Uptake Of Postpartum Contraception Research Articles

Knowledge, attitude and readiness to use contraceptives among postpartum women at a tertiary hospital in southwest Nigeria.

Background: Postpartum family planning is vital in the prevention of unintended pregnancy and closely spaced pregnancies in the first year post-delivery. This study was designed to examine the postpartum women’s knowledge, attitude, belief and readiness to contraceptive use.
 Methods: This descriptive cross-sectional study was conducted in the postnatal clinic of the University College Hospital, Ibadan, Nigeria using an interviewer-assisted structured questionnaire among one hundred and ninety-four consenting recently delivered women. Data was analysed using IBM Statistics for Windows Version 23.0. Tests of association was done using chi-square and statistical significance was set at p-value of < 0.05.
 Results: Many of the respondents (60.8%) were in the age group 30-39 years and the majority (90.3%) had tertiary level of education. Most of the respondents got their information from health talks at antenatal clinic (42.8%) and health workers (42.3%). The majority (82.5%) of respondents were aware of contraception and 157(80.9%) intended to use contraceptives, however, only 54(34.4%) were willing to adopt a method at the postnatal clinic visit. The most preferred contraceptive methods were implants (23.4%). Respondents with three or more children alive(p=0.001), had statistically significant associations with prior use of contraception while those with the tertiary level of education(p=0.001) and of the Christian religion (p=<0.001) had statistically significant associations with good knowledge of contraception. 
 Conclusion: The knowledge and readiness to use contraceptives was high but only about half were willing to adopt a method at the postnatal clinic. Robust prenatal counselling may help to increase the uptake of postpartum contraception.

Exploring Multiple Measures of Pregnancy Preferences and Their Relationship with Postpartum Contraceptive Uptake Using Longitudinal Data from PMA Ethiopia.

There are significant gaps in our understanding of how the experience of an unintended pregnancy affects subsequent contraceptive behavior. Our objective was to explore how three measures of pregnancy preferences-measuring timing-based intentions, emotional orientation, and planning status-were related to the uptake of postpartum family planning within one year after birth. Additionally, we tested whether the relationship between each measure and postpartum family planning uptake differs by parity, a key determinant of fertility preference. Adjusted hazards regression results show that the timing-based measure, specifically having a mistimed pregnancy, and the emotional response measure, specifically being unhappy, were associated with contraceptive uptake in the extended postpartum period, while those related to pregnancy planning, as measured by an adapted London Measure of Unplanned Pregnancy, were not. This effect differed by parity; high parity women were consistently the least likely to use contraception in the postpartum period, but the effect of experiencing an unwanted pregnancy or having a mixed reaction to a pregnancy was significantly stronger among high parity compared to low parity women. Greater attention to the entirety of women's responses to unanticipated pregnancies is needed to fully understand the influence of unintended pregnancy on health behaviors and outcomes for women and their children.

The more, the better: influence of family planning discussions during the maternal, newborn and child health continuum of care on postpartum contraceptive uptake and method type among young women in Ethiopia.

Background: This study examines the association between family planning (FP) discussions with health professionals during contact points on the maternal, newborn and child health continuum of care and timing of modern contraceptive uptake and method type in the one-year following childbirth in six regions of Ethiopia among adolescent girls and young women (AGYW). Methods: This paper uses panel data of women aged 15-24 who were interviewed during pregnancy and the postpartum period between 2019-2021 as part of the PMA Ethiopia survey (n=652). Results: Despite the majority of pregnant and postpartum AGYW attending antenatal care (ANC), giving birth in a health facility, and attending vaccination visits, one-third or less of those who received the service reported discussion of FP at any of these visits. When considering the cumulative effect of discussions of FP at ANC, pre-discharge after childbirth, postnatal care and vaccination visits, we found that discussion of FP at a greater number of visits resulted in increased uptake of modern contraception by one-year postpartum. A greater number of FP discussions was associated with higher long-acting reversible contraceptive use relative to non-use and relative to short-acting method use. Conclusions: Despite high attendance, there are missed opportunities to discuss FP when AGYW access care.

