Barriers to Postpartum Contraception in Texas and Pregnancy Within 2 Years of Delivery
Barriers to Postpartum Contraception in Texas and Pregnancy Within 2 Years of Delivery
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DOI：
10.1097/aog.0000000000001201
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发表时间：
2016-02-01
影响因子：
7.2
通讯作者：
Grossman, Daniel
中科院分区：
文献类型：
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作者：
Potter, Joseph E.;Hubert, Celia;Grossman, Daniel
目的：评估在分娩后2年内通过改善避孕方法可以避免的妊娠。方法：在这项队列研究中，我们采访了德克萨斯州奥斯汀一家医院的403名产后妇女，她们希望推迟生育至少2年。在产后3、6、9、12、18和24个月完成随访，24个月时保留率为83%。在每一次采访中，参与者都报告了他们的怀孕状况和避孕方法。在为期3个月和6个月的访谈中，参与者还被问及未来3个月他们更喜欢的避孕方法。我们确定了无法获得首选避孕方法的妇女的障碍类型，并使用COX模型分析了分娩后6至24个月的怀孕风险。结果：在产后6个月受访的妇女(n=377)中，三分之二的人在获得首选避孕方法方面遇到了障碍。到产后24个月，的妇女报告怀孕；71人是意外怀孕。在产后6至24个月期间，377名妇女中有77人怀孕(20.4%)，56人(14.9%)因随访而失访。在获得首选方法方面遇到障碍的女性更有可能在分娩后24个月内怀孕。她们的累积怀孕风险为34%(95%可信区间[CI]0.25-0.43)，而没有屏障的女性的累积怀孕风险为12%(95%可信区间0.05-0.18)。报告意外怀孕的妇女中，除3人外，所有妇女都表示有兴趣使用长效可逆避孕或永久避孕方法。结论：在这项研究中，如果妇女能够获得他们希望的长效和永久方法，大多数意外怀孕在分娩后24个月内是可以预防或推迟的。
OBJECTIVE:To assess pregnancies that could have been averted through improved access to contraceptive methods in the 2 years after delivery.METHODS:In this cohort study, we interviewed 403 postpartum women in a hospital in Austin, Texas, who wanted to delay childbearing for at least 2 years. Follow-up interviews were completed at 3, 6, 9, 12, 18, and 24 months after delivery; retention at 24 months was 83%. At each interview, participants reported their pregnancy status and contraceptive method. At the 3- and 6-month interviews, participants were also asked about their preferred contraceptive method 3 months in the future. We identified types of barriers among women unable to access their preferred method and used Cox models to analyze the risk of pregnancy from 6 to 24 months after delivery.RESULTS:Among women interviewed 6 months postpartum (n=377), two thirds had experienced a barrier to accessing their preferred method of contraception. By 24 months postpartum, 89 women had reported a pregnancy; 71 were unintended. Between 6 and 24 months postpartum, 77 of 377 women became pregnant (20.4%), with 56 (14.9%) lost to follow-up. Women who encountered a barrier to obtaining their preferred method were more likely to become pregnant less than 24 months after delivery. They had a cumulative risk of pregnancy of 34% (95% confidence interval [CI] 0.25-0.43) as compared with 12% (95% CI 0.05-0.18) for women with no barrier. All but three of the women reporting an unintended pregnancy had earlier expressed interest in using long-acting reversible contraception or a permanent method.CONCLUSION:In this study, most unintended pregnancies less than 24 months after delivery could have been prevented or postponed had women been able to access their desired long-acting and permanent methods.