- Email: [email protected]
Contraceptive services for pregnant and postpartum women at Komfo Anokye Teaching Hospital
308
ABSTRACTS / Contraception 86 (2012) 290–325
have subsidized insurance (all pb.001). There was no difference between Hispanic and non-Hispanic white women in choice of intrauterine devices, Implanon, birth control pills, Ortho EvraTM, NuvaRing® and condoms at hospital discharge. Hispanic women were more likely to choose depot medroxyprogesterone acetate (DMPA). In multivariate analysis, choice of DMPA was related to Hispanic ethnicity (OR 4.36, 95% CI 1.4–13.6) and inversely related to number of prenatal visits (OR 0.73, 95% CI 0.62–0.86). Conclusions: With the exception of DMPA, choice of contraception does not vary between postpartum primiparous Hispanic and non-Hispanic white women.
P42 CONTRACEPTIVE PREFERENCES OF INCARCERATED WOMEN Lotke P University of Arizona, Tucson, AZ, USA
financial incentives for attendance at follow-up visits (10 visits over 12 weeks), where assistance was provided in managing side effects and problem-solving compliance issues, and there were opportunities to switch methods as needed. Contraceptive initiation was assessed as well as continuation at 4 and 12 weeks post-enrollment. Results: All 5 women initiated an effective contraceptive method. Four weeks post-enrollment, all five remained on an effective contraceptive. Twelve weeks post-enrollment, four of the five women (80%) remained on an effective contraceptive. These rates compare favorably to the general population, in which contraceptive continuation rates average 70% and 50% at 4 and 12 weeks post initiation, respectively. Conclusions: Feasibility testing of this novel contraceptive management program suggests that it promotes contraceptive initiation and continuation among a high-risk group of drug-dependent women. Further testing of this highly promising intervention is warranted.
P44
Degen K, Nuño VL Objectives: To determine if there is an unmet need for contraception among women in a county jail. Methods: A cross-sectional anonymous survey was administered to inmates who wished to participate. In all, 48 surveys were completed among women deemed to be at risk of pregnancy. The survey examined basic demographic information, education, habits, and prior gynecologic and obstetrical history. Information about pregnancy intention, both past and future, was obtained. Results: A total of 81% of the inmates had ever been pregnant. Of these, 72% stated that they had had a previous unplanned pregnancy, and 28% reported at least one abortion in the past. Only 33% of inmates had been using contraceptives at the time of or immediately prior to incarceration. However, 78% of the women did not wish to become pregnant within the next year and 60% did not wish to become pregnant within the next 2 years. Overall, 83% of the inmates had used some form of contraception in the past, and 77% said they would be interested in starting use while in jail, a percentage that increased to 82% if it were provided for free. Almost two thirds (65%) of the women surveyed felt they would be released from jail, with the majority (72%) expecting to be on probation. Conclusions: There is a large unmet need for contraception among jail inmates. Most of these women will be released, and are at risk for unplanned pregnancy. Enabling women to initiate long-acting reversible contraception while in jail might be a way to decrease unplanned pregnancies in this high-risk population.
