Contraceptive Counseling Quality and Postpartum Contraceptive Method Satisfaction: A Multi-Institutional...

High-quality contraceptive counseling has been associated with increased contraceptive method satisfaction. We aimed to assess this relationship in the postpartum period and to investigate practical aspects of counseling underlying this association.

We used data from 219 pregnant individuals aged 21-44 years contemplating tubal sterilization who were recruited to a randomized trial assessing the efficacy of the MyDecision/MiDecisión decision aid. Three months postpartum, participants rated their satisfaction with their chosen contraceptive method and their perception of contraceptive counseling encounter quality on Likert scales. Counseling quality domains included provider demonstration of respect, explanation of methods, pressure toward a method, and response to questions, as well as subjective counseling satisfaction. We used logistic regression analyses to assess the relationship between optimal counseling (both overall and in each domain) and optimal contraceptive method satisfaction, adjusting for randomization arm and demographic covariates significant in bivariate analysis.

Participants had a mean (SD) age of 30 (5) years; 42% identified as non-Hispanic White, 25% as non-Hispanic Black, and 26% as Hispanic. Approximately one-third of participants (37%) had a tubal sterilization by study follow-up; 11% reported using no method of contraception. Many participants reported optimal contraceptive counseling (61%) and optimal method satisfaction (65%). Optimal counseling was associated with higher odds of optimal method satisfaction (aOR 1.88, 95% CI 1.03-3.46, p = 0.04). This relationship was sustained across all individual counseling quality domains.

Patient-perceived provider demonstration of respect, discussion of contraceptive pros and cons, avoidance of pressure, and answering questions were associated with postpartum contraceptive method satisfaction.