Future reproductive outcomes and contraceptive access in the first year postpartum after non-receipt of postpartum permanent contraception

Abstract

Objective: Our objective was to compare pregnancy, contraceptive uptake, and health care utilization in the 365 days following delivery, between those who requested and did not receive permanent contraception and those who requested other types of postpartum contraception.

Study design: This was a retrospective cohort study of 1412 patients among 5688 delivering in 2018 at one health system. Our primary outcome was pregnancy within 365 days postpartum and we compared 207 individuals who requested and did not receive permanent contraception, with 956 who requested other types of contraception. Secondary outcomes included care utilization and contraceptive uptake in the year postpartum.

Results: Individuals with unfulfilled permanent contraception requests had similar incidence of pregnancy by 365 days postpartum as those planning other types of contraception (9.2% vs 8.6%, p = 0.79), a difference which persisted after adjusting for parity and insurance type. Those with unfulfilled requests returned for postpartum care somewhat less frequently (58.5% vs 66.1%, p = 0.04) but were more likely to use more effective contraception (35.3% vs 17.6%, p < 0.001).

Conclusions: We report future pregnancy incidence among those with unfulfilled permanent contraception similar to patients not requesting permanent contraception. Patients had relatively high rates of postpartum visits and use of highly-effective contraception, demonstrating the value of these services.

Implications: Policies facilitating access to contraception and postpartum follow up could help reduce the risk of future pregnancy, even among those unable to access preferred contraception at the time of delivery.

Keywords: Health disparities; Permanent contraception; Postpartum contraception; Sterilization; Tubal ligation.