Offering a broad choice of contraceptives can rapidly expand use in crisis-affected settings, particularly when the choice includes long-acting reversible contraceptives (LARCs). Over 5 years, the governments of Chad and the Democratic Republic of the Congo, with support from an NGO, provided nearly 85,000 new clients with contraceptives. LARC users, which included an increasing number of IUD users, accounted for 73%.

A family planning program in 5 crisis-affected settings reached more than 52,000 new contraceptive users in just 2.5 years. Long-acting reversible contraceptives (LARCs) made up 61% of the method mix, with implants predominating in most countries. IUD use also increased over time as the program intensified its efforts to improve provider skills and user awareness. These findings demonstrate the strong popularity of LARCs and the feasibility of providing them in fragile settings even though they require more training and infrastructure support than short-acting methods.

Extending access to a wide variety of contraceptive methods, including long-acting reversible methods, is feasible in crisis-affected countries by focusing on best practices such as competency-based training, supply chain support, systematic supervision, and community mobilization. Prudent use of data helps drive program improvements.

OBJECTIVES/GOALS: Alabama has the 3rd highest maternal mortality ratio in the U.S., with more than 50% of deaths occurring postpartum. There is little evidence on the prevalence or equity of postpartum care use in Alabama. This mixed methods study examines relationships between patient and provider factors and access to, use of, and racial disparities in postpartum care. METHODS/STUDY POPULATION: I will use a sequential explanatory mixed methods design. In the quantitative phase I will analyze an integrated electronic health record and human resource dataset to identify patient and provider factors that have a relationship with receipt of at least one postpartum visit within 12 weeks of delivery in a cross-sectional, retrospective cohort of 30,000 obstetric patients in Alabama. In the qualitative phase I will describe the postpartum experiences of obstetric patients who identify as Black or African American who received or did not receive at least one postpartum visit within 12 weeks of childbirth. In the integration phase I will draw synthesized conclusions about how the results of both phases describe predictors of and barriers and facilitators to postpartum care for Black birthing people in Alabama. RESULTS/ANTICIPATED RESULTS: I will identify relationships between patient factors (e.g., race, racial concordance with primary provider, insurance status, age, parity, type of delivery, Area Deprivation Index, presence of a chronic condition or severe morbidity) and patient receipt of postpartum care. I will also explore whether health care provider factors (e.g., race, racial concordance with the patient, age, gender, provider type, years of experience) predict patient receipt of postpartum care in this retrospective cohort. In the qualitative phase, I will explore the experiences and perceptions of birthing people who identify as Black or African-American that help explain the relationships between patient and provider factors and receipt of postpartum care identified in the quantitative phase. DISCUSSION/SIGNIFICANCE: More than 50% of maternal death occurs after childbirth. Postpartum care is critical to birthing people’s survival, especially in states with high maternal mortality. This study will fill a gap in knowledge about factors that have a relationship with equitable postpartum care in Alabama.

A t a recent symposium on maternal mortality at Morehouse University, I watched a young woman descend to the microphone during a question-and-answer session aft er a sobering and intense day considering the data that described the dismal numbers and alarming racial disparities in U.S.