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Variation in Postpartum Use of Most and Moderately Effective Contraceptive Methods Among Louisiana Women

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Abstract

Background

Women experiencing unintended and short-interval pregnancies are at increased risk for adverse outcomes. Nationally, researchers report disparities in women’s use of effective contraceptive methods based on demographic, cultural, financial and system-level factors. Despite 58% of Louisiana births being unplanned, researchers have not reported on these relationships in Louisiana.

Methods

We used Louisiana Pregnancy Risk Assessment Monitoring System data from 2015 to 2018. Among postpartum women who were not abstinent, pregnant, or trying to become pregnant, we estimated use of five categories of effective contraception versus no effective method. We used multivariable multinomial logistic regression to investigate the association between effective contraceptive use and race/ethnicity, postpartum insurance and education.

Results

Among Louisiana postpartum women who were not abstinent, pregnant, or trying to become pregnant, 35.4% were not using effective contraception. Women with public insurance had greater odds of using long-acting reversible contraception than women with private insurance (adjusted odds ratio [AOR] 1.55; 95% confidence interval [CI] 1.11–2.16). Compared to women with a bachelor’s or higher, women with less than high school (AOR 2.09; CI 1.22–3.56), high school (AOR 3.11; CI 2.01–4.82) or some college education (AOR 2.48; CI 1.64–3.75) had greater odds of using permanent contraception. Black (AOR 3.83; CI 2.66–5.54) and Hispanic (AOR 3.85; CI 2.09–7.11) women, women with less than high school (AOR 6.79; CI 2.72–16.94), high school (AOR 7.26; CI 3.06–17.21) and some college (AOR 7.22; CI 3.14–16.60), and women with public insurance (AOR 1.91; CI 1.28–2.87) had greater odds of using injectable contraception.

Discussion

Results showed variation in effective contraceptive method use by race/ethnicity, insurance and education. These findings highlight the need for state-level research into the individual, provider, and policy-level factors that influence women’s contraceptive choices.

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Acknowledgements

We would like to acknowledge the Louisiana Department of Health, Bureau of Family Health staff who provided feedback throughout the early development of this project, including Rosaria Trichilo, Jennifer Le, Randal Leggett, Norah Friar, and Katie Sacca Brennan. We would also like to acknowledge Amy Zapata and Jane Herwehe for their revisions of the final manuscript. Finally, we thank the women of Louisiana who participated in the PRAMS survey. This project was supported in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 1 NU38OT000297-01-00.

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Authors and Affiliations

  1. Bureau of Family Health, Office of Public Health, Louisiana Department of Health, 1450 Poydras Street, New Orleans, LA, 70112, USA

    Katharine Bruce, Jia Benno & Lyn Kieltyka

  2. Council of State and Territorial Epidemiologists, 2635 Century Parkway NE, Atlanta, GA, 30345, USA

    Katharine Bruce

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  1. Katharine Bruce
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  2. Jia Benno
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Correspondence to Katharine Bruce.

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Bruce, K., Benno, J. & Kieltyka, L. Variation in Postpartum Use of Most and Moderately Effective Contraceptive Methods Among Louisiana Women. Matern Child Health J 24, 1151–1160 (2020). https://doi.org/10.1007/s10995-020-02971-x

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