A Novel Approach to Postpartum Contraception Provision Combined with Infant Care: A Randomized, Controlled Trial

Womens Health Issues. 2020 Mar-Apr;30(2):83-92. doi: 10.1016/j.whi.2019.12.001. Epub 2020 Jan 19.


Background: Unintended pregnancy among women with short interpregnancy intervals remains common. Women's attendance at the 4- to 6-week postpartum visit, when contraception provision often occurs, is low, whereas their attendance at well-baby visits is high. We aimed to evaluate if offering co-located contraceptive services to mothers at well-baby visits increases use of long-acting reversible contraception (LARC) at 5 months postpartum compared with usual care in a randomized, controlled trial.

Methods: Women with infants aged 4.5 months or younger who were not using a LARC method and had not undergone sterilization were eligible. Generalized linear models were used to estimate risk ratios. Likability and satisfaction of the contraception visit were assessed.

Results: Between January 2015 and January 2017, 446 women were randomized. LARC use at 5 months was 19.1% and 20.9% for the intervention and control groups, respectively, and was not significantly different after controlling for weeks postpartum (risk ratio, 0.85; 95% confidence interval, 0.59-1.23). Uptake of the co-located visit was low (17.7%), but the concept was liked; insufficient time to stay for the visit was the biggest barrier to uptake. Women who accepted the visit were more likely to use a LARC method at 5 months compared with women in the control group (risk ratio, 1.97; 95% confidence interval, 1.26-3.07).

Conclusions: Women perceived co-located care favorably and LARC use was higher among those who completed a visit; however, uptake was low for reasons including inability to stay after the infant visit. Intervention effects were possibly diluted. Future research should test a version of this intervention designed to overcome barriers that participants reported.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Birth Intervals
  • Child, Preschool
  • Contraception / methods*
  • Contraception Behavior
  • Female
  • Humans
  • Infant
  • Infant Care*
  • Long-Acting Reversible Contraception / statistics & numerical data*
  • Postpartum Period*
  • Pregnancy
  • Pregnancy, Unplanned*
  • Sterilization, Reproductive
  • Time Factors
  • Young Adult