Patterns of postpartum contraceptive use among Somali immigrant women living in Minnesota

Abstract

BackgroundThe postpartum period is a crucial time to provide family planning counseling and can decrease incidence of adverse reproductive outcomes. The purpose of this study was to characterize patterns of postpartum contraception and to investigate long acting reversible contraceptive (LARC) use among Somali women living in a metropolitan area of Minnesota in an effort to provide better family planning and reproductive health counseling in this growing immigrant population.MethodsA retrospective chart review was conducted of Somali women who delivered between January 1, 2011 and December 31, 2014. Information was collected regarding family planning counseling provided and contraceptive methods chosen at the postpartum clinic visit.ResultsOf the 747 Somali women who delivered during this time period, 56.4% had no postpartum follow up visit. At the postpartum visit, 88.3% of women received family planning counseling and 80.8% chose a contraceptive method with the remainder declining. The intrauterine device (IUD) was the most popular contraceptive method, chosen by 39.7% of women. Other than parity, no statistically significant differences were observed between women who chose LARC versus other contraceptive methods. Of the women that chose a LARC, 39.4% had it placed at the time of their postpartum visit; immediate placement was statistically significantly more likely with more recent delivery, lower BMI and obstetrician as the provider type.ConclusionsThe IUD was the most popular method of postpartum contraception. There was a trend toward increase in LARC use with increasing parity. Same-day LARC placement was uncommon, but should be encouraged in this population given high loss to follow up rate.

Family Planning Research in African Immigrant and Refugee Women: A Scoping Review

“…Language. Retrieved articles identified language barrier are one of the most significant hindrances to access to prenatal care for African refugee women in the United States, also leading to improper or passive care (Agbemenu et al, 2020;Agbemenu, Volpe, & Dyer, 2018;Banke-Thomas et al, 2019;Gurnah et al, 2011;Millar et al, 2017). A study by Banke-Thomas et al (2019) examined perceived barriers to health care access that may exist for Somali women prior to interacting with U.S. health professionals, and found language barriers factored heavily into Somali refugees' willingness to seek maternal and reproductive care.…”

Decision Making and Communication About Child Spacing Among Somali Couples in Minnesota

“…Several had experienced very short birth intervals, which highlights the need for child‐spacing education before or early in marriage and during the postpartum period to help prevent mistimed births. A Minnesota study found that Somali women were largely receptive to initiating contraception at a postpartum visit . In addition, it is possible that participants who reported that they or their spouse had experienced closely spaced births had them prior to arriving in the United States, especially because every individual who mentioned this phenomenon had arrived in the United States as an adult.…”

“…10,12,14,15 And according to a study conducted in Minnesota, Somalia-born women were generally receptive to contraceptives, most often the copper IUD, when counseled and off ered a method during a postpartum follow-up visit. 16 There is some evidence that the general contraceptive beliefs and practices of people in high-income countries receiving Somalis may infl uence Somalia-born couples' willingness to discuss contraception. For example, in Finland, where Somalis are one of the largest foreign nationality groups, 17 all Somali women participating in a informed consent was obtained, and participants received a $40 gift card.…”

“…A Minnesota study found that Somali women were largely receptive to initiating contraception at a postpartum visit. 16 In addition, it is possible that participants who reported that they or their spouse had experienced closely spaced births had them prior to arriving in the United States, especially because every individual who mentioned this phenomenon had arrived in the United States as an adult. Asking newly arrived Somali immigrants and refugees about their birth history at an initial health assessment could be an eff ective introduction to providing child-spacing information and resources.…”

“…In the few studies about contraception conducted with Somali immigrants and refugees, participants have cited economic hardship; loss of extensive social support networks; and time needed to learn English, balance multiple jobs or go to school as reasons to have smaller families . And according to a study conducted in Minnesota, Somalia‐born women were generally receptive to contraceptives, most often the copper IUD, when counseled and offered a method during a postpartum follow‐up visit …”