Provider Counseling and Women's Family Planning Decisions in the Postpartum Period

Abstract

Introduction: Provider counseling may influence women's postpartum family planning decisions. Materials and Methods: We conducted an anonymous Internet-based cross-sectional survey of postpartum women regarding multiple topics, including prenatal/postpartum care and family planning. We used multivariable logistic regression to determine associations between quantity of provider counseling (indexed as number of family planning topics discussed with a health care provider) and women's decisions regarding contraception and pregnancy spacing. Results: From January to May 2016, 2,850 women completed the survey and met inclusion criteria. Among this group, the majority were white (93%), ≥30 years (63%), and had obtained a college degree or higher (74%). Approximately half (49%) desired an interpregnancy interval (IPI) >2 years, and the minority (21%) used a highly effective contraceptive method (defined as long-acting reversible contraception or sterilization). The majority of women (56%) had received counseling on three to six family planning topics (defined as "more counseling" in regression models). Women who received more counseling were more likely to use a highly effective contraceptive method (adjusted odds ratio [AOR] 1.33, confidence interval [95% CI] 1.09-1.62) but were not more likely to desire an IPI >2 years (AOR 0.96, 95% CI 0.81-1.14). Desired IPI modified the association between provider counseling and contraception (p = 0.06 for interaction): Among those desiring an IPI >2 years, more counseling was associated with use of a highly effective contraceptive method (AOR 1.58, 95% CI 1.23-2.03), but this was not observed among those desiring a shorter IPI (AOR 1.05, 95% CI 0.73-1.49). Conclusions: Contraceptive decisions depend on both provider counseling and patient goals.

Keywords: contraception; family planning education; postpartum; pregnancy interval.

FIG. 1.

Association between quantity of provider counseling^a and use of a highly effective contraceptive method,^b stratified by desired IPI.^{c a}More counseling is defined as counseling on 3–6 family planning topics, whereas less counseling is defined as counseling on 0–2 family planning topics. Counseling could occur at any point in the prenatal or postpartum periods. ^bHighly effective methods include the IUD, contraceptive implant, tubal ligation, or vasectomy. ^cThis model examined effect modification of desired IPI on the association between quantity of provider counseling and use of a highly effective contraceptive method by adding an interaction term (desired IPI × quantity of provider counseling) to the full model. The model also adjusted for age, race, ethnicity, marital status, education, income, parity, timing of return to work, and region. p = 0.06 for interaction term. n = 2,584. IPI, interpregnancy interval; IUD, intrauterine device.