Psychosocial stressors and postpartum contraception

In a study in Obstetrics & Gynecology, researchers looked at the effect of psychosocial stressors on contraception in women with unintended pregnancies. Most of the stressors reviewed were independently linked to use of postpartum contraception. The notable exception was depression.

“The depression measure may not have been a good measure, or intimate partner violence and other stressors may confound the association between depression and contraceptive choice,” said principal investigator Julia Steinberg, PhD, an assistant professor of family science in the School of Public Health at the University of Maryland, College Park. 

Dr. Steinberg noted that roughly 37% of births in the United States are unintended and that 19% of US women conceive again within 12 months after delivery. A pregnancy conceived within 12 months after delivery is also more likely to be unintended than one conceived more than 12 months after delivery. 

Methods
The large population-based survey study analyzed cross-sectional data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to identify women who had an unintended birth between 2012 and 2015.  Women between 2 and 8 months postpartum completed a survey about their behaviors before, during and after pregnancy.

The effectiveness level of the postpartum contraceptive method was divided into five categories: none; less effective (withdrawal, rhythm, condoms or other barrier); moderately effective (pill, patch, ring or shot); long-acting reversible contraception (LARC) (intrauterine devices or implants); and sterilization (female or male). 

Findings
Complete data were available for 88.2% (n = 56,445) of the 64,030 eligible women, of whom 24.2% experienced depression; 5.3% experienced intimate partner violence; and 16.8% experienced five or more psychosocial stressors around the time of pregnancy or birth.

The other 14 stressors included a close family member who was very sick and had to be admitted to the hospital; separating or divorcing from husband or partner; moving to a new address; being homeless or having to sleep outside, in a car or in a shelter; having one’s husband or partner lose their job; losing one’s job, even though wanting to continue working; and oneself or one’s husband or partner having a forced reduction in work hours or pay.

Among the cohort, 29.9% of women used moderately effective contraception methods postpartum, followed by 21.0% using less effective contraceptive methods, 18.8% using LARC, 15.7% using no contraceptive method and 14.6% using sterilization.

Conclusions
“Providers should be discussing psychosocial experiences during the same visits as when talking about what postpartum contraceptive method the woman is considering using,” Dr. Steinberg told Contemporary OB/GYN. “A discussion on how psychosocial experiences may influence contraceptive behaviors is warranted.”

Standardized screening for psychosocial factors during prenatal and postpartum care should also be integrated into office visits.

“More research is needed on whether depression influences contraceptive behaviors, or if common factors lead women to have more depressive symptoms and engage in certain contraceptive behaviors,” Dr. Steinberg said.

Disclosures:

Dr. Steinberg reports no relevant financial disclosures.