P43 IMPROVING EFFECTIVE CONTRACEPTIVE USE AMONG DRUG-DEPENDENT WOMEN: A FEASIBILITY STUDY Heil S University of Vermont, Burlington, VT, USA Sigmon S, Meyer M, Higgins S Objectives: Rates of effective contraceptive use among drug-dependent women are low (b25%) and the rate of unintended pregnancy high (N75%). To our knowledge, no interventions have been developed or tested in this high-risk population. Monetary incentives successfully increase adherence to other types of medications (e.g., HIV medications, naltrexone, disulfiram) and medical regimens in drug-dependent populations. The present study aimed to test the feasibility of extending and adapting this approach to promote initiation and continuation of the more effective contraceptive methods (pill, patch, ring, injections, implants and intrauterine devices) among drug-dependent women at risk of unintended pregnancy. Methods: Five drug-dependent women at risk of unintended pregnancy received WHO's contraception protocol to promote contraceptive initiation followed by
POSTPARTUM CONTRACEPTION UTILIZATION AMONG LOW-INCOME WOMEN SEEKING IMMUNIZATION FOR INFANTS IN MUMBAI, INDIA Mody S University of California San Diego, San Diego, CA, USA Dasgupta A, Balaiah D, Saggurti N, Naik DD, Nair S, Raj A, Silverman J Objectives: To examine postpartum contraceptive utilization among Indian women seeking immunization for their infants in three low-income communities in Mumbai, India. Methods: We conducted a cross-sectional questionnaire among low-income postpartum women seeking immunization for their infants aged 6 months or younger at three large urban health centers in Mumbai, India, from August to December 2008. Contraceptive utilization data was collected as part of a larger study focused on the impact of perinatal domestic violence on maternal and infant health. Of 1079 study participants, 467 reported sexual activity and were thus assessed on current contraceptive use. Descriptive analyses were conducted on this subsample to assess prevalence of postpartum contraceptive utilization; chi-square analyses assessed whether demographics were associated with such utilization. Results: Participants (n=467) were aged 17–40 years (mean=24.6 yrs, SD=4.4). Fewer than half of sexually active participants (34.7%) reported current contraceptive use. Among the 162 women using contraceptives, the most common interval from delivery to initiation of contraception was 5 weeks. The most common method was condoms (77.8%, or 126). Breast-feeding rates were similar among women not using contraceptives and those using contraceptives. Women who had no formal education or who married at a younger age were more likely than other women to report no contraceptive use (pb.05). Conclusions: Postpartum contraceptive use was uncommon among low-income women seeking immunization for their infants in India. This study highlights the importance of developing interventions to increase utilization of highly effective contraceptive methods immediately following delivery, particularly for socially vulnerable women. Visits for infant immunizations may represent an opportunity for contraceptive counseling of postpartum women.
P45 CONTRACEPTIVE SERVICES FOR PREGNANT AND POSTPARTUM WOMEN AT KOMFO ANOKYE TEACHING HOSPITAL Morhe E Komfo Anokye Teaching Hospital, Kumasi, Ghana Morhe F, Dalton V
ABSTRACTS / Contraception 86 (2012) 290–325 Objectives: To assess exposure to contraceptive services among pregnant and postpartum women at Komfo Anokye Teaching Hospital, Kumasi. Methods: Baseline cross-sectional surveys of 172 pregnant women, 150 immediate postpartum women and 200 women who were 6–24 months postpartum were conducted. Respondents were randomly selected and interviews conducted by three research assistants using questionnaires with mostly close-ended questions. Variables studied included demographics, exposure to contraceptive messages, fertility desires and contraceptive intentions, and contraceptive usage. Using SPSS version 15.0, data analyses were done at 95% confidence interval and 5% level of significance. Results: Only 28% of pregnant women surveyed received one-on-one counseling on postpartum contraception. Although 78% were aware of intrauterine device (IUD), only 3.0% would accept immediate postpartum IUD placement. About 81% of immediate postpartum women planned to use contraception, yet only 3% were referred to family planning clinics. About 44% of postpartum women did not plan their last pregnancy, and 22% did not want any more children. Yet, 45% of women 6–24 months post-delivery were not using any contraception. While 4.5% of contraceptive users were on IUD or levonorgestrel implants, 49% were on calendar method and 20%, on the pill. However, women exposed to postpartum contraceptive counseling were more likely to start using long acting reversible and permanent family planning methods. Conclusions: There is inadequate exposure of clients to contraceptive counseling at the antenatal clinic and postnatal ward. A well designed postpartum contraceptive education scheme is needed in this teaching hospital.
