Low‐Income Texas Women's Experiences Accessing Their Desired Contraceptive Method at the First Postpartum Visit

Abstract

CONTEXT: Early access to contraception may increase postpartum contraceptive use. However, little is known about women’s experiences receiving their desired method at the first postpartum visit or how access is associated with use. METHODS: In a 2014–2016 prospective cohort study of low-income Texas women, data were collected from 685 individuals who desired a reversible contraceptive and discussed contraception with a provider at their first postpartum visit, usually within six weeks of birth. Women’s experiences were captured using open- and close-ended survey questions. Thematic and multivariate logistic regression analyses were employed to examine contraceptive access and barriers, and method use at three months postpartum. RESULTS: Twenty-three percent of women received their desired method at the first postpartum visit; 11% a prescription for their desired pill, patch or ring; 8% a method (or prescription) other than that desired; and 58% no method. Among women who did not receive their desired method, 44% reported clinic-level barriers (e.g., method unavailability or no same-day provision), 26% provider-level barriers (e.g., inaccurate contraceptive counseling) and 23% cost barriers. Women who used private practices were more likely than those who used public clinics to report availability and cost barriers (odds ratios, 6.4 and 2.7, respectively). Forty-one percent of women who did not receive their desired method, compared with 86% of those who did, were using that method at three months postpartum. CONCLUSION: Ameliorating the various barriers that postpartum women face may improve their access to contraceptives. Further research is needed to improve the understanding of clinic- and provider-level barriers.

Short-acting hormonal contraceptive continuation among low-income postpartum women in Texas

“…This study adds to a body of evidence suggesting that the quality of contraceptive counseling and method provision during the postpartum period fails to meet the needs and preferences of low-income women in Texas [ 11 , 12 , 16 , 17 ], and it highlights missed opportunities to provide access to the full range of contraceptive methods through policy and practice.…”

“…Antenatal and postpartum visits are opportunities to engage preferences, provide guidance on side effects and equip women with the method of contraception that best suits their needs. However, few Texas women receive high-quality postpartum contraceptive counseling or are able to obtain their desired method, which is often LARC, during their postpartum visit [ 16 , 17 ]. Lack of procedural training is a barrier to postpartum LARC provision [ 19 ], and health professionals with less comfort with LARC are less likely to discuss and provide all available methods [ [19] , [20] , [21] , [22] ].…”

Contraindications to Hormonal Contraception Among Postpartum Women in Texas

“…Prenatal contraceptive counseling is also important because low-income patients who lose health insurance before their postpartum visit 18 may choose to begin contraception immediately after delivery if they are aware of contraindications before delivery. But people should not have to modify their preferred timing of contraceptive initiation due to health insurance limitations.…”

Decisional conflict associated with clinicians discouraging particular contraceptive methods

“…[10][11][12][13][14] In instances where clinicians discouraged individuals from using a particular method due to perceived medical contraindications, those recommendations are based on outdated or inaccurate information approximately one-third of the time. 15 One way to promote clinician awareness of individuals' contraceptive preferences is to engage in shared decision making during contraceptive counselling. 16,17 Shared decision making increases patient participation in decisions when there are multiple medically appropriate options, as in the case of selecting a contraceptive method.…”

“…In addition, some clinicians do not engage in contraceptive counselling consistent with the current evidence base 10–14 . In instances where clinicians discouraged individuals from using a particular method due to perceived medical contraindications, those recommendations are based on outdated or inaccurate information approximately one‐third of the time 15 …”