Spheres of influence on contraceptive decision-making: qualitative interviews with postpartum mothers and providers

Biological and behavioral factors influence interpregnancy intervals. Individualized family planning goals and preferences regarding contraception must be supported through shared decision-making approaches. Contraceptive counseling throughout the perinatal period is multifaceted whereby intersecting health-related choices including breastfeeding are co-occurring. This study explores multi-level factors influencing postpartum contraceptive decision-making among women and perinatal care providers in a rural region of the Southeast United States.

The qualitative study triangulated perspectives of postpartum mothers (n=16) and perinatal care providers (n=8). Perinatal care providers included a range of professionals including midwives, lactation consultants, and doulas. Interviews were conducted via phone, audio recorded, and transcribed. An inductive content analysis was applied to coding and analysis.

Participants from both groups discussed the importance of knowledge about contraceptive method options, including safe methods for while breastfeeding. Although, perceptions about the impact of contraception on milk supply varied among both mothers and providers. Mothers and providers elevated the importance of provider support for individualized decisions given personal preferences and family planning goals. Multiple points of access to contraception were noted, including in-hospital provision, which can facilitate access. Providers emphasized the influence of complex social risk factors such as limited financial resources and challenges with access to housing, food, and transportation.

Postpartum contraceptive decision-making is an ongoing process based on individualized preferences. Mothers can be supported, in part, through providers acknowledging social, economic, and historical forces impacting decision-making. Future research to investigate the role of interdisciplinary care teams to enhance perinatal healthcare service provision is warranted.