 years, 185 out of 206 (89.8%) were African American, and 149 out of 200 (75.0%) were multiparous. Prenatal feeding and contraceptive intent were significantly associated with postpartum feeding and contraceptive choices, respectively (both p < 0.0001). More women who initiated breastfeeding chose no contraception (54.5% for any breastfeeding versus 32.2% for exclusive formula feeding) versus long-acting reversible contraception (LARC), tubal ligation, or other contraceptive types (χ2 = 9.28, p = 0.03). After adjusting for known confounders, only receipt of other contraceptive types (not LARC, not tubal ligation) was significantly associated with decreased odds of any breastfeeding (p = 0.02). Conclusions: Among low-income predominantly African American inner-city women, prenatal intentions were significantly associated with postnatal choices for infant feeding and contraception. After controlling for confounders, women receiving less effective types of contraception (not LARC and not tubal ligation) had reduced odds of any breastfeeding (p = 0.02).

Impact of Perinatal Depression on Contraceptive Planning [4N

INTRODUCTION: Contraceptive choice may be influenced by disturbances in perinatal mood disorders, but studies have shown mixed results. We wished to assess the postpartum contraceptive choices of women at risk for perinatal depression, specifically in regard to hormonal contraception, long-acting reversible methods, and surgical sterilization. METHODS: This retrospective cohort study evaluated a population of women (n= 419) who participated in a calibration pilot for depression screening while pregnant and after delivery using a novel computerized adaptive diagnostic screener (CAT-MH). Maternal age, race and gestational age at delivery were used to match cases (n=64) to controls (1:2). Chart review was used to screen for choice of contraception and potential confounders including pre-pregnancy mental health disorders and/or current mental health treatments. Bivariate analyses and multiple logistic regressions were used to study the impact of depressive symptoms on contraceptive planning. RESULTS: No significant differences in contraceptive choice were observed between depressed and control groups. However, worsening postpartum mood was associated with the choice of non-hormonal methods when compared to stable mood after delivery (24.1% vs. 48.3%, p=0.016). This association persisted in a multivariate logistic regression which included age, race, insurance status, obstetric history, mode of delivery, and NICU admission. Women who were treated with psychiatric medications while pregnant were more likely to choose surgical sterilization (11.3% vs. 33.9%, p=.02). CONCLUSION: A relationship between depressed maternal mood and contraceptive planning may be mediated by preexisting mental illness and use of psychiatric medications, influencing both hormonal contraception and surgical sterilization choices.

A qualitative analysis of postpartum contraceptive choice

ABSTRACTBackground: The World Health Organization recommends a minimum 24-month birth-to-pregnancy interval to improve maternal and child health. Postpartum contraception is a mechanism to achieve optimal birth spacing and prevent unintended pregnancy, which may reduce health disparities and inequalities in health status among new mothers and their children. This study investigated women’s communication channel preferences, as well as patient engagement and shared decision making about contraceptive method choice and use in the postpartum period.Method: Researchers conducted six focus groups with 47 women receiving postpartum care at an outpatient clinic. A semi-structured focus group protocol was created and tested. A constant comparative approach provided an inductive method of analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated coding based on the health belief model.Results: Participants included women 18–39 years of age with an average of 1.7 children. The majority of participants utilized Medicaid (53%) and self-identified as Black (49%) or White (43%). Participants discussed interpersonal, mass media, and new media channels featuring messages about contraception, including long-acting reversible contraception (LARC). These women negotiated complex social norms, including preferring the Internet as a primary source of information and avoiding mass media. Participants balanced messages from social networks, including physician counseling and the power of personal experiences of friends and family in contraceptive decision making.Conclusions: This study demonstrated women perceive the voices of lay experts online as the most influential source of information and prefer to receive contraceptive information online and in-person during the prenatal and postpartum period.

Effect of Contraception Decisional Aid on Postpartum Contraceptive Choice: A Replicated Time Series Study [20G

INTRODUCTION: Contraception after birth is essential to the wellbeing of mothers as well as the health of their future children. The WHO recommends a two to three year inter-pregnancy interval. Decisional aids have helped to assist women with contraceptive decision-making. Our goal was to develop and test an electronic decisional aid to inform pregnant women about options for postpartum contraception. METHODS: We conducted a replicated interrupted time series study. A decisional aid was developed using attributes from Health Belief Model’s behavioral theory. It included detailed and interactive information about reversible and permanent contraceptives. We enrolled a total of 200 pregnant women between 24 to 36 weeks into either the intervention group (received decisional aid) or control group. The primary outcome was to compare contraceptive choice between two groups. The secondary outcome was to assess whether the patient received their contraceptive choice post delivery. RESULTS: Women did not differ in their demographics or contraceptive choice prior to delivery. Of the 200 participants, 56 decided to obtain very effective contraceptives such as intrauterine device and implant postpartum. This was similar across control and intervention groups (p= .697). Post-delivery, the majority of participants received birth control that was of similar or higher efficacy. Women in the intervention group however had less decisional conflict compared to those in control group (p &lt; 0.05). CONCLUSION: The postpartum contraception decisional aid was successful in reducing decisional conflict. There was no significant difference in contraceptive choice or uptake between the intervention and control group.

