Objectives
In the 1980’s, policy makers in Mexico led a national family planning initiative focused, in part, on postpartum IUD use. The transformative impact of this initiative is not well known, and is relevant to current efforts in the United States (US) to increase women’s use of long-acting reversible contraception (LARC).
Methods
Using six nationally representative surveys, we illustrate the dramatic expansion of postpartum LARC in Mexico and compare recent estimates of LARC use immediately following delivery through 18 months postpartum to estimates from the US. We also examine unmet demand for postpartum LARC among 321 Mexican-origin women interviewed in a prospective study on postpartum contraception in Texas in 2012, and describe differences in the Mexican and US service environments using a case-study with one of these women.
Results
Between 1987 and 2014, postpartum LARC use in Mexico doubled, increasing from 9% to 19% immediately postpartum and from 13% to 26% by 18 months following delivery. In the US, <0.1% of women used an IUD or implant immediately following delivery and only 9% used one of these methods at 18 months. Among postpartum Mexican-origin women in Texas, 52% of women wanted to use a LARC method at six months following delivery, but only 8% used one. The case study revealed provider and financial barriers to postpartum LARC use.
Conclusions
Some of the strategies used by Mexico’s health authorities in the 1980s, including widespread training of physicians in immediate postpartum insertion of IUDs, could facilitate women’s voluntary initiation of postpartum LARC in the US.
Significance
The long history of postpartum LARC in Mexico is little known outside the country. The widespread availability and acceptance of postpartum LARC in Mexico illuminates the potential demand for this service among Mexican-origin women living in the US. Moreover, Mexico’s concerted effort to make LARC available to postpartum women can serve as an example for the US and other countries seeking to expand voluntary access to highly effective contraception.