Women with substance use disorders are less likely to use prescription contraceptives, especially long-acting methods, but are not significantly less likely to adhere to them once prescribed than women without substance use disorders.

Many rural primary care providers do not place long acting contraceptive devices due to lack of training. Female physicians and those providing maternity care are the most likely to place these devices. Increased training for primary care physicians both during and after residency would help increase access to these options for women in rural areas.

Objectives The postpartum period is a high-risk time for unintended pregnancy, and additional opportunities to provide contraception are needed. Our objective was to evaluate the acceptability of providing postpartum contraceptive counseling at a pediatric well baby visit, and compare it to counseling at the routine postpartum visit. Methods Postpartum women (100 per group) were recruited for this cohort study at pediatric well baby visits and obstetric postpartum visits at an academic medical center. Well baby participants completed a baseline survey followed by contraceptive counseling by an obstetrician or midwife and a post-counseling survey. Postpartum participants were surveyed after their visit only. Results All well baby visit participants completed the intervention and were enrolled earlier in the postpartum period than postpartum visit participants (mean = 4.1 vs. 6.6 weeks, respectively, p < 0.01). Following counseling, 95% of well baby participants reported being very comfortable discussing contraception, compared to 83% before counseling (RR 1.14, 95% CI 1.06, 1.25) and a higher proportion reported being very likely to use a contraception prescription obtained at the well baby visit (79% after counseling vs. 65% before; RR 1.23, 95% CI 1.08, 1.39). Similar proportions of postpartum and well baby participants were very comfortable discussing contraception at their visits (91 vs. 95%, respectively). Conclusions for practice Contraceptive counseling paired with well baby visits is acceptable among postpartum women. Acceptability increased further after the counseling intervention at the well baby visit. Obstetricians and Pediatricians can partner to offer contraceptive counseling at the well baby visit to increase opportunities for contraception education at an earlier time postpartum.

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