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Gifford K, McColl R, McDuffie MJ, Boudreaux M. Postpartum long-acting reversible contraceptive adoption after a statewide initiative. Health Serv Res 2024; 59:e14300. [PMID: 38491794 PMCID: PMC11063091 DOI: 10.1111/1475-6773.14300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVES To examine the effects of a comprehensive, multiyear (2015-2020) statewide contraceptive access intervention in Delaware on the contraceptive initiation of postpartum Medicaid patients. The program aimed to increase access to all contraceptives, including long-acting reversible contraceptives (LARC). The program included interventions specifically targeting postpartum patients (Medicaid payment reform and hospital-based immediate postpartum (IPP) LARC training) and interventions in outpatient settings (provider training and operational supports). DATA SOURCES AND STUDY SETTING We used Medicaid claims data between 2012 and 2019, from Delaware and Maryland (a comparison state), to identify births and postpartum contraceptive methods up to 60 days postpartum among patients aged 15-44 years who were covered in a full-benefit eligibility category. STUDY DESIGN Using difference-in-differences, we assessed changes in LARC, tubal ligation, and short-acting methods (oral contraceptive, injectable, patch/ring). LARC rates were assessed at 60 days after delivery and on an immediate postpartum basis. Other methods were only assessed at 60 days. Analyses were conducted separately for an early-adopting high-capacity hospital (that delivers approximately half of all Medicaid financed births) and for all other later-adopting hospitals in the state. DATA COLLECTION/EXTRACTION METHODS Data were extracted from administrative claims. PRINCIPAL FINDINGS The program increased postpartum LARC insertions by 60 days after delivery by 11.7 percentage points (95% CI: 10.7, 12.8) in the early-adopting hospital and 6.9 percentage points (95% CI: 4.8, 5.9) in later-adopting hospitals. Increases in IPP versus outpatient LARC drove the change, but we did not find evidence that IPP crowded-out outpatient LARC services. We observed decreases in short-acting methods, suggesting substitution between methods, but the share of patients with any method increased at the early-adopting hospital (5.2 percentage points; 95% CI: 3.5, 6.9) and was not statistically significantly different at the later-adopting hospitals. CONCLUSIONS Direct reimbursement for IPP LARC, in combination with provider training, had a meaningful impact on the share of Medicaid-enrolled postpartum women with LARC claims.
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Affiliation(s)
- Katie Gifford
- Biden School of Public Policy & AdministrationUniversity of DelawareNewarkDelawareUSA
| | - Rebecca McColl
- Biden School of Public Policy & AdministrationUniversity of DelawareNewarkDelawareUSA
| | - Mary Joan McDuffie
- Biden School of Public Policy & AdministrationUniversity of DelawareNewarkDelawareUSA
| | - Michel Boudreaux
- Department of Health Policy and ManagementUniversity of Maryland School of Public HealthCollege ParkMarylandUSA
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Carrandi A, Bull C, Hu Y, Grzeskowiak LE, Teede H, Black K, Callander E. Patterns in the provision of government-subsidised hormonal postpartum contraception in Queensland, Australia between 2012 and 2018: a population-based cohort study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:13-20. [PMID: 37353310 DOI: 10.1136/bmjsrh-2023-201830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Short birth intervals and unintended pregnancy are associated with poorer maternal and infant outcomes. There is a risk of pregnancy during the immediate postpartum period unless contraception is initiated. This retrospective cohort study aimed to capture the current patterns of hormonal contraceptive provision within 12 months postpartum in a high-income country. METHODS We used a linked administrative dataset comprising all women who gave birth in Queensland, Australia between 1 July 2012 and 30 June 2018 (n=339 265 pregnancies). We described our cohort by whether they were provided with government-subsidised hormonal contraception within 12 months postpartum. The associations between hormonal postpartum contraceptive provision and demographic and clinical characteristics were examined using univariate and multivariate logistic regression and presented in terms of crude and adjusted odds ratios with 95% confidence intervals. RESULTS A majority of women (60.2%) were not provided with government-subsidised hormonal postpartum contraception within 12 months postpartum. Women who were younger (<25 years), were overweight or obese, smoked, were born in Australia, were non-Indigenous, gave birth in a public hospital, or were in the lowest socioeconomic status group were more likely to be provided with postpartum contraception after adjusting for other covariates, compared with their counterparts. CONCLUSIONS Strategies to increase the provision and uptake of contraception in the immediate postpartum period are needed to prevent short birth intervals and unintended pregnancy and ensure women's fertility intentions are enacted. Ongoing research is needed to examine the factors influencing women's access to contraceptive services and, further, the types of contraception provided.
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Affiliation(s)
- Alayna Carrandi
- Monash Centre for Health Research and Implementation, Clayton, Victoria, Australia
| | - Claudia Bull
- Monash Centre for Health Research and Implementation, Clayton, Victoria, Australia
| | - Yanan Hu
- Monash Centre for Health Research and Implementation, Clayton, Victoria, Australia
| | - Luke E Grzeskowiak
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Monash University Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Clayton, Victoria, Australia
| | - Kirsten Black
- Faculty of Medicine and Health, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Emily Callander
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
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Maaskant A, Scarsi KK, Meijer L, Roubos S, Louwerse AL, Remarque EJ, Langermans JAM, Stammes MA, Bakker J. Long-acting reversible contraception with etonogestrel implants in female macaques ( Macaca mulatta and Macaca fascicularis). Front Vet Sci 2024; 10:1319862. [PMID: 38260208 PMCID: PMC10800480 DOI: 10.3389/fvets.2023.1319862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/04/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Contraception is often required for management and population control purposes in group-housed and free-roaming non-human primates. Long-acting reversible contraceptives, including subdermal progestin-releasing implants, are preferred as they eliminate challenges associated with frequent administration. Etonogestrel (ENG)-releasing subdermal implants are reversible and long-acting for a minimum of 3 years, and are commercially available for human use as Implanon® or Nexplanon®. Methods A retrospective analysis was performed detailing the contraceptive effectiveness and reversibility of subdermal placement of one-fourth or one-third of an ENG implant (68 mg/implant) in 129 female rhesus macaques (Macaca mulatta) and 67 cynomolgus macaques (Macaca fascicularis) at the Biomedical Primate Research Centre (Rijswijk, Netherlands). Furthermore, single cross-sectional ENG serum concentrations were measured for 16 rhesus and 10 cynomolgus macaques, and hemoglobin and blood chemistry pre-ENG and at timepoints >0.5, >1.5, and > 2.5 years post-ENG insertion were evaluated for 24 rhesus macaques. Finally, data were obtained using trans-abdominal ultrasound regarding the influence of ENG on uterine volume and endometrial thickness in 14 rhesus and 11 cynomolgus macaques. Results As a contraceptive ENG was in 99.80% (CI 93.50-99.99) and 99.95% (CI 99.95-100) effective in rhesus and cynomolgus macaques, respectively. Prolonged ENG durations of implant use in 14 rhesus macaques (range 3.1-5.0 years) and eight cynomolgus macaques (range 3.2-4.0 years) resulted in no unintended pregnancies. A total of 17 female macaques were allowed to breed after ENG removal, and among them, 14 female macaques (82%) had an uneventful delivery. Serum ENG concentrations with a median ENG duration of 1.2 years (range 0.1-6.0 years) and 1.9 years (range 0.6-4.7 years) resulted in median concentrations of 112 pg./mL (range 0-305 pg./mL) and 310 pg./mL (range 183-382 pg./mL) for rhesus and cynomolgus macaques, respectively. ENG had no clinical effect on hemoglobin and blood chemistry parameters nor on the thickness of the endometrial lining or uterus volume. Conclusion This study indicates that both one-fourth and one-third of the ENG implants are effective, long-acting, reversible, and safe contraceptive to use in macaques.
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Affiliation(s)
- Annemiek Maaskant
- Biomedical Primate Research Centre, Rijswijk, Netherlands
- Department Population Health Sciences, Animals in Science and Society, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Kimberly K. Scarsi
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, United States
| | - Lisette Meijer
- Biomedical Primate Research Centre, Rijswijk, Netherlands
| | - Sandra Roubos
- Biomedical Primate Research Centre, Rijswijk, Netherlands
| | | | | | - Jan A. M. Langermans
- Biomedical Primate Research Centre, Rijswijk, Netherlands
- Department Population Health Sciences, Animals in Science and Society, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | | | - Jaco Bakker
- Biomedical Primate Research Centre, Rijswijk, Netherlands
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Ahrens KA. Using mothers as the denominator. Paediatr Perinat Epidemiol 2024; 38:66-68. [PMID: 38050464 DOI: 10.1111/ppe.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
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Eastin EF, Nelson DA, Shaw JG, Shaw KA, Kurina LM. Postpartum long-acting reversible contraceptive use among active-duty, female US Army soldiers. Am J Obstet Gynecol 2023; 229:432.e1-432.e12. [PMID: 37460035 DOI: 10.1016/j.ajog.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/02/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Postpartum use of long-acting reversible contraception has been found to be effective at increasing interpregnancy intervals, reducing unintended pregnancies, and optimizing health outcomes for mothers and babies. Among female active-duty military service members, reproductive planning may be particularly important, yet little is known about postpartum long-acting reversible contraceptive use among active-duty soldiers. OBJECTIVE This study aimed to (1) quantify postpartum uptake of long-acting reversible contraception among active-duty female US Army soldiers and (2) identify demographic and military-specific characteristics associated with use. STUDY DESIGN This retrospective cohort study used longitudinal data of all digitally recorded health encounters for active-duty US Army soldiers from 2014 to 2017. The servicewomen included in our analysis were aged 18 to 44 years with at least one delivery and a minimum of 4 months of total observed time postdelivery within the study period. We defined postpartum long-acting reversible contraception use as initiation of use within the delivery month or in the 3 calendar months following delivery and identified likely immediate postpartum initiation via the proxy of placement recorded during the same month as delivery. We then evaluated predictors of postpartum long-acting reversible contraception use with multivariable logistic regression. RESULTS The inclusion criteria were met by 15,843 soldiers. Of those, 3162 (19.96%) initiated the use of long-acting reversible contraception in the month of or within the 3 months following delivery. Fewer than 5% of these women used immediate postpartum long-acting reversible contraception. Among women who initiated postpartum long-acting reversible contraceptive use, 1803 (57.0%) received an intrauterine device, 1328 (42.0%) received an etonogestrel implant, and 31 received both (0.98%). Soldiers of younger age, self-reported White race, and those who were married or previously married were more likely to initiate long-acting reversible contraception in the postpartum period. Race-stratified analyses showed that self-reported White women had the highest use rates overall. When compared with these women, the adjusted odds of postpartum use among self-reported Black and Asian or Pacific Islander women were 18% and 30% lower, respectively (both P<.001). There was also a trend of decreasing postpartum use with increasing age within each race group. Differences observed between age groups and race identities could partially be attributed to differential use of permanent contraception (sterilization), which was found to be significantly more prevalent among both women aged 30 years or older and among women who identified as Black. CONCLUSION Among active-duty US Army servicewomen, 1 in 5 used postpartum long-acting reversible contraception, and fewer than 5% of these women used an immediate postpartum method. Within this population with universal healthcare coverage, we observed relatively low rates of use and significant differences in the uptake of effective postpartum long-acting contraceptive methods across self-reported race categories.
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Affiliation(s)
- Ella F Eastin
- Stanford University School of Medicine, Stanford, CA
| | - D Alan Nelson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Kate A Shaw
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Lianne M Kurina
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA.
