PDF icon Download PDF
Am J Perinatol 2025; 42(04): 428-434
DOI: 10.1055/s-0044-1789279
Original Article

Utilization of Immediate Postpartum Contraception and Its Association with Interpregnancy Interval: 10-Year Experience at a Single Center

Macie L. Champion 
1   Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Sarah E. Beebe
1   Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Christina T. Blanchard
1   Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Margaret Boozer
1   Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Brian M. Casey
1   Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Akila Subramaniam
1   Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations

Funding None.
› Further Information
Also available ateRefHebammen
 
 PDF Download Permissions and Reprints

Abstract

Objective Increasing availability of immediate postpartum long-acting reversible contraception (LARC) has added contraceptive alternatives to bilateral tubal ligation (BTL) in the immediate postpartum period. The resultant access to long-term contraception has provided patients with improved control over the timing of pregnancies. Our objective is to evaluate changes in the utilization of immediate postpartum contraceptive methods over a 10-year period and its association with interpregnancy interval (IPI).

Study Design Retrospective cohort study of 36,445 patients delivered at a single academic hospital center from 2012 to 2020. Deliveries <23 weeks gestation and patients who underwent a cesarean hysterectomy or postpartum hysterectomy for obstetric indications were excluded. The primary outcome was the utilization of postpartum BTL, intrauterine devices, contraceptive implants, and Depo-Provera over the study time period. The secondary outcomes were IPI and interdelivery interval (IDI). Outcomes were compared using appropriate tests of trend. We adjusted for significant covariates as assessed in baseline characteristics.

Results A total of 35,281 patients were included in our study. Groups were different in baseline characteristics including age, race/ethnicity, parity, BMI, insurance status, comorbidity risk, and attendance at postpartum exam. Over the study period, there was a significant difference in utilization of Depo-Provera, LARC, intrauterine device (IUD), and implant (p < 0.001). There was a significant increase in IPI (p < 0.001) and IDI (p < 0.001).

Conclusion We observed a significant increase in utilization of immediate postpartum LARC over the study period which corresponded to a significant increase in IPI and IDI. Our findings emphasize the importance of the availability of immediate postpartum contraception as well as its effectiveness in improving family planning options for reproductive-aged patients. We found significantly increased IPI and IDI associated with increased utilization of long-acting reversible contraceptives immediately postpartum. Our findings emphasize the importance of providers offering these options to patients as well as being comfortable initiating immediate postpartum contraception.

Key Points

  • Immediate postpartum LARC access has increased over the past 10 years.

  • Access to more methods of contraception allows patients more options for family planning.

  • Increased utilization of LARC led to increased IPI and IDI.


 

Keywords

contraception - interpregnancy interval - postpartum contraception - LARC

Access to contraception remains challenging for many patients in the United States. Barriers to access include geographic location, hesitancy to seek health care, and affordability.[1] In 2010, 19.1 million patients were in need of publicly funded contraceptive services due to age or poverty level, representing more than half of the reproductive-aged population.[2] The American College of Obstetricians and Gynecologists (ACOG) estimates that around 45% of all pregnancies in the United States are unintended.[3] For many patients, the peripartum period represents one of the few times when they have regular access to health care. Actively providing counseling to patients regarding contraceptive options and offering immediate postpartum contraception eliminates many barriers that patients face in accessing family planning options.

Offering immediate postpartum contraception or sterilization available during a patient's hospitalization for delivery has multiple benefits for patients and ensures a contraceptive plan if they are unable to return for a postpartum visit. Approximately 10 to 40% of patients do not attend their postpartum visit, and 40 to 57% report having unprotected intercourse prior to their 6-week visit.[3] The availability of long-acting reversible contraception (LARC) in the immediate postpartum period has expanded over the past decade and allows patients a reliable form of contraception without necessitating permanent sterilization. Over the last decade, Medicaid has expanded coverage for immediate postpartum LARC placement, which has led to a significant increase in the utilization of these devices.[4]

According to data from the National Survey of Family Growth, 2.4% of patients using contraception in 2002 reported using a long-acting reversible contraceptive, which increased to 8.9% of patients in 2009,[5] and up to 12% in 2013.[6] Over this time period, rates of sterilization remained stable with 27% of patients who desired contraception undergoing bilateral tubal ligation (BTL) in 2002 and 25% in 2013.[2] Outside of a study based on data from 2001 to 2008 that showed a greater utilization of BTL over intrauterine device placement,[7] there are limited data comparing rates of utilization of immediate postpartum contraception.