Attitudes and perceptions towards postpartum contraceptive use among seroconcordant partners with HIV in rural Mozambique: a qualitative study

BackgroundPostpartum contraceptive uptake reduces short interpregnancy intervals, unintended pregnancies, and their negative sequalae: poor maternal and fetal outcomes. Healthy timing and spacing of pregnancy in people living with HIV (PLHIV) also allows time to achieve viral suppression to reduce parent-to-child HIV transmission. There is scant understanding about how couples-based interventions impact postpartum contraceptive uptake among PLHIV in sub-Saharan Africa.MethodsWe interviewed 38 recently pregnant people and 26 of their partners enrolled in the intervention arm of the Homens para Saúde Mais (HoPS+) [Men for Health Plus] trial to assess their perceptions of, attitudes towards, and experiences with contraceptive use. Individuals in the HoPS+ intervention arm received joint—as opposed to individual—HIV-related services during pregnancy and postpartum periods, six counseling and skills sessions, and nine sessions with a peer support couple. Our thematic analysis of the 64 in-depth interviews generated 14 deductive codes and 3 inductive codes across themes within the Information, Motivation, and Behavior Model of health behavior change.ResultsParticipants reported accurate and inaccurate information about birth spacing and contraceptive methods. They described personal (health, economic, and religious) and social (gender norms, desired number of children) motivations for deciding whether to use contraceptives—with slightly different motivations among pregnant and non-pregnant partners. Finally, they explained the skills needed to overcome barriers to contraceptive use including how engagement in HoPS+ improved their shared decision-making skills and respect amongst partners—which facilitated postpartum contraceptive uptake. There were also several cases where non-pregnant partners unilaterally made family planning decisions despite disagreement from their partner.ConclusionsThese findings suggest that couples-based interventions during pregnancy and post-partum periods aimed at increasing postpartum contraceptive uptake must center pregnant partners’ desires. Specifically, pregnant partners should be allowed to titrate the level of non-pregnant partner involvement in intervention activities to avoid potentially emboldening harmful gender-based intercouple decision-making dynamics.

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.

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.

Pregnancy trends and associated factors among Kenyan adolescent girls and young women pre- and post-COVID-19 lockdown

Globally, COVID-19 has had a negative impact on health systems and health outcomes, with evidence of differential gender impacts emerging. The COVID-19 timeline of events spanning from closures and restrictions to phased reopenings is well-documented in Kenya. This unique COVID-19 situation offered us the opportunity to study a natural experiment on pregnancy trends and outcomes in a cohort of Kenyan adolescent girls and young women (AGYW), enrolled in the KENya Single-dose HPV-vaccine Efficacy (KEN SHE) Study. The KEN SHE Study enrolled sexually active AGYW aged 15–20 years from central and western Kenya. Pregnancy testing was performed at enrollment and every 3 months. We determined pregnancy incidence trends pre- and post-COVID-19 lockdown, pregnancy outcomes (delivery, spontaneous, or induced abortion), and postabortion and postpartum contraceptive uptake. Kaplan–Meier survival estimates of incidence rates were used to estimate the cumulative probability of pregnancy during the study period. Cox regression was used to investigate factors associated with pregnancy incidence. Of the 2,223 AGYW included in the analysis, median age was 18.6 IQR (17.6–20.3), &amp;gt;90% had at least secondary school education, 95% were single at the time of enrollment, and 82% had a steady/primary sexual partner. Pregnancy incidence peaked at 2.27 (95% CI [1.84, 2.81])/100 women-years of observation at the end of the first quarter of 2020, a period coinciding with the government-imposed lockdown. AGYW had 60% increased risk of being pregnant during the lockdown when compared to prelockdown period (HR = 1.60, 95% CI [1.25, 2.05]). Among the 514 pregnancies reported, 127 (25%) ended in abortion, of which 66 (52%) were induced abortions. Our findings demonstrate the adverse sexual and reproductive health (SRH) consequences of the COVID-19 pandemic and the lockdown measures among AGYW. As services continue to be disrupted by the pandemic, there is an urgent need to strengthen and prioritize AGYW-centered SRH services, including contraception and safe abortion.

The role of family planning counselling during maternal and child health services in postpartum modern contraceptive uptake in Ethiopia: A national longitudinal study.