P46 EFFECT OF STRUCTURED CONTRACEPTIVE COUNSELING ON CONTRACEPTIVE KNOWLEDGE AND USE FOLLOWING WALK-IN VISITS FOR PREGNANCY TESTING OR EMERGENCY CONTRACEPTION Rapkin R University of Pittsburgh, Pittsburgh, PA, USA Baldauf E, Parisi S, Berkhoudt K, Updike G, Schwarz E Objectives: Women seeking walk-in pregnancy testing (WIP) and emergency contraception (EC) are at high risk for unintended pregnancy. We evaluated the effect of structured contraceptive counseling on contraceptive knowledge and use three months after women sought WIP or EC from a Title X clinic in Pittsburgh. Methods: Women aged 15–45 who sought WIP or EC and wanted to avoid pregnancy for at least 6 months were asked to complete a telephone survey three months after their clinic visit. We compared responses from patients seen before (January through August 2011; n=127) and after (August through December 2011; n=54) the clinic began offering brief (nine sentences) structured counseling about highly effective reversible contraceptives. Results: Surveys were completed by 35% of women who visited the clinic. Most (73%) participants were African-American; 33% reported a previous unintended pregnancy. After the introduction of structured counseling, more women had accurate knowledge of the effectiveness of intrauterine devices (IUDs) (37% vs. 13%; pb.05) and implants (33% vs. 11%; pb.05) compared with that of other contraceptives, the reversibility of IUDs (61% vs. 44%; pb.05) and implants (56% vs. 36%; pb.05) and knew that IUDs can be used for 5 or more years (72% vs. 50%; pb.05). Additionally, after the introduction of structured counseling, fewer women reported that they had not used any method of contraception in the 3 months since they visited the clinic (9% vs. 28%; pb.05). Conclusions: In this sample, structured contraceptive counseling is associated with increased contraceptive knowledge and contraceptive use at a 3-month telephone follow-up, and may decrease women's risk of unintended pregnancy.
309
P47 FAMILY PLANNING INTENTIONS AND SATISFACTION WITH CONTRACEPTIVE CARE: A QUALITATIVE EXPLORATION OF POSTPARTUM LATINA WOMEN IN NORTH CAROLINA Zerden M University of North Carolina, Chapel Hill, NC, USA Stuart G, Verbiest S, deRosset L, Tang J Objectives: North Carolina has one of the fastest growing Latino populations in the United States, yet providers have minimal information on how to address the family planning needs of this population. We explored three domains relating to postpartum care: family size intentions, influence of social networks in family planning decisions and satisfaction with contraceptive care. Methods: We conducted semi-structured interviews with postpartum Mexican-American women aged 18–30 years who were within 3 months of delivery. Salient themes were identified, coded and analyzed using ATLAS ti. Results: Twenty women were interviewed. Almost all had specific family size intentions: Most desired 1–3 children with 3–5 years between births. Family size was influenced by partners, but not by social networks. Participants desired longer intrapartum intervals for optimal infant development. Financial considerations were relevant, but were not the main reason cited. Social networks were the driving influence for some participants' desire for longacting reversible contraception (LARC). The benefit of LARC was known by many, but cost was a barrier for Mexican-raised participants. Mexican-raised participants also expressed greater trust in the medical establishment than those raised in the United States. The majority of participants harbored no concerns regarding prejudice or negative motivations for contraceptive services. Conclusions: Postpartum Latinas possess specific family planning intentions. Achievement of these intentions may be challenged by finances and partner desires. Ideal family size is likely smaller than many health care providers assume. Providers can utilize existing trust to encourage the most effective forms of contraception.
P48 VARIATION IN POSTPARTUM CONTRACEPTIVE METHOD USE: RESULTS FROM THE PREGNANCY RISK ASSESSMENT MONITORING SYSTEM (PRAMS) White K University of Alabama at Birmingham, Birmingham, AL, USA Potter J, Hopkins K, Grossman D Objectives: Recent studies indicate there is substantial state-level variation in women's reproductive health outcomes like unintended pregnancy. This may be due to differences in access to reproductive health services. In this study, we assess variation in postpartum contraceptive use across women's state of residence and payment source for delivery. Methods: We used data from the Phase 5 (2004–2008) Pregnancy Risk Assessment Monitoring System (PRAMS), a survey of women who are 2 to 4 months postpartum. Information on women's current contraceptive method was available for 13 states and New York City. We computed the weighted proportion of women using permanent, long-acting and highly effective methods according to payment source for delivery (Medicaid or other insurance) and examined differences across states. Results: Most women reported using a contraceptive at the time of the survey, and overall use was similar for women with Medicaid-paid deliveries (84%) and those who had private or other insurance (85%). Overall, women with Medicaid-paid deliveries were more likely to report female sterilization and injections as their current method than women whose delivery was paid through private or other insurance. In addition, the percentage of women using specific methods varied across states. For
ABSTRACTS / Contraception 86 (2012) 290–325
have subsidized insurance (all pb.001). There was no difference between Hispanic and non-Hispanic white women in choice of intrauterine devices, Implanon, birth control pills, Ortho EvraTM, NuvaRing® and condoms at hospital discharge. Hispanic women were more likely to choose depot medroxyprogesterone acetate (DMPA). In multivariate analysis, choice of DMPA was related to Hispanic ethnicity (OR 4.36, 95% CI 1.4–13.6) and inversely related to number of prenatal visits (OR 0.73, 95% CI 0.62–0.86). Conclusions: With the exception of DMPA, choice of contraception does not vary between postpartum primiparous Hispanic and non-Hispanic white women.
