Postpartum contraception: needs vs. reality

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Abstracts / Contraception 80 (2009) 194–226

sterilization increased from 10 in 2003 to 47 in 2007 (p=.005). Results were unchanged when normalized by numbers of deliveries per year. Conclusions: More women are using highly effective contraception through increased usage of IUDs while the overall rate of sterilization remained constant. Among women choosing sterilization, sterilization after vaginal delivery has decreased while transcervical sterilization has become more common.

Borrero S University of Pittsburgh, Pittsburgh, PA, USA

Results: Thirty-four women (60%) chose oral LNG and 23 (40%) chose the copper IUD. Participants' mean age was 23.7 years, 39% came from minority groups, 68% had incomes less than $20,000, and 44% were nulliparous. One month after presenting for EC, 21 of 22 (96%) in the IUD group were still using the IUD and all 22 were using a reliable method of contraception. In the LNG group, 13 of 25 (52%) were using an effective method of contraception (pb.001). The IUD group had no pregnancies, perforations, expulsions or upper genital tract infections. There was one pregnancy in the oral LNG group. Conclusions: Utah women were willing to accept the IUD as EC in a clinical trial. Women selecting the IUD for EC were more likely to be using an effective method of contraception 1 month later. This difference remains significant even if all those lost to follow-up in the LNG group were assumed to be using an effective method of contraception at 1 month.

Lin Y, Dehlendorf C, Schwarz EB, Creinin MD, Nikolajski C, Ibrahim S

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P25 DIFFERENCES IN KNOWLEDGE MAY CONTRIBUTE TO RACIAL VARIATION IN TUBAL STERILIZATION RATES

Objectives: Black women are significantly more likely to use female sterilization as a contraceptive method compared to white women. The reasons underlying this racial difference are unknown, but may be related to differences in knowledge regarding contraception. The objective of this study was to assess for racial differences in knowledge about sterilization and contraceptive alternatives. Method: A survey instrument was developed to assess awareness of and knowledge about sterilization and effective contraceptive alternatives. Black and white women aged 18–45 years who had undergone sterilization were identified using a registry. Self-administered surveys were mailed to 300 potential participants. We compared responses for black versus white women using t tests and Fisher's Exact Tests. Multivariable regression analysis was used to compare percentage of correct answers for knowledge items while controlling for confounders. Results: We received 190 of 300 surveys (63%). Participants were 32% black and 67% white. Black women were younger, less often married and had similar educational attainment. More black women had never heard of IUDs (10.3% vs. 1.6%; p=.013). Black women more often thought that sterilization was 100% effective (55.0% vs. 39.7%; p=.059); reversal could easily restore fertility (58.9% vs. 36.0%; pb.001); sterilization would reverse itself after 5 years (55.3% vs. 20.8%; pb.001); and ovaries and uterus were removed during sterilization (6.8% vs. 0.0%; pb.001). Black women had a lower mean correct score (65.4% vs. 80.3%; pb.001) even after adjusting for confounders. Conclusions: Misinformation about sterilization and less awareness of contraceptive alternatives may contribute to racial disparities in sterilization rates.

A SURVEY OF WOMEN OBTAINING EMERGENCY CONTRACEPTION: ARE THEY WILLING TO USE THE COPPER IUD? Turok D University of Utah, Salt Lake City, UT, USA Handley E, Simonsen SE, North R, Frost C, Murphy P, Gurtcheff S Objectives: To determine if women presenting for emergency contraception (EC) at Planned Parenthood Association of Utah (PPAU) clinics are interested in the copper IUD for EC. Method: This cross-sectional survey used anonymous written questionnaires. The survey was offered to women who presented for EC at participating PPAU clinics (n=4) during the study period (Nov 2008–Jan 2009). The outcome variable of interest was willingness to use of the copper IUD for EC. Results: Of survey respondents, 163 of 527 (31%) said they would be interested in an EC method that was long-term, highly effective and reversible. Interested women were not significantly different from noninterested women in relation to age, marital status, education, household income, gravidity, prior abortions, prior STIs or relationship status. Sixty women (36.8% of those interested or 11.4% of all those surveyed) would wait an hour and undergo an exam to get the method and would still want the method knowing it was an IUD. However, only 11 of these women could also pay $350 (2% of all respondents). Conclusions: Women presenting for EC at PPAU clinics are interested in the copper IUD for EC but cost is a potential barrier. P28

