Exploring Postpartum Use of Advance Provision of Ulipristal Acetate and Its Promotion of Reproductive Autonomy

To assess use of advance provision of ulipristal acetate and to explore user perspectives on emergency contraception and reproductive autonomy.

In this prospective observational study, participants choosing no contraception or lower-efficacy contraception (barrier, withdrawal, or fertility awareness method) were recruited postpartum and received ulipristal acetate before hospital discharge. Surveys were completed at baseline and 6 weeks, 3 months, and 6 months postpartum. Univariate logistic regression models examined the association between ulipristal acetate use and participant demographics. Interviews were conducted at 6 weeks with early ulipristal acetate users and at 6 months with all participants, exploring topics around contraception and reproductive autonomy. Reflexivity and memo writing enhanced data collection. Interviews were inductively coded in NVivo 12 and analyzed with reflexive thematic analysis.

Seventy-five participants were recruited. Of these participants, 12 (16%) reported using ulipristal acetate during the study period, with a mean±SD of 2.6±2.4 ulipristal acetate uses. Those who identified as Latinx had 5.30 greater odds of using ulipristal acetate (95% CI, 1.41-20.5, P=.014). Participants with lower income (<$100,000) had higher odds of using ulipristal acetate (odds ratio 8.40, 95% CI, 1.37-163, P=.019). Semistructured interviews (n=19) revealed strong approval of advance provision of ulipristal acetate. Participants endorsed improved access, ease and confidence in use, and greater control over their reproductive decision making. This was especially relevant for those with prior negative experiences with contraception or unwanted or coercive counseling from providers.

Postpartum patients choosing lower-efficacy contraception valued advance provision of ulipristal acetate and reflected on ulipristal acetate as a user-controlled option, bolstering reproductive autonomy. Advance provision of ulipristal acetate can be a useful intervention to increase contraceptive access for postpartum patients before discharge.