Family planning counselling can help improve the postpartum modern contraceptive uptake. However, studies in Ethiopia indicate inconsistent effects of integrated family planning counselling on postpartum modern contraceptive uptake. This study aimed to determine the extent of family planning counselling and its role in improving postpartum contraceptive uptake among women in Ethiopia. We used the Performance Monitoring for Action (PMA) Ethiopia panel survey data, a community-based prospective cohort study. Randomly selected pregnant women were recruited at the baseline interview and followed by six weeks and six months postpartum. A weighted generalised linear model fitted with a Poisson distribution and a log link function was used to estimate the adjusted relative risk (aRR) and 95% Confidence Interval (CI) of modern contraceptive uptake. The coverages of family planning counselling provision during ANC, prior to discharge and child immunisation were 20%, 27% and 23%, respectively. The modern contraceptive uptakes by six weeks and six months postpartum were 18% and 36%, respectively. Family planning counselling prior to discharge from the facility was associated with increased modern contraceptive uptake by six weeks (aRR 1.25; 95% CI 0.94, 1.65) and six months postpartum periods (aRR 1.07; 95% CI 0.90, 1.27). Moreover, women who received family planning counselling during child immunisation were 35% more likely to use modern contraceptives by six months postpartum (aRR 1.35;95% CI 1.12, 1.62). However, counselling during ANC visits was not associated with modern contraceptive uptake by either six weeks or six months postpartum. A significant proportion of women had missed the opportunity, and the postpartum modern contraceptive uptake was low. Despite these, family planning counselling prior to discharge from the facility and during child immunisation improved the postpartum modern contraceptive uptake. However, our finding revealed insufficient evidence that family planning counselling during ANC is associated with postpartum modern contraceptive uptake.

Shared Decision-Making: The Way Forward for Postpartum Contraceptive Counseling.

There are multi-level barriers that impact uptake of postpartum contraception and result in disparities, including clinical barriers such as provider bias. Fortunately, clinicians have direct control over their contraceptive counseling practices, and thus reducing structural barriers is actionable through high quality contraceptive counseling that equips patients with the knowledge and guidance they need to fulfill their reproductive desires. Yet, many commonly employed contraceptive counseling strategies, like One Key Question and WHO tiered contraceptive counseling, are not patient-driven, do not account for the important nuances of contraceptive choices, and are not focused specifically on the postpartum period. Given the history of eugenics and reproductive coercion in the US, supporting patient through their contraceptive decision-making process is especially vital. Additionally, contraceptive preferences vary based on patient-level factors and fluctuate over time and counseling should account for such differences. Shared contraceptive decision-making occurs when patients provide input on their values, desires, and preferences and clinicians share medical knowledge and evidence-based information without judgement. This approach is considered the most ethically sound form of counseling, as it maximizes patient autonomy. Shared decision-making also has clinical benefits, including increased patient satisfaction. In sum, shared contraceptive decision-making should be universally adopted to promote ethical, high-quality care and reproductive autonomy.

Contraceptive uptake and associated factors among women in the immediate postpartum period at Kawempe Hospital

IntroductionWithin Africa, contraceptive use is low although about 214 million women who are not using contraception want to avoid pregnancy. In Uganda, modern contraceptive uptake is at 35% resulting in unwanted or unplanned pregnancies which may increase morbidity and mortality among children and mothers. Contraceptive uptake at 6 weeks postpartum is encouraged but it is not very effective since there is low attendance during this visit. Additionally, some women may have become sexually active by the visit at 6 weeks postpartum leading to early conception.ObjectivesThis study sought to determine contraceptive uptake in the immediate postpartum period and the associated factors among women delivering at Kawempe Hospital.MethodsThis study employed a cross-sectional study design where 397 women aged 18–49 years were recruited using systematic random sampling. The women who were discharged within 72 h after delivery were considered. Data collection was done using an interviewer-administered data collection tool. Data was double entered into EpiData version 4.2 and analyzed using STATA version 13 at univariate using descriptive statistics then at bivariate and multivariate levels using logistic regression with contraceptive uptake as the outcome.ResultsWe enrolled 397 participants. Their mean age range was 18–45 years and a median of 25 years (IQR 22, 30). The majority of the participants, 333 (83.88%), were married and 177 (44.58%) were housewives or unemployed. Contraceptive uptake in the immediate postpartum period among these participants was 15.4% (61/397). The factors independently associated with immediate postpartum contraceptive uptake were grand multiparity (aOR = 2.57; 95% CI 1.11–5.95; p = 0.028), cesarean delivery (aOR = 2.63; 95% CI 1.24–5.57; p = 0.011), and prior contraceptive counseling during Antenatal (aOR = 9.05; 95% CI 2.65–30.93; p = < 0.001).ConclusionThere was a 15.4% contraceptive uptake among immediate postpartum women which is very low. The factors independently associated with immediate postpartum contraceptive uptake were grand multiparity, cesarean section, and prior contraceptive counseling during antenatal care. Efforts need to be made to improve contraceptive uptake among immediate postpartum mothers such that the high unmet need for contraception is reduced and short inter-pregnancy intervals are controlled.

