Abstract
Objective To determine the association of age at index birth with postpartum contraceptive use and optimal interpregnancy interval (IPI, defined as delivery to next pregnancy >18 months), controlling for provider type and client demographics among adolescent mothers who have repeat pregnancies. Methods California’s 2008 birth records were linked to California’s Medi-Cal and Family PACT claims data to identify 26,393 women with repeat births between 2002 and 2008, whose index birth occurred as an adolescent, and who received publicly-funded services within 18 months after the index birth. Multivariable regression analyses were conducted to examine the relationship between timing of contraception provision and interpregnancy intervals, adjusting for socio-demographic factors. Results Seventy-eight percent of adolescent women did not receive contraception at their first postpartum visit, and twenty-eight percent of adolescent women never received contraception from a Family PACT or Medi-Cal provider. Adolescents who were older at their index birth had lower rates of optimal IPIs. Native American, Asian-Pacific Islander and Latina women had lower rates of optimal IPIs compared to white women. Compared to those using only barrier methods, adolescent women receiving highly effective contraceptive methods had a 4.25 times higher odds of having an optimal IPI than those receiving hormonal methods (OR 2.10), or using no method (OR 0.70). Conclusion Effective postpartum contraceptive use and being a Family PACT provider were associated with optimal birth spacing among adolescent mothers, yet racial and ethnic disparities persisted. A missed opportunity was the provision of contraception at the first postpartum visit. Providers should aim to remove barriers to initiation of contraception at this visit.
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References
Bixby Center for Global Reproductive Health, University of California, San Francisco. Family PACT Program Report, FY2009-10, 2011. 2012.
Braveman P., Brindis C., Biggs A., et al. Latina voices: Findings from a study of Latina teen childbearing in the Fresno and Los Angeles Areas. 2011.
California Department of Public Health, Maternal Child and Adolescent Health. California Teen Births 2000-2012. http://www.cdph.ca.gov/programs/mcah/Documents/MO-MCAH-2012TBR-DataSlides.pdf. Accessed August 24, 2014.
Centers for Disease Control and Prevention. (2012a). Prepregnancy contraceptive use among teens with unintended pregnancies resulting in live births-pregnancy risk assessment monitoring system (PRAMS), 2004–2008. Morbidity and Mortality Weekly Report, 61, 25–29.
Centers for Disease Control and Prevention. (2012b). Sexual experience and contraceptive use among female teens-United States, 1995, 2002, and 2006–2010. Morbidity and Mortality Weekly Report, 61, 297–301.
Chabot, M. J., Navarro, S., Swann, D., & Darney, P. (2014). Thiel de Bocanegra H. Association of access to publicly funded family planning services with adolescent birthrates in California counties. American Journal of Public Health, 104(Suppl 1), e1–e6. doi:10.2105/AJPH.2013.301454.
Chapman, D. J., & Perez-Escamilla, R. (2013). Acculturative type is associated with breastfeeding duration among low-income Latinas. Matern Child Nutrition, 9(2), 188–198.
Conde-Agudelo, A., Rosas-Bermudez, A., & Kafury-Goeta, A. C. (2006). Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA, 295(15), 1809–1823.
Damle, L. F., Gohari, A. C., McEvoy, A. K., Desale, S. Y., & Gomez-Lobo, V. (2015). Early initiation of postpartum contraception: does it decrease rapid repeat pregnancy in adolescents? Journal of Pediatric and Adolescent Gynecology, 28(1), 57–62. doi:10.1016/j.jpag.2014.04.005.
DeFranco EA, Stamilio DM, Boslaugh SE, Gross GA, Muglia LJ. A short interpregnancy interval is a risk factor for preterm birth and its recurrence. American Journal Obsteterics Gynecology. 2007;197(3):264.e1-264.e6. doi: S0002-9378(07)00818-6 [pii].
Delara, R. M., Madden, E., & Bryant, A. S. (2014). Asian and Pacific Islander populations have higher rates of short interpregnancy intervals. Obstetrics and Gynecology, 123(Suppl 1), 186S.
Gavin, L., Warner, L., O’Neil, M., et al. (2013). Vital signs: Repeat births among teens-United States, 2007–2010. Morbidity and Mortality Weekly Report, 62(13), 249–255.
Gilbert, W., Jandial, D., Field, N., Bigelow, P., & Danielsen, B. (2004). Birth outcomes in teenage pregnancies. The Journal of Maternal-Fetal and Neonatal Medicine, 16, 265–270.
Hamilton, B., Martin, J., Osterman, M., & Curtin, S. (2015). Births: Preliminary Data for 2014. National Vital Statistics Reports., 64(6), 1–19.
Harper, C. C., Brown, B. A., Foster-Rosales, A., & Raine, T. R. (2010). Hormonal contraceptive method choice among young, low-income women: how important is the provider? Patient Education and Counseling, 81(3), 349–354. doi:10.1016/j.pec.2010.08.010.
Heck, K. E., Braveman, P., Cubbin, C., Chavez, G. F., & Kiely, J. L. (2006). Socioeconomic status and breastfeeding initiation among California mothers. Public Health Reports, 121(1), 51–59.