Our institution is located in Alabama, a state where reproductive rights are limited. We additionally serve a high-risk patient population with multiple barriers to seeking care who often have limited access to health care both during and between pregnancies. For our patients, access to immediate postpartum contraception helps to remove many barriers they face in family planning. Therefore, we sought to evaluate the utilization of immediate postpartum contraception as well as interdelivery interval (IDI) over a time period that reflects increased accessibility to these methods and the association with interpregnancy intervals (IPIs).

Materials and Methods

We performed a retrospective cohort study of all deliveries at the University of Alabama at Birmingham between January 2012 and December 2020. Patients who delivered at less than 23 weeks gestation or underwent a cesarean hysterectomy or postpartum hysterectomy for obstetric indications were excluded. Institutional Review Board approval was obtained from the University of Alabama at Birmingham (IRB-300006252-002). Our protocol followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.[8]

At our institution, options for immediate postpartum contraception include BTL, intrauterine device placement, etonogestrel implant placement, or administration of Depo-Provera. At our institution, immediate postpartum BTLs are performed on the day of delivery, postpartum day 1, or postpartum day 2, depending on the logistics surrounding the patient's delivery as well as patient preference. In accordance with recommendations by the ACOG, patients are considered candidates for immediate postpartum intrauterine device placement within 10 minutes of placental delivery if they have a vaginal delivery or cesarean delivery that is not complicated by chorioamnionitis.[3] For patients who elect to have an immediate postpartum implant placed, placement occurs prior to transfer to the mother–baby unit or on the floor prior to discharge. In patients with postpartum hemorrhage, provider discretion accounting for the severity of hemorrhage and time to resolution are used to guide the decision for placement. Patients who desire Depo-Provera as contraception receive an injection on the day of discharge which is administered by their postpartum nurse.

Prior to Medicaid coverage of immediate postpartum LARC, the Bixby Center for Global Reproductive Health provided intrauterine devices and etonogestrel implants for immediate postpartum placement at our institution beginning in 2017.[9] Patients were eligible for a Bixby-funded device if they desired long-acting reversible contraceptive placement, were <30% of the federal poverty level without insurance coverage for placement, and the device would be placed immediately postabortion or postpartum. The Bixby program continued to fund immediate postpartum contraception for many of our patients even after Medicaid expansion to cover immediate postpartum LARC.

The primary outcome of this study was the utilization of various methods of immediate postpartum contraception (BTL, intrauterine device, subdermal implant, and Depo-Provera) stratified by delivery year. The secondary outcomes of this study were IPI and IDI stratified by year. We defined IPI as days between delivery of the index pregnancy and the estimated due date of the subsequent pregnancy. We defined IDI as days between the delivery of the index pregnancy and the day of delivery of the subsequent pregnancy.

All data were collected via extraction from Cerner-based electronic medical records with a subset of records abstracted manually by trained research team members. Algorithms for contraceptive methods included operative and procedure notes, medication administration records, and billing procedure codes.

We compared baseline characteristics and demographics (age at delivery, race, parity, body mass index, insurance status, marital status, diagnosis of chorioamnionitis, attendance of 6-week postpartum exam, and designation of high-risk vs. low-risk pregnancy) across each year of the study time period using chi-square tests and one-way analyses of variance (ANOVAs), as appropriate. Diagnosis of chorioamnionitis was extracted using a previously validated algorithm. Patients were designated as either high-risk or low-risk based on their primary clinic of service during the pregnancy, with local health departments and our institution's generalist obstetrics practice considered low-risk and our maternal–fetal medicine or fetal care clinic as high-risk.

We evaluated rates of utilization of each method of immediate contraception (percentage [%]) by delivery year and compared them across each year using chi-square tests and one-way ANOVAs, as appropriate. We then evaluated secondary outcomes, including IPI and IDIs, using chi-square and Kruskal–Wallis tests, as appropriate. We used polynomial (cubic) regression models to model rates of immediate postpartum contraception, IPI, and IDI over time using p-values from the cubic interaction terms. The polynomial regression models were also adjusted for significant covariates noted in baseline characteristics. We lastly performed a mediation analysis (utilizing bias-corrected bootstrapping) to evaluate the contribution of individual methods of contraception on IPI over time. All primary analyses were performed using SAS 9.4 (Cary, NC) and at a significance level of 0.05.