Breastfeeding and Contraceptive Methods in Women With Severe Acute Respiratory Syndrome Coronavirus- 2 (SARS-COV-2) Infection in Peripartum Period.

Objective: This study aimed to assess the exclusive breastfeeding and contraceptive methods among women delivering within 1-week of a positive test for severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) infection. Materials and methods: In this study, 106 women with SARS-CoV-2 infection who were either asymptomatic or had mild disease were included. They were admitted for maternity care at a tertiary center between May to September 2020. The data was collected during their hospital stay and subsequently by telephonic or in-person interviews at 4-6 weeks and 8-10 weeks postpartum for contraceptive use, breastfeeding and use of facemask and hand-hygiene. Results: Sixty-three (59.4%) women had vaginal delivery and 43 (40.6%) required cesarean-section. Only one of the 98 newborns who were tested for SARS-CoV-2 turned out positive. Initiation of breastfeeding was delayed by an average of three days due to preparing the Reverse transcription polymerase chain reaction (RT-PCR) report. Exclusive breastfeeding was practiced by 69% and mixed feeding by 26%.Pre breastfeeding hand hygiene and facemask use declined after discharge (100% to 53.75% at 8-10 weeks postpartum). Out of 106, 86 (81%) women used no contraception at 8-10 weeks postpartum, continued with post-placental-IUD in 8/106 (7.5%) and tubal-sterilization during cesarean in 8/106 (7.5%) cases. Only 4/106 (4%) adopted alternative methods like barrier contraception. Conclusion: The practice of exclusive breastfeeding remains unchanged among women who suffered from SARS-CoV-2 infection in the peripartum period while uptake of postpartum contraception was minimal except for the women who opted for long term contraceptive methods in the immediate postpartum period.

Women's experiences of, and preferences for, postpartum contraception counselling.

The lack of access to and uptake of postpartum contraception is a key contributor to an estimated 121million unintended pregnancies worldwide. Research on counselling and women's preferences for postpartum contraception is scarce in Australia. We therefore aimed to explore Australian women's experiences of, and preferences for, accessing postpartum contraceptive counselling. In this qualitative study, English-speaking women of reproductive age (18-40years) with at least one child under the age of 5years were recruited via social media to participate in a semi-structured telephone interview. Interviews focussed on women's experiences of, and preferences for, postpartum contraception. The interviews were audio-recorded, transcribed, coded and thematically analysed. Twenty women participated. Most did not receive in-depth contraceptive counselling antenatally or postnatally, though had brief discussions with their GPs or obstetricians at the 6-week postnatal check. Participants felt some counselling throughout their antenatal and postnatal care would have been useful, particularly those who experienced medical complications perinatally. Most participants expressed a general preference for their GP or a midwife to provide such counselling, rather than an obstetrician or nurse, and they noted characteristics such as compassion, trust and care as being particularly important. The provision of postpartum contraceptive counselling could be enhanced in Australia. Contraceptive uptake in the postpartum period may be promoted by ensuring consistent and routine provision of contraceptive counselling for women antenatally and postnatally by their maternity carers.

Delivery of home-based postpartum contraception in Southwest Trifinio, Guatemala: Reach, adoption, and implementation in a cluster-randomized trial

ObjectiveThe objective of this analysis was to present our secondary outcomes (reach, adoption, implementation, maintenance domains) of a prospective trial to test the efficacy of a home-based intervention to increase postpartum contraceptive uptake. Study DesignWe executed a cluster-randomized trial to determine if provision of contraception in the home setting increased uptake of postpartum methods. We collected secondary outcomes on how our implementation strategies of revising professional roles and changing service sites performed in terms of the number of people our study enrolled of all women eligible (reach), how it was accepted by the providers (adoption), what methods were used to conduct the study (implementation), and preliminary results on whether or not the intervention will be continued (maintenance). We conducted a survey and focus group discussion to assess adoption and implementation among intervention nurse staff, and a survey in a convenience sample of patients in the intervention arm to assess acceptability. ResultsOur primary outcome of effectiveness has been published; implant uptake was 25% in the intervention cohort compared to 3% in the control clusters. Our reach was 89%, as 208 of the 234 eligible women consented to participate. Among a convenience sample of N = 25 patients completing a survey on the intervention 12 months after enrollment, ≥ 68% (n = 17 of 25) felt the intervention was acceptable. From the nursing perspective (N = 7), only a minority of nurses felt the intervention was complicated (n = 1, 17%), and (n = 7, 100%) reported the intervention was acceptable. ConclusionsOur intervention achieved good reach (89% of the eligible population) and was acceptable to the majority of patients and providers. Practitioners interested in achieving greater reach of contraceptive interventions in their communities may consider changing service sites to convenience their clients, as our results suggest this approach was acceptable. ImplicationsThe unique contribution of this paper is in its success with training nurses to insert contraceptive implants during postpartum home visits, which resulted in increased uptake of the contraceptive implant where access to the device was previously limited. Given the trial's successful feasibility and acceptability to both nurses and patients, perhaps this intervention has the potential to be adapted and scaled to other settings.