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Asratie MH, Tesema GA, Chilot D, Aragaw FM, Merid MW, Belay DG. Socio-demographic and antenatal care-related factors associated with early post-partum family planning use in Ethiopia: evidence from Ethiopian Demographic and Health Survey 2016 data. Front Glob Womens Health 2023; 4:1131143. [PMID: 37727741 PMCID: PMC10505931 DOI: 10.3389/fgwh.2023.1131143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/20/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction Initiation of family planning in the early post-partum period is a strategic move to reduce maternal, neonatal, and child mortality due to the negative consequences of short interbirth interval and the complications of unintended pregnancy. Antenatal care (ANC) is the noteworthy predictor of scaling up early initiation of post-partum family planning (PPFP) and preventing unintended pregnancy before menses resume. Despite the great role of ANC, information is scant about the effect of content, timing, and the number of ANC visits on the early initiation of PPFP in Ethiopia. Objective This study aimed to assess the association of ANC services with the early initiation of PPFP in Ethiopia. Methods The study was based on Ethiopian Demographic and Health Survey 2016 data, which was a cross-sectional survey from 18 January 2016 to 27 June 2016. A total weighted sample size of 2,920 post-partum women was included. A multilevel logistic regression model was used because of the hierarchical data, and variables with a p-value of ≤0.2 in the bivariable multilevel analysis were taken to multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval (CI) was used to declare both the direction and strength of the association, and variables with a p-value of <0.05 were considered as statistically significant for the outcome variable. Results The early initiation of PPFP was 20.4%. Women with at least four ANC visits [adjusted odds ratio (AOR) = 1.31; CI 1.12-2.32], women who started ANC within the first trimester (AOR = 1.25; CI 1.10-2.23), complete routine ANC (AOR = 1.11; CI 1.01-2.03), post-natal care (AOR = 1.45; CI 1.19-1.87), resumption of menses (AOR = 1.67; CI 1.18-1.93), urban residency (AOR = 2.14; CI 1.18-2.51), and high community women's education (AOR = 1.71; CI 1.51-2.11) were variables significantly associated with the early initiation of PPFP. Conclusion The early initiation of PPFP in Ethiopia was very low. Attention needs to be given to the quality of ANC, post-natal care, resumption of menses, residency, and community-level education of women to increase the prevalence of the early initiation of PPFP in Ethiopia. Therefore, the government should design a program targeting the quality of ANC in rural communities, considering women without menses and scaling up the education of women at the community level to the culture of the early initiation of PPFP in order to achieve reduced maternal, neonatal, and child mortality.
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Affiliation(s)
- Melaku Hunie Asratie
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dagmawi Chilot
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDTAfrica), Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
- Department of Human Physiology, University of Gondar, College of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Barbieri MM, Dantas-Silva A, Caleffi LS, Morais SS, Juliato CRT, Bahamondes L, Surita FG. One-year follow-up of immediate postpartum contraceptive implant insertion in adolescents. EUR J CONTRACEP REPR 2023; 28:58-64. [PMID: 36287505 DOI: 10.1080/13625187.2022.2133536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Our study aimed to evaluate the acceptability, adverse effects and continuation rates among adolescents who accepted the etonogestrel (ENG) subdermal implant and compared to adolescents who chose other methods during the immediate postpartum period before hospital discharge, with one year follow-up up. MATERIALS AND METHODS We conducted a cohort non-randomised study at the Women's Hospital, University of Campinas. All women up to 19 years of age, who gave birth at the hospital between July 2019 and April 2020, were invited to participate and were offered the ENG-implant or the routine contraceptive methods. They were followed for one year postpartum. RESULTS We included 100 teenagers and 72 accepted the ENG-implant. Students are more likely to accept the ENG-implant than non-students (PR: 1.25 [95%CI 0.99-1.59]). Up to one year of follow-up, survival analysis showed that the time of adherence to the method was longer for the ENG-implant users (p = 0.0049). More than 90% of the adolescents were satisfied with the implant; however, five requested early removal due to menstrual irregularity and local discomfort. CONCLUSION Provision ENG-implant for adolescents in the immediate postpartum demonstrated high acceptance and ensured effective contraception. After one year, most of them were satisfied, with a high continuation rate and without unplanned pregnancies.
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Affiliation(s)
- Mariane M Barbieri
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| | - Amanda Dantas-Silva
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| | - Leticia S Caleffi
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| | - Sirlei S Morais
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| | - Cassia R T Juliato
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
| | - Fernanda G Surita
- Department of Obstetrics and Gynaecology, State University of Campinas, Campinas, Brazil
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Uptake of Immediate Postpartum LARCs and Associated Factors among Mothers Who Gave Birth at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. Int J Reprod Med 2022; 2022:1422094. [PMID: 35844775 PMCID: PMC9282987 DOI: 10.1155/2022/1422094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background Postpartum family planning is an effective strategy for reducing maternal and childhood morbidity and mortality by preventing unintended pregnancy and short interpregnancy intervals. Despite the paramount advantages of long-acting reversible contraceptives (LARC), their uptake remains low in Ethiopia. Therefore, the aim of this study was to assess the uptake of immediate postpartum LARC methods and its associated factors among women who gave birth in Hawassa University Comprehensive Specialized Hospital, Hawassa city, Southern Ethiopia. Methods An institution-based cross-sectional study was conducted among 418 eligible mothers who were in the immediate postpartum period. Data were collected using a pretested structured questionnaire before their discharge from the hospital and analyzed by using SPSS version 20. The statistical significance was declared at P value less than 0.05. Results The uptake LARCs among immediate postpartum mothers was 25.4%. The most commonly reported reasons for not using LARC were preference to start contraception after six weeks of delivery (43.3%) and the need to use other methods of contraception (26%). Having unplanned birth (AOR: 1.97; 95% CI: 1.04-3.71) and receiving family planning counselling on LARCs during the postpartum period (AOR: 21.1; 95% CI: 6.49-68.66) were factors significantly associated with immediate postpartum LARC use. Conclusion Low utilization of immediate postpartum LARC uptake was found in the current study setting. There was increased utilization of immediate postpartum LARC among mothers who received family planning counselling during the postpartum period. Therefore, strengthening family planning counselling during the immediate postpartum period is crucial to enhance postpartum LARC use.
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Boydell N, Cooper M, Cameron ST, Glasier A, Coutts S, McGuire F, Harden J. Perspectives of obstetricians and midwives on the provision of immediate postpartum intrauterine devices: a qualitative service evaluation. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:85-92. [PMID: 34187901 DOI: 10.1136/bmjsrh-2021-201170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Immediate postpartum intrauterine device (PPIUD) insertion is safe and effective but largely unavailable in Europe. Data on maternity staff views on the provision and implementation of PPIUD services are limited. The objective of this qualitative evaluation was to explore the views and experiences of obstetricians and midwives providing PPIUD within a UK maternity setting, in order to identify areas for improvement and inform service provision in other areas. METHODS Qualitative health services research within two public maternity hospitals in Lothian (Edinburgh and surrounding region), UK. Interviews with 30 maternity staff (obstetricians n=8; midwives n=22) involved in PPIUD provision. Data were analysed thematically. RESULTS Maternity staff were positive about the benefits of PPIUD for women. Midwives reported initial concerns about PPIUD safety, and the impact on workload; these views shifted following training, and as PPIUD was embedded into practice. Having a large pool of PPIUD-trained staff was identified as an important factor in successful service implementation. Having PPIUD 'champions' was important to address staff concerns, encourage training uptake, and advocate for the service to ensure continued resourcing. CONCLUSIONS PPIUD in maternity services can help address unmet need for effective contraception in the immediate postpartum period. We emphasise the importance of widespread engagement around PPIUD among all healthcare professionals involved in the care of women, to ensure staff are informed and supported. Clinical champions and leaders play a key role in amplifying the benefits of PPIUD, and advancing organisational learning.
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Affiliation(s)
- Nicola Boydell
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Sharon T Cameron
- Chalmers Centre, NHS Lothian, Edinburgh, UK
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Anna Glasier
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Shiona Coutts
- Department of Obstetrics and Gynecology, NHS Lothian, Edinburgh, UK
| | - Frances McGuire
- Department of Obstetrics and Gynecology, NHS Lothian, Edinburgh, UK
| | - Jeni Harden
- Usher Institute, The University of Edinburgh, Edinburgh, UK
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Bléas C, Llouquet F, Neveu ME, Gaudu S, Fernandez H, Vigoureux S. Study on the use practices and knowledges of French practitioners about the use of intra-uterine devices in early post-partum contraception in France. J Gynecol Obstet Hum Reprod 2022; 51:102240. [PMID: 34610488 DOI: 10.1016/j.jogoh.2021.102240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Intra-Uterine Device (IUD) insertion is possible in early postpartum. Although this contraception method is recognized and used in lots of country, it seems infrequent and poorly known in France. Our study aims to assess the barriers to the application of this method in France. METHODS A questionnaire was sent to obstetricians-gynaecologist professionals and midwives in France, through the affiliation to CNGOF (French National College of Obstetricians and Gynecologists) and to CNSF (French National College of Midwives). Questions were focused on the practices and knowledge about the insertion of IUD in early postpartum. RESULTS four hundred eight practitioners responded. Amongst them, 63% knew about the possibility to use IUDs after a vaginal delivery and 31% knew it could be inserted during cesarean section. Ten percent of them used this method. Most of these practitioners (80% of them) would like to discuss the insertion of an IUD in early postpartum with their patients and 71% would like to perform the insertion themselves after training. Besides, this study shows that contraception is rarely addressed by physicians during the follow-up of pregnancies. Less than 15% of respondents report discussing the topic systematically with the patient during the pregnancy follow during pregnancy follow. CONCLUSION insertion of IUDs in early postpartum is uncommon in France. The main limitation seems to be a lack of knowledge, but practitioners seem to be interested in this practice. Training courses could be created in order to rase up the adoption of this practice.
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Affiliation(s)
- C Bléas
- Faculty of medicine University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe, France.
| | - F Llouquet
- Faculty of medicine Université Paris-Descartes, 12 Rue de l'École de Médecine, 75006 Paris, France
| | - M-E Neveu
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France
| | - S Gaudu
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France
| | - H Fernandez
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, Soins Primaires, Paris-Sud University, Paris-Saclay University, UVSQ, INSERM, Villejuif Cedex, France
| | - S Vigoureux
- CESP-INSERM, U1018, Soins Primaires, Paris-Sud University, Paris-Saclay University, UVSQ, INSERM, Villejuif Cedex, France; Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
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Knutson AJ, Boyd SS, Long JB, Kjerulff KH. Early Resumption of Sexual Intercourse after First Childbirth and Unintended Pregnancy within Six Months. Womens Health Issues 2021; 32:51-56. [PMID: 34602327 DOI: 10.1016/j.whi.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We aimed to evaluate factors associated with early resumption of sexual intercourse after first childbirth and assess whether early intercourse is associated with unprotected intercourse, subsequent pregnancy, and unintended pregnancy over 6 months. METHODS This secondary analysis used data from the First Baby Study, a prospective study of women aged 18-35 years with singleton pregnancies who delivered at 76 hospitals in Pennsylvania. At 1 and 6 months postpartum, women were asked about intercourse and the use of birth control since childbirth. We compared women who resumed intercourse in the first month after childbirth (early resumption) with those who resumed intercourse later, via multivariable logistic regression models. RESULTS In our cohort, 261 of 2,643 women (9.9%) reported first intercourse within the first postpartum month (7-31 days). Women who resumed intercourse early were less educated, younger, and less likely to breastfeed, have had a perineal laceration, or have had an episiotomy than those who resumed intercourse later. In addition, they were more likely to have unprotected intercourse in at least one of the first 6 months after first childbirth (adjusted odds ratio [aOR], 2.33; 95% confidence interval [CI], 1.76-3.09); to be pregnant by 6 months postpartum (aOR, 3.03; 95% CI, 1.48-6.20); and to report that pregnancy as unintended (aOR, 3.32; 95% CI, 1.50-7.36). CONCLUSIONS Nearly 10% of women resumed intercourse in the first month after childbirth. Because early resumption of intercourse was associated with a greater likelihood of unprotected intercourse and unintended pregnancy within 6 months of first childbirth, clinicians should focus efforts on comprehensive family planning and contraception counseling beginning in the prenatal period.
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Affiliation(s)
- Alex J Knutson
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Sarah S Boyd
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jaime B Long
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Kristen H Kjerulff
- Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania.
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Wilson C, Phillips AK, Iobst SE, Myers ER, Trego L, Allard RJ, Landoll R. A Scoping Review of Unintended Pregnancy in Active Duty United States Military Women. Womens Health Issues 2021; 31 Suppl 1:S66-S80. [PMID: 34454705 DOI: 10.1016/j.whi.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/14/2020] [Accepted: 11/12/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The purpose of this scoping review was to apply the Social Ecological Model for Military Women's Health to literature on unintended pregnancy (UIP) to answer the question: In United States active duty military women (population) with the potential for UIP (context), what is known about risk factors, prevention, and pregnancy outcomes (concepts)? METHODS We conducted this review based on a PRISMA-ScR protocol registered a priori in Open Science Framework. Following a literature search of six databases and the grey literature, we used DistillerSR to manage data screening and data charting. The Social Ecological Model for Military Women's Health served as the theoretical framework to chart findings regarding UIP at the individual, microsystem, mesosystem, exosystem, and macrosystem levels. RESULTS A total of 74 research, review, and grey literature articles met the inclusion criteria. Risk factors included specific demographics, military service, and recent deployment. Prevention included contraceptive practices, access, and education that should take place early in servicewomen's careers and before deployment. Outcomes included early return from deployment, personal career challenges, and seeking alternative health services outside the military health system. CONCLUSIONS Research and policy initiatives should focus on decreasing risk factors in the military working environment, with particular attention to the deployed environment. These initiatives should include input from military leaders, health care providers, servicewomen, and servicemen with the goal of decreasing the incidence of unintended pregnancies. Pregnancy intentionality among military women should be considered as a concept to shape intervention research to reduce unintended pregnancies.
