A Novel Approach to Postpartum Contraception Provision Combined with Infant Care: A Randomized, Controlled Trial.
Journal
Women's health issues : official publication of the Jacobs Institute of Women's Health
ISSN: 1878-4321
Titre abrégé: Womens Health Issues
Pays: United States
ID NLM: 9101000
Informations de publication
Date de publication:
Historique:
received:
02
12
2018
revised:
05
11
2019
accepted:
02
12
2019
pubmed:
23
1
2020
medline:
18
8
2020
entrez:
23
1
2020
Statut:
ppublish
Résumé
Unintended pregnancy among women with short interpregnancy intervals remains common. Women's attendance at the 4- to 6-week postpartum visit, when contraception provision often occurs, is low, whereas their attendance at well-baby visits is high. We aimed to evaluate if offering co-located contraceptive services to mothers at well-baby visits increases use of long-acting reversible contraception (LARC) at 5 months postpartum compared with usual care in a randomized, controlled trial. Women with infants aged 4.5 months or younger who were not using a LARC method and had not undergone sterilization were eligible. Generalized linear models were used to estimate risk ratios. Likability and satisfaction of the contraception visit were assessed. Between January 2015 and January 2017, 446 women were randomized. LARC use at 5 months was 19.1% and 20.9% for the intervention and control groups, respectively, and was not significantly different after controlling for weeks postpartum (risk ratio, 0.85; 95% confidence interval, 0.59-1.23). Uptake of the co-located visit was low (17.7%), but the concept was liked; insufficient time to stay for the visit was the biggest barrier to uptake. Women who accepted the visit were more likely to use a LARC method at 5 months compared with women in the control group (risk ratio, 1.97; 95% confidence interval, 1.26-3.07). Women perceived co-located care favorably and LARC use was higher among those who completed a visit; however, uptake was low for reasons including inability to stay after the infant visit. Intervention effects were possibly diluted. Future research should test a version of this intervention designed to overcome barriers that participants reported.
Sections du résumé
BACKGROUND
Unintended pregnancy among women with short interpregnancy intervals remains common. Women's attendance at the 4- to 6-week postpartum visit, when contraception provision often occurs, is low, whereas their attendance at well-baby visits is high. We aimed to evaluate if offering co-located contraceptive services to mothers at well-baby visits increases use of long-acting reversible contraception (LARC) at 5 months postpartum compared with usual care in a randomized, controlled trial.
METHODS
Women with infants aged 4.5 months or younger who were not using a LARC method and had not undergone sterilization were eligible. Generalized linear models were used to estimate risk ratios. Likability and satisfaction of the contraception visit were assessed.
RESULTS
Between January 2015 and January 2017, 446 women were randomized. LARC use at 5 months was 19.1% and 20.9% for the intervention and control groups, respectively, and was not significantly different after controlling for weeks postpartum (risk ratio, 0.85; 95% confidence interval, 0.59-1.23). Uptake of the co-located visit was low (17.7%), but the concept was liked; insufficient time to stay for the visit was the biggest barrier to uptake. Women who accepted the visit were more likely to use a LARC method at 5 months compared with women in the control group (risk ratio, 1.97; 95% confidence interval, 1.26-3.07).
CONCLUSIONS
Women perceived co-located care favorably and LARC use was higher among those who completed a visit; however, uptake was low for reasons including inability to stay after the infant visit. Intervention effects were possibly diluted. Future research should test a version of this intervention designed to overcome barriers that participants reported.
Identifiants
pubmed: 31964564
pii: S1049-3867(19)30511-0
doi: 10.1016/j.whi.2019.12.001
pmc: PMC8696743
mid: NIHMS1550405
pii:
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
83-92Subventions
Organisme : NCRR NIH HHS
ID : UL1 RR029879
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002003
Pays : United States
Informations de copyright
Copyright © 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Références
NCHS Data Brief. 2016 Apr;(240):1-8
pubmed: 27111053
MMWR Morb Mortal Wkly Rep. 2017 Apr 28;66(16):422-426
pubmed: 28448483
Obstet Gynecol. 2015 Jun;125(6):1471-1477
pubmed: 26000519
South Med J. 2009 Mar;102(3):260-4
pubmed: 19204612
Contracept Reprod Med. 2016 Apr 14;1:7
pubmed: 29201396
Int J Epidemiol. 2001 Dec;30(6):1317-22
pubmed: 11821338
J Gen Intern Med. 2015 Aug;30 Suppl 3:S576-85
pubmed: 26105671
J Womens Health (Larchmt). 2016 Apr;25(4):381-90
pubmed: 26579952
Contraception. 2017 Sep;96(3):175-182
pubmed: 28596122
Contraception. 2009 Dec;80(6):512-8
pubmed: 19913144
Contraception. 2013 Jul;88(1):52-7
pubmed: 23158805
J Perinatol. 2012 Jan;32(1):45-50
pubmed: 21546941
J Womens Health (Larchmt). 2005 Dec;14(10):929-35
pubmed: 16372894
Contraception. 2017 Mar;95(3):245-250
pubmed: 27589883
Pediatrics. 2017 Oct;140(4):
pubmed: 28882876
Matern Child Health J. 2016 Nov;20(Suppl 1):144-153
pubmed: 27339649
Obstet Gynecol. 2016 Feb;127(2):289-96
pubmed: 26942356
Contraception. 2017 Apr;95(4):335-338
pubmed: 27913231
Matern Child Health J. 2016 Nov;20(Suppl 1):132-143
pubmed: 27342600
Med Care. 2012 Mar;50(3):217-26
pubmed: 22310560
Matern Child Health J. 2018 Nov;22(11):1624-1631
pubmed: 29931493
Am J Obstet Gynecol. 2017 Jul;217(1):47.e1-47.e7
pubmed: 28263752
Womens Health Issues. 2011 Jul-Aug;21(4):277-85
pubmed: 21565526
Obstet Gynecol. 2017 Jan;129(1):3-9
pubmed: 27926643
BJOG. 2005 Sep;112(9):1315-21
pubmed: 16101614
J Adolesc Health. 2003 Nov;33(5):359-68
pubmed: 14596957
Obstet Gynecol. 2017 Aug;130(2):393-402
pubmed: 28697112
Contraception. 2008 Aug;78(2):90-8
pubmed: 18672108
Matern Child Health J. 2006 Nov;10(6):511-6
pubmed: 16807794