 

Results

Of 36,445 patients who delivered at our institution between 2012 and 2020, 35,281 met the inclusion criteria for our analysis. One was excluded due to being an electronic medical record test patient, 1,141 were excluded due to preterm delivery prior to 23 weeks gestation, and 155 were excluded due to undergoing cesarean hysterectomy or immediate postpartum hysterectomy ([Fig. 1]).

Zoom
Fig. 1 Inclusion criteria.

Baseline demographics are presented in [Table 1]. Groups were significantly different in age, race/ethnicity, parity, body mass index (kg/m2), insurance status, marital status, comorbidity risk (high-risk vs. low-risk), chorioamnionitis, and attendance of postpartum exam across the study period ([Table 1]).

Table 1

Baseline demographics

2012 (n = 3,507)

2013 (n = 3,822)

2014 (n = 3,905)

2015 (n = 3,904)

2016 (n = 4,166)

2017 (n = 4,168)

2018 (n = 4,006)

2019 (n = 4,153)

2020 (n = 3,793)

p-Value

Age, mean ± SD

26.4 ± 6.0

26.6 ± 5.9

26.9 ± 5.8

27.2 ± 5.8

27.4 ± 6.0

27.8 ± 6.0

27.9 ± 6.0

28.1 ± 6.1

28.2 ± 6.1

<0.001

Race

<0.001

 White

1,069 (30.7%)

1,162 (30.7%)

1,287 (33.3%)

1,236 (32.0%)

1,374 (33.3%)

1,429 (34.6%)

1,430 (36.2%)

1,473 (35.9%)

1,339 (36.0%)

 African American

1,757 (50.5%)

1,936 (51.2%)

1,906 (49.4%)

1,903 (49.3%)

1,945 (47.2%)

1,958 (47.5%)

1,828 (46.2%)

1,890 (46.0%)

1,682 (45.2%)

 Hispanic

510 (14.7%)

566 (15.0%)

546 (14.1%)

591 (15.3%)

665 (16.1%)

599 (14.5%)

587 (14.8%)

626 (15.2%)

561 (15.1%)

 Asian/other

142 (4.1%)

116 (3.1%)

123 (3.2%)

130 (3.4%)

138 (3.4%)

140 (3.4%)

111 (2.8%)

118 (2.9%)

136 (3.7%)

Parity

0.12

 Nulliparous

1,277 (36.5%)

1,393 (36.5%)

1,382 (35.4%)

1,299 (33.3%)

1,429 (34.4%)

1,451 (34.9%)

1,398 (35.0%)

1,445 (34.9%)

1,337 (35.3%)

 Parous

2,221 (63.5%)

2,427 (63.5%)

2,520 (64.6%)

2,602 (66.7%)

2,726 (65.6%)

2,709 (65.1%)

2,602 (65.1%)

2,699 (65.1%)

2,452 (64.7%)

 BMI (kg/m2), mean ± SD

29.4 ± 9.3

29.3 ± 8.9

29.4 ± 10.1

29.6 ± 17.0

29.5 ± 10.7

29.7 ± 10.9

30.0 ± 10.3

30.2 ± 10.6

29.9 ± 10.0

0.012

Insurance status

<0.001

 Private

974 (27.8%)

1,071 (28.0%)

1,148 (29.4%)

1,201 (30.8%)

1,309 (31.4%)

1,439 (34.5%)

1,444 (36.1%)

1,532 (36.9%)

1,466 (38.7%)

 Medicaid

2,470 (70.5%)

2,696 (70.5%)

2,737 (70.1%)

2,672 (68.4%)

2,828 (67.9%)

2,677 (64.2%)

2,531 (63.2%)

2,576 (62.0%)

2,288 (60.3%)

 Self-pay

62 (1.8%)

55 (1.4%)

20 (0.5%)

31 (0.8%)

29 (0.7%)

52 (1.3%)

31 (0.8%)

45 (1.1%)

39 (1.0%)