Assessing the Impact of the COVID-19 Pandemic on Postpartum Contraception Uptake

<strong>Background:</strong> Due to COVID-19, telemedicine was incorporated into postpartum care to reduce transmission risk. <strong>Research Question:</strong> Our objective was to compare postpartum contraception uptake between March 1, 2019–May 31, 2019 and March 1, 2020–May 31, 2020. <strong>Study Design/Methods:</strong> This is a retrospective cohort study of postpartum patients who delivered at the Mount Sinai Hospital System between March 1, 2019–May 31, 2019 and March 1, 2020–May 31, 2020. We recorded postpartum contraception uptake at hospital discharge and at outpatient postpartum visits. We compared four categories: short-acting reversible contraception (SARC), long-acting reversible contraception (LARC), “barrier methods/other” (condoms, diaphragms, spermicides), and sterilization. The 2019 and 2020 patient cohorts did not differ significantly in terms of maternal age, gravidity, ethnicity, or insurance type. This study was approved by the Mount Sinai IRB. <strong>Results:</strong> 1,106 patients were included in our analysis, 443 and 663 who delivered in 2019 and 2020 respectively. There were no significant differences in the number of patients offered and accepting contraception at hospital discharge and postpartum visit between the 2019 and 2020 groups. Type of contraception given at postpartum visit differed significantly between 2019 and 2020 (p = 0.006), with the 2020 group more likely to use SARC (55 vs. 42%) and less likely to use LARC (15 vs. 24%). Notably, 26% of the 2020 group had telehealth postpartum visits (vs. 0% in 2019). Within the 2020 group, type of contraception differed significantly between in-person and telehealth visits (p = 0.001). Patients who had telehealth visits were less likely to use “barrier/other” methods (14 vs. 32%) and more likely to use SARC (67 vs. 51%). <strong>Conclusions:</strong> Despite COVID-19, overall uptake of postpartum contraception did not change significantly; however, the type of contraception differed significantly, particularly at telehealth visits. Additional research is needed to understand why telehealth postpartum visits may increase the uptake of short acting contraception and decrease barrier methods.

Postpartum contraceptive uptake and fertility desires following obstetric anal sphincter injury.

Our primary objective was to compare rates of contraceptive use among postpartum heterosexual primiparous women with and without obstetric anal sphincter injury (OASIS). The secondary objective was to compare fertility desires among women with and without OASIS. This was a planned secondary analysis of a prospective cohort study of postpartum sexual function among primiparous postpartum women. Women with a history of vaginal delivery with and without OASIS completed online surveys at baseline and 3months postpartum. Sixty-nine women completed baseline and 3-month surveys. Forty-one percent of women with OASIS and 36% without OASIS were not using contraception at 3months postpartum. One-third of women in either group reported using at least moderately effective contraception (P = 0.9), defined as using hormonal contraception or an intrauterine contraceptive device, and excluding condoms. Most women with OASIS (54%) desired to wait 1 to 2years before attempting another pregnancy. One fifth of women with and without OASIS desired another pregnancy within the next year (P = 0.4). A minority of postpartum primiparous women in the present cohort reported using moderately effective contraception 3months postpartum, regardless of whether they sustained OASIS. The discrepancy between current contraceptive use and desired birth spacing suggests an unmet contraceptive need within our population and an opportunity for improved contraceptive counseling consistent with patients' family planning goals, as well as national and international guidelines on birth spacing. Larger prospective studies are needed to further understand the unmet contraceptive need among women with OASIS.

