Study Finds Most Unintended Second Pregnancies Could Be Prevented With LARC
January 14, 2016 — The majority of unintended pregnancies that occur within two years of giving birth could be averted or delayed if women were able to access their preferred method of long-acting reversible contraception, according to a study published in Obstetrics & Gynecology,Reuters reports.
For the study, researchers interviewed 403 women who gave birth in 2012 at hospitals in Austin, Texas. All of the participants said they wanted to postpone another delivery for at least two years.
The researchers followed up with participants three, six, nine, 12, 18 and 24 months after the initial interview. The women were asked about their pregnancy status and method of birth control. Soon after giving birth, they also reported their preferred method of contraception, regardless of what method they were currently using.
The researchers interviewed 377 of the participants six months after giving birth, two-thirds of whom reported that they already faced an obstacle to accessing their preferred method of birth control. According to the study, most of the barriers were financial or difficulties with the health system. Women who said they encountered obstacles also were more likely to be using less effective types of birth control, such as oral contraception or condoms.
Meanwhile, among women who did not face obstacles, 75% were using permanent methods, such as vasectomy or sterilization, or LARC methods, such as an intrauterine device or hormonal implant.
The researchers recorded 77 pregnancies between six and 24 months postpartum, accounting for 12% of women who faced no barriers to contraceptive access and about 43% of those who faced obstacles related to finances or the health system.
Further, the researchers found that among the 71 pregnancies reported as unintended, 46% of women said they would have preferred to use a permanent form of contraception, while 87% said they would like to use LARC or would consider LARC if it were available at a low cost or at no cost.
Study Author Details Link Between Findings, Access to Care in Texas
Lead author Joseph Potter of the Population Research Center at the University of Texas-Austin said one of the obstacles hindering women's access to their preferred contraceptive method was a 30-day mandatory delay in 2012 for Medicaid beneficiaries to access sterilization.
In addition, he noted that Texas' 2011 cuts to family planning funding also could have made it more difficult for women to access their preferred method of birth control in 2012. According to Potter, there were 79 clinic closures, and the clinics that remained open often were operated on limited funding and were unable to purchase LARC. "We started recruiting in April of 2012, so that was right at the very worst time in Texas," Potter said.
Potter noted that the state has since restored funding, and the state's Medicaid program has started to reimburse for the immediate postpartum placement of LARC. However, according to Potter, there currently is only one hospital in Texas that provides immediate postpartum LARC, which means that women in other parts of the state have to address their birth control needs at a postpartum follow-up appointment.
"A lot needs to be done to make access to highly effective contraception a reality for low income or uninsured women," Potter said, adding, "Counseling is important during prenatal care so women know they have this option, and actually implementing availability of immediate postpartum long-acting reversible contraception is a very important step."
Heike Thiel de Bocanegra of the University of California-San Francisco's Bixby Center for Global Reproductive Health, who was not involved with the study, said, "I am not surprised that the main barriers to contraceptive use are financial and health system barriers, but it is thought-provoking to see that the percentage of women who had an unintended pregnancy and would have liked to use a highly effective contraceptive method was so high." De Bocanegra added, "Short interpregnancy intervals are associated with medical problems for [the woman] and child."
Meanwhile, Lauren Zapata of the National Center for Chronic Disease Prevention and Health Promotion, who also was not involved with the study, noted that many women in the U.S. commonly face obstacles to obtaining LARC and sterilization.
Zapata said, "Measures that may increase women's access to preferred contraceptives might include: improving insurance coverage for postpartum contraceptives, authorizing reimbursement for postpartum LARC and eliminating the 30-day waiting period for sterilization of Medicaid patients, and ensuring women have access to the full range of methods while they are still having regular or scheduled appointment with obstetric providers" (Doyle, Reuters, 1/13).