What do Women Want? Experiences of Low-Income Women with Postpartum Contraception and Contraceptive Counseling

Abstract

BackgroundContraceptive counseling can increase postpartum contraception use, yet the optimal method and timing for counseling are unknown. The objective was to investigate preferences of underserved pregnant and postpartum women regarding contraception use and counseling.MethodSurveys regarding contraception experiences and perceptions of contraceptive counseling were conducted with 57 women age 18 and older who were postpartum or antepartum with a previous delivery within 5 years and receiving Medicaid-funded care at an academic medical center. Health literacy was assessed using REALM-7. Responses were analyzed using descriptive statistics.ResultsA majority of women reported unplanned pregnancies (78%). Women using contraception at the time of conception reported “not sure” (30%) and “taken wrong” (30%) as primary reasons for failure. Most subjects had at least a high school level of health literacy (88%), desired to use a postpartum contraceptive method (92%) and had a high self-reported understanding of that method (94%). Most women reported receiving counseling (91%) and stated that the best time for counseling was both before and after childbirth (84%). However, only 60% of subjects intended to use the method they were prescribed at discharge; reasons for changing included side effects (37%), desire for different contraception (23%) and too complicated of a method prescribed (17%).ConclusionWomen perceived the best timing of contraceptive education to be both antepartum and postpartum. Despite a high frequency of prior contraceptive failure, self-reported understanding of the chosen postpartum contraceptive method was high. Contraception counseling should be tailored to a woman’s perceived needs, with such education occurring frequently and within the context of her health literacy.

Client Preferences for Contraceptive Counseling: A Systematic Review

“…38 Female clients or potential clients of family planning services were the population for all studies, with nine studies assessing preferences of adolescent clients specifically. 18,20,21,23,24,27,29,36,37 Other studies focused on women seeking prenatal and postpartum care, 16,17,30 Latina immigrant women, 19 young women who had experienced pregnancy,” 56 college students, 21 homeless women, 35 women seeking abortion/ 8,31 and women or adolescents seeking emergency care. 20,29,38 Four studies sought to assess differences in preferences between Latina, black, and white participants.…”

“…Sixteen articles (from 15 studies) indicated client preference for receipt of detailed information about contraceptive methods. 3,7,16–20,22–25,27,30,32,33,35 Eight studies (from nine articles) emphasized the importance to clients of personalized contraceptive information that met their individual needs and preferences. 7,16–18,20,22,25,27,32 Studies reported on varied client priorities for contraceptive information.…”

“…Twelve studies included results on client preferences for modes of communication for contraceptive information. 3,16–18,20,22,23,25,27,29,30,35,38 In eight qualitative and mixed-methods studies, participants expressed wanting to receive written information to complement verbal information from providers. 3,16–18,20,22,25,27,35…”

“…In two interview studies, participants described preference for seeing written materials during their visit. 25,30 In Dasari and colleagues, 35 participants liked receiving written materials to take with them after visits. Participants in four qualitative studies liked to access information from web sources that could complement counseling.…”

“…Three studies focused on preferences for the timing of counseling in relation to other reproductive health care. 16,28,30 In the study by Yee et al 30 of women who had received prenatal and postpartum care, 84% of participants reported a preference for contraceptive counseling both before and after delivery. Participants in a similar population indicated in interviews that they preferred provider-initiated counseling throughout the prenatal period, to give clients multiple opportunities to make a decision and “plan ahead.” 16 In the survey study by Matulich and colleagues 28 with abortion clients in Northern California, 64% did not want to talk about contraception on the day of their abortion procedure, with about half reporting this was because they already knew what method they wanted to use.…”