P42 CONTRACEPTIVE PREFERENCES OF INCARCERATED WOMEN Lotke P University of Arizona, Tucson, AZ, USA
financial incentives for attendance at follow-up visits (10 visits over 12 weeks), where assistance was provided in managing side effects and problem-solving compliance issues, and there were opportunities to switch methods as needed. Contraceptive initiation was assessed as well as continuation at 4 and 12 weeks post-enrollment. Results: All 5 women initiated an effective contraceptive method. Four weeks post-enrollment, all five remained on an effective contraceptive. Twelve weeks post-enrollment, four of the five women (80%) remained on an effective contraceptive. These rates compare favorably to the general population, in which contraceptive continuation rates average 70% and 50% at 4 and 12 weeks post initiation, respectively. Conclusions: Feasibility testing of this novel contraceptive management program suggests that it promotes contraceptive initiation and continuation among a high-risk group of drug-dependent women. Further testing of this highly promising intervention is warranted.
P44
Degen K, Nuño VL Objectives: To determine if there is an unmet need for contraception among women in a county jail. Methods: A cross-sectional anonymous survey was administered to inmates who wished to participate. In all, 48 surveys were completed among women deemed to be at risk of pregnancy. The survey examined basic demographic information, education, habits, and prior gynecologic and obstetrical history. Information about pregnancy intention, both past and future, was obtained. Results: A total of 81% of the inmates had ever been pregnant. Of these, 72% stated that they had had a previous unplanned pregnancy, and 28% reported at least one abortion in the past. Only 33% of inmates had been using contraceptives at the time of or immediately prior to incarceration. However, 78% of the women did not wish to become pregnant within the next year and 60% did not wish to become pregnant within the next 2 years. Overall, 83% of the inmates had used some form of contraception in the past, and 77% said they would be interested in starting use while in jail, a percentage that increased to 82% if it were provided for free. Almost two thirds (65%) of the women surveyed felt they would be released from jail, with the majority (72%) expecting to be on probation. Conclusions: There is a large unmet need for contraception among jail inmates. Most of these women will be released, and are at risk for unplanned pregnancy. Enabling women to initiate long-acting reversible contraception while in jail might be a way to decrease unplanned pregnancies in this high-risk population.