Marital status

<0.001

 Single

2,040 (58.2%)

2,228 (58.3%)

2,263 (58.0%)

2,270 (58.2%)

2,449 (58.8%)

2,424 (58.2%)

2,292 (57.2%)

2,402 (57.8%)

2,149 (56.7%)

 Married

1,273 (36.3%)

1,409 (36.9%)

1,469 (37.6%)

1,476 (37.8%)

1,542 (37.0%)

1,560 (37.4%)

1,550 (38.7%)

1,560 (37.6%)

1,503 (39.6%)

 Divorced

92 (2.6%)

100 (2.6%)

88 (2.3%)

85 (2.2%)

89 (2.1%)

85 (2.0%)

78 (2.0%)

59 (1.4%)

52 (1.4%)

 Other

67 (1.9%)

61 (1.6%)

65 (1.7%)

57 (1.5%)

56 (1.3%)

71 (1.7%)

65 (1.6%)

84 (2.0%)

51 (1.3%)

 Unknown

35 (1.0%)

24 (0.6%)

20 (0.5%)

16 (0.4%)

30 (0.7%)

28 (0.7%)

21 (0.5%)

48 (1.2%)

38 (1.0%)

Comorbidity risk

<0.001

 High risk

982 (29.9%)

733 (20.5%)

767 (20.8%)

733 (19.8%)

780 (19.6%)

865 (21.6%)

899 (23.7%)

1,003 (25.4%)

916 (25.2%)

 Low risk

2,308 (70.2%)

2,839 (79.5%)

2,920 (79.2%)

2,973 (80.2%)

3,207 (80.4%)

3,138 (78.4%)

2,899 (76.3%)

2,950 (74.6%)

2,713 (74.8%)

 Dx of chorion

23 (0.7%)

134 (3.5%)

205 (5.3%)

203 (5.2%)

209 (5.0%)

213 (5.1%)

174 (4.3%)

174 (4.2%)

145 (3.8%)

<0.001

 Attended 6-wk PPE

701 (20.0%)

932 (24.4%)

948 (24.3%)

1,196 (30.6%)

1,337 (32.1%)

1,264 (30.3%)

1,113 (27.8%)

1,105 (26.6%)

916 (24.2%)

<0.001

Mode of delivery

<0.001

 Cesarean

1,072 (30.7%)

1,252 (32.9%)

1,184 (30.5%)

1,172 (30.2%)

1,281 (30.9%)

1,363 (32.9%)

1,353 (34.0%)

1,412 (34.2%)

1,237 (32.8%)

 Vaginal

2,420 (69.3%)

2,552 (67.1%)

2,701 (69.5%)

2,715 (69.9%)

2,867 (69.1%)

2,782 (67.1%)

2,623 (66.0%)

2,720 (65.8%)

2,531 (67.2%)

Abbreviations: BMI, body mass index; Dx, diagnosis; PPE, postpartum exam; SD, standard deviation; wk, week.


Notes: Data are presented as numbers (percentages) unless stated otherwise.


p-values were calculated using chi-square tests for categorical variables and one-way analyses of variance for continuous variables.


Rates of the utilization of various methods of contraception (BTL, Depo-Provera, intrauterine device, and implant) stratified by delivery year are presented in [Table 2] and illustrated in [Fig. 2]. Overall, there was no change in utilization of immediate postpartum BTL (p-value = 0.52) but significant differences in utilization of Depo-Provera (p-value <0.001), LARC (including both intrauterine device and etonogestrel implant; p-value <0.001), and in both intrauterine device (p-value <0.001) and etonogestrel implant placement (p-value <0.001) individually ([Table 2]). There was a trend toward decreased utilization of Depo-Provera (21.4% utilization in 2012 compared with 11.9% utilization in 2020) and a trend toward increased utilization of LARC (4.9% in 2012 compared with 20.8% in 2020; [Table 2]). There was a substantial increase in LARC utilization in 2017 from 4% in 2016 to 17% in 2017, which corresponds to our institutional implementation of the Bixby program which provided funding for immediate postpartum placement of LARC ([Table 2]). Both intrauterine device and implant utilization were significantly different over the time period (p-value <0.001, <0.001, respectively). Implementation of intrauterine devices overall increased from 1.3% in 2011 to 14.1% in 2020. Implant placement increased from 1.3% in 2011 to a peak of 10.9% in 2019, followed by a decrease to 7.1% in 2020. Differences remained statistically significant after adjusting for significantly different baseline characteristics (maternal age, BMI at intake exam, insurance status, comorbidity risk, attendance at 6-week postpartum visit; [Table 2]).

