Contraceptive access is critical for optimal pregnancy spacing

New research from the UCSF Bixby Center sheds light on the critical role of contraceptive access to help achieve the ideal amount of time between pregnancies. Heike Thiel de Bocanegra and colleagues from the UCSF Bixby Center examined data from women who received services through California's Medicaid or family planning expansion program. The Bixby Center provides ongoing program support and evaluation for this program, which aims to promote optimal reproductive health and reduce unintended pregnancy by increasing access to comprehensive family planning services for low-income Californians.

Previous research has shown that pregnancies less than 18 months apart place mothers and infants at an increased risk of poor health outcomes, including preterm birth and low birth weight. This new study examined the effect of contraceptive type and length of coverage on the timing between pregnancies. Women who used long-acting reversible methods after birth, including intrauterine devices or implants, were almost four times more likely to wait 18 or more months between pregnancies compared with women who used condoms or other barrier methods. Additionally, women who used hormonal methods — such as the pill, patch, injectable or ring — were almost twice as likely to wait 18 or more months between pregnancies compared with women who used a barrier method alone.

In a related study, Bixby Center researchers found that receiving a contraceptive method within 90 days after birth was significantly associated with better timing between pregnancies. Despite this, only 41% of women in the study had a claim for contraception in their medical records within those 90 days.

Both of these studies reveal that public programs can improve on the contraceptive services they provide to women who have recently given birth. Doing so has the potential to improve the timing between pregnancies, along with women and infants’ health outcomes. The researchers identified opportunities to improve contraceptive access in the postpartum period:

• Ensure links between hospital and outpatient records so that contraceptive counseling and provision can be shared across healthcare providers.
• Establish clinic protocols that allow any medical visit during the postpartum period to be used for contraceptive counseling and provision, including visits to the pediatrician for the infant.
• Add contraceptive counseling to the infant-visit checklist for normal visits in the three months following birth.
• Create reminders to review contraception in electronic health records during the postpartum period.