Conference Coverage
Brief educational intervention promotes postpartum LARC use
Major finding: Twenty-three percent of women who received the intervention changed their contraceptive method choice, with 94% of those choosing a...
NEW ORLEANS – A telephone call made at 4 weeks postpartum to reinforce counseling about contraception did not increase the use of highly effective contraception at 6 months, according to findings from a randomized controlled study involving 258 women.
However, the rates of highly effective contraceptive use at 6 months were fairly high, at 71% and 67% in the intervention and control groups, respectively, and the study identified three factors associated with contraceptive use, Dr. Michelle M. Isley reported at the annual meeting of the American College of Obstetricians and Gynecologists.
On multivariate analysis, an intention to use a highly effective contraceptive method at 1-2 days postpartum was positively associated with use of such a contraceptive method at 6 months. A plan to breast-feed for a longer period of time, and a history of miscarriage were each negatively associated with the use of a highly effective contraceptive method at 6 months, said Dr. Isley of Ohio State University, Columbus.
The finding that an intention to use contraception was associated with actual use at 6 months has possible implications for patient counseling, she said. "This suggests that counseling in the prenatal period is valuable."
Dr. Isley noted, however, that 60% of study participants said their provider had talked to them about contraception prior to delivery. "I think we could do better here."
The finding of a negative association between plans to breast-feed for a longer period and use of contraception at 6 months suggests there may be a perception that birth control is not safe to use during breast-feeding. A simple educational intervention about birth control methods that are safe and effective during breast-feeding could be useful in these cases, Dr. Isley said.
Women planning to breast-feed may also be counting on reduced fertility during lactation.
"If women are relying on lactational amenorrhea for their birth control, then I think we ought to provide better, more thorough information about this method so that women can use it more effectively," she said.
As for the findings of a negative association between prior miscarriage and contraceptive use at 6 months postpartum, it is possible that these women believe their fertility is decreased, but more research is needed to clarify this association, she noted.
Study subjects had a mean age of 29 years and were enrolled and randomized at 1-2 days postpartum. Each woman completed a baseline questionnaire on demographic information and contraceptive use intentions. Those randomized to the intervention group received a phone call at 4 weeks postpartum from a study staff member, who readdressed the importance of postpartum contraception, answered basic questions about contraception, and encouraged the woman to attend her postpartum visit.
Contraceptive methods considered to be highly effective in this study were reversible methods including pills, patch, injection, implants, and intrauterine devices. The intervention and control groups did not differ significantly with respect to baseline characteristics.
The results underscore the importance of finding new and inventive ways of providing postpartum contraception, Dr. Isley said.
"As we all are aware, unintended pregnancy is a prevalent public health problem," she said, noting that improving the postpartum use of highly effective contraceptive methods can decrease unintended pregnancy and provide women with a method for controlling the timing of pregnancy.
"More efforts need to be made to figure out how to talk to women about birth control and how to promote these highly effective methods so that ultimately we can decrease mistimed and unintended pregnancies," she said.
Dr. Isley reported having no disclosures.