Use of a Reproductive Life Planning Tool at the Pediatric Well‐Baby Visit with Postpartum Women

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Unintended pregnancy is a persistent public health challenge in the U.S. Women who have had a recent pregnancy are at increased risk of unintended pregnancy compared to other women of reproductive age not using contraception, with rates up to 44% in the first postpartum (PP) year. In addition, adequate birth spacing in the postpartum period is important for both the health of the mother and the infant. Pregnancies with a short interpregnancy interval have been associated with increased risk of preeclampsia, preterm birth, and low birth weight. Low-income women of color are at increased risk of unintended pregnancy and inadequate birth spacing which in turn increases their risk of adverse pregnancy outcomes. Improved access to timely health care and contraception in the postpartum (PP) period is needed to reduce unintended pregnancies and help women achieve desired birth spacing. While the PP visit has historically been considered to be the place for women to discuss and receive contraception, many women, particularly low-income women, do not attend the PP visit. A novel approach to increasing receipt of PP care and contraception is the adoption of a reproductive life planning. Explorations of the use of a self-administered Reproductive Life Plan Tool (RLPT) by pediatricians in the context of the Well-Baby Visit (WBV) with postpartum mothers, holds great promise. The objective of the proposed study is to determine whether use of a simple self-administered Reproductive Life Plan Tool at the 2-month WBV increases the proportion of postpartum women receiving woman's health care and contraception at 6-months PP, compared to women not exposed to such an intervention. The two specific aims of the project are: Aim I. To determine if introducing a self-administered Reproductive Life Planning Tool (RLPT) with postpartum mothers during the 2-month WBV will increase the proportion of women receiving a well-woman primary care health visit by 6 months postpartum. Aim Ia. To determine if introducing a self-administered Reproductive Life Planning Tool (RLPT) with postpartum mothers during the 2-month WBV will increase utilization rates of contraception by 6 months postpartum. Aim II: To assess patient-, provider-, and systems-level barriers and facilitators to integrating a self-administered Reproductive Life Planning Tool designed to facilitate referral of postpartum women for primary well-woman care in the context of a pediatric clinic. If successful, the results of this study have great potential to inform clinical and public health practice to increase women's use of health care and contraception in the postpartum period.