Randomized Controlled Trial of Home-Based Hormonal Contraceptive Dispensing for Women At Risk of Unintended Pregnancy

Prenatal and Postpartum Home Visits and Postpartum Contraceptive Use: A Cross-Sectional Analysis

Background: The postpartum period is a time of unmet contraceptive need for many women. Home visits by a health care worker during pregnancy or after delivery could increase postpartum contraceptive use and decrease barriers to accessing postpartum care. This study investigated the association between prenatal or postpartum home visits and postpartum contraceptive use using a large sample of U.S. women from 41 states. Subjects and Methods: We conducted a cross-sectional analysis using weighted survey data from the 2012-2015 Phase 7 Pregnancy Risk Assessment and Monitoring Systems Core and Standard Questionnaires. Descriptive statistics and multivariate logistic regression models estimated the association between having a prenatal or postpartum home visit and self-reported postpartum contraceptive use. Results: Of 141,296 women, approximately 21% received prenatal or postpartum home visits and 79% used postpartum contraception. After controlling for sociodemographic, reproductive, and health-related factors, women who received prenatal or postpartum home visits had a higher odds of postpartum contraception use (adjusted odds ratio 1.08, 95% confidence interval 1.02-1.15, p = 0.009). Women who were older, were minority race, had less than a high school education, received inadequate prenatal care, experienced partner abuse during pregnancy, or experienced multiple stressors during pregnancy had a lower odds of postpartum contraception use in adjusted analyses controlling for home visitation. Conclusion: Given the benefits of recommended interpregnancy intervals to both the mother and the baby, adding formal contraceptive counseling and offering a variety of postpartum contraceptive methods in the home could further strengthen home visitation programs in the United States and may support women in achieving their reproductive goals.

Causal assessment in demographic research

Causation underlies both research and policy interventions. Causal inference in demography is however far from easy, and few causal claims are probably sustainable in this field. This paper targets the assessment of causality in demographic research. It aims to give an overview of the methodology of causal research, pointing out various problems that can occur in practice. The “Intervention studies” section critically examines the so-called gold standard in causality assessment in experimental studies, randomized controlled trials, and the use of quasi-experiments and interventions in observational studies. The “Multivariate statistical models” section deals with multivariate statistical models linking a mortality or fertility indicator to a series of possible causes and controls. Single and multiple equation models are considered. The “Mechanisms and structural causal modelling” section takes into account a more recent trend, i.e., mechanistic explanations in causal research, and develops a structural causal modelling framework stemming from the pioneering work of the Cowles Commission in econometrics and of Sewall Wright in population genetics. The “Assessing causality in demographic research” section examines how causal analysis could be further applied in demographic studies, and a series of proposals are discussed for this purpose. The paper ends with a conclusion pointing out, in particular, the relevance of structural equation models, of triangulation, and of systematic reviews for causal assessment.

Resumption of sexual intercourse post partum and the utilisation of contraceptive methods in China: a cross-sectional study

OBJECTIVE

This is a cross-sectional study that aimed to examine the resumption of sexual intercourse post partum, the utilisation of contraceptive methods and the influencing factors among Chinese women at a tertiary teaching hospital.

DESIGN

This is a questionnaire survey by written and online interview for participants.

PARTICIPANTS

Based on medical records, we sent online questionnaires about postpartum sexual intercourse and contraception plans to 550 eligible women.

MAIN OUTCOME MEASURES

Potential factors affecting postpartum sexual intercourse and utilisation of contraception were determined by analysis of epidemiological and clinical factors and sexual experiences during and after pregnancy.

RESULTS

Of 550 eligible participants, 406 women (73.8%) with a postpartum period of 8.5 months (range 6-10) completed the questionnaires; 146 of 406 (36.0%) resumed sexual intercourse within 3 months, and 259 of 279 (92.8%) used contraceptive methods. In univariate and multivariate analyses, sexual intercourse during pregnancy (adjusted OR 4.4, 95% CI 2.8 to 6.9) and resumption of menstruation (adjusted OR 2.5, 95% CI 1.5 to 4.3) were significant influencing factors in resumption of sexual intercourse within 3 months after childbirth. No factor was found to be associated with using contraceptive methods or the general resumption of sexual intercourse post partum. The questionnaire had good reliability and validity.

CONCLUSIONS

Having sexual intercourse during pregnancy and resuming menstruation earlier were independent factors for resumption of sexual intercourse within 3 months after delivery. Almost all women who had postpartum sexual intercourse used various contraceptive methods.