How to Protect Unwanted Second Pregnancy

Most unintended pregnancies within two years of a woman giving birth could have been prevented or postponed if women had access to the long-acting contraception of their choice, according to a study in Texas.

“A lot needs to be done to make access to highly effective contraception a reality for low income or uninsured women,” said lead author Joseph E. Potter of the Population Research Centre at the University of Texas at Austin.


“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,” he said.

The researchers interviewed 403 women who gave birth in Austin hospitals, all of whom said they wanted to delay childbearing for at least two years. They were interviewed again three, six, nine, 12, 18 and 24 months later.

The women reported their pregnancy status and contraceptive method and soon after giving birth they also noted their preferred contraceptive method, regardless of whether that was what they were using.

Less effective methods

At six months postpartum, 377 women were interviewed and two-thirds said they had already encountered a barrier to using their preferred method. The problem was often a financial or health system barrier, and these women were more often using less effective methods such as condoms or hormonal contraception.

Among women who did not have barriers, three quarters were using permanent methods such as vasectomy, sterilisation or long-acting reversible contraception (LARC) methods such as an intrauterine device (IUD) or hormonal implant.

There were 77 reported pregnancies between six months and 24 months postpartum, including 12 percent of the women who met no barriers to contraception and about 43 per cent of women who encountered financial or health system barriers, according to the results in Obstetrics and Gynecology.

Public funding

Texas drastically reduced public funding for subsidised family planning services in 2011, so women in 2012 may have had a harder time accessing birth control options that year than before or since, Potter added.

“We started recruiting in April of 2012, so that was right at the very worst time in Texas,” he said.

There had been 79 clinic closures, and those that were open were extremely short on funds and were not able to buy long-acting contraception, he said.

Main barriers to contraceptive use

“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,” said Heike Thiel de Bocanegra of the Bixby Centre for Global

Reproductive Health at the University of California, San Francisco, who was not part of the new study. “Short inter-pregnancy intervals are associated with medical problems for mother and child.”

Barriers to postpartum long-acting contraception and sterilisation are common in the United States, said Lauren Zapata of the National Centre for Chronic Disease Prevention and Health Promotion, who also was not part of the new study.

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