Contraceptive Uptake After Obstetric Anal Sphincter Injuries (OASIS): A 5-Year Retrospective Review [08J

INTRODUCTION: OASIS is a complication of vaginal delivery. Although recurrence rates are low, women often feel apprehensive regarding subsequent births, with some wishing to delay future pregnancy. We aimed to evaluate contraceptive practices and interpregnancy interval of women who sustained OASIS. METHODS: We conducted a retrospective chart review of women who sustained OASIS from 2012–2017. We selected women who delivered during the same time period without OASIS as controls. We abstracted relevant demographic characteristics, delivery data, and documented postpartum contraceptive choice provided. We performed our analysis using independent two-sample t-test and chi-square test for unadjusted analyses and multivariable logistic regression for adjusted analyses, with alpha&lt;0.05. RESULTS: We included 314 women with OASIS and 297 without as controls. Women who experienced OASIS were more likely to be nulliparous, have an assisted vaginal delivery, and experience a wound complication. There were similar rates of postpartum contraceptive uptake in both groups (82% vs 84%, P=.58). Greater than 50% of women in each cohort chose hormonal or long-acting contraceptives, with the majority choosing long-acting methods. Our multivariable regression showed no difference in method choice between groups. Of women with OASIS who had a subsequent delivery, 14% chose elective Cesarean section and the OASIS recurrence rate was 6%. Average interpregnancy interval was no different between cohorts (19.6 vs 20.7 months, P=.53). CONCLUSION: Although there were no significant differences in contraception uptake or type used in women who experienced OASIS, overall hormonal and long-acting contraception uptake was high. Experiencing OASIS does not appear to affect interpregnancy interval.

The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use

ObjectiveWe examined whether Medicaid-enrolled women in CenteringPregnancy group prenatal care had higher rates of (1) postpartum visit attendance and (2) postpartum uptake of contraceptives, compared to women in individual prenatal care. Study designWe linked birth certificates and Medicaid claims for women receiving group prenatal care in 18 healthcare practices and applied preferential-within cluster propensity score methods to identify a comparison group, accounting for the nested data structure by practice. We examined five standardized, claims-based outcomes: postpartum visit attendance; contraception within 3 days; and any contraception, long-acting reversible contraception (LARC), and permanent contraception within eight weeks. We assessed outcomes using logistic regression for two treatment levels: (1) any group attendance compared to no group attendance and (2) attendance at five or more group sessions to at least five prenatal care visits, including crossovers attending fewer than five group sessions (minimum threshold analysis). ResultsWomen attending at least five group sessions had higher rates of postpartum visit attendance (71.5% vs. 67.5%, p < .05). Women with any group attendance (N = 2834) were more likely than women with individual care only (N = 13,088) to receive contraception within 3 days (19.8% vs. 16.9%, p < .001) and to receive a LARC within eight weeks’ postpartum (18.0% vs. 15.2%, p < .001). At both treatment levels, group participants were less likely to elect permanent contraception (5.9% vs. 7.8%, p < 0.001). Women meeting the five-visit group threshold were not more likely to initiate contraception or LARCs within 8 weeks’ postpartum. ConclusionParticipation in at least five group compared to five individual prenatal care visits is associated with greater rates of postpartum visit attendance. Additional engagement and education in group prenatal care may influence postpartum visit attendance. ImplicationsPlanning for postpartum care and contraception during prenatal care is an important strategy for connecting women to postpartum healthcare. Regardless of prenatal care model, women have low uptake of contraception in the postpartum period. Increased use of group prenatal care with its scheduled family planning discussion may help to increase postpartum contraceptive uptake. This benefit is dependent on availability of postpartum contraception options.

The Association of Public Insurance with Postpartum Contraception Preference and Provision.