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Affiliation(s)
- Candy Wilson
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland.
| | | | | | - Evan R Myers
- Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Lori Trego
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado
| | - Rhonda J Allard
- Uniformed Services University of the Health Sciences, James A. Zimble Learning Resource Center, Bethesda, Maryland
| | - Ryan Landoll
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland
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Barbieri MM, Juliato CRT, Surita FG. Provision and Guidance for Postpartum Contraception - Ensuring Reproductive Rights during Times of Crises. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:247-249. [PMID: 33979885 PMCID: PMC10183938 DOI: 10.1055/s-0041-1729985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Changes in Rates of Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the USA, 2012-2016. Matern Child Health J 2021; 25:1562-1573. [PMID: 33970416 DOI: 10.1007/s10995-021-03152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine recent rates of long-acting and permanent methods (LAPM) of contraception use during delivery hospitalization and correlates of their use. METHODS A retrospective cohort study utilizing the 2012-2016 National Inpatient Sample of hospitalizations in the United States of America. The International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes were used to identify deliveries, inpatient long-acting reversible contraception (IPP LARC), and postpartum tubal ligation (PPTL). We conducted univariable and multivariable logistic regression to examine associations between demographic, clinical, hospital and geographical characteristics with likelihood of LAPM including IPP LARC and PPTL. RESULTS Our sample included 3,642,328 unweighted deliveries. The rate of IPP LARC increased from 34.6 to 54.9 per 10,000 deliveries (58.7%), while the rate of PPTL utilization decreased from 719.5 to 671.8 per 10,000 deliveries (6.6%) over the study period. In multivariable analysis of LAPM utilization versus neither, cesarean delivery (aOR 7.25, 95% CI 7.08-7.43) was associated with greater utilization. Native American (aOR 4.01, 95% CI 2.91-5.53) race was associated with increased use of IPP LARC compared to a non-long-acting method of contraception. Age between 18 and 29 years (aOR 6.21, 95% CI 5.42-7.11) was associated with greater use of IPP LARC versus PPTL. Delivering in a rural hospital ((aOR 0.09, 95% CI 0.06-0.12) and cesarean delivery (aOR 0.09, 95% CI 0.06-0.12) were associated with greater use PPTL versus IPP LARC. CONCLUSIONS The IPP LARC rate remains at less than 10% the PPTL rates in our study timeframe. The demonstrated variation in uptake of highly effective methods of contraception inpatient after delivery offer possible opportunities for better understanding and improvement in access.
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Barbieri MM, Herculano TB, Dantas Silva A, Bahamondes L, Juliato CRT, Surita FG. Acceptability of ENG-releasing subdermal implants among postpartum Brazilian young women during the COVID-19 pandemic. Int J Gynaecol Obstet 2021; 154:106-112. [PMID: 33656758 PMCID: PMC9087758 DOI: 10.1002/ijgo.13663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate etonogestrel (ENG)-implant acceptance during the immediate postnatal period among adolescents and young women during the COVID-19 pandemic, and to compare variables according to choice and discuss possible implications of this measure during the pandemic period. METHODS A cross-sectional study was designed. All women aged up to 24 years, who delivered between April 25, 2020, and June 24, 2020, at Women's Hospital, University of Campinas, São Paulo, Brazil were considered. The ENG-implant or other contraceptive methods were offered prior to hospital discharge. The participants were split into two groups: (1) those who chose the ENG-implant and (2) those that refused the implant. Descriptive, bivariate, and multivariate analyses were performed. RESULTS 151 women were included, with 76.2% selecting the ENG-implant. The average age was 19.5 years; 73.2% of pregnancies were unplanned, 32.5% already had a previous pregnancy, 74% were single, and 75.5% were not in full time education. Further, 70.5% had previously used contraceptives, with 89.1% unsatisfied with their previous method that opted for the ENG-implant (P = 0.07). CONCLUSION Offering the ENG-implant to youths during the immediate postnatal period is evidence-based care, and contraceptive provision is an essential health promotion tool, even during a pandemic. Thinking quickly about public policies in times of crisis is important to guarantee sexual and reproductive rights.
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Affiliation(s)
- Mariane Massaini Barbieri
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Thuany Bento Herculano
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Amanda Dantas Silva
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Cassia Raquel Teatin Juliato
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Fernanda Garanhani Surita
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Campinas, SP, Brazil
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Thomas JL, Lewis JB, Ickovics JR, Cunningham SD. Associations between Adverse Childhood Experiences and Sexual Risk among Postpartum Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3848. [PMID: 33917634 PMCID: PMC8038841 DOI: 10.3390/ijerph18073848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/16/2022]
Abstract
Epidemiological evidence suggests that exposure to adverse childhood experiences (ACEs) is associated with sexual risk, especially during adolescence, and with maternal and child health outcomes for women of reproductive age. However, no work has examined how ACE exposure relates to sexual risk for women during the postpartum period. In a convenience sample of 460 postpartum women, we used linear and logistic regression to investigate associations between ACE exposure (measured using the Adverse Childhood Experiences Scale) and five sexual risk outcomes of importance to maternal health: contraceptive use, efficacy of contraceptive method elected, condom use, rapid repeat pregnancy, and incidence of sexually transmitted infections (STIs). On average, women in the sample were 25.55 years of age (standard deviation = 5.56); most identified as Black (60.4%), White (18%), or Latina (14.8%). Approximately 40% were exposed to adversity prior to age 18, with the modal number of experiences among those exposed as 1. Women exposed to ACEs were significantly less likely to use contraception; more likely to elect less-efficacious contraceptive methods; and used condoms less frequently (p = 0.041 to 0.008). ACE exposure was not associated with rapid repeat pregnancy or STI acquisition, p > 0.10. Screening for ACEs during pregnancy may be informative to target interventions to reduce risky sexual behavior during the postpartum period.
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Affiliation(s)
- Jordan L. Thomas
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Jessica B. Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Jeannette R. Ickovics
- Yale-NUS College, Singapore 138527, Singapore;
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA
| | - Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06032, USA
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Retrospective Analysis of the Effectiveness and Reversibility of Long-Acting Contraception Etonogestrel (Implanon ®) inCommon Marmosets ( Callithrix jacchus). Animals (Basel) 2021; 11:ani11040963. [PMID: 33808451 PMCID: PMC8066542 DOI: 10.3390/ani11040963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Due to the breeding success of common marmosets in captivity, colony managers need to achieve a balance between maintaining sustainable population numbers while preventing the breeding of surplus animals. Population control can be achieved by various methods, reversible and nonreversible. Long-acting reversible contraceptives are preferred, as they are not permanent and eliminate the logistical problems associated with the daily or weekly administration of oral or injectable contraceptives. Implanon® (etonogestrel) is a widely used progestin-based contraceptive in marmosets with the theoretical advantages of being reversible and long-acting. However, no dose and efficacy data are available yet. In this study, we examined, by using electronic health records, the relationship between the use of one-fourth or one-third of an etonogestrel implant in female marmosets and the number of parturitions, interbirth interval, litter size, body weight, stillbirths and unintended pregnancies. We have concluded that etonogestrel implants are efficacious and safe to use in marmosets. Our data result in recommendations about the use of etonogestrel implants in marmosets. Our data can probably be extrapolated to other callitrichids. Abstract Contraception is an important population control method for the colony management of primates housed in captivity. Etonogestrel (ENG) implants (i.e., Implanon®) are a widely used progestin-based contraceptive in common marmosets (Callithrix jacchus) with the theoretical advantages of being reversible and long-acting. However, no dose and efficacy data are available yet. Therefore, data from 52 adult female marmosets contracepted with ENG (one-fourth or one-third of an implant) housed at the Biomedical Primate Research Centre (BPRC, Rijswijk, The Netherlands) over the past 18 years were analyzed. Using an electronic database, a retrospective longitudinal cohort study was conducted to calculate the reproductive data before, during and after ENG use. The data show an effectiveness in preventing pregnancy of 99%. The implant was effective within one week after insertion. Unintended pregnancies did occur, but in 60% of these cases, the animals were already pregnant at the time of implant insertion. In these cases, healthy offspring were born despite the use of the implant. No stillbirths, neonatal deaths or maternal deaths could be linked to ENG use. After implant removal, 83% of the animals delivered healthy offspring. No difference in contraception efficacy was observed between the use of one-fourth or one-third of an implant. ENG achieved a contraceptive protection exceeding 99% and was shown to be reversible concerning fertility. To our knowledge, this is the first detailed analysis on the use of ENG in marmosets.
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Muyama DL, Musaba MW, Opito R, Soita DJ, Wandabwa JN, Amongin D. Determinants of Postpartum Contraception Use Among Teenage Mothers in Eastern Uganda: A Cross-Sectional Study. Open Access J Contracept 2020; 11:187-195. [PMID: 33335432 PMCID: PMC7737944 DOI: 10.2147/oajc.s281504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction In Uganda, the proportion of women having another live birth before age 20 years (repeat adolescent birth) has not declined in 30 years. More women want to delay the next birth. We determined the prevalence and factors associated with postpartum contraceptive use among teenage mothers in Mbale City. Patients and Methods We conducted a cross-sectional study in all the six government-supported health facilities within Mbale City. Over a period of 3 months, 511 teenage mothers in the postpartum period were consecutively enrolled by midwives/nurses. Data were collected using a pretested interviewer-administered questionnaire. We used logistic regression in STATA version 14, to determine the association between various sociodemographic characteristics and utilization of contraception. We set the level of significance at 5% and report odds ratios and the corresponding 95% confidence intervals. Results Most of the respondents - 314/511 [61.5%, 95% CI= 57.1-65.6%] - were using contraceptives. More than three-fourth (238/314) of the respondents opted for short-term methods of contraception. In the adjusted analyses, intention to resume school [AOR 1.79 (1.16-2.74)], and utilization of maternal Child Heath services such as postnatal care services [AOR 0.40 (0.25-0.63)] were significantly associated with utilisation of postpartum contraception. Conclusion We found a high prevalence of postpartum contraceptives use - over 6 in 10 women - although they were using mainly short-term methods. Those with intentions of resuming schooling and utilised postnatal care services were most likely to use contraceptives. This is encouraging and calls for inquiry into why their use is higher than the national averages. Further, the results call for renewed efforts to maintain adolescent mothers in school.
