Unmet demand for highly effective postpartum contraception in Texas

Objectives: We aimed to assess women's contraceptive preferences and use in the first 6months after delivery. The postpartum period represents a key opportunity for women to learn about and obtain effective contraception, especially since 50% of unintended pregnancies to parous women occur within 2years of a previous birth.

Methods: We conducted a prospective cohort study of 800 postpartum women recruited from three hospitals in Austin and El Paso, TX. Women aged 18–44 who wanted to delay childbearing for at least 24months were eligible for the study and completed interviews following delivery and at 3 and 6months postpartum. Participants were asked about the contraceptive method they were currently using and the method they would prefer to use at 6months after delivery.

Results: At 6 months postpartum, 13% of women were using an IUD or implant, and 17% were sterilized or had a partner who had had a vasectomy. Twenty-four percent were using hormonal methods, and 45% relied on less effective methods, mainly condoms and withdrawal. Yet 44% reported that they would prefer to be using sterilization, and 34% would prefer to be using LARC.

Conclusions: This study shows a considerable preference for LARC and permanent methods at six months postpartum. However, there is a marked discordance between women’s method preference and actual use, indicating substantial unmet demand for highly effective methods of contraception.

Implications: In two Texas cities, many more women preferred long-acting and permanent contraceptive methods (LAPM) than were able to access these methods at six months postpartum. Women’s contraceptive needs could be better met by counseling about all methods, reducing cost barriers and by making LAPM available at more sites.