Abstract
Objectives
We sought to examine women's experiences with immediate postpartum LARC counseling
and use in the context of South Carolina's Medicaid policy.
Study design
In 2016–18, we conducted semi-structured individual interviews with 25 women, ages
18–35, who gave birth within 2 years of the interview in South Carolina while insured
by Medicaid and received contraceptive counseling about immediate postpartum LARC
during their pregnancies. We analyzed the interviews using a combination of deductive
and inductive coding approaches.
Results
Participants were counseled on immediate postpartum LARC during prenatal care (n=23)
and/or while in the hospital for childbirth (n=16). Some expressed dissatisfaction
with providers' approaches to contraceptive counseling because they either did not
receive enough information to make a fully informed decision or felt they were being
pressured to use LARC. Among those who received in-hospital contraceptive counseling,
some objected to the timing because they were in labor and/or already had a non-LARC
postpartum contraceptive plan. Three out of the 10 participants who elected to receive
immediate postpartum LARC later desired removal but encountered barriers.
Conclusions
Our findings suggest providers' timing, style, and content of contraceptive counseling
about immediate postpartum LARC may not be sufficiently patient-centered. Additionally,
lack of access to unfettered LARC removal limits patients' reproductive autonomy.
Implications
If providers use a patient-centered approach to immediate postpartum LARC counseling,
consistently engage in comprehensive contraceptive counseling during prenatal care,
avoid pressuring patients to choose LARC, and collaborate with hospital staff to increase
care coordination, they can improve Medicaid recipients' contraceptive care experiences
and facilitate informed contraceptive decision-making.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Declines in unintended pregnancy in the United States, 2008–2011.N Engl J Med. 2016; 374: 843-852
- Long acting reversible contraception in postpartum adolescents: early initiation of etonogestrel implant is superior to IUDs in the outpatient setting.J Pediatr Adolesc Gynecol. 2012; 25: 59-63
- Short interpregnancy intervals in the United States.Obstet Gynecol. 2013; 122: 64-71
- Long-acting reversible contraception (LARC) for adolescent.Curr Opin Obstet Gynecol. 2012; 24: 293-298
- Long-acting reversible contraceptives for teenagers: primary care recommendations.Nurse Practitioner. 2015; 40: 38-46
- Why do women experience untimed pregnancies? A review of contraceptive failure rates.Best Pract Res Clin Obstet Gynaecol. 2010; 24: 443-455
- Leveling the playing field: the promise of long-acting reversible contraceptives for adolescents.Guttmacher Policy Rev. 2013; 16: 13-18
- Acceptance of long-acting reversible contraceptive methods by adolescent participants in the contraceptive CHOICE project.Contraception. 2011; 84: 493-498
- Game change in Colorado: widespread use of long-acting reversible contraceptives and rapid decline in births among young, low-income women.Perspect Sex Reprod Health. 2014; 46: 125-132
- The contraceptive CHOICE project: reducing barriers to long-acting reversible contraception.Am J Obstet Gynecol. 2010; 203: 115.e1-115.e7
- Accessibility of long-acting reversible contraceptives (LARCs) in federally qualified health centers (FQHCs).Contraception. 2014 Feb 1; 89: 91-96
- Cost as a barrier to long-acting reversible contraceptive (LARC) use in adolescents.J Adolesc Health. 2013; 52: S59-S63
- Barriers and facilitators to adolescents' use of long-acting reversible contraceptives.J Pediatr Adolesc Gynecol. 2017; 30: 18-22
- Advocating for immediate postpartum LARC: increasing access, improving outcomes, and decreasing cost.Contraception. 2014; 90: 468-471
- Medicaid reimbursement for postpartum LARC by state.([updated 2018 Aug 21; cited 2018 Aug 27]. Available from:)
- Exposure to routine availability of immediate postpartum LARC: effect on attitudes and practices of labor and delivery and postpartum nurses.Contraception. 2018; 97: 411-414
- Implementing immediate postpartum long-acting reversible contraception programs.Obstet Gynecol. 2017; 129: 3-9
- The South Carolina Postpartum LARC Toolkit. Columbia, SC: Choose Well Initiative and the South Carolina Birth Outcomes Initiative.2017 (Available from:)https://www.choosewellsc.org/img/SC_Postpartum_LARC_Toolkit.pdfDate accessed: June 18, 2018
- Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Practice Bulletin 186.Obstet Gynecol. 2017; 130 (e251-269)
- Medicaid administrator experiences with the implementation of immediate postpartum long-acting reversible contraception.Womens Health Issues. 2016; 26: 313-320
- Rethinking Medicaid coverage and payment policy to promote high value care: the case of long-acting reversible contraception.Womens Health Issues. 2018; 28: 137-143
- Increased utilization of immediate postpartum etonogestrel contraceptive implant in adolescents after novel Medicaid policy change.J Pediatr Adolesc Gynecol. 2017; 30: 273-274
- Contraception after delivery among publicly insured women in Texas: use compared with preference.Obstet Gynecol. 2017; 130: 393-402
- Basics of qualitative research.3rd ed. Sage, Thousand Oaks, CA2008
- Provider bias in long-acting reversible contraception (LARC) promotion and removal: perceptions of young adult women.Am J Public Health. 2016; 106: 1932-1937
- “She just told me to leave it”: Women's experiences discussing early elective IUD removal.Contraception. 2016; 94: 357-361
- Beyond coercion: let us grapple with bias.Obstet Gynecol. 2015; 126: 915-916
- Under (implicit) pressure: young Black and Latina women's perceptions of contraceptive care.Contraception. 2017; 96: 221-226
- An exploration of perceived contraceptive coercion at the time of abortion.Contraception. 2018; 97: 329-334
- Shared decision making in contraceptive counseling.Contraception. 2017; 95: 452-455
- “My body. My choice”: a qualitative study of the influence of trust and locus of control on postpartum contraceptive choice.J Health Commun. 2018; : 1-8
- Women or LARC first? Reproductive autonomy and the promotion of long-acting reversible contraceptive methods.Perspect Sex Reprod Health. 2014; 46: 171-175
- Agency-without-choice: the visual rhetorics of long-acting reversible contraception promotion.Symbolic Interaction. 2018; 41: 334-356
- Inpatient postpartum long-acting reversible contraception: care that promotes reproductive justice.Obstet Gynecol. 2017; 130: 783-787
- Urban minority Women's perceptions of and preferences for postpartum contraceptive counseling.J Midwifery Womens Health. 2011; 56: 54-60
- Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use.Clin Obstet Gynecol. 2014; 57: 659-673
- Women's preferences for contraceptive counseling and decision making.Contraception. 2013; 88: 250-256
Article info
Publication history
Published online: April 24, 2019
Accepted:
April 14,
2019
Received in revised form:
April 12,
2019
Received:
September 26,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
