Unintended pregnancy and postpartum contraceptive use in women with and without chronic medical disease who experienced a live birth

Background

Maternal chronic medical disease and unintended pregnancies increase the risk of maternal and infant morbidity and mortality. Little is known regarding the relationship between chronic medical disease status and pregnancy intendedness or contraceptive use.

Study Design

We compared pregnancy intention and postpartum contraception use in women with and without chronic medical disease who experienced a live birth using data from the Florida Pregnancy Risk Assessment Monitoring System 2004–2005.

Results

Women aged ≥20 years with chronic medical disease were more likely to report that the index pregnancy was unintended (odds ratio [OR]=1.56, 95% confidence interval [CI] 1.28–2.03) and reported similar postpartum contraception nonuse (OR=0.85, 95% CI 0.60–1.19) compared to those without chronic medical disease. Women aged <20 years with chronic medical disease were less likely to report that the index pregnancy was unintended (OR=0.50, 95% CI 0.28–0.88) and reported similar postpartum contraception nonuse (OR=0.99, 95% CI 0.54–1.82) compared to those without chronic medical disease.

Conclusions

In our study population, age and chronic medical disease were associated with different risks of pregnancy intention in the index pregnancy. Women with and without chronic disease in both age groups reported similar postpartum contraception use.     

Medicaid and receipt of interval postpartum long-acting reversible contraception

Objective

We sought to evaluate the impact of insurance type on receipt of an interval postpartum LARC, controlling for demographic and clinical factors.

长效可逆避孕方法在产后避孕中的重要价值

<正>我国的非意愿妊娠人工流产率呈逐年增高趋势,而已生育妇女在人工流产总数中占到50. 3%[1]。产后是女性的特殊生理时期,多数女性认为哺乳、闭经可以起到暂时避孕的效果,部分女性因担心避孕对泌乳及胎儿生长发育造成不良影响,而忽略或停止这一时期的避孕,导致产后1年内的人工流产率较育龄期女性平均水平高。此外,产后女性恢复排卵时间因是否母乳喂养而有差异。对于不完全母乳喂养的女性,平均恢复排卵的     

Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors

Background

This study was conducted to determine the relationship between unintended pregnancy and maternal behaviors before, during and after pregnancy.

Study Design

Data were analyzed from a stratified random sample of 9048 mothers who delivered live born infants between 2001 and 2006 and completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey 2 to 9 months after delivery. Binary and ordinal logistic regression methods with appropriate survey weights were used to control for socio-demographic factors.

Results

Compared to women with intended pregnancies, mothers with unwanted pregnancies were more likely to consume less than the recommended amount of preconception folic acid [adjusted odds ratio (OR) 2.39, 95% confidence interval (CI) 1.7-3.2], smoke prenatally (OR 2.03, 95% CI 1.5-2.9), smoke postpartum (OR 1.86, 95% CI 1.35-2.55) and report postpartum depression (OR 1.98, 95% CI 1.48-2.64); they were less likely to initiate prenatal care during the first trimester (OR 0.34, 95% CI 0.3-0.5) and breastfeed for 8 or more weeks (OR 0.74, 95% CI 0.57-0.97). Compared to women with intended pregnancies, women with mistimed pregnancies were also more likely to consume inadequate folic acid, delay prenatal care and report postpartum depression.

Conclusion

Even after controlling for multiple socio-demographic factors, unwanted and mistimed pregnancies were associated with unhealthy perinatal behaviors.     

Prenatal intent and postpartum receipt of long-acting reversible contraception among women receiving medication-assisted treatment for opioid use disorder

Background

Many women with opioid use disorder (OUD) do not use highly effective postpartum contraception such as long-acting reversible contraception (LARC). We evaluated factors associated with prenatal intent and postpartum receipt of LARC among women receiving medication-assisted treatment (MAT) for OUD.

Fertility and contraceptive use among young adults in Harare, Zimbabwe

In 1986, a survey of young adults aged 14-24 in Harare, Zimbabwe obtained information about their knowledge, attitudes, and sexual behavior. Most adolescent childbearing took place within marriage, although sexual intercourse was generally initiated before marriage. Knowledge of family planning was high, but contraceptive use lagged behind knowledge. Fewer than half of the respondents had talked to an elder about family planning, sex, or pregnancy. Fourteen percent of young women who were unmarried at the time of first intercourse used contraceptives, compared to 18 percent of young unmarried men. Current contraceptive use among sexually active unmarried youths was 36 percent among women and 29 percent among men. One consequence of low contraceptive use was a high number of unwanted premarital pregnancies. Twenty-nine percent of the women had been pregnant; those not married at the time they got pregnant generally got married soon after. Of the girls who got pregnant while in school, 90 percent had to drop out of school. A second consequence of low contraceptive use is an increased risk of transmission of STDs and AIDS among the youth of Harare.     

Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project

Background

Adolescent women have a high risk of unintended pregnancy. Currently, there are little data about their choice to initiate long-acting reversible contraception (LARC).

Study Design

We evaluated the association of age and preference for a LARC vs. a non-LARC method among adolescent participants in the Contraceptive CHOICE Project, comparing those aged 14–17 years to adolescents aged 18–20 years. We then analyzed the association between age and choice of the implant vs. the intrauterine device (IUD) among adolescents.

Results

Of the 5086 women enrolled, 70% (n=3557) of participants chose a LARC method. Among adolescents aged 14–20 years, 69% of 14–17-year-olds chose LARC, while 61% of 18–20-year-olds chose LARC (relative risk 1.16, 95% confidence interval 1.03–1.30). Among adolescents choosing a LARC method, 63% (n=93/148) of the 14–17-year-olds chose the implant, whereas 71% (n=364/510) of the 18–20-year-olds chose the IUD.

Conclusion

Long-acting reversible contraception use is clearly acceptable and common among adolescents enrolled in the Contraceptive CHOICE Project, with the younger group being most interested in the implant.     

Short and long-term impact of adolescent pregnancy on postpartum contraceptive use: implications for prevention of repeat pregnancy.

PURPOSE: To describe patterns and changes in contraceptive use among pregnant adolescents in early and later postpartum compared with nonpregnant adolescents. METHODS: One-hundred-seventy-six pregnant and 187 nonpregnant adolescents, recruited through community clinics, were interviewed three times (baseline, 6-month follow-up, 12-month follow-up) about their condom and hormonal contraceptive practices. Changes in contraception use and patterns of consistent hormonal and/or condom use were examined. Statistical analyses included General Estimating Equations (GEE) and multinomial regression. RESULTS: Pregnant adolescents increased hormonal contraceptive use from baseline to early postpartum, but decreased use from early postpartum to late postpartum. Nonpregnant adolescents did not change their hormonal contraceptive use over time. Neither group changed condom use over time. Pregnant adolescents were more likely to be consistent dual users and hormonal-only users during the 6-month follow-up compared with nonpregnant adolescents. These findings persisted at the 12-month follow-up, although there was a decline in hormonal contraception use. CONCLUSIONS: Adolescents change their contraceptive use during the postpartum period. Given the slight decline in contraceptive use in late postpartum in this sample, more work is necessary to maintain motivation to continue these positive postpartum trends.     

Unintended pregnancy and women's use of prenatal care in Ecuador

This paper assesses the relationship between unintended pregnancy--both unwanted and mistimed and several dimensions of use of prenatal care among women in Ecuador, where the level of unintended pregnancy has risen considerably in recent years. Data were collected from a nationally representative sample of 3988 women interviewed in the 1994 Demographic and Maternal-Child Health Survey. Multivariate logistic regression was used to assess jointly the effect of pregnancy intention status (unwanted, mistimed, planned) on three aspects of prenatal care use while controlling for potential confounders. Women with unwanted pregnancies were 32% less likely than women with planned pregnancies to seek out prenatal care. Women with unwanted pregnancies were also 25% less likely to initiate care in the first trimester and 29% less likely to receive at least an adequate number of visits. Mistimed pregnancy was not associated with receiving care, timely initiation of care or receiving an adequate number of visits.     

Changes in the use of effective and long-acting reversible contraception in Vietnam

Objectives

To calculate the prevalence and identify correlates of unmet need for contraception and to assess whether prevalence of use of effective contraception and long-acting reversible contraception (LARC) has changed over time among married or cohabiting, reproductive-age women in Vietnam.

Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception

BackgroundThis study evaluated the total costs of unintended pregnancy (UP) in the United States (US) from a third-party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure.Study DesignAn economic model was constructed to estimate direct costs of UP as well as the proportion of UP costs that could be attributed to imperfect contraceptive adherence. The model considered all women requiring reversible contraception in the US: the pattern of contraceptive use and the rates of UP were derived from published sources. The costs of UP in the United States and the proportion of total cost that might be avoided by improved adherence through increased use of LARC were estimated.ResultsAnnual medical costs of UP in the United States were estimated to be $4.6 billion, and 53% of these were attributed to imperfect contraceptive adherence. If 10% of women aged 20–29 years switched from oral contraception to LARC, total costs would be reduced by $288 million per year.ConclusionsImperfect contraceptive adherence leads to substantial UP and high, avoidable costs. Improved uptake of LARC may generate health care cost savings by reducing contraceptive non-adherence.     

