Burke Kristen Lagasse, Thaxton Lauren, Potter Joseph E
Population Research Center, University of Texas at Austin, Austin, TX, USA.
Department of Sociology, University of Texas at Austin, Austin, TX, USA.
Contracept X. 2020 Dec 28;3:100052. doi: 10.1016/j.conx.2020.100052. eCollection 2021.
The objective was to assess continuation of the pill, patch, ring or injectable (i.e., short-acting hormonal contraception); characteristics associated with discontinuation; and subsequent method use among low-income postpartum women in Texas.
Using a 24-month cohort study of 1700 women who delivered in eight Texas hospitals and were uninsured or publicly insured at the time of delivery, we focused on 456 women who used short-acting hormonal contraception within 6 months after delivery. We classified this sample according to characteristics and method preference, and estimated rates of discontinuation and associated predictors using life tables and Cox models. We assessed reasons for discontinuation and subsequent contraceptive use among those who discontinued.
Roughly half used the pill and half used the injectable. One hundred seventy-eight (39%) expressed a baseline preference for the method they used, 162 (36%) preferred a long-acting reversible contraception method, and 41 (9%) preferred sterilization. After 1 year, 72% had discontinued [95% confidence interval (CI) 67.1-75.7]. Foreign-born Hispanic women were less likely to discontinue than U.S.-born Hispanics [adjusted hazard ratio (aHR), 0.65; 95% CI 0.50-0.84]. Those who wanted a more effective method (aHR, 1.44; 95% CI 1.12-1.85) and those who lost insurance coverage (aHR, 1.47; 95% CI 1.12-1.92) were more likely to discontinue. The most common reasons for discontinuation were side effects and access/cost. Of those who discontinued, 243 (68%) switched to a less effective or no method. Only 47 (13%) switched to their preferred method.
Short-acting hormonal contraceptive discontinuation is high in this population. Many switch to less effective methods after discontinuation despite preferring methods at least as effective as the pill, patch, ring or injectable.
Expanding contraceptive coverage in the 2 years after delivery should be a state and federal policy priority. In clinics, providers should discuss contraceptive preferences throughout pregnancy and the interpregnancy interval.
评估口服避孕药、避孕贴片、阴道避孕环或注射用避孕药（即短效激素避孕法）的持续使用情况；与停用相关的特征；以及得克萨斯州低收入产后妇女后续的避孕方法使用情况。
采用一项针对在得克萨斯州8家医院分娩且在分娩时未参保或参加公共保险的1700名妇女的24个月队列研究，我们重点关注了456名在产后6个月内使用短效激素避孕法的妇女。我们根据特征和方法偏好对该样本进行分类，并使用生命表和Cox模型估计停用率及相关预测因素。我们评估了停用的原因以及停用者后续的避孕方法使用情况。
大约一半的人使用口服避孕药，另一半使用注射用避孕药。178人（39%）表示对其所使用的方法有基线偏好，162人（36%）倾向于长效可逆避孕法，41人（9%）倾向于绝育。1年后，72%的人停用了[95%置信区间（CI）67.1 - 75.7]。外国出生的西班牙裔妇女比美国出生的西班牙裔妇女停用的可能性更小[调整后风险比（aHR），0.65；95% CI 0.50 - 0.84]。那些想要更有效方法的人（aHR，1.44；95% CI 1.12 - 1.85）以及失去保险覆盖的人（aHR，1.47；95% CI 1.12 - 1.92）停用的可能性更大。停用的最常见原因是副作用以及获取/成本问题。在那些停用的人中，243人（68%）转而使用效果较差或不使用任何方法。只有47人（13%）转而使用她们偏好的方法。
该人群中短效激素避孕法的停用率很高。许多人在停用后转而使用效果较差的方法，尽管她们偏好至少与口服避孕药、避孕贴片、阴道避孕环或注射用避孕药效果相当的方法。
扩大产后2年内的避孕覆盖范围应成为州和联邦政策的优先事项。在诊所中，医护人员应在整个孕期和两次妊娠间隔期间讨论避孕偏好。
