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Increasing Access to Immediate Postpartum Long-Acting Reversible Contraception on Pregnancy and Contraceptive
Rebecca Tsai1,2, Elijah Wade3, Lue-Yen S Tucker3
1Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Santa Clara Medical Center, Santa Clara, CA, USA.
Introduction:
To evaluate the impact of increasing access to immediate postpartum (IPP) long-acting reversible contraceptions (LARCs) on pregnancy and contraceptive outcomes in patients that desired permanent contraception prior to delivery.
Methods:
This retrospective cohort study compared patients aged > 18 years at gestational age 24 weeks 0 days and above, who desired permanent contraception before and after an organization-wide intervention to increase access to IPP LARCs. The authors collected demographic information, birth control method documented at discharge, LARC usage within 3 months of delivery, LARC type, and unintended pregnancy 1 year after delivery. Patients specified whether their pregnancies were unintended at time of first pregnancy-related care. Patients who obtained permanent contraception during their delivery encounter were excluded. Mann-Whitney and χ2 tests were used to assess group differences.
Results:
The authors reviewed 1607 patient records (846 preintervention; 761 postintervention). The cohorts were similar in age, body mass index, parity, and gestational age at delivery. Out of the 846 preintervention patients, 183 (22%) underwent LARC placement (39 [21%] arm implant; 144 [79%] intrauterine device), and 16 (1.9%) patients had a 1-year interval unintended pregnancy. Out of the 761 postintervention patients, 190 (25%) underwent LARC placement (54 [28%] arm implant; 136 [72%] intrauterine device), and 7 (0.9%) patients had a 1-year interval unintended pregnancy.
Discussion:
With increased access to IPP LARCs, patients who did not obtain desired permanent contraception were more likely to utilize LARCs at 3 months postpartum and less likely to have another pregnancy within 1 year.
Conclusion:
Patients unable to receive requested postpartum permanent contraception appear to benefit from increased access to IPP LARCs.
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