Postpartum Urogynecologic Care: Do Sociodemographic Factors Impact Attendance?

Perineal lacerations can lead to incontinence, sexual dysfunction, and persistent pain if inadequately treated. Subspecialty, urogynecology-run peripartum clinics tailored for patients with these lacerations have grown in prevalence. However, factors associated with follow-up care are poorly understood.

The objective of this study was to identify sociodemographic and clinical factors associated with nonattendance to a urogynecology-led postpartum clinic.

This retrospective cohort study included patients who received a referral to this clinic within 1 year postpartum between October 1, 2020 and August 30, 2024. Eligibility criteria included age at least 18 years. Demographic and obstetric data were abstracted from the medical record. Associations with clinic attendance within 6 months of referral placement were assessed using t tests and Fisher exact tests, followed by log-binomial regression with inverse probability of treatment weighting to adjust for confounders.

Of 412 referrals, 390 (94.7%) were eligible, and 292 (74.9%) attended a visit. Patients were primarily English-speaking (87.9%), employed (69.7%), White (55.6%), and with private insurance (74.4%). Living in a zip code with a lower median income, lower education level, and Medicaid insurance or self-pay were associated with clinic nonattendance (P=0.007, P<0.001, and P<0.001, respectively). Identifying as Hispanic, not White, or Asian, and not speaking English as a primary language were associated with nonattendance (P=0.039, P<0.001, and P<0.001, respectively). After adjusting for confounders, patients with private insurance were not significantly more likely to attend the clinic compared with those without private insurance.

Uninsured status, unemployment, and non-English speaking patients are associated with nonattendance to this postpartum subspecialty clinic; it is imperative to bridge this care gap.