Details:

Alternative Title:
Am J Obstet Gynecol
Personal Author:
Oduyebo, Titilope ; Zapata, Lauren B. ; Boutot, Maegan E. ; Tepper, Naomi K. ; Curtis, Kathryn M. ; ... More +
Oduyebo, Titilope ; Zapata, Lauren B. ; Boutot, Maegan E. ; Tepper, Naomi K. ; Curtis, Kathryn M. ; D’Angelo, Denise V. ; Marchbanks, Polly A. ; Whiteman, Maura K. Less -
Description:
BACKGROUND:

Contraception use among postpartum women is important to prevent unintended pregnancies and optimize birth spacing. Long-acting reversible contraception, including intrauterine devices and implants, is highly effective, yet compared to less effective methods utilization rates are low.

OBJECTIVES:

We sought to estimate prevalence of long-acting reversible contraception use among postpartum women and examine factors associated with long-acting reversible contraception use among those using any reversible contraception.

STUDY DESIGN:

We analyzed 2012–2015 data from the Pregnancy Risk Assessment Monitoring System, a population-based survey among women with recent live births. We included data from 37 sites that achieved the minimum overall response rate threshold for data release. We estimated the prevalence of long-acting reversible contraception use in our sample (n = 143,335). We examined maternal factors associated withlong-acting reversible contraception use among women using reversible contraception (n = 97,013) using multivariable logistic regression (long-acting reversible contraception vs other type of reversible contraception) and multinomial regression (long-acting reversible contraception vs other hormonal contraception and long-acting reversible contraception vs other nonhormonal contraception).

RESULTS:

The prevalence of long-acting reversible contraception use overall was 15.3%. Among postpartum women using reversible contraception, 22.5% reported long-acting reversible contraception use, which varied by site, ranging from 11.2% in New Jersey to 37.6% in Alaska. Factors associated with postpartum long-acting reversible contraception use vs use of another reversible contraceptive method included age ≤ 24 years (adjusted odds ratio =1.43; 95% confidence = interval 1.33–1.54) and ≥35 years (adjusted odds ratio=0.87; 95% confidence interval =0.80–0.96) vs 25–34 years; public insurance (adjusted odds ratio = 1.15; 95% confidence interval = 1.08–1.24) and no insurance (adjusted odds ratio = 0.73; 95% confidence interval = 0.55–0.96) vs private insurance at delivery; having a recent unintended pregnancy (adjusted odds ratio = 1.44; 95% confidence interval =1.34-.54) or being unsure about the recent pregnancy (adjusted odds=ratio 1.29; 95% confidence interval =1.18–1.40) vs recent pregnancy intended; having≥1 previous live birth (adjusted odds ratio=1.40; 95% confidence interval = 1.31–1.48); and having a postpartum check-up after recent live birth (adjusted odds ratio =2.70; 95% confidence interval2.35–3.11). Hispanic and non-Hispanic black postpartum women had a higher rate of long-acting reversible contraception use (26.6% and 23.4%, respectively) compared to non-Hispanic white women (21.5%), and there was significant race/ethnicity interaction with educational level.

CONCLUSION:

Nearly 1 in 6 (15.3%) postpartum women with a recent live birth and nearly 1 in 4 (22.5%) postpartum women using reversible contraception reported long-acting reversible contraception use. Our analysis suggests that factors such as age, race/ethnicity, education, insurance, parity, intendedness of recent pregnancy, and postpartum visit attendance may be associated with postpartum long-acting reversible contraception use. Ensuring all postpartum women have access to the full range of contraceptive methods, including long-acting reversible contraception, is important to prevent unintended pregnancy and optimize birth spacing. Contraceptive access may be improved by public health efforts and programs that address barriers in the postpartum period, including increasing awareness of the availability, effectiveness, and safety of long-acting reversible contraception (and other methods), as well as providing full reimbursement for contraceptive services and removal of administrative and logistical barriers.


Subjects:
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Adult Age Factors Black Or African American Contraceptive Agents, Female Drug Implants Educational Status Ethnicity Female Hispanic Or Latino Humans Insurance, Health Intrauterine Devices Long-Acting Reversible Contraception Medically Uninsured Odds Ratio Postpartum Period Pregnancy Pregnancy, Unplanned White Young Adult
Source:
Am J Obstet Gynecol. 221(1):43.e1-43.e11
Pubmed ID:
30885772
Pubmed Central ID:
PMC6592782
Document Type:
Journal Article
Funding:
CC999999/ImCDC/Intramural CDC HHS/United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:aa48caa92ab978f7f4adf7a9c1ab0d6bb8a6372356844d1964de652581ba6625
Download URL:
https://stacks.cdc.gov/view/cdc/79389/cdc_79389_DS1.pdf
File Type:

Supporting Files

• nihms-1027788.nxml

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