Women’s informed choice and satisfaction with immediate postpartum long-acting reversible contraception in Georgia

Abstract

BackgroundSeveral state Medicaid agencies have recently started reimbursing for long-acting reversible contraception (LARC) placement immediately postpartum. Women’s perspectives are critical for ensuring that this change increases access to LARC while empowering women to choose the method and timing of contraception that best meets their needs. We conducted a pilot study in Georgia, which recently changed its Medicaid reimbursement policy, to assess women’s informed choice and satisfaction with immediate postpartum LARC.MethodsWe sampled all women with a live birth paid for by Georgia Medicaid during November 2015 through February 2017 who received an immediate postpartum LARC. We then used a one-to-one match to sample women who did not receive immediate postpartum LARC. Women were contacted via telephone for a 25–30 min interview regarding their knowledge, attitudes, and behaviors related to immediate postpartum LARC and their satisfaction with postpartum contraception. We calculated descriptive statistics and components of informed choice overall and by receipt of immediate postpartum LARC, using chi-square tests to calculate differences by group.ResultsWe approached 470 women and completed interviews with 51; 25 (49%) received immediate postpartum LARC (24 implants, 1 intrauterine device). Two-thirds reported their provider discussed the option of receiving immediate postpartum LARC during prenatal care, with over 90% reporting they received all the information they needed to make a decision. Most women believed the ideal time to begin using birth control postpartum is in the hospital immediately after delivery, although this differed significantly by women’s receipt of immediate postpartum LARC. Most women who received immediate postpartum LARC reported they are very or extremely happy with their device, although 40% also reported wanting their device removed at some point.ConclusionsWomen on Medicaid in Georgia report making informed choices regarding immediate postpartum LARC. Among those who received immediate postpartum LARC, women report high levels of satisfaction.

Utilisation of immediate postpartum family planning among postpartum women at public hospitals of North Shoa Zone, Ethiopia: a cross-sectional study

“…This study revealed that 21.3% (95% CI 17.8 to 25.1) of postpartum women used IPPFP, consistent with studies done in Ethiopia (19.1%–21.6%) 31–33. However, the current finding was lower than the studies conducted in Georgia (49%),34 Kenya (50.3%),35 Jimma (53.2%)5 and Addis Ababa (45.5%),36 and higher than the studies conducted in Pakistan (4%)37 and Ethiopia (12.7%–13.6%) 38 39. These variations might possibly be due to differences in sociocultural and demographic characteristics, study setting, data collection period and inclusion criteria.…”

“…In the multivariable logistic regression analysis, maternal age (30)(31)(32)(33)(34), planning status of pregnancy, reproductive intention, partner support to use FP, attitude towards FP and maternal satisfaction with intrapartum care were statistically significantly associated with utilisation of IPPFP.…”

Contraceptive Choice Among Couples of Childbearing Age (Pus) in Bengkulu Province

“…The informed choice regarding the use of long-term contraceptives from health workers is best given from the start of the pregnancy program. This is proven by research conducted by DeSisto et al, (2018) where 34 respondents received an informed choice and more than 90% of the respondents decided to use long-term contraceptives immediately after delivery (24 implants, 1 IUD). The majority of women believe the right time to use contraception in the hospital is immediately after giving birth, although 40% of respondents want the contraception to be put out again.…”

Patient acceptability, continuation and complication rates with immediate postpartum levonorgestrel intrauterine device insertion at caesarean section and vaginal birth

“…As would be expected from the low continuation rates, overall satisfaction was lower in our cohort than other studies which have reported 80-98.3% of patients would recommend immediate postpartum IUD placement to a friend. 15,28 The lower satisfaction of women in this cohort may have been due in part to the financial loss and inconvenience incurred if the device was expelled. This is because patients were responsible for the cost of their own device initially as well as arranging and funding reinsertion.…”