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Abstract
Background Short birth intervals and unintended pregnancy are associated with poorer maternal and infant outcomes. There is a risk of pregnancy during the immediate postpartum period unless contraception is initiated. This retrospective cohort study aimed to capture the current patterns of hormonal contraceptive provision within 12 months postpartum in a high-income country.
Methods We used a linked administrative dataset comprising all women who gave birth in Queensland, Australia between 1 July 2012 and 30 June 2018 (n=339 265 pregnancies). We described our cohort by whether they were provided with government-subsidised hormonal contraception within 12 months postpartum. The associations between hormonal postpartum contraceptive provision and demographic and clinical characteristics were examined using univariate and multivariate logistic regression and presented in terms of crude and adjusted odds ratios with 95% confidence intervals.
Results A majority of women (60.2%) were not provided with government-subsidised hormonal postpartum contraception within 12 months postpartum. Women who were younger (<25 years), were overweight or obese, smoked, were born in Australia, were non-Indigenous, gave birth in a public hospital, or were in the lowest socioeconomic status group were more likely to be provided with postpartum contraception after adjusting for other covariates, compared with their counterparts.
Conclusions Strategies to increase the provision and uptake of contraception in the immediate postpartum period are needed to prevent short birth intervals and unintended pregnancy and ensure women’s fertility intentions are enacted. Ongoing research is needed to examine the factors influencing women’s access to contraceptive services and, further, the types of contraception provided.
- Contraceptive Agents, Female
- family planning services
- Reproductive Rights
- Patient Preference
- Patient Rights
- family planning policy
Data availability statement
Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available. Data include de-identified patient data, and can be accessed upon application to Queensland’s Perinatal Data Collection (please visit: https://www.health.qld.gov.au/hsu/collections/pdc).
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- Contraceptive Agents, Female
- family planning services
- Reproductive Rights
- Patient Preference
- Patient Rights
- family planning policy
Data availability statement
Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available. Data include de-identified patient data, and can be accessed upon application to Queensland’s Perinatal Data Collection (please visit: https://www.health.qld.gov.au/hsu/collections/pdc).
Footnotes
Twitter @LaneCarrandi
Contributors AC, CB, HT and EC were involved in the conception and design of the project. EC acquired the data. CB undertook the analysis, and all authors were involved in the interpretation of the data. AC led the drafting of the article and the other authors provided critical feedback. All authors approved the final version to be published and agreed to be accountable for all aspects of the work. EC acts as guarantor.
Funding EC, HT receive salary support from the National Health and Medical Research Council (NHMRC) through fellowship schemes. LEG receives salary support from the Channel 7 Children’s Research Foundation.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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