McNamara Kelly A, Black Kirsten, Bond Oliver, Murnion Bridin, Gordon Adrienne, Ludlow Joanne, Nassar Natasha
Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
RPA Women's and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2025 Apr;65(2):235-242. doi: 10.1111/ajo.13887. Epub 2024 Oct 21.
Women with substance use disorders (SUD) use less contraception, and experience higher rates of unintended pregnancy, compared to women without SUD. Contraception is discussed at the six-week postnatal appointment, which many women with SUD do not attend. Therefore, it is important women have the opportunity to formulate contraception plans before discharge from the birth admission.
To assess postpartum contraception plans, including initiation and method of interest, among women with SUD and compare these to women without SUD.
All births from January 2011 to September 2019 from one New South Wales local health district were analysed. Data included maternal demographics, SUD, and contraception plans. Chi-squared statistics and multivariate multinomial regression analyses were used to compare outcomes for women with and without SUD.
Of 59 195 mothers, 429 (0.7%) had a SUD. There were 50.1% of women with SUD and 56.2% without SUD (P = 0.03) who had no documented plan for contraception. There were 37.3% of women with SUD and 42.4% without SUD (P = 0.06) who had a prescription for contraception or a referral to discuss contraception. There were 12.5% of women with SUD and 1.4% without SUD (P < 0.001) who initiated contraception in hospital.
Although postpartum contraception initiation was higher among women with SUD, half of all women (with or without SUD) were discharged without a plan for contraception initiation. Embedding provision of postpartum contraception into maternity care, or investigating other opportunities, may improve access for all women, including those with SUD.
与没有物质使用障碍（SUD）的女性相比，患有物质使用障碍的女性使用避孕措施较少，意外怀孕率更高。产后六周的预约门诊会讨论避孕问题，但许多患有物质使用障碍的女性并未就诊。因此，重要的是女性在分娩出院前有机会制定避孕计划。
评估患有物质使用障碍的女性的产后避孕计划，包括开始时间和感兴趣的方法，并将其与没有物质使用障碍的女性进行比较。
分析了2011年1月至2019年9月新南威尔士州一个地方卫生区的所有分娩情况。数据包括产妇人口统计学信息、物质使用障碍情况和避孕计划。使用卡方统计和多变量多项回归分析来比较患有和未患有物质使用障碍的女性的结果。
在59195名母亲中，429名（0.7%）患有物质使用障碍。患有物质使用障碍的女性中有50.1%、没有物质使用障碍的女性中有56.2%（P = 0.03）没有记录在案的避孕计划。患有物质使用障碍的女性中有37.3%、没有物质使用障碍的女性中有42.4%（P = 0.06）有避孕处方或被转诊去讨论避孕问题。患有物质使用障碍的女性中有12.5%、没有物质使用障碍的女性中有1.4%（P < 0.001）在医院开始使用避孕措施。
尽管患有物质使用障碍的女性产后开始使用避孕措施的比例较高，但所有女性（无论是否患有物质使用障碍）中有一半在出院时没有开始避孕的计划。将产后避孕服务纳入孕产妇护理中，或探索其他机会，可能会改善所有女性，包括患有物质使用障碍的女性获得避孕服务的机会。
