Social-ecological factors shaping women's postpartum permanent contraception decision-making: Qualitative insights from a multi-site study

BackgroundThe clinician-patient relationship is known to impact contraceptive care utilization, but less studied is how factors external to the clinician-patient relationship, such as prior experiences seeking reproductive healthcare or family dynamics and social networks, matter to patients' postpartum contraceptive decision-making.ObjectiveOur objective was to examine factors external to current patient-provider relationships that contribute to women's decision-making surrounding postpartum permanent contraception (PC).DesignThis was a qualitative study at four U.S. healthcare systems with 75 postpartum women who had a documented plan for PC.MethodsWe conducted semi-structured interviews between March 2022 and June 2023. We employed a modified grounded theory approach to codebook thematic analysis.ResultsPatients described experiences across four key domains: individual, family, social networking, and policy ecologies. Individual-level influences included prior experiences with clinicians, health concerns, miscarriage experiences, future life goals, and apprehension toward medical procedures. Family-level influences centered on maintaining family wellbeing and accommodating partner preferences. Social networks shaped decisions through information and experiences shared by relatives, friends, community members, and social media. Policy-level influences included concerns regarding abortion access and parental leave policies.ConclusionWomen's decisions regarding postpartum permanent contraception are shaped by a complex interplay of personal experiences, family priorities, social networks, and policy contexts. Contraceptive counseling that acknowledges these influences may better support reproductive autonomy, address misinformation, and facilitate patient-centered decision-making.