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Affiliation(s)
- Doreen L Muyama
- Department of Public and Community Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ronald Opito
- Department of Programs, Population Services International, Kampala, Uganda
| | - David J Soita
- Department of Public and Community Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Julius N Wandabwa
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Dinah Amongin
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
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Adeniyi OV, Ajayi AI, Somefun OD, Lambert JS. Provision of immediate postpartum contraception to women living with HIV in the Eastern Cape, South Africa; a cross-sectional analysis. Reprod Health 2020; 17:194. [PMID: 33298097 PMCID: PMC7724693 DOI: 10.1186/s12978-020-01049-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Universal access to contraception is an important strategy adopted by the South African government to reduce the high rate of unintended pregnancies, especially in women living with HIV. In this article, we describe the choices of contraception and also, examine the influencing factors of the choices of contraception in the immediate postpartum period in parturient women with HIV in the Eastern Cape, South Africa. METHODS In this prospective cross-sectional study, 1617 parturient women with HIV completed a survey on the choice of contraception received in the immediate postpartum period (within 72 h) across three large maternity services in the Eastern Cape between September 2015 to May 2016. Additional information was extracted from their medical records. Choices of contraception were categorised as; short-acting (injectables), long-acting reversible (intrauterine device and implants) and permanent contraception (tubal ligation). Adjusted and unadjusted logistic regression models were employed to determine the influencing factors of the choices of contraception received by the cohort. RESULTS Participants were predominantly single (69.1%), unemployed (75.1%), had a grade 7-12 level of education (88.4%) and were HIV positive before their index pregnancy (81.3%). The prevalence of immediate postpartum contraception was high (n = 1507; 93.2%) with Injectables being the preferred choice in the majority of the participants (n = 1218; 75.3%). After controlling for all relevant covariates, single marital status was associated with a higher likelihood of immediate postpartum contraceptive initiation (AOR; 1.82 95% CI 1.10-3.03). Overall, women were more likely to initiate a long-acting reversible and irreversible methods when older than 35 years and having had more than two children. CONCLUSIONS We found a high prevalence of immediate postpartum contraception with a preference for Injectables in the study setting. Long-term monitoring of this cohort will elucidate on contraceptive discontinuation and risk of unintended pregnancies in the region. Ensuring universal access to contraceptives is an important strategy to reduce the rate of unintended pregnancies at the population level. This strategy was adopted by the South African government with a vision of stemming the tide of unintended pregnancies among women living with HIV. In this study, the choices of contraception adopted by women living with HIV following the delivery of their babies were explored. In addition, the study highlights the factors that predict these choices. Participants were asked the choice of contraception they had received prior to being discharged from the maternity centres where they had delivered their babies. The various types of contraception were then categorised by their duration of action. Three distinct groups emerged; short-acting injectables, long acting reversible contraceptives and permanent methods. Of the 1617 women included in the study, 1117 were single and 1314 knew their HIV status prior to the onset of the index pregnancy. Almost all the women (1507 out of 1617) received one form of contraception before leaving the hospital. Many women (1218 out of 1617) chose injectable contraception (short-acting contraception) over the other types of contraception. Women who were older than 34 years and who had three or more children were more likely to choose a long-acting reversible contraceptive and permanent method over the short-acting contraception or nothing. In conclusion, given the short duration of action of the predominant method adopted by these women, a long-term follow up of the study participants will provide more information on the continued use of contraception and risk for unintended pregnancies.
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Affiliation(s)
- Oladele Vincent Adeniyi
- Department of Family Medicine & Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha/East London Hospital Complex, Cecilia Makiwane Hospital, East London, South Africa.
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi, Kenya
| | - Oluwaseyi Dolapo Somefun
- Demography and Population Studies (DPS), University of the Witwatersrand, Johannesburg, South Africa
| | - John Shearer Lambert
- Department of Infectious Diseases, Medicine and Sexual Health. Mater, Rotunda and University College, Dublin, Ireland
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Association of Immediate Postpartum Etonogestrel Implant Insertion and Venous Thromboembolism. Obstet Gynecol 2020; 135:1275-1280. [PMID: 32459418 DOI: 10.1097/aog.0000000000003760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the rate of readmissions for postpartum venous thromboembolism (VTE) during the first 30 days postdelivery between women with and without the immediate postpartum insertion of the etonogestrel contraceptive implant. METHODS The Nationwide Readmissions Database from 2016 was used to identify women with a singleton delivery, immediate postpartum insertion of the etonogestrel contraceptive implant, and readmission for VTE within 30 days of discharge. Those with a prior history of VTE or anticoagulant therapy were excluded. These women were compared with the number of women readmitted within 30 days for VTE who did not have the contraceptive implant placed during delivery admission. RESULTS Of 3,387,120 deliveries, 8,369 women underwent etonogestrel contraceptive implant placement during the delivery admission. There was no difference identified in the rate of readmission for VTE between exposed and unexposed women. Of these, seven had received a postpartum etonogestrel contraceptive implant (0.85/1,000; 95% CI 0.22-1.45/1,000 deliveries), compared with 1,192 without an etonogestrel contraceptive implant (0.35/1,000; 95% CI 0.33-0.37/1,000 deliveries); odds ratio (OR) 2.41; 95% CI 0.58-9.89. The rates of diabetes, thrombophilia, systemic lupus erythematosus, and cesarean birth did not differ between groups. Women who underwent etonogestrel contraceptive implant placement were younger and were more likely to have government-sponsored health insurance, a smoking history, hypertension, peripartum infection, or postpartum hemorrhage than women who did not receive an etonogestrel contraceptive implant (P<.001). After adjusting for these confounders, there remained no difference in rates of VTE, adjusted OR 1.81; 95% CI 0.44-7.45. CONCLUSION The immediate postpartum placement of the etonogestrel contraceptive implant was not associated with an increased rate of VTE; however, our sample size was underpowered to determine no difference.
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Stafford JD, Goggins ER, Lathrop E, Haddad LB. Health Literacy and Associated Outcomes in the Postpartum Period at Grady Memorial Hospital. Matern Child Health J 2020; 25:599-605. [PMID: 33196925 DOI: 10.1007/s10995-020-03030-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Many studies correlate lower health literacy with poorer health outcomes and inferior provider-patient communication. Little is known about how impaired health literacy among women receiving prenatal care at inner city public hospitals may impact reproductive health behaviors and outcomes. The objective of this study was to assess health literacy among postpartum women receiving care at a public tertiary care center and to explore the association of impaired health literacy with prenatal care attendance and postpartum outcomes. METHODS Written consent was obtained before completing the 7-item REALM-SF study tool to assess health literacy. A score of zero to three indicated low health literacy, four to six moderately low health literacy, and seven adequate health literacy. Patients completed a 25-item demographic questionnaire, and medical outcomes were obtained via this questionnaire and chart review. Descriptive statistics were generated, and bivariate and multivariate analyses evaluated the association between REALM-SF score and study outcomes. RESULTS We recruited 300 adult English-speaking postpartum women and 293 were included in the final analysis. The majority of participants (53.9%) experienced impaired health literacy (score zero to six). Most respondents completed high school or higher education (77.1%), 17.8% had no prenatal care, and 83.6% reported that this pregnancy was unplanned. After adjusting for age, race, and education, women in the lowest health literacy group were less likely to indicate a plan to exclusively breastfeed (aRR = 0.54, p = 0.03). CONCLUSIONS FOR PRACTICE Impaired health literacy affects a majority of our patients and is associated with reproductive health outcomes, including exclusive breastfeeding. Health care providers should attempt to overcome differences in health literacy through strong breastfeeding promotion. Verbal and written patient education materials should be tailored to the needs of patients with impaired health literacy.
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Affiliation(s)
- Jade D Stafford
- Department of Obstetrics and Gynecology, Emory University School of Medicine, 550 Peachtree St NE, MOT 8th Floor, Atlanta, GA, 30308, USA.
| | - Emily R Goggins
- Department of Obstetrics and Gynecology, Emory University School of Medicine, 550 Peachtree St NE, MOT 8th Floor, Atlanta, GA, 30308, USA
| | - Eva Lathrop
- Department of Obstetrics and Gynecology, Emory University School of Medicine, 550 Peachtree St NE, MOT 8th Floor, Atlanta, GA, 30308, USA
| | - Lisa B Haddad
- Department of Obstetrics and Gynecology, Emory University School of Medicine, 550 Peachtree St NE, MOT 8th Floor, Atlanta, GA, 30308, USA
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Kanakuze CA, Kaye DK, Musabirema P, Nkubito P, Mbalinda SN. Factors associated with the uptake of immediate postpartum intrauterine contraceptive devices (PPIUCD) in Rwanda: a mixed methods study. BMC Pregnancy Childbirth 2020; 20:650. [PMID: 33109097 PMCID: PMC7590736 DOI: 10.1186/s12884-020-03337-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/14/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Rwanda has a high unmet need for family planning which could be reduced by improving access to postpartum intrauterine contraceptives device (PPIUCD) insertion. The objective of the study was to assess the prevalence and factors associated with the uptake of PPIUCD among postpartum women in Muhima Hospital. METHODS A concurrent mixed-method study was used. Three hundred eight three (383) immediate postpartum mothers, and 10 health services providers were interviewed using a structured questionnaire and in-depth interviews respectively. Logistics regression was done to assess for factors associated with PPIUCD uptake and thematic analysis was used for qualitative data. RESULTS The prevalence for PPIUCD use was 28.1%, women who had spontaneous vaginal delivery were more likely to take up PPIUCD (Adjusted Odds Ratio (AOR) 2.623, 95% CI = 2.017-6.507 compared to those who had cesarean section; women who received PPIUCD counselling during the antenatal period were more likely to use PPIUCD ((AOR 2.072, 95% CI = 1.018-4.218) as compared to those who didn't receive any form of counselling; mothers who received spouse approval were more likely to use PPIUCD (AOR 2.591,95% CI = 1.485-4.492); as compared to those who didn't receive any spousal approval; women who had more than one child were more likely to use PPIUCD (AOR =2.265, 95% CI = 1.472-3.163) as compared to prime gravida; Mothers with birth to pregnancy interval less than two years were more likely to use PPIUCD (AOR =2.123, CI =1.477-2.706) as compared to those who had birth to pregnancy interval more than 2 years. From the qualitative findings, health education of mothers and partners on PPIUCD, training of health care providers, and availability of supplies to provide PPIUCD influenced the use of PPIUCD. CONCLUSION The acceptability to use for PPIUCD was high in this population. PPIUCD uptake was associated with normal birth, PPIUCD counselling, spousal approval, parity, birth interval, level of education. Health education of mothers and partners on PPIUCD, training of health providers, and availability of supplies to provide PPIUCD influenced uptake of PPIUCD.
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Grants
- D43 TW010132 FIC NIH HHS
- R25 TW011213 FIC NIH HHS
- D43TW010132 by Office of the Director, National Institutes of Health (OD), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Neurological Disorders And Stroke (NINDS), National Heart, Lung, And Blood Institute (NHLBI), Fogarty Interna
- 1R25TW011213. Fogarty International Center of the National Institutes of Health.
- by Office of the Director, National Institutes of Health (OD), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Neurological Disorders And Stroke (NINDS), National Heart, Lung, And Blood Institute (NHLBI), Fogarty Interna
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Affiliation(s)
- Chris Adrien Kanakuze
- Faculty of Health Sciences, Kibogora Polytechnic, P.O. Box: 31, Rusizi, Rwanda
- Department of Nursing, Makerere University, College of Health Sciences, School of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Dan Kabonge Kaye
- Department of Obstetrics and Gynecology, Makerere University, College of Health Sciences, School of Medicine, Kampala, Uganda
| | - Priscilla Musabirema
- Midwifery department, Faculty of Nursing Science, University of Rwanda, Kigali, Rwanda
| | - Pascal Nkubito
- Department of Obstetrics and Gynecology, Muhima Hospital, Kigali, Rwanda
| | - Scovia Nalugo Mbalinda
- Department of Nursing, Makerere University, College of Health Sciences, School of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Boydell N, Cooper M, Cameron ST, Glasier A, Coutts S, McGuire F, Harden J. Women’s experiences of accessing postpartum intrauterine contraception in a public maternity setting: a qualitative service evaluation. EUR J CONTRACEP REPR 2020; 25:465-473. [DOI: 10.1080/13625187.2020.1815006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Michelle Cooper
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
- Obstetrics and Gynaecology, NHS Lothian, Edinburgh, UK
| | - Sharon T. Cameron
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
- Obstetrics and Gynaecology, NHS Lothian, Edinburgh, UK
| | - Anna Glasier
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Shiona Coutts
- Obstetrics and Gynaecology, NHS Lothian, Edinburgh, UK
| | | | - Jeni Harden
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Associations between immediate postpartum long-acting reversible contraception and short interpregnancy intervals. Contraception 2020; 102:409-413. [PMID: 32918870 DOI: 10.1016/j.contraception.2020.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We aimed to evaluate the rates of short interpregnancy interval pregnancies and deliveries among women who receive immediate postpartum LARC. STUDY DESIGN We conducted a retrospective cohort study of all women who delivered at Montefiore Medical Center between January 2015 and June 2016 (N = 9561). In this cohort, we identified all repeat deliveries and pregnancies within 18 months of the initial delivery. Using logistic regression models, we compared rates of short interpregnancy interval delivery and pregnancy among recipients of an immediate postpartum IUD, immediate postpartum implant, and no immediate postpartum LARC, adjusting for covariates including patient age, mode of delivery, socioeconomic status, and race. RESULTS In our cohort, 12.9% of patients received immediate postpartum LARC. The rates of short interpregnancy interval delivery were 3.3% (N = 259/7833) among patients who did not receive immediate postpartum LARC, 1% (N = 6/595) among immediate postpartum IUD recipients, and 0.4% (N = 2/562) among immediate postpartum implant recipients. The rates of short interpregnancy interval pregnancy were 13.8% (N = 1082/7833) among patients who did not receive immediate postpartum LARC, 7.4% (N = 44/595) among immediate postpartum IUD recipients, and 5.2% (N = 29/562) among immediate postpartum implant recipients. Both recipients of immediate postpartum IUDs and immediate postpartum implants had lower rates of short interpregnancy interval delivery and pregnancy compared to patients who did not receive immediate postpartum LARC. CONCLUSIONS This study confirms that women who received immediate postpartum IUDs and implants have lower rates of short interpregnancy interval pregnancies. IMPLICATIONS Making immediate postpartum LARC widely available is a promising public health approach to help women achieve a longer interpregnancy interval.