P43 IMPROVING EFFECTIVE CONTRACEPTIVE USE AMONG DRUG-DEPENDENT WOMEN: A FEASIBILITY STUDY Heil S University of Vermont, Burlington, VT, USA Sigmon S, Meyer M, Higgins S Objectives: Rates of effective contraceptive use among drug-dependent women are low (b25%) and the rate of unintended pregnancy high (N75%). To our knowledge, no interventions have been developed or tested in this high-risk population. Monetary incentives successfully increase adherence to other types of medications (e.g., HIV medications, naltrexone, disulfiram) and medical regimens in drug-dependent populations. The present study aimed to test the feasibility of extending and adapting this approach to promote initiation and continuation of the more effective contraceptive methods (pill, patch, ring, injections, implants and intrauterine devices) among drug-dependent women at risk of unintended pregnancy. Methods: Five drug-dependent women at risk of unintended pregnancy received WHO's contraception protocol to promote contraceptive initiation followed by
POSTPARTUM CONTRACEPTION UTILIZATION AMONG LOW-INCOME WOMEN SEEKING IMMUNIZATION FOR INFANTS IN MUMBAI, INDIA Mody S University of California San Diego, San Diego, CA, USA Dasgupta A, Balaiah D, Saggurti N, Naik DD, Nair S, Raj A, Silverman J Objectives: To examine postpartum contraceptive utilization among Indian women seeking immunization for their infants in three low-income communities in Mumbai, India. Methods: We conducted a cross-sectional questionnaire among low-income postpartum women seeking immunization for their infants aged 6 months or younger at three large urban health centers in Mumbai, India, from August to December 2008. Contraceptive utilization data was collected as part of a larger study focused on the impact of perinatal domestic violence on maternal and infant health. Of 1079 study participants, 467 reported sexual activity and were thus assessed on current contraceptive use. Descriptive analyses were conducted on this subsample to assess prevalence of postpartum contraceptive utilization; chi-square analyses assessed whether demographics were associated with such utilization. Results: Participants (n=467) were aged 17–40 years (mean=24.6 yrs, SD=4.4). Fewer than half of sexually active participants (34.7%) reported current contraceptive use. Among the 162 women using contraceptives, the most common interval from delivery to initiation of contraception was 5 weeks. The most common method was condoms (77.8%, or 126). Breast-feeding rates were similar among women not using contraceptives and those using contraceptives. Women who had no formal education or who married at a younger age were more likely than other women to report no contraceptive use (pb.05). Conclusions: Postpartum contraceptive use was uncommon among low-income women seeking immunization for their infants in India. This study highlights the importance of developing interventions to increase utilization of highly effective contraceptive methods immediately following delivery, particularly for socially vulnerable women. Visits for infant immunizations may represent an opportunity for contraceptive counseling of postpartum women.
P45 CONTRACEPTIVE SERVICES FOR PREGNANT AND POSTPARTUM WOMEN AT KOMFO ANOKYE TEACHING HOSPITAL Morhe E Komfo Anokye Teaching Hospital, Kumasi, Ghana Morhe F, Dalton V
ABSTRACTS / Contraception 86 (2012) 290–325 Objectives: To assess exposure to contraceptive services among pregnant and postpartum women at Komfo Anokye Teaching Hospital, Kumasi. Methods: Baseline cross-sectional surveys of 172 pregnant women, 150 immediate postpartum women and 200 women who were 6–24 months postpartum were conducted. Respondents were randomly selected and interviews conducted by three research assistants using questionnaires with mostly close-ended questions. Variables studied included demographics, exposure to contraceptive messages, fertility desires and contraceptive intentions, and contraceptive usage. Using SPSS version 15.0, data analyses were done at 95% confidence interval and 5% level of significance. Results: Only 28% of pregnant women surveyed received one-on-one counseling on postpartum contraception. Although 78% were aware of intrauterine device (IUD), only 3.0% would accept immediate postpartum IUD placement. About 81% of immediate postpartum women planned to use contraception, yet only 3% were referred to family planning clinics. About 44% of postpartum women did not plan their last pregnancy, and 22% did not want any more children. Yet, 45% of women 6–24 months post-delivery were not using any contraception. While 4.5% of contraceptive users were on IUD or levonorgestrel implants, 49% were on calendar method and 20%, on the pill. However, women exposed to postpartum contraceptive counseling were more likely to start using long acting reversible and permanent family planning methods. Conclusions: There is inadequate exposure of clients to contraceptive counseling at the antenatal clinic and postnatal ward. A well designed postpartum contraceptive education scheme is needed in this teaching hospital.
