Contraceptive counseling and postpartum contraceptive use

Abstract

OBJECTIVE The objective of the study was to examine the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use. STUDY DESIGN The Pregnancy Risk Assessment Monitoring System 2004–2008 data were analyzed from Missouri, New York state, and New York City (n = 9536). We used multivariable logistic regression to assess the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use, defined as any method and more effective methods (sterilization, intrauterine device, or hormonal methods). RESULTS The majority of women received prenatal (78%) and postpartum (86%) contraceptive counseling; 72% received both. Compared with those who received no counseling, those counseled during 1 time period (adjusted odds ratio [AOR], 2.10; 95% confidence interval [CI], 1.65–2.67) and both time periods (AOR, 2.33; 95% CI, 1.87–2.89) had significantly increased odds of postpartum use of a more effective contraceptive method (32% vs 49% and 56%, respectively; P for trend < .0001). Results for counseling during both time periods differed by type of health insurance before pregnancy, with greater odds of postpartum use of a more effective method observed for women with no insurance (AOR, 3.51; 95% CI, 2.18–5.66) and Medicaid insurance (AOR, 3.74; 95% CI, 1.98–7.06) than for those with private insurance (AOR, 1.87; 95% CI, 1.44–2.43) before pregnancy. Findings were similar for postpartum use of any contraceptive method, except that no differences by insurance status were detected. CONCLUSION The prevalence of postpartum contraceptive use, including the use of more effective methods, was highest when contraceptive counseling was provided during both prenatal and postpartum time periods. Women with Medicaid or no health insurance before pregnancy benefited the most.

Impact of Contraceptive Counseling in Clinical Settings

“…Additional articles 58–63 meeting the inclusion criteria for this systematic review have been published since our initial search of the literature. Three cross-sectional studies 59,61,63 did not provide details about the contraceptive counseling received by women.…”

“…Three cross-sectional studies 59,61,63 did not provide details about the contraceptive counseling received by women. One cohort study 62 supported the importance of provider–patient interaction, personalized discussions, and addressing psychosocial determinants of contraceptive use behaviors during counseling.…”

Impact of Structured Counseling on Choice of Contraceptive Method Among Postpartum Women

“…Therefore, concerted efforts to educate postpartum women on available contraceptive methods could have a proportionally bigger impact on increasing postpartum contraception usage and reducing maternal and infant mortalities. The prevalence of postpartum contraceptive use, including the use of more effective methods, was highest when contraceptive counseling was provided during both prenatal and postpartum time periods [23]. Hence consideration should be given to counseling at both pre-natal and post-partum time so that there is greater acceptance of contraceptive methods among post-partum women.…”

Prevalence and Predictors of Prenatal and Postpartum Contraceptive Counseling in Two Texas Cities

“…Despite these benefits, postpartum use of highly effective contraception (i.e. intrauterine devices (IUDs) and implants) remains low in the U.S. (White et al, 2015; Zapata et al, 2015). Barriers to postpartum contraceptive use include lack of access to postpartum care, loss of public insurance at 60 days postpartum, lack of availability of IUDs and implants at healthcare practices, lack of clinician knowledge and training, and a lack of contraceptive counseling; both prenatally and postpartum (Biggs, Arons, Turner, & Brindis, 2013; Potter et al, 2014; Zerden et al, 2015).…”

“…Although receipt of prenatal and postpartum contraceptive counseling are independently associated with increased likelihood of postpartum contraceptive use (Hernandez, Sappenfield, Goodman, & Pooler, 2011; Wilson, Fowler, & Koo, 2013; Zapata et al, 2015), prevalence of postpartum contraceptive use is highest when women receive both prenatal and postpartum contraceptive counseling (Zapata et al, 2015). Prenatal counseling is particularly important because women who are not exclusively breastfeeding are at risk for unintended pregnancy as early as 27 days postpartum (Glasier, Logan, & McGlew, 1996; Speroff & Mishell Jr., 2008), and many low-income women lose their emergency (pregnancy) Medicaid at 60 days postpartum making the postpartum visit the last opportunity for contraception.…”