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Harrison MS, Bunge-Montes S, Rivera C, Jimenez-Zambrano A, Heinrichs G, Bolanos A, Asturias E, Berman S, Sheeder J. Primary and secondary three-month outcomes of a cluster-randomized trial of home-based postpartum contraceptive delivery in southwest Trifinio, Guatemala. Reprod Health 2020; 17:127. [PMID: 32819394 PMCID: PMC7439552 DOI: 10.1186/s12978-020-00974-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/05/2020] [Indexed: 11/20/2022] Open
Abstract
DESIGN This a cluster-randomized parallel arm pragmatic trial to observe the association of home-based postpartum contraceptive provision, including the contraceptive implant, with implant utilization rates at 3 months post-enrollment. METHODS In a region of rural Guatemala referred to as the Southwest Trifinio, twelve communities are served by a community-based antenatal and postnatal care program. The communities were combined into eight clusters based on 2017 birth rates and randomized to receive the home-based contraceptive delivery (condoms, pills, injection, implant) during the routine 40-day postpartum visit. All participants receive comprehensive contraceptive counseling beginning at the first antenatal visit, so control clusters received this as part of routine care; this education preceded the study intervention. RESULTS Once the 12 communities were combined into 8 clusters by expected birth volume and nurse team, which we expected to translate to eventual postpartum visits, the allocation sequence was generated in SAS. Of 208 women enrolled in the study, 108 were in four intervention and 100 in four control clusters. We used descriptive statistics to produce counts and percentages of characteristics of the study population overall and by intervention arm followed by univariate modeling using a mixed effects regression adjusted for cluster. Three-month contraceptive initiation rates were 56.0% in the control clusters compared to 76.8% in the intervention clusters, p < 0.001. Women in control clusters overwhelmingly opted for the injectable contraceptive (94.6%) while women in intervention clusters chose both the injection (61.5%) and the implant (33.7%), p < 0.001. Implant use by 3 months, the primary outcome of the study, was significantly higher in the intervention arm (25.9%) compared to the control arm (3.6%), p < 0.001, RR 1.3 CI [1.2, 1.4]. CONCLUSION Our study was designed to respond to previously identified barriers to contraceptive uptake, and it was successful. Not only did it increase overall use of contraception by 3 months, but it shifted that contraceptive use away from short-acting methods in favor of longer-acting methods, with high continuation and satisfaction rates and no adverse outcomes reported. TRIAL REGISTRATION clinicaltrials.gov , NCT04005391 ; Retrospectively Registered 7/2/2019.
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Affiliation(s)
- Margo S. Harrison
- University of Colorado, Anschutz Medical Campus, Mail Stop B198-2, Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Aurora, CO 80045 USA
| | - Saskia Bunge-Montes
- Fundación para la Salud Integral de los Guatemaltecos (FSIG), Quetzaltenango, Guatemala
| | - Claudia Rivera
- Fundación para la Salud Integral de los Guatemaltecos (FSIG), Quetzaltenango, Guatemala
| | - Andrea Jimenez-Zambrano
- University of Colorado, Anschutz Medical Campus, Mail Stop B198-2, Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Aurora, CO 80045 USA
| | | | - Antonio Bolanos
- Fundación para la Salud Integral de los Guatemaltecos (FSIG), Quetzaltenango, Guatemala
| | - Edwin Asturias
- University of Colorado, Anschutz Medical Campus, Mail Stop B198-2, Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Aurora, CO 80045 USA
| | - Stephen Berman
- University of Colorado, Anschutz Medical Campus, Mail Stop B198-2, Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Aurora, CO 80045 USA
| | - Jeanelle Sheeder
- University of Colorado, Anschutz Medical Campus, Mail Stop B198-2, Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Aurora, CO 80045 USA
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Harrison MS, Zucker R, Scarbro S, Sevick C, Sheeder J, Davidson AJ. Postpartum Contraceptive Use Among Denver-Based Adolescents and Young Adults: Association with Subsequent Repeat Delivery. J Pediatr Adolesc Gynecol 2020; 33:393-397.e1. [PMID: 32251837 PMCID: PMC7650863 DOI: 10.1016/j.jpag.2020.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To determine the association of postpartum contraceptive use with repeat deliveries among adolescents and youth. DESIGN Retrospective, observational analysis of electronic health record data. SETTING Single, urban facility in Denver, Colorado, United States. PARTICIPANTS Women aged 10-24 years who gave birth between January 1, 2011 and December 31, 2015. INTERVENTIONS AND MAIN OUTCOME MEASURES Postpartum contraceptive use and time to subsequent delivery. RESULTS Among 4068 women, 1735 (43%) used postpartum contraception. In adjusted analyses, characteristics associated with contraceptive use included Hispanic ethnicity (relative risk [RR], 1.1; P = .03), incremental prenatal visits (RR, 1.01; P = .047), and attendance at postpartum care (RR, 1.60; P < .001). Long-acting reversible contraceptive (LARC) use was higher among women younger than 15 years (reference: 20-24 years; RR, 1.12; P < .001) and lower among women aged 18-19 years (RR, 0.93; P = .009). Hispanic women had higher rates of LARC use than non-Hispanic women (RR, 1.07; P = .02). Compared with inpatient LARC placement, outpatient placement (1-4 weeks and 5 or more weeks) rates were lower (RR, 0.77 and RR, 0.89, respectively; P < .001). Time to subsequent delivery was shorter in non-LARC users (median, 659 days) and contraception nonusers (median, 624 days) compared with LARC users (median, 790 days; P < .001); non-LARC postpartum contraceptive use did not significantly alter time to repeat delivery compared with that in women who used no method (P = .24). CONCLUSION Postpartum LARC use reduced the risk of repeat pregnancy with a significant increase in time to the next delivery. Non-LARC use was not different from no contraceptive use in terms of time to repeat delivery.
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Affiliation(s)
- Margo S Harrison
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Aurora, Colorado.
| | - Rachel Zucker
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado
| | - Sharon Scarbro
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado
| | - Carter Sevick
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeanelle Sheeder
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Aurora, Colorado
| | - Arthur J Davidson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; Denver Public Health, Denver Health, Denver, Colorado
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The effect of an educational video on long-acting reversible contraception (LARC) utilization at 6-8 weeks postpartum period: a randomized controlled trial. Arch Gynecol Obstet 2020; 302:1503-1509. [PMID: 32734413 DOI: 10.1007/s00404-020-05710-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/25/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Long-acting reversible contraception is highly effective in preventing unintended pregnancy and unsafe abortion. An educational video administered during early postpartum period might be an effective tool to improve postpartum LARC use. The objectives were to evaluate whether a postpartum educational video about LARC could increase postpartum LARC utilization at 6-8 weeks postpartum and to assess why postpartum women did not receive LARC. METHODS This randomized-controlled trial was conducted at the postpartum unit of a university Hospital between August 2016 and February 2017. Postpartum women who were aged > 20 years and willing to participate were recruited. Participants allocated to the study group watched the 7-min educational video on LARC methods while the control group did not. To assess LARC utilization, data were collected at 6-8 weeks postpartum using telephone calls and/or medical record review to determine postpartum contraception use and reasons for not using LARC. RESULTS Two-hundred and seventy participants were enrolled, and the video (135) and non-video (135) groups had similar baseline characteristics. In the video group, 57.8% (95% CI 49.0-66.2) reported using a LARC method, compared to 25.9% (95% CI 18.8-34.2) in the non-video group (p < 0.05). The reasons for not using LARC in both groups were inconvenience of access (42.0-43.8%) and uncertainty about methods (17.0-24.6%). CONCLUSION The educational video introduced at immediate postpartum period was efficacious in increasing the utilization of LARC at 6-8 weeks postpartum. Inconvenience of access was the most common reason cited for not using LARC. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.in.th TCTR20171225001 "retrospectively registered".
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Bhide S, Ascha M, Wilkinson B, Verbus E, Montague M, Morris J, Arora KS. Variation in effectiveness of planned postpartum contraception at two time points from prenatal to postpartum care. Contraception 2020; 102:246-250. [PMID: 32540241 DOI: 10.1016/j.contraception.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify characteristics of women who have consistent plans in terms of contraceptive effectiveness from antepartum to postpartum care. STUDY DESIGN This is a secondary analysis of a retrospective chart review of women who delivered at a single tertiary care center from 2012 to 2014. Preferred postpartum contraceptive plan was abstracted at three time points (prenatal care, hospital discharge, and outpatient postpartum care) and categorized into three tiers of effectiveness. We then examined consistency between the first two time points for the effectiveness in postpartum contraceptive method planned. RESULTS Of the 8,394 women in the study cohort, 2,642 (31.5%) had a consistent postpartum contraceptive plan. Women who had a consistent plan were more likely to have higher parity (aOR 2.36, 95% CI 2.06-2.70 for parity 2+), choose highly effective methods of contraception (p < 0.001), achieve their contraception plan (adjusted odds ratio [aOR] 2.16, 95% confidence interval [95% CI] 1.85-2.52), but not more likely to have a subsequent pregnancy within 365 days of delivery (aOR 0.92, 95% CI 0.81-1.05). CONCLUSION Better understanding contraceptive decision-making as a journey and removing external barriers during that process is a necessary component of pregnancy care. IMPLICATIONS Counseling and documentation of contraceptive preferences throughout antepartum and postpartum care can help improve contraceptive outcomes.
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Affiliation(s)
- Sayuli Bhide
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Mustafa Ascha
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States
| | - Barbara Wilkinson
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Emily Verbus
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Mary Montague
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Jane Morris
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States.
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Uhm S, Garcia-Ruiz N, Creinin MD, Blanton A, Chen MJ. Progestin-only pill use over 6 months postpartum. Contraception 2020; 102:251-253. [PMID: 32544400 DOI: 10.1016/j.contraception.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine progestin-only pill (POP) use at 3 and 6 months postpartum among women who chose POPs at the postpartum visit. STUDY DESIGN Secondary data analysis of a prospective observational study with telephone interviews at 3 and 6 months postpartum to assess contraceptive use. RESULTS Of 440 women who attended the postpartum visit, 92 (20.9%) chose POPs. Current POP use was 44/84 (52.4%) at 3 months, 33/76 (43.4%) at 6 months, and 32/76 (42.1%) at both 3- and 6-month follow-up assessments. CONCLUSION About half of women who plan POP use at the postpartum visit are not using this method at 3 months after delivery. IMPLICATIONS About half of women with a prescription for progestin-only pills will be not using this method at 3 months postpartum; further understanding of continued sexual activity and breastfeeding may clarify pregnancy risk for those not reporting modern contraception use during the postpartum period.
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Affiliation(s)
- Suji Uhm
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States.
| | - Nuria Garcia-Ruiz
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States
| | - Aubrey Blanton
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States
| | - Melissa J Chen
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States
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Goulding AN, Bauer AE, Muddana A, Bryant AG, Stuebe AM. Provider Counseling and Women's Family Planning Decisions in the Postpartum Period. J Womens Health (Larchmt) 2020; 29:847-853. [PMID: 32176571 PMCID: PMC8104026 DOI: 10.1089/jwh.2019.7872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Provider counseling may influence women's postpartum family planning decisions. Materials and Methods: We conducted an anonymous Internet-based cross-sectional survey of postpartum women regarding multiple topics, including prenatal/postpartum care and family planning. We used multivariable logistic regression to determine associations between quantity of provider counseling (indexed as number of family planning topics discussed with a health care provider) and women's decisions regarding contraception and pregnancy spacing. Results: From January to May 2016, 2,850 women completed the survey and met inclusion criteria. Among this group, the majority were white (93%), ≥30 years (63%), and had obtained a college degree or higher (74%). Approximately half (49%) desired an interpregnancy interval (IPI) >2 years, and the minority (21%) used a highly effective contraceptive method (defined as long-acting reversible contraception or sterilization). The majority of women (56%) had received counseling on three to six family planning topics (defined as "more counseling" in regression models). Women who received more counseling were more likely to use a highly effective contraceptive method (adjusted odds ratio [AOR] 1.33, confidence interval [95% CI] 1.09-1.62) but were not more likely to desire an IPI >2 years (AOR 0.96, 95% CI 0.81-1.14). Desired IPI modified the association between provider counseling and contraception (p = 0.06 for interaction): Among those desiring an IPI >2 years, more counseling was associated with use of a highly effective contraceptive method (AOR 1.58, 95% CI 1.23-2.03), but this was not observed among those desiring a shorter IPI (AOR 1.05, 95% CI 0.73-1.49). Conclusions: Contraceptive decisions depend on both provider counseling and patient goals.