P26 POSTPARTUM CONTRACEPTION: NEEDS VS. REALITY DOES EMERGENCY CONTRACEPTION CHOICE IMPACT EFFECTIVE CONTRACEPTION 1 MONTH LATER? A PROSPECTIVE COMPARISON OF THE COPPER IUD AND ORAL LEVONORGESTREL

Baylson A Thomas Jefferson University, Philadelphia, PA, USA

Turok D University of Utah, Salt Lake City, UT, USA

Objectives: The aim of this study is to prospectively assess patients' perceptions, needs and use of postpartum contraception. In addition, participants will be asked if they would have liked an intrauterine device (IUD) placed immediately after delivery. Method: Postpartum patients in an urban university hospital were asked to complete a written survey regarding postpartum contraception. Participants were asked about contraception counseling both antenatally and since delivery. Participants were also asked if they would have elected to have an IUD inserted immediately after delivery. Participants were contacted 4–6 months after delivery regarding ongoing contraceptive use. Results: 175 surveys were completed; 77% (134) reported discussing contraception antenatally and 87.4% (153) postpartum. Combined oral contraceptive pills (OCP), IUD and depot medroxyprogesterone acetate

Gurtcheff S, Handley E, Sok C, Simonsen SE, Murphy P Objectives: To compare use of effective contraception 1 month after choosing the copper intrauterine device (IUD) or oral levonorgestrel (LNG) for emergency contraception (EC). Method: This prospective observational study offered women presenting for EC over a 10-week period either the copper IUD or LNG for EC. The research site was a single Planned Parenthood Association of Utah Clinic. The primary outcome was use of an effective method of contraception (defined as N91% contraceptive effectiveness with actual use) 1 month after presenting for EC.

Wolf A, Gorby N

Abstracts / Contraception 80 (2009) 194–226 (DMPA) were the most commonly discussed methods antenatally (37%, 30%, 26%) and postpartum (43%, 31%, 29%), respectively; 23% (39) of women would have elected immediate postplacental IUD placement if available. Of the 59 patients who responded 4–6 months after delivery 20%, 8% and 5% reported using OCP, DMPA and IUD; 22% (13) of the participants contacted at follow-up still desired an IUD, of which 62% would have elected for postplacental placement, if available. Conclusions: Prenatal visits and postpartum contact with providers create an opportunity to discuss family planning and contraception. Although most patients reported both antenatal and immediate postpartum contraceptive counseling, significantly fewer reported continued contraceptive use at 4–6 months postpartum. Initiation of postplacental IUD placement would increase contraceptive use at 6 months in this population. P29 TWO-WEEK POSTPARTUM IMPLANON INSERTION IS NOT EQUIVALENT TO IMMEDIATE POSTPARTUM LARC Tocce K University of Colorado at Denver, Aurora, CO, USA Python J, Sheeder J, Teal S

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or to receive DMPA alone. Bleeding calendars and questionnaires assessed bleeding, DMPA continuation and acceptability of the ring. An intention to treat analysis was performed and groups were compared using chi-square and Wilcoxon statistical tests in SAS 9.1. Results: Seventy-one participants enrolled and 69% (n=49) completed the first 90 days of follow-up. To date, data are available for 38 participants. Participants receiving vaginal estrogen had a median of 16 (range 3–61) bleeding or spotting days compared to 20 days (range 0–95) in the DMPA alone group. Eighty percent (n=16) in the vaginal ring group and 72% (n=13) in the DMPA alone group received a second injection (p=.57). Ninety percent (18/20) who used the vaginal ring were satisfied, 75% (15/20) would use the ring again, and 85% (17/20) would recommend the ring to a friend starting DMPA. Conclusions: The vaginal ring is highly acceptable in this population. Bleeding and continuation were similar between groups. These findings do not support routine use of this intervention during DMPA initiation. P31 PROVIDING CONTRACEPTION AND CONTRACEPTIVE COUNSELING TO ADOLESCENTS: PERSPECTIVES OF RESIDENTS FROM THREE SPECIALTIES Perriera L University of Pittsburgh, Pittsburgh, Pennsylvania, PA, USA

