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Postpartum Contraception Usage Among Somali Women in Olmsted County, Minnesota

Cope, Adela G., MD; Mara, Kristin C., MS; Weaver, Amy L., MS; Casey, Petra M., MD

doi: 10.1097/AOG.0000000000003154
Contents: Contraception: Original Research

OBJECTIVE: To compare postpartum contraception use between Somali and non-Somali women.

METHODS: A retrospective cohort study was performed using the Rochester Epidemiology Project. All Somali women aged 18 and older with live singleton births in Olmsted County, Minnesota, in 2009–2015 (n=317) were included, and a group of age-matched non-Somali women (n=317) were identified. Postpartum contraception was defined as the use of any method within 12 months after the first delivery within the study period. Rates of contraception use and types of contraception used were compared between groups using χ2 analysis. Among Somali women, an a priori list of factors was evaluated for associations with postpartum contraception use by including these factors in a multivariable logistic regression model.

RESULTS: After the index birth, 33 Somali women did not present for follow-up, compared with 12 non-Somali women (10.4% vs 3.8%, difference 6.6%, 95% CI 2.3–10.9%). Somali women were less likely to use postpartum contraception than non-Somali women (69.4% vs 92.8%, odds ratio [OR] 0.18, 95% CI 0.11–0.29). Among those using postpartum contraception, both groups had comparable use of long-acting reversible contraception (LARC) (19.9% vs 23.7%, difference −3.8%, 95% CI −11.8% to 4.0%) and non-LARC hormonal contraception (39.3% vs 42.4%, difference −3.1%, 95% CI −12.7% to 6.0%). However, Somali women were more likely to use less reliable methods (40.3% vs 20.8%, difference 19.5%, 95% CI 11.0–28.5%). Among Somali women, contraception use was less likely with older maternal age (OR 0.12 for oldest vs youngest quartile, 95% CI 0.04–0.37) and more likely with prepregnancy contraception use (OR 15.46, 95% CI 5.18–46.18).

CONCLUSION: Somali women were less likely to use postpartum contraception. Similar practices and beliefs may also be present in other immigrant populations. Recognition of sociocultural differences in immigrant populations and potential health care provider biases may improve patient–provider relationships and counseling practices.

In this comparison of contraception use in Somali and non-Somali women in the United States, Somali women were less likely to use postpartum contraception, highlighting opportunities for improvement in counseling practices.

Department of Obstetrics and Gynecology and the Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.

Corresponding author: Adela G. Cope, MD, 200 First Street SW, Rochester, MN 55905; email:

This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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

Presented at the American College of Obstetricians and Gynecologists' Annual Clinical and Scientific Meeting, April 27–29, 2018, Austin, TX.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at

Received September 25, 2018

Received in revised form December 10, 2018

Accepted December 20, 2018

© 2019 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.