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Affiliation(s)
- Alison N. Goulding
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Anna E. Bauer
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anitha Muddana
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Department of Lactation, North Carolina Women's Hospital, Chapel Hill, North Carolina
| | - Amy G. Bryant
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Alison M. Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Psychosocial Factors Associated With Postpartum Contraceptive Method Use After an Unintended Birth. Obstet Gynecol 2020; 135:821-831. [PMID: 32168207 DOI: 10.1097/aog.0000000000003745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether depression, intimate partner violence, and other psychosocial stressors were independently associated with effectiveness level of postpartum contraception among women who recently had an unintended birth. METHODS We analyzed cross-sectional data from PRAMS (the Pregnancy Risk Assessment Monitoring System) to identify women who had an unintended birth between 2012 and 2015. The effectiveness level of the contraceptive method was coded into one of five categories based on the postpartum contraceptive method that women were using: none, less effective (withdrawal, rhythm, condoms, or other barrier), moderately effective (pill, patch, ring, or shot), long-acting reversible contraception (LARC; intrauterine devices or implants), and sterilization (female or male sterilization). Multinomial logistic regression was used to examine whether prepregnancy depression or elevated postpartum depressive symptoms, intimate partner violence before or during pregnancy, and number of psychosocial stressors before birth were associated with effectiveness level of method (compared with no method), in models adjusted for sociodemographics, pregnancy context, and postpartum context. RESULTS Complete data were available for 56,445 (88.2%) of the 64,030 eligible women: 24.2% experienced depression; 5.3% experienced intimate partner violence; and 16.8% experienced five or more psychosocial stressors around the time of pregnancy or birth. In adjusted models, experiencing intimate partner violence and more stressors lowered women's relative risk of using sterilization, LARC, moderately effective methods, and less-effective contraceptive methods relative to no method use. Only prepregnancy depression was associated with using sterilization compared with no method use. CONCLUSIONS Experiencing intimate partner violence and having more psychosocial stressors were each independently associated with not using a postpartum contraceptive method. Standardized screening for psychosocial factors during prenatal and postpartum care should be integrated, and practices that encourage the discussion of patients' psychosocial experiences and postpartum contraception use together are warranted.
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Lichtenstein Liljeblad K, Kopp Kallner H, Brynhildsen J. Risk of abortion within 1-2 years after childbirth in relation to contraceptive choice: a retrospective cohort study. EUR J CONTRACEP REPR 2020; 25:141-146. [PMID: 32083501 DOI: 10.1080/13625187.2020.1718091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The primary objective of the study was to investigate whether the choice of long-acting reversible contraception (LARC) was associated with the risk of abortion over a period of 24 months postpartum. The secondary objective was to analyse whether other significant factors were affecting the risk of abortion during this period.Methods: In this retrospective cohort study, we analysed 11,066 women who had delivered in three Swedish cities during 2013 and 2014. Demographic and medical variables were obtained from medical records. Attendance at the postpartum visit, choice of postpartum contraception and history of abortion was noted. Logistic regression analysis was performed to assess factors associated with the risk of abortion. The main outcome measure was the proportion of women with abortion up to 24 months postpartum.Results: Data from 11,066 women were included in the final analysis. Within 12-24 months after delivery 2.5% of women had an abortion. The choice of LARC after childbirth reduced the risk of subsequent abortion (odds ratio 0.74; 95% confidence interval [CI] 0.60, 0.91; p = .005). Smoking, age <25 years and have had a previous abortion significantly increased the risk of abortion during follow-up, whereas exclusive breastfeeding decreased the risk.Conclusions: Increasing the proportion of women who choose LARC postpartum could decrease the risk of abortion for up to 2 years after childbirth.
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Affiliation(s)
- Karin Lichtenstein Liljeblad
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics & Gynaecology, Department of Clinical & Experimental Medicine, Linköping University, Linköping, Sweden
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Cooper M, McGeechan K, Glasier A, Coutts S, McGuire F, Harden J, Boydell N, Cameron ST. Provision of immediate postpartum intrauterine contraception after vaginal birth within a public maternity setting: Health services research evaluation. Acta Obstet Gynecol Scand 2019; 99:598-607. [PMID: 31837002 PMCID: PMC7217220 DOI: 10.1111/aogs.13787] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 11/26/2022]
Abstract
Introduction Expanding access to postpartum intrauterine contraception (PPIUC) can reduce unintended pregnancies and short inter‐pregnancy intervals; however, provision across Europe is limited. Our aim was to determine the feasibility, clinical outcomes and patient satisfaction of providing immediate PPIUC after vaginal birth using a health services research model. Material and methods Phased introduction of PPIUC across two Lothian maternity hospitals; all women intending vaginal birth during the study period without a contraindication to use of the method were eligible to receive PPIUC. Midwives and obstetric doctors were trained in vaginal PPIUC insertion using Kelly forceps. Women received information antenatally and had PPIUC insertion of either a levonorgestrel intrauterine system or a copper intrauterine device within 48 hours of vaginal birth. Follow‐up was conducted in‐person at 6 weeks postpartum and by telephone at 3, 6 and 12 months. Primary outcomes were: uptake, complications (infection, uterine perforation), expulsion and patient satisfaction at 6 weeks; and method of continuation up to 12 months. Secondary outcomes included hazard ratio for expulsion adjusted for demographic and insertion‐related variables. Results Uptake of PPIUC was 4.6% of all vaginal births; 465/447 (96.1%) of those requesting PPIUC successfully received it and most chose a levonorgestrel intrauterine system (73%). At 6 weeks postpartum, the infection rate was 0.8%, there were no perforations and 98.3% of women said they would recommend the service. The complete expulsion rate was 29.8% (n = 113) and most had symptoms (n = 79). Of the additional 121 devices removed, 118 were because of partial expulsion. The rate of complete/partial expulsion was higher for insertions by midwives compared with those by doctors. The re‐insertion rate after expulsion/removal was 87.6% and method continuation at 12 months was 79.6%. Conclusions Routine PPIUC at vaginal birth is feasible. Complications were extremely rare. High expulsion rates may be observed in early stages of service introduction and with inexperienced providers. Re‐insertion and therefore longer‐term continuation rates of intrauterine contraception were very high. In settings with low rates of attendance for interval postpartum intrauterine contraception insertion, PPIUC could be a useful intervention to prevent unintended and closely spaced pregnancies.
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Affiliation(s)
- Michelle Cooper
- MRC Center for Reproductive Health, University of Edinburgh, Edinburgh, UK.,Department of Obstetrics and Gynecology, NHS Lothian, Edinburgh, UK
| | - Kevin McGeechan
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Anna Glasier
- MRC Center for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Shiona Coutts
- Department of Obstetrics and Gynecology, NHS Lothian, Edinburgh, UK
| | - Frances McGuire
- Department of Obstetrics and Gynecology, NHS Lothian, Edinburgh, UK
| | - Jeni Harden
- Usher Institute of Population Health Science, University of Edinburgh, Edinburgh, UK
| | - Nicola Boydell
- Usher Institute of Population Health Science, University of Edinburgh, Edinburgh, UK
| | - Sharon T Cameron
- MRC Center for Reproductive Health, University of Edinburgh, Edinburgh, UK.,Department of Obstetrics and Gynecology, NHS Lothian, Edinburgh, UK
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Long-acting reversible contraceptive (LARCs) methods. Best Pract Res Clin Obstet Gynaecol 2019; 66:28-40. [PMID: 32014434 DOI: 10.1016/j.bpobgyn.2019.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 02/06/2023]
Abstract
Unplanned pregnancy (UP) is a public health problem, which affects millions of women worldwide. Providing long-acting reversible contraceptive (LARC) methods is an excellent strategy to avoid or at least reduce UP, because the effectiveness of these methods is higher than other methods, and is indeed comparable to that of permanent contraception. As the initial introduction of the inert plastic intrauterine device (IUD) and of the six-rod implant, pharmaceutical companies have introduced a copper IUD (Cu-IUD), different models of levonorgestrel-releasing intrauterine system (LNG IUS), and one and two-rod implants, which certainly improved women's LARC options. The main characteristic of LARCs is that they provide high contraceptive effectiveness with a single intervention, and that they can be used for a long time. Emerging evidence from the last few years has demonstrated that it is possible to extend the use of the 52 mg LNG IUS and of the etonogestrel-implant beyond five- and three years, respectively, which adds new value to these LARCs.
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Verbus E, Ascha M, Wilkinson B, Montague M, Morris J, Mercer BM, Arora KS. The Association of Public Insurance with Postpartum Contraception Preference and Provision. Open Access J Contracept 2019; 10:103-110. [PMID: 31908549 PMCID: PMC6927572 DOI: 10.2147/oajc.s231196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/07/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Prior 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. OBJECTIVE To assess differences in planned method and provision of postpartum contraception according to insurance type. STUDY DESIGN This 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. RESULTS Of 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). CONCLUSION Public 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.
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Affiliation(s)
- Emily Verbus
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mustafa Ascha
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Wilkinson
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mary Montague
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jane Morris
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Brian M Mercer
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
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Cost Sharing and Utilization of Postpartum Intrauterine Devices and Contraceptive Implants Among Commercially Insured Women. Womens Health Issues 2019; 29:465-470. [PMID: 31495642 DOI: 10.1016/j.whi.2019.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 07/09/2019] [Accepted: 07/26/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cost sharing may impede postpartum contraceptive use. We evaluated the association between out-of-pocket costs and long-acting reversible contraceptive (LARC) insertion among commercially insured postpartum women. METHODS Using the Clinformatics Data Mart, we examined out-of-pocket costs for LARC insertions at 0 to 3 and 4-60 days postpartum among women in employer-sponsored health plans from 2013 to 2016. Patient costs were estimated by summing copayment, coinsurance, and deductible payments for LARC services (device + placement). Multivariable logistic regression evaluated the association between plan cost sharing for LARC services (at least one beneficiary with >$200 cost share) and LARC insertion by 60 days postpartum (yes/no). RESULTS We identified 396,073 deliveries among women in 51,797 employer-based plans. Overall, LARC placement by 60 days postpartum was observed after 5.2% (n = 20,604) of deliveries. Inpatient LARC insertion (n = 233; 0.06% of deliveries) was less common than outpatient LARC insertion (n = 20,375; 5.14% of deliveries). Cost sharing was observed in 23.4% of LARC insertions (inpatient IUD: median, $50.00; range, $0.93-5,055.91; inpatient implant: median, $11.91; range, $2.49-650.14; outpatient IUD: median, $25.00; range, $0.01-3,354.80; outpatient implant: median, $27.20; range, $0.18-2,444.01). Among 5,895 plans with at least one LARC insertion and after adjusting for patient age, poverty status, race/ethnicity, region, and plan type, women in plans with cost sharing of more than $200 demonstrated lower odds of LARC use by 60 days postpartum (odds ratio, 0.74; 95% confidence interval, 0.71-0.77). CONCLUSIONS Cost sharing for postpartum LARC is associated with use, suggesting that out-of-pocket costs may impede LARC access for some commercially insured postpartum women. Reducing out-of-pocket costs for the most effective forms of contraception may increase use.