Objectives: Few adolescents resume intercourse within 2 weeks of delivery. Long-acting, reversible methods of contraception (LARC) initiation 2 weeks postpartum should be equivalent to immediate. This pilot study was conducted to see if 2-week postpartum Implanon insertion meets the goals of immediate postpartum LARC. Method: Over 6 months, 116 ethnically diverse teens in a comprehensive adolescent-pregnancy program reported 3rd trimester contraceptive plans. Those who expressed interest were to receive Implanon at one of the three routine visits within 2 weeks postpartum. Patients who desired an IUD were to receive it at 6 weeks postpartum. Results: Of the 116 participants, 38 (33%) stated an intent to use Implanon. Postpartum, 26 (68%) of these patients received Implanon, 14 (37%) within 14 days; all patients reported abstinence prior to Implanon insertion. By 3 months postpartum, 35 of 116 had Implanon placed. Of those placed later than 2 weeks postpartum, 14 (67%) reported abstinence prior to Implanon insertion. Thirtyseven participants stated their third trimester contraceptive intent was an IUD. Eighteen of these teens received an IUD; three were inserted by 8 weeks postpartum. Of the 18 IUD acceptors, 13 (72%) had resumed intercourse prior to IUD insertion. Conclusions: Attempts to provide Implanon insertion within 2 weeks of delivery resulted in a 37% success rate. While 60% of patients who received Implanon or an IUD were abstinent prior to initiation of LARC, there were no predictors of who would abstain. Immediate postpartum LARC insertion would eliminate this risk window. P30 PILOT STUDY OF VAGINAL ESTROGEN SUPPLEMENTATION DURING DMPA INITIATION Dempsey A Medical University of South Carolina, Charleston, SC, USA Westhoff C Objectives: Study objectives are to evaluate whether vaginal estrogen supplementation during the first 90 days of depot medroxyprogesterone acetate (DMPA) use decreases bleeding and increases continuation to a second injection and to describe acceptability of this intervention. Method: This prospective randomized, controlled 6-month trial enrolled English or Spanish-speaking women ≥18 years of age initiating DMPA. Participants were randomized to receive an estrogen vaginal ring for 90 days

Swanier B, Gold M, Akers A Objectives: To explore perspectives of residents in specialties that routinely care for adolescents regarding provision of contraception and contraceptive counseling to adolescents. Method: Between November 2008 and February 2009, resident physicians at the University of Pittsburgh Medical Center from Pediatrics, Obstetrics and Gynecology (Ob/Gyn) and Family Medicine residency programs participated in focus groups. Three focus groups were conducted in each specialty. Discussions explored resident comfort with counseling adolescents about contraceptive methods and assessed which methods are routinely offered. Each discussion lasted 60–80 min, was audio-recorded, transcribed and analyzed using a grounded theory approach to content analysis. Results: Fifty-four residents (18 per specialty), representing all training years, participated. All residents denied having lectures or clinics focused on adolescent contraceptive counseling. Comfort with contraceptive counseling and method initiation differed by specialty. Ob/Gyn residents were comfortable offering adolescents all approved contraceptive methods except sterilization, especially long-acting methods. Pediatric and family medicine residents were most comfortable offering contraceptive pills and depomedroxyprogesterone acetate. They felt implants and intrauterine devices were less appropriate for adolescents and rarely provided these methods due to lack of familiarity. All specialties agreed condoms should be used for the prevention of sexually transmitted infections, not pregnancy prevention. Conclusions: Ob/Gyn residents have more experience and comfort providing long-acting reversible methods such as intrauterine devices and implants to adolescents. Additional clinical and didactic teaching is necessary to improve family medicine and pediatric residents' comfort with discussing and providing highly effective long-acting contraceptive methods to adolescents. P32 PREFERENCES FOR DECISION MAKING ABOUT CONTRACEPTION AMONG HEALTHY ADULT WOMEN Diedrich J University of California, San Francisco, San Francisco, CA, USA Tharayil M, Steinauer J, Drey E, Dehlendorf C