Hoffman H. By the numbers: the public costs of teen childbearing in California. 2006.
Horwitz, S. M., Klerman, L. V., Kuo, H. S., & Jekel, J. F. (1991). School-age mothers: predictors of long-term educational and economic outcomes. Pediatrics, 87(6), 862–868.
James, A. T., Bracken, M. B., Cohen, A. P., Saftlas, A., & Lieberman, E. (1999). Interpregnancy interval and disparity in term small for gestational age births between black and white women. Obstetrics and Gynecology, 93, 109–112.
Khoshnood, B., Lee, K. S., Wall, S., Hsieh, H. L., & Mittendorf, R. (1998). Short interpregnancy intervals and the risk of adverse birth outcomes among five racial/ethnic groups in the United States. American Journal of Epidemiology, 148(8), 798–805.
Kirby D. Emerging Answers 2007: Research findings on programs to reduce teen pregnancy and sexually transmitted diseases. The National Campaign to Prevent Teen and Unplanned Pregnancy. 2007.
Klerman L. Another chance: Preventing additional births to teen mothers. 2004.
Manlove, J., Ryan, S., & Franzetta, K. (2004). Contraceptive use and consistency in U.S. teenagers’ most recent sexual relationships. Perspect Sex Reprod Health., 36(6), 265–275. doi:10.1363/3626504.
Maternal and Infant Health Statistics. Medi-Cal Birth Statistics. October 2014.
Office of Disease Prevention and Health Promotion. Healthy People 2020. 2010.
Office of Family Planning, Department of Health Care Services. Family PACT Policies, Procedures and Billing Instructions. Sacramento, California, 2008.. 2008.
Paukku, M., Quan, J., Darney, P., & Raine, T. (2003). Adolescents’ contraceptive use and pregnancy history: is there a pattern? Obstetrics and Gynecology, 101(3), 534–538.
Phipps, M., Rosengard, C., Weitzen, S., Meers, A., & Billinkof, Z. (2008). Age group differences among pregnant adolescents: Sexual behavior, health habits and contraceptive use. Journal of Pediatric and Adolescent Gynecology, 21, 9–15.
Polit, D. F., & Kahn, J. R. (1986). Early subsequent pregnancy among economically disadvantaged teenage mothers. American Journal of Public Health, 76(2), 167–171.
Sparks, P. J. (2011). Racial/ethnic differences in breastfeeding duration among WIC-eligible families. Womens Health Issues., 21(5), 374–382. doi:10.1016/j.whi.2011.03.002.
Sterling, S. P., & Sadler, L. S. (2009). Contraceptive use among adolescent Latinas living in the United States: The impact of culture and acculturation. J Pediatr Health Care, 23(1), 19–28. doi:10.1016/j.pedhc.2008.02.004.
Thiel de Bocanegra H, Chang R, Howell M, Darney P. Interpregnancy intervals: impact of postpartum contraceptive effectiveness and coverage. American Journal Obstetrics Gynecology. 2014;210(4):311.e1-311.e8. doi: 10.1016/j.ajog.2013.12.020.
Thiel de Bocanegra H, Chang R, Menz M, Howell M, Darney P. Postpartum contraception in publicly-funded programs and interpregnancy intervals. Obstetrics Gynecology. 2013;122(2 Pt 1):296-303. doi: 10.1097/AOG.0b013e3182991db6.
Trussell, J. (2012). Update on and correction to the cost effectiveness of contraceptives in the United States. Contraception., 85(2), 218. doi:10.1016/j.contraception.2011.06.011.
Ventura, S., Hamilton, B., & Mathews, T. (2014). National and state patterns of teen births in the United States, 1940–2013. National Vital Statistics Reports., 63(4), 1–34.
Waddell, E. N., Orr, M. G., Sackoff, J., & Santelli, J. S. (2010). Pregnancy risk among black, white, and Hispanic teen girls in New York City public schools. J Urban Health., 87(3), 426–439. doi:10.1007/s11524-010-9454-4.
Wilson, E. K., Fowler, C. I., & Koo, H. P. (2013). Postpartum contraceptive use among adolescent mothers in seven states. Journal of Adolescent Health, 52(3), 278–283. doi:10.1016/j.jadohealth.2012.05.004.
Zhu, B., Haines, K., Le, T., McGrath-Miller, K., & Boulton, M. (2001). Effect of the interval between pregnancies on perinatal outcomes among black and white women. American Journal of Obstetrics and Gynecology, 185, 1403–1410.
Acknowledgements
This work was supported by a grant from the Doris Duke Charitable Foundation to the University of California, San Francisco to fund Clinical Research Fellow Sarah Isquick. This study was also supported by funds from the State of California, Department of Health Care Services, Office of Family Planning, Contract # 12-89338. All analysis, interpretations, or conclusions reached are those of UCSF, not the State of California.
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Isquick, S., Chang, R., Thiel de Bocanegra, H. et al. Postpartum Contraception and Interpregnancy Intervals Among Adolescent Mothers Accessing Public Services in California. Matern Child Health J 21, 752–759 (2017). https://doi.org/10.1007/s10995-016-2164-0
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DOI: https://doi.org/10.1007/s10995-016-2164-0