Injectable contraceptive discontinuation and subsequent unintended pregnancy among low-income women.

OBJECTIVES: This study investigated rates of discontinuation of the recently introduced injectable contraceptive depot medroxyprogesterone acetate (DMPA) and postdiscontinuation rates of unprotected intercourse and unintended pregnancy. METHODS: A sample of 402 low-income, urban, minority women were interviewed when they initiated DMPA use and 12 months later. RESULTS: The 12-month life-table discontinuation rate was 58%, with half of the discontinuers stopping after only one injection. Menstrual changes and other side effects were the most frequently cited reasons for discontinuation. Approximately half of the discontinuers at risk for unintended pregnancy either did not make the transition to another contraceptive or used contraception only sporadically. The cumulative unintended pregnancy rate by 9 months postdiscontinuation was 20%. CONCLUSIONS: DMPA initiators were at substantial risk for unintended pregnancy because most quickly discontinued use and did not make the transition to consistent use of another contraceptive.     

Adolescent mothers' postpartum contraceptive use: a qualitative study

CONTEXT: Effective contraceptive use among first‐time adolescent mothers can reduce the risk of a rapid repeat pregnancy and associated negative maternal and child health outcomes. Many adolescent mothers begin using a highly effective method after delivery; however, their rates of contraceptive discontinuation are high. Little research has explored the factors that influence adolescents’ postpartum contraceptive use. METHODS: In‐depth interviews were conducted with 21 black, white and Latina adolescent first‐time mothers from rural and urban areas of North Carolina between November 2007 and February 2009. In addition, interviews were conducted with 18 key informants—professionals who work closely with adolescent mothers. Interviews explored adolescent mothers’ health behaviors, including contraceptive use, before and after pregnancy. Content analysis was used to identify key themes and patterns. RESULTS: Teenagers’ use of contraceptives, particularly injectables, IUDs and implants, increased postpartum. Reasons for this improvement included improved clarity of intention to avoid pregnancy and improved contraceptive knowledge, support and access after delivery. However, this increased access often did not continue long after delivery, and levels of method switching were high. Among the barriers to postpartum contraceptive use that key informants cited were lack of information and parental support, as well as the loss of Medicaid and continuity of care. CONCLUSIONS: Ongoing follow‐up may help reduce adolescent mothers’ risk of contraceptive discontinuation postpartum. Increasing use of long‐acting methods also may help reduce their vulnerability to gaps in contraceptive use and discontinuation, which increase the risk of unintended pregnancy.     

Ambivalence and pregnancy: adolescents' attitudes, contraceptive use and pregnancy

CONTEXT: It is often argued that adolescents who become pregnant do not sufficiently appreciate the negative consequences, and that prevention programs should target participants' attitudes toward pregnancy. METHODS: Data from the first two waves of the National Longitudinal Study of Adolescent Health were used to examine whether 15-19-year-old females' attitudes toward pregnancy influence their contraceptive consistency and their risk of pregnancy. Characteristics and attitudes associated with pregnancy and contraceptive use were assessed using bivariate and multivariate analysis. RESULTS: Twenty percent of female adolescents were defined as having antipregnancy attitudes, 8% as having propregnancy attitudes and 14% as being ambivalent toward pregnancy; the remainder were considered to have mainstream attitudes. Among sexually experienced adolescents, having an attitude toward pregnancy was not associated with risk of pregnancy. However, those who were ambivalent about pregnancy had reduced odds of using contraceptives consistently and inconsistently rather than not practicing contraception at all (odds ratios, 0.5 and 0.4, respectively). Antipregnancy respondents did not differ from proprepregancy respondents in terms of their contraceptive consistency. However, having a positive attitude toward contraception was associated with increased likelihood of inconsistent and consistent contraceptive use compared with nonuse (1.6 and 2.1, respectively). CONCLUSIONS: Programs designed to prevent pregnancy need to give young women information about pregnancy and opportunities to discuss the topic so that they form opinions. Furthermore, programs should emphasize positive attitudes toward contraception, because effective contraceptive use is shaped by such attitudes and is strongly associated with reduction of pregnancy risk.