Potter Joseph E, Coleman-Minahan Kate, White Kari, Powers Daniel A, Dillaway Chloe, Stevenson Amanda J, Hopkins Kristine, Grossman Daniel
Population Research Center, University of Texas, Austin, Texas; the College of Nursing, University of Colorado-Denver, Denver, Colorado; Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama; the Institute of Behavioral Science, University of Colorado-Boulder, Boulder, Colorado; and ANSIRH, University of California, San Francisco, San Francisco, California.
Obstet Gynecol. 2017 Aug;130(2):393-402. doi: 10.1097/AOG.0000000000002136.
To assess women's preferences for contraception after delivery and to compare use with preferences.
In a prospective cohort study of women aged 18-44 years who wanted to delay childbearing for at least 2 years, we interviewed 1,700 participants from eight hospitals in Texas immediately postpartum and at 3 and 6 months after delivery. At 3 months, we assessed contraceptive preferences by asking what method women would like to be using at 6 months. We modeled preference for highly effective contraception and use given preference according to childbearing intentions using mixed-effects logistic regression testing for variability across hospitals and differences between those with and without immediate postpartum long-acting reversible contraception (LARC) provision.
Approximately 80% completed both the 3- and 6-month interviews (1,367/1,700). Overall, preferences exceeded use for both-LARC: 40.8% (n=547) compared with 21.9% (n=293) and sterilization: 36.1% (n=484) compared with 17.5% (n=235). In the mixed-effects logistic regression models, several demographic variables were associated with a preference for LARC among women who wanted more children, but there was no significant variability across hospitals. For women who wanted more children and had a LARC preference, use of LARC was higher in the hospital that offered immediate postpartum provision (P<.035) as it was for U.S.-born women (odds ratio [OR] 2.08, 95% CI 1.17-3.69) and women with public prenatal care providers (OR 2.04, 95% CI 1.13-3.69). In the models for those who wanted no more children, there was no significant variability in preferences for long-acting or permanent methods across hospitals. However, use given preference varied across hospitals (P<.001) and was lower for black women (OR 0.26, 95% CI 0.12-0.55) and higher for U.S.-born women (OR 2.32, 95% CI 1.36-3.96), those 30 years of age and older (OR 1.82, 95% CI 1.07-3.09), and those with public prenatal care providers (OR 2.04, 95% CI 1.18-3.51).
Limited use of long-acting and permanent contraceptive methods after delivery is associated with indicators of health care provider and system-level barriers. Expansion of immediate postpartum LARC provision as well as contraceptive coverage for undocumented women could reduce the gap between preference and use.
评估产后女性对避孕方法的偏好，并比较实际使用情况与偏好之间的差异。
在一项针对18 - 44岁、希望推迟生育至少2年的女性的前瞻性队列研究中，我们对来自德克萨斯州八家医院的1700名参与者在产后即刻、产后3个月和6个月进行了访谈。在3个月时，我们通过询问女性希望在6个月时使用何种避孕方法来评估她们的避孕偏好。我们根据生育意愿，使用混合效应逻辑回归模型来模拟对高效避孕方法的偏好以及偏好情况下的使用情况，同时对医院间的差异以及有无产后即刻长效可逆避孕（LARC）服务的人群差异进行检验。
约80%的参与者完成了产后3个月和6个月的访谈（1367/1700）。总体而言，对于两种长效可逆避孕方法，偏好超过实际使用：分别为40.8%（n = 547）对比21.9%（n = 293）；对于绝育，偏好为36.1%（n = 484）对比17.5%（n = 235）。在混合效应逻辑回归模型中，几个人口统计学变量与希望生育更多孩子的女性对长效可逆避孕方法的偏好相关，但医院间无显著差异。对于希望生育更多孩子且偏好长效可逆避孕方法的女性，在提供产后即刻长效可逆避孕服务的医院中，长效可逆避孕方法的使用率更高（P <.035），美国出生的女性也是如此（优势比[OR] 2.08，95%置信区间1.17 - 3.69），以及有公共产前护理提供者的女性（OR 2.04，95%置信区间1.13 - 3.69）。在对不希望再生育的女性的模型中，各医院对长效或永久性避孕方法的偏好无显著差异。然而，偏好情况下的实际使用率在医院间存在差异（P <.001），黑人女性的使用率较低（OR 0.26，95%置信区间0.12 - 0.55），美国出生的女性、30岁及以上的女性（OR 1.82，95%置信区间1.07 - 3.09）以及有公共产前护理提供者的女性的使用率较高（OR 2.04，95%置信区间1.18 - 3.51）。
产后长效和永久性避孕方法的使用受限与医疗保健提供者和系统层面的障碍指标相关。扩大产后即刻长效可逆避孕服务以及为无证女性提供避孕覆盖范围，可能会缩小偏好与使用之间的差距。
