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Barriers to Postpartum Contraception in Texas and Pregnancy Within 2 Years of Delivery

Potter, Joseph E. PhD; Hubert, Celia PhD; Stevenson, Amanda Jean MA; Hopkins, Kristine PhD; Aiken, Abigail R. A. MD, MPH, PhD; White, Kari PhD, MPH; Grossman, Daniel MD

doi: 10.1097/AOG.0000000000001201
Contents: Original Research

OBJECTIVE: To assess pregnancies that could have been averted through improved access to contraceptive methods in the 2 years after delivery.

METHODS: In this cohort study, we interviewed 403 postpartum women in a hospital in Austin, Texas, who wanted to delay childbearing for at least 2 years. Follow-up interviews were completed at 3, 6, 9, 12, 18, and 24 months after delivery; retention at 24 months was 83%. At each interview, participants reported their pregnancy status and contraceptive method. At the 3- and 6-month interviews, participants were also asked about their preferred contraceptive method 3 months in the future. We identified types of barriers among women unable to access their preferred method and used Cox models to analyze the risk of pregnancy from 6 to 24 months after delivery.

RESULTS: Among women interviewed 6 months postpartum (n=377), two thirds had experienced a barrier to accessing their preferred method of contraception. By 24 months postpartum, 89 women had reported a pregnancy; 71 were unintended. Between 6 and 24 months postpartum, 77 of 377 women became pregnant (20.4%), with 56 (14.9%) lost to follow-up. Women who encountered a barrier to obtaining their preferred method were more likely to become pregnant less than 24 months after delivery. They had a cumulative risk of pregnancy of 34% (95% confidence interval [CI] 0.25–0.43) as compared with 12% (95% CI 0.05–0.18) for women with no barrier. All but three of the women reporting an unintended pregnancy had earlier expressed interest in using long-acting reversible contraception or a permanent method.

CONCLUSION: In this study, most unintended pregnancies less than 24 months after delivery could have been prevented or postponed had women been able to access their desired long-acting and permanent methods.

Most unintended pregnancies in the 2 years after delivery could be prevented or postponed if women had access to their preferred contraceptive method.

Population Research Center, University of Texas at Austin, Austin, Texas; National Institute of Public Health of Mexico, Mexico, DF; Office of Population Research, Princeton University, Princeton, New Jersey; Health Care Organization & Policy, University of Alabama at Birmingham, Birmingham, Alabama; and Ibis Reproductive Health and ANSIRH, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California.

Corresponding author: Joseph E. Potter, PhD, Population Research Center, University of Texas at Austin, 305 East 23rd Street, Stop G1800, Austin, TX 78712-1699; e-mail:

Supported by grants from the Susan T. Buffett Foundation and the Society of Family Planning (SFPRF7-4). Infrastructural support was provided by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD042849) to the Population Research Center, University of Texas at Austin, and (R24HD047879) to the Office of Population Research, Princeton University. Dr. White also received support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K01HD079563).

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the North American Forum on Family Planning, October 10–14, 2014, Miami, Florida, and at the Annual Meeting of the Population Association of America, April 30–May 2, 2015, San Diego, California.

The authors thank Chloe Dillaway and Natasha Mevs-Korff for superb research assistance.

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.