Table 2

Rates of utilization of methods of immediate postpartum contraception by delivery year

2012 (n = 3,507)

2013 (n = 3,822)

2014 (n = 3,905)

2015 (n = 3,904)

2016 (n = 4,166)

2017 (n = 4,168)

2018 (n = 4,006)

2019 (n = 4,153)

2020 (n = 3,793)

p-Value

Adjusted p-value[a]

BTL

421 (12.0%)

491 (12.9%)

495 (12.7%)

492 (12.6%)

502 (12.1%)

495 (11.9%)

491 (12.3%)

452 (10.9%)

386 (10.2%)

0.52

0.88

Depo

750 (21.4%)

774 (20.3%)

833 (21.3%)

984 (25.2%)

915 (22.0%)

599 (14.4%)

457 (11.4%)

427 (10.3%)

450 (11.9%)

<0.001

<0.001

LARC

170 (4.9%)

122 (3.2%)

123 (3.2%)

186 (4.8%)

164 (3.9%)

727 (17.4%)

765 (19.1%)

1,041 (25.1%)

787 (20.8%)

<0.001

<0.001

IUD

89 (2.5%)

65 (1.7%)

73 (1.9%)

119 (3.1%)

123 (3.0%)

502 (12.0%)

425 (10.6%)

594 (14.3%)

533 (14.1%)

<0.001

<0.001

Implant

81 (2.3%)

57 (1.5%)

50 (1.3%)

77 (2.0%)

64 (1.5%)

248 (6.0%)

351 (8.8%)

451 (10.9%)

271 (7.1%)

<0.001

<0.001

Abbreviation: BTL, bilateral tubal ligation; IUD, intrauterine device; LARC, long-acting reversible contraception.


a Adjusted for maternal age, first visit body mass index, insurance, marital status, comorbidity risk, and 6-week postpartum visit.


Zoom
Fig. 2 Utilization of immediate postpartum contraception from 2012 to 2020. BTL, bilateral tubal ligation; LARC, long-acting reversible contraception.

Secondary outcomes (IPI and IDI) are presented in [Table 3]. Over the study period, there was a significant difference in IPI (p-value <0.001) and IDI (p-value <0.001; [Table 3]). Both IPI and IDI saw statistically significant increases over the study period (p-value =0.031, p-value =0.024, respectively). Over the study period, the IPI increased from 6 months in 2012 to >32 months, and the IDI increased from 15 to 41 months ([Table 3] and [Fig. 3]).

Table 3

Rates of secondary outcomes per delivery year

2012 (n = 3,507)

2013 (n = 3,822)

2014 (n = 3,905)

2015 (n = 3,904)

2016 (n = 4,166)

2017 (n = 4,168)

2018 (n = 4,006)

2019 (n = 4,153)

2020 (n = 3,793)

p-Value

Interpregnancy interval (mean ± SD; months)

6.6 ± 3.2

12.0 ± 6.5

16.0 ± 9.2

19.1 ± 11.4

22.6 ± 14.1

25.1 ± 17.1

27.8 ± 19.9

30.5 ± 21.8

32.7 ± 24.0

<0.001

Interdelivery interval (mean ± SD; months)

15.3 ± 3.3

20.8 ± 6.6

24.8 ± 9.3

27.9 ± 11.5

31.4 ± 14.1

33.9 ± 17.0

36.6 ± 19.9

39.2 ± 21.8

41.5 ± 24.0

<0.001

Abbreviation: SD, standard deviation.


Zoom
Fig. 3 Interpregnancy and interdelivery intervals from 2012 to 2020.

Finally, to determine the contribution of immediate reversible contraception methods to IPI over time, a mediation analysis was completed. This analysis found that both intrauterine device (IUD) and implant had a very small partial mediation effect on the IPI (IUD 0.56% mediation [95% CI: −1.24 to −0.03] p-value 0.04, implant 1.01% [95% CI: 0.56 to 1.64], p < 0.001). In other words, IUDs and implants both had approximately 1% or less contribution over time to IPI.


