Postpartum Contraceptive Choices among Ethnically Diverse Women in New Mexico

Objective

To determine if postpartum contraceptive choices by primiparous women differ by ethnicity.

Study design

Retrospective nested cohort study analyzing women's characteristics and contraceptive choice.

Results

Of 652 participants, 312 (47.8%) were Hispanic, 287 (44.0%) were non-Hispanic white and 53 (8.1%) were American Indian (AI). Ethnic groups did not vary in choice of intrauterine devices (IUD), implant or pills. In multivariate analysis, depot medroxyprogesterone acetate (DMPA) choice was related to AI (OR 15.28, CI 4.49 – 52.04) and Hispanic ethnicity (OR 3.44, CI 1.12 – 10.58).

Conclusion

Contraceptive choice did not vary between ethnic groups for most methods. DMPA use was higher among Hispanic and AI women.

Predictors of immediate postpartum choice of contraceptive method

Contraceptive Methods	Unadjusted		Adjusted
	OR (95% CI)	p value	OR (95% CI)	p value
IUD/Implant	IUD/Implant		IUD/Implant
Ethnicity
- NHW	Referent	0.07	Referent	0.06
- Hispanic	1.27 (0.91 – 1.76)		1.04 (0.73 – 1.47)
- American Indian	0.62 (0.32 – 1.21)		0.46 (0.22 – 0.92)
Age ≥ 25 years	0.45 (0.33 – 0.63)	<0.001	0.49 (0.35 – 0.70)	<0.001
BMI ≥ 25	0.95 (0.69 – 1.31)	0.76
Weight gain ≥ 15 kg	1.32 (0.96 – 1.82)	0.08
≥ 4 year college education	0.52 (0.36 – 0.76)	<0.001
Unplanned pregnancy	2.05 (1.48 – 2.84)	<0.001	1.78 (1.25 – 2.46)	0.001
Late prenatal care	1.15 (0.78 – 1.69)	0.47
≥ 12 prenatal visits	1.21 (0.88 – 1.67)	0.25
Breastfeeding immediately PP	0.51 (0.24 – 1.1)	0.09
Postpartum visit	1.62 (1.01 – 2.60)	0.04
Married/Cohabitating	0.59 (0.41 – 0.84)	0.003
Insurance at time of delivery
- Private	Referent	0.02
- Medicaid	1.41 (0.98 – 2.02)
- Military	2.56 (1.25 – 5.35)
- Self-pay	0.62 (0.23 – 1.63)

Pills/Patch/Ring	Pills/Patch/Ring		Pills/Patch/Ring
Ethnicity
- NHW	Referent	0.95	Referent	0.81
- Hispanic	0.97 (0.68 – 1.39)		0.92 (0.64 – 1.33)
- American Indian	0.90 (0.46 – 1.76)		0.79 (0.36 – 1.72)
Age ≥ 25 years	1.25 (0.89 – 1.76)	0.20
BMI ≥ 25	1.01 (0.71 – 1.42)	0.97
Weight gain ≥ 15 kg	0.88 (0.62 – 1.24)	0.46
≥ 4 year college education	1.36 (0.94 – 1.98)	0.11
Unplanned pregnancy	0.86 (0.61-1.22)	0.40
Late prenatal care	1.06 (0.70 -1.60)	0.77
≥ 12 prenatal visits	0.90 (0.63 – 1.27)	0.54
Breastfeeding immediately PP	1.69 (0.67 – 4.24)	0.26
Postpartum visit	0.66 (0.42 – 1.05)	0.08
Married/Cohabitating	1.53 (1.03 – 2.28)	0.04	1.50 (1.00 – 2.25)	0.04
Insurance at time of delivery
- Private	Referent	0.15
- Medicaid	0.90 (0.61 – 1.32)
- Military	0.58 (0.25 – 1.35)
- Self-pay	2.03 (0.86 – 4.8)

DMPA	DMPA		DMPA
Ethnicity
- NHW	Referent	<0.001	Referent	<0.001
- Hispanic	4.59 (1.54 – 13.68)		3.44 (1.12 – 10.58)
- American Indian	22.63 (6.92 – 74.02)		15.28 (4.49 – 52.04)
Age ≥ 25 years	0.62 (0.30-1.26)	0.19
BMI ≥ 25	0.79 (0.39 – 1.60)	0.51
Weight gain ≥ 15 kg	0.94 (0.46-1.90)	0.86
≥ 4 year college education	0.14 (0.03 – 0.58)	0.006	0.22 (0.05 – 0.99)	0.05
Unplanned pregnancy	0.49 (0.24-1.02)	0.06	0.43 (0.20 – 0.92)	0.03
Late prenatal care	2.23 (1.06 – 4.73)	0.04
≥ 12 prenatal visits	0.30 (0.14 – 0.68)	0.004
Breastfeeding immediately PP	0.51 (0.15 – 1.79)	0.29
Postpartum visit	0.31 (0.15 – 0.64)	0.001
Married/Cohabitating	0.45 (0.21 – 0.95)	0.04
Insurance at time of delivery		0.01
- Private	Referent
- Medicaid	15.36 (2.08 – 113.69)
- Military	5.09 (0.31-83.24)
- Self-pay	35.60 (3.79 – 334.18)

Full article at:   http://goo.gl/KVP7Oc

By:  Rameet H. Singh, MD MPH, Rebecca G. Rogers, MD, Lawrence Leeman, MD MPH, Noelle Borders, CNM MSN,Jessica Highfill, MD, and Eve Espey, MD MPH

Rameet H. Singh, University of New Mexico School of Medicine Department of Obstetrics and Gynecology, Albuquerque, New Mexico;

Contributor Information.

Contact details for corresponding author: Rameet H. Singh, MD MPH, University of New Mexico School of Medicine, Department of Obstetrics and Gynecology, MSC 105580, 1 UNM, Albuquerque, NM 87131, Tel: (505) 925-0688, Fax: (505) 272-3698,

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