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Atkin K, Scannell M, Nicholas PK. Use of Dolutegravir for Antiretroviral Therapy for Women of Childbearing Age. J Obstet Gynecol Neonatal Nurs 2019; 48:664-673. [PMID: 31479630 DOI: 10.1016/j.jogn.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 10/26/2022] Open
Abstract
The purpose of this article is to offer an update on the use of antiretroviral therapy (ART) for HIV among women of childbearing age. We focus specifically on the use of dolutegravir (DTG) because of a recently identified potential safety issue related to neural tube defects in the fetuses of women who used DTG at the time of conception. Nurses and advanced practice registered nurses should engage in shared decision-making processes for reproductive life planning with women of childbearing age who are living with or are at risk for HIV. During these processes, exploration of the full range of ART regimens is essential. Consistent and reliable contraception is necessary with the use of DTG because it is not recommended in the first trimester of pregnancy.
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Lazenby G, Francis E, Brzozowski N, Rucker L, Dempsey A. Postpartum LARC discontinuation and short interval pregnancies among women with HIV: a retrospective 9-year cohort study in South Carolina. Contraception 2019; 100:279-282. [PMID: 31226321 DOI: 10.1016/j.contraception.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate rates of discontinuation and short interval pregnancy among women with HIV who received a postpartum IUD or implant. METHODS We conducted a retrospective cohort study of women who had an IUD or implant placed within 3 months postpartum during a 9-year period (1/1/09 to 2/14/18). We assessed the prevalence of discontinuation within 12 months and rates of subsequent delivery within 18 months. We examined differences in these outcomes between women with and without HIV. RESULTS Of the 794 women who received a long-acting reversible contraception (LARC) within 3 months postpartum, most chose an IUD (85%). Twenty-one percent (165) elected for immediate postpartum placement: 119 IUDs and 46 implants. Women with HIV were more likely to receive an implant (48% vs 13%, p<.0001) and were more likely to have immediate postpartum placement (76% vs 17%, p<.0001). Women with HIV (n=50) were not more likely to remove LARC devices within 12 months of placement (38% vs 36%, p=.9), and they did not experience any short interval pregnancies. CONCLUSIONS Women with HIV in South Carolina were more likely than HIV-negative women to receive immediate postpartum LARC and to receive an implant. They were not more likely to discontinue LARC within 12 months nor experience short interval pregnancies. IMPLICATIONS Further study is needed to evaluate preferences for implants and immediate postpartum insertion among women with HIV.
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Affiliation(s)
- Gweneth Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425.
| | - Elizabeth Francis
- Department of College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
| | - Nicole Brzozowski
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
| | - Lindsay Rucker
- Department of College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
| | - Angela Dempsey
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 628a, Charleston, SC, 29425
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Vricella LK, Gawron LM, Louis JM, Louis JM. Society for Maternal-Fetal Medicine (SMFM) Consult Series #48: Immediate postpartum long-acting reversible contraception for women at high risk for medical complications. Am J Obstet Gynecol 2019; 220:B2-B12. [PMID: 30738885 DOI: 10.1016/j.ajog.2019.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Reproductive planning is essential for all women and most important for those with complex health conditions or at high risk for complications. Pregnancy planning can allow these high-risk women the opportunity to receive preconception counseling, medication adjustment, and risk assessment related to health conditions that have a direct impact on maternal morbidity and mortality risk. Despite the need for pregnancy planning, medically complex women face barriers to contraceptive use, including systemic barriers, such as underinsurance for women at increased risk for complex medical conditions as well as low uptake of effective postpartum contraception. Providing contraceptive counseling and a full range of contraceptive options, including immediate postpartum long-acting reversible contraception (LARC), is a means of overcoming these barriers. The purpose of this document is to educate all providers, including maternal-fetal medicine subspecialists, about the benefits of postpartum contraception, and to advocate for widespread implementation of immediate postpartum LARC placement programs. The following are Society for Maternal-Fetal Medicine recommendations: we recommend that LARC be offered to women at highest risk for adverse health events as a result of a future pregnancy (GRADE 1B); we recommend that obstetric care providers discuss the availability of immediate postpartum LARC with all pregnant women during prenatal care and consult the U.S. Medical Eligibility Criteria for Contraceptive Use guidelines to determine methods most appropriate for specific medical conditions (GRADE 1C); we recommend that women considering immediate postpartum intrauterine device insertion be counseled that although expulsion rates are higher than with delayed insertion, the benefits appear to outweigh the risk of expulsion, as the long-term continuation rates are higher (GRADE 1C); we recommend that obstetric care providers wishing to utilize immediate postpartum LARC obtain training specific to the immediate postpartum period (BEST PRACTICE); for women who desire and are eligible for LARC, we recommend immediate postpartum placement after a high-risk pregnancy over delayed placement due to overall superior efficacy and cost-effectiveness (GRADE 1B); we recommend that women considering immediate postpartum LARC be encouraged to breastfeed, as current evidence suggests that these methods do not negatively influence lactation (GRADE 1B); for women who desire and are eligible for LARC, we suggest that early postpartum LARC placement be considered when immediate postpartum LARC placement is not feasible (GRADE 2C); and we recommend that contraceptive counseling programs be patient-centered and provided in a shared decision-making framework to avoid coercion (BEST PRACTICE).
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Affiliation(s)
| | | | | | - Judette M Louis
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
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Thwaites A, Tran AB, Mann S. Women's and healthcare professionals' views on immediate postnatal contraception provision: a literature review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:88-94. [PMID: 31000571 DOI: 10.1136/bmjsrh-2018-200231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/21/2019] [Accepted: 03/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Provision of immediate postnatal contraception, including long-acting reversible contraceptive (LARC) methods, is increasingly identified and endorsed as a key strategy for reducing unplanned and rapid repeat pregnancies. This literature review aims to evaluatethe views of women and healthcare professionals regarding the receipt, initiation or delivery of these services. METHODS Databases (Embase, Medline, CINAHL, HMIC) were searched for relevant English language studies, from January2003 to December 2017. In addition, Evidence Search, Google Scholar and Scopus (citation search) were used to identify further literature. Other relevant websites were accessed for policies, guidance and supplementary grey literature. RESULTS There is clear guidance on how to deliver good-quality postnatal contraception to women, but the reality of service delivery in the UK does not currently meet these aspirations, and guidance on implementation is lacking. The available evidence on the provision of immediate postnatal contraception focuses more on clinical rather than patient-centred outcomes. Research on postnatal women's views is limited to receptivity to LARC and contraception counselling rather than what influences their decision-making process at this time. Research on views of healthcare professionals highlights a range of key systemic barriers to implementation. CONCLUSIONS While views of postnatal women and healthcare professionals are largely in support of immediate postnatal contraception provision, important challenges have been raised and present a need for national sharing of service commissioning and delivery models, resources and evaluation data. Provider attitudes and training needs across multidisciplinary groups also need to be assessed and addressed as collaborative working across a motivated, skilled and up-to-date network of healthcare professionals is viewed as key to successful service implementation.
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Affiliation(s)
- Annette Thwaites
- EGA Institute for Women's Health, University College London, London, UK
| | | | - Sue Mann
- Public Health England, London, UK
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Wilkinson B, Ascha M, Verbus E, Montague M, Morris J, Mercer B, Arora KS. Medicaid and receipt of interval postpartum long-acting reversible contraception. Contraception 2019; 99:32-35. [PMID: 30194927 PMCID: PMC6289711 DOI: 10.1016/j.contraception.2018.08.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/20/2018] [Accepted: 08/29/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We sought to evaluate the impact of insurance type on receipt of an interval postpartum LARC, controlling for demographic and clinical factors. STUDY DESIGN This is a retrospective cohort study of 1072 women with a documented plan of LARC for contraception at time of postpartum discharge. This is a secondary analysis of 8654 women who delivered at 20 weeks or beyond from January 1, 2012, through December 31, 2014, at an urban teaching hospital in Ohio. LARC receipt within 90 days of delivery, time to receipt, and rate of subsequent pregnancy after non-receipt were compared between women with Medicaid and women with private insurance. Postplacental LARC was not available at the time of study completion. RESULTS One hundred eighty-seven of 822 Medicaid-insured and 43 of 131 privately insured women received a LARC postpartum (22.7% vs 32.8%, P=.02). In multivariable analysis, private insurance status was not significantly associated with LARC receipt (OR 1.29, 95% C.I. 0.83-1.99) though adequate prenatal care was (OR 2.33, 95% C.I. 1.42-4.00). Of women who wanted but did not receive a LARC, 208 of 635 (32.8%) Medicaid patients and 19 of 88 (21.6%) privately insured patients became pregnant within 1 year (P=.02). CONCLUSION Differences in receipt of interval postpartum LARC were not significant between women with Medicaid insurance versus private insurance after adjusting for clinical and demographic factors. Adequate prenatal care was associated with LARC receipt. Medicaid patients who did not receive a LARC were more likely to become pregnant within one year of delivery than those with private insurance. IMPLICATIONS While insurance-related barriers have been reduced given recent policy changes, access to care remains an important determinant of postpartum LARC provision and subsequent unintended pregnancy.
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Affiliation(s)
- Barbara Wilkinson
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA
| | - Mustafa Ascha
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
| | - Emily Verbus
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Mary Montague
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Jane Morris
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Brian Mercer
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
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Ahrens KA, Hutcheon JA, Ananth CV, Basso O, Briss PA, Ferré CD, Frederiksen BN, Harper S, Hernández‐Díaz S, Hirai AH, Kirby RS, Klebanoff MA, Lindberg L, Mumford SL, Nelson HD, Platt RW, Rossen LM, Stuebe AM, Thoma ME, Vladutiu CJ, Moskosky S. Report of the Office of Population Affairs' expert work group meeting on short birth spacing and adverse pregnancy outcomes: Methodological quality of existing studies and future directions for research. Paediatr Perinat Epidemiol 2019; 33:O5-O14. [PMID: 30300948 PMCID: PMC6378402 DOI: 10.1111/ppe.12504] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/09/2018] [Accepted: 08/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends that women wait at least 24 months after a livebirth before attempting a subsequent pregnancy to reduce the risk of adverse maternal, perinatal, and infant health outcomes. However, the applicability of the WHO recommendations for women in the United States is unclear, as breast feeding, nutrition, maternal age at first birth, and total fertility rate differs substantially between the United States and the low- and middle-resource countries upon which most of the evidence is based. METHODS To inform guideline development for birth spacing specific to women in the United States, the Office of Population Affairs (OPA) convened an expert work group meeting in Washington, DC, on 14-15 September 2017 among reproductive, perinatal, paediatric, social, and public health epidemiologists; obstetrician-gynaecologists; biostatisticians; and experts in evidence synthesis related to women's health. RESULTS Presentations and discussion topics included the methodological quality of existing studies, evaluation of the evidence for causal effects of short interpregnancy intervals on adverse perinatal and maternal health outcomes, good practices for future research, and identification of research gaps and priorities for future work. CONCLUSIONS This report provides an overview of the presentations, discussions, and conclusions from the expert work group meeting.
