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Am J Perinatol
DOI: 10.1055/a-2335-2951
Original Article

Influence of Pregnancy Intention on Postpartum Contraceptive Choice at an Urban Academic Medical Center

Meghan St John
1   Department of Obstetrics and Gynecology, Western Pennsylvania Hospital, Allegheny Health Network Medical Education Consortium, Pittsburgh, Pennsylvania
,
Kirby Sullivan
2   Department of Internal Medicine, George Washington School of Medicine and Health Sciences, Washington, District of Columbia
,
Emily A. DeFranco 
3   Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, Kentucky
,
Elizabeth Kelly
4   Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
5   Perinatal Institute Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
› Author Affiliations Funding M.S.J. received research funding from the University of Cincinnati Department of Obstetrics and Gynecology and the University of Cincinnati College of Medicine Women's Health Medical Student Scholars Program.
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Abstract

Objective This study aimed to describe postpartum contraception preferences in the context of pregnancy intention (PI).

Study Design A prospective cohort study analyzing postpartum contraceptive choice (PCC) in 431 postpartum women who delivered at a single academic medical center. 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.

Results 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 to 24 years (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% confidence interval [CI]: 1.36, 2.47), and more likely to desire voluntary sterilization, aRR = 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, aRR = 1.56 (95% CI: 1.18, 2.06).

Conclusion 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.

Key Points

  • Nearly three out of four pregnancies in this study were mistimed or unintended.

  • Women with mistimed or unintended pregnancies are more likely to choose highly effective postpartum contraception or voluntary sterilization.

  • Public health initiatives to improve access to family planning services and postpartum contraception, including surgery for bilateral tubal ligation before discharge from the hospital postdelivery, are important areas of focus to help attenuate the rates of unintended pregnancy in the United States.

Keywords

postpartum - contraception - intention - LARC - pregnancy intention

Note

This study was presented at the American College of Obstetricians and Gynecologists Virtual Conference, from October 30 to 31, 2020.




Publication History

Received: 03 October 2023

Accepted: 27 May 2024

Accepted Manuscript online:
29 May 2024

Article published online:
01 July 2024

© 2024. Thieme. All rights reserved.

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