Increasing Access to Immediate Postpartum Long-Acting Reversible Contraception on Pregnancy and Contraceptive Outcomes in Patients Seeking Permanent Contraception Postpartum

Rebecca Tsai; Elijah Wade; Lue-Yen S Tucker; Cynthia Triplett; Karrie Murphy

doi:10.7812/TPP/24.172

Increasing Access to Immediate Postpartum Long-Acting Reversible Contraception on Pregnancy and Contraceptive Outcomes in Patients Seeking Permanent Contraception Postpartum

Perm J. 2026 Jun 15;30(2):102-108. doi: 10.7812/TPP/24.172. Epub 2025 Sep 23.

Authors

Rebecca Tsai^{1

2}, Elijah Wade³, Lue-Yen S Tucker³, Cynthia Triplett⁴, Karrie Murphy¹

Affiliations

¹ Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Santa Clara Medical Center, Santa Clara, CA, USA.
² Now with Partners in Women's Health, Denver, CO, USA.
³ Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, USA.
⁴ Department of Graduate Medical Education, Kaiser Permanente Northern California, Santa Clara Medical Center, Santa Clara, CA, USA.

Abstract

Introduction: To evaluate the impact of increasing access to immediate postpartum (IPP) long-acting reversible contraceptions (LARCs) on pregnancy and contraceptive outcomes in patients that desired permanent contraception prior to delivery.

Methods: This retrospective cohort study compared patients aged > 18 years at gestational age 24 weeks 0 days and above, who desired permanent contraception before and after an organization-wide intervention to increase access to IPP LARCs. The authors collected demographic information, birth control method documented at discharge, LARC usage within 3 months of delivery, LARC type, and unintended pregnancy 1 year after delivery. Patients specified whether their pregnancies were unintended at time of first pregnancy-related care. Patients who obtained permanent contraception during their delivery encounter were excluded. Mann-Whitney and χ² tests were used to assess group differences.

Results: The authors reviewed 1607 patient records (846 preintervention; 761 postintervention). The cohorts were similar in age, body mass index, parity, and gestational age at delivery. Out of the 846 preintervention patients, 183 (22%) underwent LARC placement (39 [21%] arm implant; 144 [79%] intrauterine device), and 16 (1.9%) patients had a 1-year interval unintended pregnancy. Out of the 761 postintervention patients, 190 (25%) underwent LARC placement (54 [28%] arm implant; 136 [72%] intrauterine device), and 7 (0.9%) patients had a 1-year interval unintended pregnancy.

Discussion: With increased access to IPP LARCs, patients who did not obtain desired permanent contraception were more likely to utilize LARCs at 3 months postpartum and less likely to have another pregnancy within 1 year.

Conclusion: Patients unable to receive requested postpartum permanent contraception appear to benefit from increased access to IPP LARCs.

Keywords: Family Planning; Immediate Postpartum Permanent Contraception; Long-Acting Reversible Contraception.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Health Services Accessibility* / statistics & numerical data
Humans
Long-Acting Reversible Contraception* / statistics & numerical data
Postpartum Period*
Pregnancy
Pregnancy Outcome
Pregnancy, Unplanned
Retrospective Studies
Young Adult