 

Discussion

In summary, we found that utilization of immediate postpartum LARC, including intrauterine device and subdermal implant, increased over the study period while rates of Depo-Provera declined. Utilization of immediate postpartum BTL remained stable. We additionally found that rates of both IPI and IDI increased over time. The increasing availability of immediate postpartum LARC has expanded options for patients who desire reliable contraception but do not want to commit to permanent sterilization. The expanded availability of these contraceptive methods as well as their reliability likely contributed to the increase in IPI and IDI we observed across the study period. However, we were unable to demonstrate a significant mediation effect of these contraceptive methods.

The association between initiation of postpartum contraception and IPI has been studied previously. White et al evaluated patterns of contraception utilization and pregnancy within 18 months of delivery using survey data in a paper published in 2015. Similar to our study, this study group found that patients who initiated permanent sterilization or LARC had fewer unintended pregnancies and fewer pregnancies within 18 months of a prior delivery.[10] This study was designed to evaluate initiation of contraceptive methods throughout the 4-year study period and did not evaluate contraception initiation immediately postpartum. Additionally, these authors included long-acting reversible contraceptive methods and sterilization (either patient or partner) in the same category, whereas our study evaluated each of these as individual contraceptive methods.

Other studies have explored the increased uptake of postpartum LARC since the expansion of Medicaid reimbursement. A retrospective cohort study published in 2021 showed an increase in the utilization of long-acting reversible contraceptive methods following Medicaid expansion, particularly in high-risk individuals. This study did not specifically evaluate the impact on IPI or IDI.[11] A similar study published in 2020 demonstrated increased utilization of LARC as well as fewer short-interval pregnancies with Medicaid expansion.[12] Our study adds to these data in that we were able to evaluate IPIs over a 9-year study period, evaluated multiple methods of contraception, and are able to demonstrate the effectiveness of LARC with nearly five-fold increases in the length of IPI and IDIs.


 

Strengths and LImitations

Strengths of our study include a diverse patient population, many of whom are high-risk individuals. We additionally were able to obtain a large sample size at a single institution. Contraception utilization additionally was extracted from the chart using operative notes, procedure notes, and medication administration documented in the medication administration record, as opposed to relying on self-reported use. Our study additionally evaluates contraceptive choices by our population over a 10-year time period where accessibility to long-acting reversible contraceptives increased.

Given that we examined only pregnancies and follow-ups from a single institution, patients may have sought care at other institutions for a subsequent pregnancy and thus their IPIs would not be captured in this analysis. We do not, however, anticipate that this would impact patients who chose any single contraceptive method in greater proportion than another. By excluding deliveries less than 23 weeks gestation, our study does not explore the known association between preterm delivery and shortened IPI. Additionally, our study does not examine the long-term compliance with patients' chosen immediate postpartum contraceptive choice, and discontinuation of long-active reversible contraception or Depo-Provera within the postpartum period may have impacted the IPI for these methods.


 

Conclusion

In conclusion, our study showed that the implementation of LARC has increased over the period of 2012 to 2020 at our institution. Perhaps associated with the increased use of these more reliable contraceptive methods, the overall IPI has increased over time. The increase in IPI and IDI seen in this study highlights the impact that the implementation of immediate postpartum contraception can have on reproductive health. The results of this study support that increasing availability and uptake of immediate postpartum LARC allows patients more control over their reproductive future. Future studies could explore long-term compliance with LARC following immediate postpartum implementation.


 

 

Conflict of Interest

None declared.

Note

All individuals who contributed to this work have met the standard criteria for authorship.



Address for correspondence

Macie L. Champion, MD
Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham
1700 6th Avenue S, Birmingham
AL 35233   

Publication History

Received: 24 April 2024

Accepted: 06 August 2024

Article published online:
03 September 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA


  Permissions and Reprints
Zoom
Fig. 1 Inclusion criteria.
Zoom
Fig. 2 Utilization of immediate postpartum contraception from 2012 to 2020. BTL, bilateral tubal ligation; LARC, long-acting reversible contraception.
Zoom
Fig. 3 Interpregnancy and interdelivery intervals from 2012 to 2020.