BackgroundPrior studies have noted that public insurance status is associated with increased uptake of postpartum contraception whereas others have pointed to public insurance as a barrier to accessing highly effective forms of contraception.ObjectiveTo assess differences in planned method and provision of postpartum contraception according to insurance type.Study DesignThis is a secondary analysis of a retrospective cohort study examining postpartum women delivered at a single hospital in Cleveland, Ohio from 2012–2014. Contraceptive methods were analyzed according to Tier-based effectiveness as defined by the Centers for Disease Control and Prevention. The primary outcome was postpartum contraception method preference. Additional outcomes included method provision, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery.ResultsOf the 8281 patients in the study cohort, 1372 (16.6%) were privately and 6990 (83.4%) were publicly insured. After adjusting for the potentially confounding clinical and demographic factors through propensity score analysis, public insurance was not associated with preference for a Tier 1 versus Tier 2 postpartum contraceptive method (matched adjusted odds ratio [maOR] 0.89, 95% CI 0.69–1.15), but was associated with a preference for Tier 1/2 vs Tier 3/None (maOR 1.41, 95% CI 1.17–1.69). There was no difference between women with private or public insurance in terms of method provision by 90 days after delivery (maOR 0.94, 95% CI 0.75–1.17). Public insurance status was also associated with decreased postpartum visit attendance (maOR 0.54, 95% CI 0.43–0.68) and increased rates of subsequent pregnancy within 365 days of delivery (maOR 1.29, 95% CI 1.05–1.59).ConclusionPublic insurance status does not serve as a barrier to either the preference or provision of effective postpartum contraception. Women desiring highly- or moderately effective methods of contraception should have these methods provided prior to hospital discharge to minimize barriers to method provision.

Delivery of home-based postpartum contraception in rural Guatemalan women: a cluster-randomized trial protocol

BackgroundPostpartum contraception is important to prevent unintended and closely spaced pregnancies following childbirth.MethodsThis study is a cluster-randomized trial of communities in rural Guatemala where women receive ante- and postnatal care through a community-based nursing program. When nurses visit women for their postpartum visit in the intervention clusters, instead of providing only routine care that includes postpartum contraceptive education and counseling, the nurses will also bring a range of barrier, short-acting, and long-acting contraceptives that will be offered and administered in the home setting, after routine clinical care is provided.DiscussionA barrier to postpartum contraception is access to medications and devices. Our study removes some access barriers (distance, time, cost) by providing contraception in the home. We also trained community nurses to place implants, which are a type of long-acting reversible contraceptive method that was previously only available in the closest town which is about an hour away by vehicular travel. Therefore, our study examines how home-based delivery of routinely available contraceptives and the less routinely available implant may be associated with increased uptake of postpartum contraception within 3 months of childbirth. The potential implications of this study include that nurses may be able to be trained to safely provide contraceptives, including placing implants, in the home setting, and provision of home-based contraception may be an effective way of delivering an evidence-based intervention for preventing unintended and closely spaced pregnancies in the postpartum period.Trial registrationClinicaltrials.gov, NCT04005391. Retrospectively registered on 1 July 2019.

Effect of integrating maternal health services and family planning services on postpartum family planning behavior in Ethiopia: results from a longitudinal survey

BackgroundVery few postpartum women want to become pregnant within the next 2 years, but approximately 60% of postpartum women in low- and middle-income countries are not using contraceptive methods. The World Health Organization recommends that women receive postpartum family planning (PPFP) counseling during antenatal, immediate postpartum, and postnatal services. Our objective was to establish whether PPFP counseling is being provided in antenatal and postnatal care services in SNNPR, Ethiopia and whether receipt of PPFP counseling improved uptake of postpartum family planning use by 6 months postpartum.MethodsLongitudinal data from the Performance Monitoring for Accountability 2020 – Maternal and Newborn Health study were used. At screening, 329 women were identified as six or more months pregnant; 307 completed the survey at 6 months postpartum. We used weighted parametric survival analysis with Weibull distribution to assess the effect of receipt of postpartum counseling in antenatal and/or postnatal care by 6 weeks postpartum on contraceptive uptake, after adjusting for intention to use family planning, wantedness of the index pregnancy, delivery location, amenorrhea, exclusive breastfeeding, residence, parity, and education.ResultsCoverage of PPFP counseling is low; by six-weeks postpartum only 20% of women had received counseling. Women who received counseling in postnatal care only and postnatal care and antenatal care took up contraception at significantly higher rates than women who did not receive any counseling (HR: 3.4, p < .01 and HR: 2.5, p = .01, respectively). There was no difference between women who received PPFP counseling only in ANC and women who did not receive counseling at all. Women who did not want the child at all took up contraception at significantly lower rates than women who wanted the child at that time (HR: 0.3, p = .04). Women who had four or more children took up contraception at significantly lower rates than woman with 1–3 children (HR: 0.3, p = .01). There were no significant differences by delivery location, exclusive breastfeeding, residence, or education.ConclusionIntegration of postpartum family planning counseling into postnatal care services is an effective means to increase postpartum contraceptive uptake, but significant gaps in coverage, particularly in the delivery and postnatal period, remain.