P46 EFFECT OF STRUCTURED CONTRACEPTIVE COUNSELING ON CONTRACEPTIVE KNOWLEDGE AND USE FOLLOWING WALK-IN VISITS FOR PREGNANCY TESTING OR EMERGENCY CONTRACEPTION Rapkin R University of Pittsburgh, Pittsburgh, PA, USA Baldauf E, Parisi S, Berkhoudt K, Updike G, Schwarz E Objectives: Women seeking walk-in pregnancy testing (WIP) and emergency contraception (EC) are at high risk for unintended pregnancy. We evaluated the effect of structured contraceptive counseling on contraceptive knowledge and use three months after women sought WIP or EC from a Title X clinic in Pittsburgh. Methods: Women aged 15–45 who sought WIP or EC and wanted to avoid pregnancy for at least 6 months were asked to complete a telephone survey three months after their clinic visit. We compared responses from patients seen before (January through August 2011; n=127) and after (August through December 2011; n=54) the clinic began offering brief (nine sentences) structured counseling about highly effective reversible contraceptives. Results: Surveys were completed by 35% of women who visited the clinic. Most (73%) participants were African-American; 33% reported a previous unintended pregnancy. After the introduction of structured counseling, more women had accurate knowledge of the effectiveness of intrauterine devices (IUDs) (37% vs. 13%; pb.05) and implants (33% vs. 11%; pb.05) compared with that of other contraceptives, the reversibility of IUDs (61% vs. 44%; pb.05) and implants (56% vs. 36%; pb.05) and knew that IUDs can be used for 5 or more years (72% vs. 50%; pb.05). Additionally, after the introduction of structured counseling, fewer women reported that they had not used any method of contraception in the 3 months since they visited the clinic (9% vs. 28%; pb.05). Conclusions: In this sample, structured contraceptive counseling is associated with increased contraceptive knowledge and contraceptive use at a 3-month telephone follow-up, and may decrease women's risk of unintended pregnancy.
309
P47 FAMILY PLANNING INTENTIONS AND SATISFACTION WITH CONTRACEPTIVE CARE: A QUALITATIVE EXPLORATION OF POSTPARTUM LATINA WOMEN IN NORTH CAROLINA Zerden M University of North Carolina, Chapel Hill, NC, USA Stuart G, Verbiest S, deRosset L, Tang J Objectives: North Carolina has one of the fastest growing Latino populations in the United States, yet providers have minimal information on how to address the family planning needs of this population. We explored three domains relating to postpartum care: family size intentions, influence of social networks in family planning decisions and satisfaction with contraceptive care. Methods: We conducted semi-structured interviews with postpartum Mexican-American women aged 18–30 years who were within 3 months of delivery. Salient themes were identified, coded and analyzed using ATLAS ti. Results: Twenty women were interviewed. Almost all had specific family size intentions: Most desired 1–3 children with 3–5 years between births. Family size was influenced by partners, but not by social networks. Participants desired longer intrapartum intervals for optimal infant development. Financial considerations were relevant, but were not the main reason cited. Social networks were the driving influence for some participants' desire for longacting reversible contraception (LARC). The benefit of LARC was known by many, but cost was a barrier for Mexican-raised participants. Mexican-raised participants also expressed greater trust in the medical establishment than those raised in the United States. The majority of participants harbored no concerns regarding prejudice or negative motivations for contraceptive services. Conclusions: Postpartum Latinas possess specific family planning intentions. Achievement of these intentions may be challenged by finances and partner desires. Ideal family size is likely smaller than many health care providers assume. Providers can utilize existing trust to encourage the most effective forms of contraception.
P48 VARIATION IN POSTPARTUM CONTRACEPTIVE METHOD USE: RESULTS FROM THE PREGNANCY RISK ASSESSMENT MONITORING SYSTEM (PRAMS) White K University of Alabama at Birmingham, Birmingham, AL, USA Potter J, Hopkins K, Grossman D Objectives: Recent studies indicate there is substantial state-level variation in women's reproductive health outcomes like unintended pregnancy. This may be due to differences in access to reproductive health services. In this study, we assess variation in postpartum contraceptive use across women's state of residence and payment source for delivery. Methods: We used data from the Phase 5 (2004–2008) Pregnancy Risk Assessment Monitoring System (PRAMS), a survey of women who are 2 to 4 months postpartum. Information on women's current contraceptive method was available for 13 states and New York City. We computed the weighted proportion of women using permanent, long-acting and highly effective methods according to payment source for delivery (Medicaid or other insurance) and examined differences across states. Results: Most women reported using a contraceptive at the time of the survey, and overall use was similar for women with Medicaid-paid deliveries (84%) and those who had private or other insurance (85%). Overall, women with Medicaid-paid deliveries were more likely to report female sterilization and injections as their current method than women whose delivery was paid through private or other insurance. In addition, the percentage of women using specific methods varied across states. For