Perceptions and availability of postpartum contraception among women and health care providers following preterm birth

Summary: 
Pregnancy occurring less than six months after delivery puts women at an increased risk of preterm birth and can be prevented through use of contraception after delivery. We aimed to (a) assess factors that influence contraceptive services (counseling and provision) during prenatal, delivery, and postpartum care and (b) the preferences and experiences with contraceptive services of women with a recent preterm birth.

RAP Awardee
Heike Thiel de Bocanegra, PhD | Obstetrics, Gynecology & Reproductive Science | UCSF School of Medicine

Award Cycle: Spring 2016

Background

Pregnancy occurring less than six months after delivery puts women at an increased risk of preterm birth and can be prevented through use of contraception after delivery.

Objective

We aimed to (a) assess factors that influence contraceptive services (counseling and provision) during prenatal, delivery, and postpartum care and (b) the preferences and experiences with contraceptive services of women with a recent preterm birth.

Method

We analyzed aggregate birth data from all 18 maternity facilities in San Francisco, Alameda, and Fresno counties. We conducted qualitative interviews with 27 medical providers and 35 women with a preterm birth.

Results

Medical providers reported the lack of a champion to implement IUD and implant provision at Labor and Delivery, provider preference to discuss contraception at the postpartum visit, and insufficient coordination between providers to communicate women’s contraceptive choice as barriers to effective contraceptive services. In the patient interviews, five themes emerged: (1) timing and frequency of contraceptive counseling; (2) quality of patient-provider interaction; (3) prior experiences with contraception, (4) need to discuss contraception in the context of the preterm birth, age, and future pregnancies and (5) clinic barriers to contraceptive use. 

Conclusion

Postpartum contraceptive counseling needs to integrate discussions of birth spacing and childbearing plans, particularly with women who experience a preterm birth. Gaps in care coordination and provider-patient communication may lead to use of less effective or no contraceptive methods and risk of repeat pregnancies.  Findings inform projects to improve counseling and better access to family planning methods, and advocate for changes at hospitals and outpatient clinics.