Postpartum contraceptive use and interpregnancy interval among women with opioid use disorder

ObjectiveThe purpose of this study was to describe postpartum contraceptive utilization patterns among women with OUD and evaluate the relationship between postpartum contraceptive method choice and interpregnancy interval. MethodsA retrospective cohort study was conducted with women in Pennsylvania Medicaid with a diagnosis of OUD between 2008 and 2013. Postpartum contraceptive use within 90 days after delivery was identified through claims data and categorized by effectiveness (highly-effective, effective, and no method observed). Kaplan-Meier time-to-event analyses and multivariable-adjusted marginal Cox regression models were used to evaluate the relationship between postpartum contraceptive method choice and interpregnancy interval. Multivariable logistic regression analyses were used to identify risk factors predictive of a short interpregnancy interval (≤18 months). ResultsWe identified 7805 women (9260 pregnancies) who had a diagnosis of OUD. Nearly three-quarters (74.5%) had no contraceptive method observed, 18.1% received an effective method, and only 7.4% received a highly-effective method (LARC or female sterilization) during the postpartum period. In Kaplan-Meier analyses, no significant differences were found in the time-to-next pregnancy interval when an effective contraceptive method vs. no contraceptive method was used. In multivariable analysis, predictors of a significantly longer interpregnancy interval were LARC use (HR 0.43, 95% CI 0.26–0.69), gestational hypertension (HR 0.80, 95% CI 0.65–0.97), and age (HR 0.95, 95% CI 0.94–0.96). Approximately 20% of women with OUD had a short interpregnancy interval. ConclusionFew women with OUD use highly-effective postpartum contraception, which is protective against short interpregnancy intervals.

“My Body. My Choice”: A Qualitative Study of the Influence of Trust and Locus of Control on Postpartum Contraceptive Choice

Postpartum contraception helps reduce unintended pregnancy and space births to improve maternal and child health. This study explored women’s perceptions of contraceptive choice during the postpartum period in the context of locus of control and trust in healthcare providers. Researchers conducted six focus groups with 47 women, ages 18–39, receiving postpartum care at an outpatient clinic. Techniques from grounded theory methodology provided an inductive approach to analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated a constant-comparative coding process to identify emergent themes. Participants expressed a preference for relationship-centered care, in which healthcare providers listened, individualized their approach to care through rapport-building, and engaged women in shared decision-making about contraceptive use through open communication, reciprocity, and mutual influence. Conflicting health messages served as barriers to uptake of effective contraception. While participants trusted their healthcare provider’s advice, many women prioritized personal experience and autonomy in decisions about contraception. Providers can promote trust and relationship-centered care to optimize contraceptive uptake by listening, exploring patient beliefs and preferences about contraception and birth spacing, and tailoring their advice to individuals. Results suggest that antenatal contraceptive counseling should incorporate information about effectiveness, dispel misconceptions, and engage patients in shared decision-making.

Postpartum contraceptive choices among women attending a well-baby clinic in Ghana.

To assess postpartum contraceptive choices among women attending a well-baby clinic in Ghana. From April 1 to May 31, 2011, a descriptive cross-sectional survey was conducted among women who attended the well-baby clinic of Komfo Anokye Teaching Hospital, Kumasi, at 6-24months after delivery. Participants were consecutively recruited and interviewed using semi-structured questionnaires. Data were collected on demographics, exposure to family planning counseling, message content, and postpartum contraceptive choices. Differences between the profiles of women who did or did not take up postpartum family planning were assessed. Of the 200 women enrolled, 44 (22.0%) wanted no more children and the last pregnancy was unintended among 88 (44.0%). In all, 110 (55.0%) women took up postpartum contraception, with the calendar method (n=57; 51.8%) and injectable contraceptives (n=22; 20.0%) cited as popular choices. Family planning counseling was received at the prenatal clinic by 47 (23.5%) women, with 12 (6.0%) given written referrals on the postnatal ward. More previous contraceptive users than previous non-users chose long-acting or permanent postpartum methods (P<0.001). Inadequate postpartum family planning counseling and referrals during maternity care were recorded, suggesting that a comprehensive educational intervention is required to improve uptake.