Correlates of early postpartum contraceptive use
ESC Congress Library. Hellerstedt W. May 28, 2014; 50617; A-202 Disclosure(s): None
Dr. Wendy Hellerstedt
Dr. Wendy Hellerstedt
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Objectives: The postpartum period presents a time of risk for unwanted conception because contraceptive use may be inconsistent or delayed. Short pregnancy intervals are associated with social vulnerability and with maternal and offspring health risks. We identified correlates of contraceptive use in women at 2 to 4 months postpartum.

Method: Data were from 7,392 adult respondents of Minnesota's 2004-2008 Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Respondents were randomly selected from their infants’ Minnesota birth certificate at 2-4 months’ postpartum.  Postpartum contraceptive was assessed by a question about whether the respondent (or partner) was doing anything to prevent pregnancy at the time of the survey.  The variables in multivariable logistic regression analyses included pre-conception contraception; sociodemographics; pregnancy health, health care, and substance use; pre-conception stressors; infant size for gestation; and postpartum depressive symptoms.  Because breastfeeding may be associated with contraceptive use (or interpreted as contraception), we also conducted stratified analyses by breastfeeding duration (more than one week and one week or less).

Results: Eighty-seven percent of the respondents reported doing something to prevent pregnancy postpartum and 21% reported they were doing something to prevent pregnancy when they became pregnant. Associations between postpartum contraceptive use and its correlates were similar in combined and in breastfeeding-stratified models:  pre-pregnancy contraceptive use, prenatal contraceptive counseling, and having had a postpartum well-woman visit were positively associated while having other/no source of income versus wages and having experienced intimate partner violence prior to pregnancy were negatively associated. For women who did not breastfeed, the number of stressors experienced in the 12 months before their infants’ birth was positively associated with not using postpartum contraception (p = .01 for trend). For those who breastfed, parity of 2+ compared to none prior to this pregnancy was negatively associated (adjusted odds ratio 0.76; 95% confidence interval, 0.6,0.9)

Conclusions: Eighty-seven percent of PRAMS respondents reported postpartum contraceptive use, but the survey data were insufficient to determine how women defined contraceptive use, when they began use, type(s) of contraceptives they used, and how efficiently and consistently they used them.  Despite limitations, our data showed that pre-pregnancy contraceptive use and prenatal contraceptive counseling were positively associated with postpartum contraceptive use. Postpartum contraceptive use was also associated with having had a postpartum maternal health care visit, suggesting the need for both prenatal and postpartum contraceptive counseling to reduce their risk for rapid repeat pregnancy.
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