Providing Inpatient Contraception Care Within a Reproductive Justice Framework

Abstract

is the fundamental human right to exercise personal autonomy over one's body, to make decisions about having or not having children, and to raise children in communities that are safe. 1 The American College of Nurse Midwives' (ACNM) position statement on comprehensive sexual and reproductive health care services supports the reproductive justice framework and acknowledges it as an essential foundation for comprehensive contraceptive care. 2 Access to comprehensive contraception options are especially important considering that approximately 45% of all pregnancies in the United States are unintended or mistimed. 3 Evidence has shown that short-interval pregnancies are associated with complications such as preterm birth and adverse neonatal outcomes. 3 In addition, laws restricting access to abortion further underscore this fundamental need. 4 The American College of Obstetrics and Gynecology (ACOG) recommends completing contraceptive counseling early in prenatal care to allow time for the individual to determine the appropriate fit for themselves and their family. 3 However, barriers to prenatal care may pose limitations for some individuals. According to the most recent statistics from ACOG, 40% of women do not return for postpartum care. 5 These statistics hamper the efficiency of outpatient prenatal and postpartum contraceptive counseling and impede equity in providing contraceptive care to those who may need it most. 3 Because of these issues, the provision of contraception services as part of inpatient care has become a more widespread practice.Ethical concerns, however, have arisen regarding how this has been implemented and to whom this care is provided. A recent study found that inpatient contraceptive counseling for individuals with similar risk factors was not universal. 6 Young Black non-Hispanic and multiparous individuals were more likely to have inpatient contraception counseling documented. In addition, women with public insurance were also 64.7% more likely to have documented counseling compared with those with private insurance, and 46.2% were