Are there differences in
postpartum contraceptive use between women with and without immigration
background? Do women more commonly use contraception following a high-risk
pregnancy or caesarean section? What role does current breastfeeding play and,
amongst immigrants, what is the effect of acculturation level on the frequency
of contraceptive use?
Data collection was carried
out as part of a larger study in three Berlin delivery units using standardised
interviews (questionnaires covering e.g. sociodemographics, immigration
history/acculturation and use of antenatal care); telephone interviews
comprising 6 questions on postpartum contraception, breastfeeding and
postpartum complications were conducted on a sample of the study population six
months after delivery.
247 women with, and 358 women
without a background of immigration were included in the study (total study
population n = 605, response rate 81.1 %). 68 % of 1st generation immigrants,
87 % of 2nd/3rd generation women and 73 % of women without immigration
background (non-immigrants) used contraception. In the logistical regression
analysis 1st generation immigrants were less likely than non-immigrants to be
using contraception six months postpartum, and 1st generation immigrants with
low acculturation level were significantly less likely to use contraception
than 2nd/3rd generation women with low acculturation level.
In the extended postpartum
period there was no major difference in contraceptive use between immigrants in
general and non-immigrants. It remains unclear whether the differing
contraceptive behaviour of 1st generation immigrants is the result of less
access to information, sociocultural factors or differing contraceptive
requirements and further targeted, qualitative study is required.
Table 2 Contraception at six months post partum.
| 1st generation immigrants | 2nd + 3rd generation women | Non-immigrants | Total | ||
|---|---|---|---|---|---|
| * vaginal ring, 3-monthly injection, sterilisation (female, male), coitus interruptus, natural family planning, others | |||||
| Contraception: yes | n | 118 | 60 | 261 | 439 |
| % | 68.2 | 87.0 | 73.1 | 73.3 | |
| missing = 6 | |||||
| Method: | n | 117 | 60 | 261 | 438 |
| % | 29.9 | 50.0 | 39.1 | 38.1 |
| % | 13.7 | 16.7 | 9.2 | 11.4 |
| % | 47.0 | 33.3 [v] | 45.2 | 43.8 |
| % | 9.4 | 6.5 | 6.7 | |
Table 4 Influence of various factors on contraceptive use six months after delivery.
| Contraception “yes” in % (n) | |||||
|---|---|---|---|---|---|
| 1st generation immigrants | 2nd + 3rd generation women | Non-immigrants | |||
| Fisherʼs Exact Tests: Ref. = Referenz, ** p < 0.01, n. s. = nicht signifikant | |||||
| Acculturation level | low | 67.4 (58)** | 96.3 (26) Ref. | – | |
| high | 70.5 (55) n. s. | 78.4 (29) Ref. | – | ||
| low | oral contraceptive | 34.5 (20) | 53.9 (14) | – | |
| condom | 39.7 (23) | 30.8 (11) | – | ||
| other | 25.9 (15) | 15.4 (4) | – | ||
| high | oral contraceptive | 23.6 (13) | 46.7 (14) | – | |
| condom | 58.2 (32) | 33.3 (10) | – | ||
| other | 18.2 (10) | 20.0 (6) | – | ||
| Mode of delivery | vaginal | 70.9 (83) n. s. | 87.5 (42) n. s. | 75.4 (147) Ref. | |
| Caesarean section | 62.5 (35) n. s. | 85.7 (18) n. s. | 70.4 (114) Ref. | ||
| vaginal | oral contraceptive | 28.9 (24) | 47.6 (20) | 39.9 (59) | |
| condom | 43.4 (36) | 33.3 (14) | 49.3 (73) | ||
| other | 27.7 (23) | 19.1 (8) | 10.8 (16) | ||
| Caesarean section | oral contraceptive | 31.4 (11) | 52.6 (10) | 37.4 (43) | |
| condom | 54.3 (19) | 26.3 (5) | 40.0 (46) | ||
| other | 14.3 (5) | 21.1 (4) | 22.6 (26) | ||
| High risk pregnancy | no | 71.4 (85) n. s. | 87.2 (41) n. s. | 74.5 (180) Ref. | |
| yes | 60.4 (32) n. s. | 86.4 (19) n. s. | 69.8 (81) Ref. | ||
| no | oral contraceptive | 28.2 (24) | 48.8 (20) | 42.9 (78) | |
| condom | 49.4 (42) | 36.6 (15) | 45.6 (83) | ||
| other | 22.4 (19) | 14.6 (6) | 11.5 (21) | ||
| yes | oral contraceptive | 31.3 (10) | 50.0 (10) | 29.6 (24) | |
| condom | 40.6 (13) | 20.0 (4) | 44.4 (36) | ||
| other | 28.1 (9) | 30.0 (6) | 25.9 (21) | ||
| Midwifery postpartum care | no | 71.4 (50) n. s. | 89.2 (33) n. s. | 69.8 (44) Ref. | |
| yes | 66.0 (68) n. s. | 84.4 (27) n. s. | 73.8 (217) Ref. | ||
| no | oral contraceptive | 40.0 (20) | 41.2 (14) | 47.8 (22) | |
| condom | 30.0 (15) | 35.3 (12) | 37.0 (17) | ||
| other | 30.0 (15) | 23.5 (8) | 15.2 (7) | ||
| yes | oral contraceptive | 22.1 (15) | 59.3 (16) | 36.9 (80) | |
| condom | 58.8 (40) | 25.9 (7) | 47.0 (102) | ||
| other | 19.1 (13) | 14.8 (4) | 16.1 (35) | ||
| Current breastfeeding | no | 66.2 (51) n. s. | 89.4 (47) n. s. | 77.2 (129) Ref. | |
| yes | 69.8 (67) n. s. | 81.8 (22) n. s. | 69.5 (132) Ref. | ||
| no | oral contraceptive | 37.3 (19) | 51.2 (22) | 50.0 (65) | |
| condom | 43.1 (22) | 25.6 (11) | 32.3 (42) | ||
| other | 19.6 10) | 23.3 (10) | 17.7 (23) | ||
| yes | oral contraceptive | 23.9 (16) | 44.4 (8) | 27.8 (37) | |
| condom | 49.3 (33) | 44.4 (8) | 57.9 (77) | ||
| other | 26.9 (18) | 11.1 (2) | 14.3 (19) | ||
| All | |||||
| Religion | Christian | 74.5 (164) | |||
| none/other | 67.0 (140) | ||||
| Muslim | 79.4 (135) | ||||
| Christian | oral contraceptive | 35.8 (59) | |||
| condom | 52.7 (87) | ||||
| other | 11.5 (19) | ||||
| none/other | oral contraceptive | 34.8 (49) | |||
| condom | 45.4 (64) | ||||
| other | 19.9 (28) | ||||
| Muslim | oral contraceptive | 43.4 (59) | |||
| condom | 30.9 (42) | ||||
| other | 25.7 (35) | ||||
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By:
1Charité Universitätsmedizin Berlin, Campus
Virchow-Klinikum, Klinik für Gynäkologie, Berlin
2Alice Salomon Hochschule Berlin, Berlin
3Universität Bielefeld, Fakultät für
Gesundheitswissenschaften, AG Epidemiologie und International Public Health,
Bielefeld
Correspondence Prof. Dr. med. Matthias David
Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für
Gynäkologie, Augustenburger Platz 1, 13353 Berlin, ; Email: ed.etirahc@divad.saihttam
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