Postpartum Contraception and Interpregnancy Intervals Among Adolescent Mothers Accessing Public Services in California

Abstract

Objective To determine the association of age at index birth with postpartum contraceptive use and optimal interpregnancy interval (IPI, defined as delivery to next pregnancy >18 months), controlling for provider type and client demographics among adolescent mothers who have repeat pregnancies. Methods California's 2008 birth records were linked to California's Medi-Cal and Family PACT claims data to identify 26,393 women with repeat births between 2002 and 2008, whose index birth occurred as an adolescent, and who received publicly-funded services within 18 months after the index birth. Multivariable regression analyses were conducted to examine the relationship between timing of contraception provision and interpregnancy intervals, adjusting for socio-demographic factors. Results Seventy-eight percent of adolescent women did not receive contraception at their first postpartum visit, and twenty-eight percent of adolescent women never received contraception from a Family PACT or Medi-Cal provider. Adolescents who were older at their index birth had lower rates of optimal IPIs. Native American, Asian-Pacific Islander and Latina women had lower rates of optimal IPIs compared to white women. Compared to those using only barrier methods, adolescent women receiving highly effective contraceptive methods had a 4.25 times higher odds of having an optimal IPI than those receiving hormonal methods (OR 2.10), or using no method (OR 0.70). Conclusion Effective postpartum contraceptive use and being a Family PACT provider were associated with optimal birth spacing among adolescent mothers, yet racial and ethnic disparities persisted. A missed opportunity was the provision of contraception at the first postpartum visit. Providers should aim to remove barriers to initiation of contraception at this visit.

Quantile regression analysis of language and interpregnancy interval in Quebec, Canada

“…We considered inter vals at the 20 th percentile of the distribu tion as short, and intervals at the 80 th percentile as long, because these cutoff points approached the < 18 months and ≥ 60 months used in traditional analy ses. 4,5,7,9,22 For both short and long inter vals, we obtained the absolute difference in the interpregnancy interval between Anglophones and Francophones in months. We computed 95% CIs for all estimates, and adjusted for maternal education, rural residence, material deprivation, immi grant status, and time period at second delivery.…”

“…[4][5][6][7]9,22,23 The World Health Organization encour ages a minimum interval of 24 months between pregnancies, 9 following evidence that intervals shorter than 18 months, or longer than 60 months, increase the risk of adverse maternal and perinatal out comes. [8][9][10][11][12][13] To calculate the interpregnancy interval, we subtracted the date of deliv ery of the firstborn infant from the con ception date of the secondborn infant.…”

“…We expressed the interpregnancy interval as a continuous variable in months, and for descriptive statistics categorized the interval as short (less than 18 months), optimal (18 to 59 months), or long (60 months or more) following previous literature. 4,5,7,9,22 …”

“…Education is a well established marker of socioeconomic status shown to be associated with inter pregnancy intervals. [4][5][6][7]22 Rurality is a marker of low socioeconomic status also associated with reproductive health, includ ing short interpregnancy intervals. 23,25 Mate rial deprivation is an indicator of area socioeconomic status fre quently used to investigate perinatal health differences.…”

“…Several studies report an association between foreign place of birth and interpregnancy intervals. 6,7,22 We included periods to evaluate trends over time, and limited the analysis to two time periods to make sure there were enough women in each period to enable compari sons. We did not adjust for maternal age in the primary analysis, as women who are older at their first pregnancy cannot have long interpregnancy intervals for physiological reasons.…”