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Affiliation(s)
- Katherine A. Ahrens
- Office of Population AffairsOffice of the Assistant Secretary for HealthRockvilleMaryland
| | - Jennifer A. Hutcheon
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cande V. Ananth
- Department of Obstetrics and GynecologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew York,Department of EpidemiologyJoseph L. Mailman School of Public HealthColumbia UniversityNew YorkNew York
| | - Olga Basso
- Department of Obstetrics and GynecologyRoyal Victoria HospitalResearch Institute of McGill University Health CentreMontrealQuebecCanada,Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Peter A. Briss
- National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and PreventionAtlantaGeorgia
| | - Cynthia D. Ferré
- Maternal and Infant Health BranchDivision of Reproductive HealthNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgia
| | - Brittni N. Frederiksen
- Office of Population AffairsOffice of the Assistant Secretary for HealthRockvilleMaryland
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Sonia Hernández‐Díaz
- Department of EpidemiologyHarvard T. H. Chan School of Public HealthBostonMassachusetts
| | - Ashley H. Hirai
- US Department of Health and Human ServicesHealth Resources and Services Administration, Maternal and Child Health BureauOffice of Epidemiology and ResearchRockvilleMaryland
| | - Russell S. Kirby
- Department of Community and Family HealthUniversity of South Florida College of Public HealthTampaFlorida
| | - Mark A. Klebanoff
- Center for Perinatal ResearchDepartments of Pediatrics and Obstetrics and Gynecology and Division of EpidemiologyThe Research Institute at Nationwide Children's HospitalThe Ohio State UniversityColumbusOhio
| | | | - Sunni L. Mumford
- Division of Intramural Population Health Research, Epidemiology BranchNational Institute of Child Health and Human DevelopmentBethesdaMaryland
| | - Heidi D. Nelson
- Department of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandOregon
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Lauren M. Rossen
- Reproductive Statistics BranchDivision of Vital StatisticsNational Center for Health StatisticsCenters for Disease Control and PreventionHyattsvilleMaryland
| | - Alison M. Stuebe
- Department of Obstetrics and GynecologyDepartment of Maternal and Child HealthGillings School of Global Public HealthUniversity of North Carolina School of MedicineChapel HillNorth Carolina
| | - Marie E. Thoma
- Department of Family ScienceUniversity of MarylandCollege ParkMaryland
| | - Catherine J. Vladutiu
- US Department of Health and Human ServicesHealth Resources and Services Administration, Maternal and Child Health BureauOffice of Epidemiology and ResearchRockvilleMaryland
| | - Susan Moskosky
- Office of Population AffairsOffice of the Assistant Secretary for HealthRockvilleMaryland
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Thwaites A, Logan L, Nardone A, Mann S. Immediate postnatal contraception: what women know and think. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 45:bmjsrh-2018-200078. [PMID: 30463845 DOI: 10.1136/bmjsrh-2018-200078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/07/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Postpartum women are at risk of rapid repeat, unplanned pregnancy with associated adverse outcomes for mother and child. We aimed to better understand their contraceptive needs to improve delivery of services and prevent unplanned pregnancies. METHODS A cross-sectional survey of women on the postnatal ward of an inner-city hospital was administered over a 6-week period in June and July 2017 to determine their level of knowledge, intentions and preferences regarding postnatal contraception. RESULTS 272 women were surveyed: 86% of all women on the postnatal ward during the study period. 10% (26/272) had never used any method of contraception previously and 22% (59/272) had ever used a long-acting reversible contraception (LARC) method. 18% (48/272) recalled a health professional speaking to them about contraception at any point during their pregnancy and 32% (87/272) said they needed more information to decide on their postnatal contraceptive method. 54% (147/272) of women did not think any LARC methods were safe immediately postnatally, rising to 71% (194/272) if breastfeeding. However, 47% (129/272) of women said that they would prefer to get their contraception from the ward before discharge and 46% (126/272) were likely to accept LARC, if safe, in this setting. CONCLUSIONS Almost half the women in our survey would welcome provision of postnatal contraception, including LARC, on the postnatal ward but the women surveyed currently lack the knowledge to make informed choices in this setting. There is therefore a need for effective, tailored contraceptive choices discussions with every woman during pregnancy, as well as integrated planning for postnatal provision of the woman's chosen method.
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Affiliation(s)
| | - Louise Logan
- Public Health England, Health Improvement Directorate, London, UK
| | - Anthony Nardone
- Public Health England, Health Improvement Directorate, London, UK
| | - Sue Mann
- Public Health England, Health Improvement Directorate, London, UK
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Holden EC, Lai E, Morelli SS, Alderson D, Schulkin J, Castleberry NM, McGovern PG. Ongoing barriers to immediate postpartum long-acting reversible contraception: a physician survey. Contracept Reprod Med 2018; 3:23. [PMID: 30455978 PMCID: PMC6222995 DOI: 10.1186/s40834-018-0078-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Postpartum women are at risk for unintended pregnancy. Access to immediate long-acting reversible contraception (LARC) may help decrease this risk, but it is unclear how many providers in the United States routinely offer this to their patients and what obstacles they face. Our primary objective was to determine the proportion of United States obstetric providers that offer immediate postpartum LARC to their obstetric patients. Methods We surveyed practicing Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists (ACOG) about their use of immediate postpartum LARC. These members are demographically representative of ACOG members as a whole and represent all of the ACOG districts. Half of these Fellows were also part of the Collaborative Ambulatory Research Network (CARN), a group of ACOG members who voluntarily participate in research. We asked about their experience with and barriers to immediate placement of intrauterine devices and contraceptive implants after delivery. Results There were a total of 108 out of 600 responses (18%). Participants practiced in a total of 36 states and/or US territories and their median age was 52 years. Only 26.9% of providers surveyed offered their patients immediate postpartum LARC, and of these providers, 60.7% work in a university-based practice. There was a statistically significant association between offering immediate postpartum LARC and practice type, with the majority of providers working at a university-based practice (p < 0.001). Multiple obstacles were identified, including cost or reimbursement, device availability, and provider training on device placement in the immediate postpartum period. Conclusion The majority of obstetricians surveyed do not offer immediate postpartum long-acting reversible contraception to patients in the United States. This is secondary to multiple obstacles faced by providers.
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Affiliation(s)
- Emily C Holden
- 1Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, 185 South Orange Avenue, E-level, Newark, NJ 07103 USA
| | - Erica Lai
- 1Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, 185 South Orange Avenue, E-level, Newark, NJ 07103 USA
| | - Sara S Morelli
- 1Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, 185 South Orange Avenue, E-level, Newark, NJ 07103 USA.,2Reproductive Endocrinology and Infertility, University Reproductive Associates, 214 Terrace Avenue, Hasbrouck Heights, NJ 07604 USA
| | - Donald Alderson
- 3Rutgers University Biostatistics and Epidemiology Services Center, Rutgers University, 65 Bergen St, Newark, NJ 07103 USA
| | - Jay Schulkin
- 4Department of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195-6460 USA
| | - Neko M Castleberry
- 5American College of Obstetricians and Gynecologists, 409 12th Street, SW, Washington, DC 2002420024-9998 USA
| | - Peter G McGovern
- 1Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, 185 South Orange Avenue, E-level, Newark, NJ 07103 USA.,2Reproductive Endocrinology and Infertility, University Reproductive Associates, 214 Terrace Avenue, Hasbrouck Heights, NJ 07604 USA
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Sonalkar S, Hunter T, Gurney EP, McAllister A, Schreiber C. A Decision Analysis Model of 1-Year Effectiveness of Intended Postplacental Compared With Intended Delayed Postpartum Intrauterine Device Insertion. Obstet Gynecol 2018; 132:1211-1221. [PMID: 30303909 PMCID: PMC6328318 DOI: 10.1097/aog.0000000000002926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare, using decision analysis methodology, the 1-year probability of pregnancy after intended postplacental intrauterine device (IUD) insertion with intended delayed insertion at an outpatient postpartum visit (delayed postpartum placement). METHODS We developed an evidence-based decision model with the primary outcome of 1-year probability of pregnancy. We compared 1-year probability of pregnancy after intended postplacental or intended delayed postpartum IUD placement. We obtained estimates from the literature for the proportions of the following: mode of delivery, successful IUD placement, IUD type, postpartum visit attendance, IUD expulsion, IUD discontinuation, and contraceptive use, choice, and efficacy after IUD discontinuation. We performed sensitivity analyses and a Monte Carlo simulation to account for variations in proportion estimates. RESULTS One-year probabilities of pregnancy among a theoretical cohort of 2,500,000 women intending to receive a postplacental IUD after vaginal birth and 1,250,000 women intending to receive a postplacental IUD after cesarean birth were 17.3% and 11.2%, respectively; the 1-year probability of pregnancy among a theoretical cohort of 2,500,000 women intending to receive a delayed postpartum IUD was 24.6%. For delayed postpartum IUD placement to have effectiveness equal to postplacental placement, 91.4% of women delivering vaginally and 99.7% of women delivering by cesarean would need to attend postpartum care. Once placed, the effectiveness of postplacental IUDs was lower than that of delayed postpartum IUDs: 1-year probabilities of pregnancy after IUD placement at a vaginal birth, cesarean birth, and an outpatient postpartum visit were 15.4%, 6.6%, and 3.9%, respectively. CONCLUSION After accounting for factors that affect successful IUD placement and retention, this decision model indicates that intended postplacental IUD insertion results in a lower 1-year probability of pregnancy as compared with intended delayed postpartum IUD insertion.
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Affiliation(s)
- Sarita Sonalkar
- University of Pennsylvania Perelman School of Medicine, Department of Obstetrics and Gynecology
| | | | | | - Arden McAllister
- University of Pennsylvania Perelman School of Medicine, Department of Obstetrics and Gynecology
| | - Courtney Schreiber
- University of Pennsylvania Perelman School of Medicine, Department of Obstetrics and Gynecology
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Montague M, Ascha M, Wilkinson B, Verbus E, Morris J, Mercer BM, Arora KS. Role of Bridge Contraception in Postpartum Long-Acting Reversible Contraception and Sterilization Fulfillment Rates. Obstet Gynecol 2018; 132:583-590. [PMID: 30095782 PMCID: PMC6105446 DOI: 10.1097/aog.0000000000002803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the association of bridge contraception with interval long-acting reversible contraception (LARC) and sterilization fulfillment rates. METHODS This is a secondary analysis of a retrospective single-center cohort chart review study examining 1,851 postpartum women who requested LARC or sterilization after discharge. Bridge contraception was requested by 597 of these women. Primary outcomes included LARC or sterilization fulfillment, time to fulfillment, postpartum visit attendance, and pregnancy within 365 days of delivery. RESULTS The rate of LARC or sterilization fulfillment within 90 days of delivery was 147 of 597 (24.6%) women using bridge contraception and 287 of 1,254 (22.9%) women not using bridge contraception (P=.41). After adjusting for maternal age, parity, gestational age, mode of delivery, adequacy of prenatal care, race-ethnicity, and education level, the use of bridge contraception was associated with LARC or sterilization fulfillment (adjusted odds ratio [OR] 1.30, 95% CI 1.02-1.67). Adequacy of prenatal care and black race was associated with fulfillment. The use of bridge contraception was not associated with time to fulfillment (adjusted hazard ratio 1.17, 95% CI 0.95-1.44) or postpartum visit attendance (adjusted OR 0.97, 95% CI 0.77-1.23). The use of bridge contraception was not associated with increased pregnancy within 365 days of delivery (OR 1.00, 95% CI 0.95-1.05; adjusted OR 0.96, 95% CI 0.73-1.26). CONCLUSION Bridge contraception is associated with increased LARC and sterilization fulfillment after postpartum discharge. Long-acting reversible contraception or sterilization fulfillment after discharge occurred in less than one in four women. Strategies to improve provision of LARC or sterilization before hospital discharge are necessary.
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Affiliation(s)
- Mary Montague
- School of Medicine and the Department of Epidemiology and Biostatistics, Case Western Reserve University, and the Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio
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Dude A, Matulich M, Estevez S, Liu LY, Yee LM. Disparities in Postpartum Contraceptive Counseling and Provision Among Mothers of Preterm Infants. J Womens Health (Larchmt) 2018; 27:676-683. [PMID: 29359987 PMCID: PMC5962326 DOI: 10.1089/jwh.2017.6561] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Use of effective contraception could be one method to decrease recurrent preterm birth by increasing intervals between pregnancies. We assessed correlates of contraceptive counseling and uptake among women who delivered preterm. MATERIALS AND METHODS This is a retrospective cohort study of women who delivered live-born singletons or twins before 32 weeks' gestation. We assessed documented contraceptive counseling and method uptake by postpartum discharge, using inpatient medical records, and correlates of highly effective contraception uptake by the postpartum visit using outpatient records. RESULTS Of 594 eligible women, 44.6% (n = 265) had documented inpatient contraceptive counseling, but only 21.4% (n = 127) left the hospital using a World Health Organization (WHO) tier 1 or 2 method. Women who were younger, non-Hispanic black, multiparous, and delivered at earlier gestational ages were more likely to have inpatient counseling documented. Compared with women with private insurance, women with public insurance were more likely to have documented counseling (22.8% vs. 87.5%, p < 0.001; adjusted odds ratio [aOR] 9.55, 95% confidence interval [CI] 5.31-17.2) and to uptake a WHO tier 1 or 2 method as an inpatient (5.8% vs. 52.0%, p < 0.001; aOR 9.51, 95% CI 4.78-18.9). Of the 175 women with outpatient records available who attended a postpartum visit, only 54.9% (n = 96) adopted a WHO tier 1 or tier 2 method. CONCLUSION Although all women in this cohort were at risk of recurrent preterm birth, counseling about contraception after a preterm birth (<32 weeks) was not universal. Women with multiple risk factors for recurrent preterm birth, such as multiparity and public insurance, were more likely to have received documented contraceptive counseling and highly effective contraceptives.
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Affiliation(s)
- Annie Dude
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Melissa Matulich
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Samantha Estevez
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lilly Y. Liu
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lynn M. Yee
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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