Do women with unintended births use highly effective postpartum contraception? An analysis of data from the National Survey of Family Growth, 2006-2010
Paris, Amy Elizabeth
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OBJECTIVES: Half of all U. S. pregnancies are unintended, and of these, about 6 out of 10 are carried to term. These are known as “unintended births,” and they are at elevated risk for adverse social, economic and health outcomes. The goal of this study was to examine, using the latest data from the National Survey of Family Growth (2006-2010), whether women with unintended births were more likely than their counterparts to use effective postpartum contraception. METHODS: In this retrospective cohort study of U.S. women ages 15-44, all births within three years of the study interview were classified as intended or unintended, and the method and timing of postpartum contraception were ascertained. Our primary outcome was time to initiation of a highly effective postpartum contraceptive method during the first postpartum year. Highly effective contraception was defined as a method with less than one pregnancy per 100 woman-years of typical use. Secondary outcomes included time to initiation of any contraceptive use over the first postpartum year, and postpartum contraceptive non-use. RESULTS: Complete data was available for 2,691 births. Young, black, undereducated, unmarried, and poor women, as well as those who paid for their delivery with Medicaid were more likely than their counterparts to have unintended births (p<0.0001). After adjustment for confounders, women with unintended births were 1.4 (95% CI: 1.2-1.6) times as likely to use highly effective postpartum contraception compared to women with intended births. During the first month postpartum, women with unintended pregnancies were 0.8 times as likely to use no contraceptive method as women with intended births (95% CI 0.7-0.9, p=0.0046); there were no differences between groups for the rest of the first postpartum year. Married women, white women, women with college degrees, and women with who were giving birth for the first time were somewhat more likely than others to initiate effective contraception after an unwanted pregnancy. CONCLUSION: A relatively small difference in time to initiation of highly effective postpartum contraception, along with an almost 1 in 5 prevalence of postpartum contraceptive nonuse for the entire first postpartum year, indicates that women in this study sample are not well-prepared to prevent recurrence of unintended birth. These results add to the body of data supporting effective postpartum contraception as a public health priority.
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