Provider counseling and family planning postpartum

Women’s postpartum contraceptive decisions are influenced by both their personal goals and provider counseling, according to a survey of postpartum women in the Journal of Women’s Health.

“Our findings underscore the importance of engaging women in shared decision-making about contraceptive choices, and to specifically elicit their goals for pregnancy spacing and family size,” said lead author Alison Goulding, MD, MSCR, a clinical instructor and Fellow in ob/gyn at the University of North Carolina School of Medicine in Chapel Hill.

Dr. Goulding’s clinical experiences inspired her to undertake the study. “As an ob/gyn, my daily interactions with patients demonstrate the great importance of reproductive life planning,” she said. “I wanted to better understand how our profession can counsel and support women in making complex family planning decisions.”

Methods
From January to May 2016, a total of 2,850 postpartum women completed the anonymous Internet cross-sectional survey of multiple topics, including prenatal/postpartum care and family planning. The majority of participants were white (93%), aged 30 years or older (63%) and had at least a college degree (74%). 

Findings
Roughly half (49%) of the cohort desired an interpregnancy interval (IPI) of at least 2 years, but only a minority (21%) used a highly effective contraceptive method defined as long-acting reversible contraception (LARC) or sterilization. Nonetheless, the majority of women (56%) reported that they had received counseling on three to six different family planning topics during the prenatal or postpartum periods. 

“We found that women who received more family planning counseling were 33% more likely to use a highly effective method of postpartum contraception, compared to those receiving less family planning counseling,” Dr. Goulding told Contemporary OB/GYN. “But they were not more likely to desire a longer interpregnancy interval.”

On the other hand, the desired interpregnancy interval modified the association between counseling and contraception. For instance, among women desiring an interpregnancy interval greater than 2 years, more counseling was associated with a 58% higher likelihood of using a highly effective contraceptive method. 

“However, for women desiring a shorter interpregnancy interval, there was no association between the amount of provider counseling and the method of contraception,” Dr. Goulding said. 

Conclusions
Study results were surprising because the authors hypothesized that women who received more family planning counseling would be more likely to use highly effective contraception and to desire a longer interpregnancy interval. 

“Our findings suggest that women’s reproductive goals helped guide provider counseling,” Dr. Goulding said. “For example, if a woman expressed the desire for a shorter interpregnancy interval, her provider may have decided to focus counseling on shorter-term contraceptive methods in line with her goals.” 

One of the limitations of the study, though, is that the population sampled was more white, educated, and older than the average population of postpartum women in the United States. The sample was also limited to breastfeeding mothers, which can influence both contraceptive choice and provider counseling.

“Still, given the profound implications of reproductive life planning for both personal and community health, it is important to understand how ob/gyns can best support and empower women to make decisions that maximize health and align with their personal goals,” Dr. Goulding said.

Further research is needed, however, to evaluate the quality of family planning counseling, “so that we can understand how both quantity and quality of counseling influence women’s decision-making,” Dr. Goulding said. “We also need more research in diverse samples of women that better reflect the diversity of the U.S. population.”

Disclosures:

Dr. Goulding reports no relevant financial disclosures.