Contraception After Delivery Among Publicly Insured Women in Texas (original) (raw)

Objective-To assess women's preferences for contraception after delivery, and to compare use with preferences. Methods-In a prospective cohort study of women aged 18-44 years who wanted to delay childbearing for at least 2 years, we interviewed 1,700 participants from eight hospitals in Texas immediately postpartum and at 3 and 6 months after delivery. At 3 months, we assessed contraceptive preferences by asking what method women would like to be using at 6 months. We modeled preference for highly effective contraception and use given preference according to childbearing intentions using mixed-effects logistic regression, testing for variability across hospitals and differences between those with and without immediate postpartum long-acting reversible contraception (LARC) provision. Results-Approximately 80% completed both the 3 and 6-month interviews (1367/1700). Overall, preferences exceeded use for both LARC: 40.8% [n=547] vs. 21.9% [n=293] and sterilization: 36.1% [n=484] vs. 17.5% [n=235]. In the mixed-effects logistic regression models, several demographic variables were associated with a preference for LARC among women who wanted more children, but there was no significant variability across hospitals. For women who wanted more children and had a LARC preference, use of LARC was higher in the hospital that offered immediate postpartum provision (p<0.035), as it was for US-born women (OR 2.08, 95% CI 1.17-3.69) and women with public prenatal care providers (OR 2.04, 95% CI 1.13-3.69). In the models for those who wanted no more children, there was no significant variability in preferences