Understanding Long-Acting Reversible Contraceptive Decision-Making in the Immediate Postpartum Period
ACOG ePoster. DeWitt J. Apr 27, 2018; 211418
Jacob DeWitt
Jacob DeWitt
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Abstract
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Introduction: To qualitatively assess factors influencing pregnant women's desire for immediate postpartum long-acting reversible contraceptives (IPP LARCs), among women who change their minds about IPP LARC administration after delivery.

Methods: Data were derived from a larger cohort study evaluating the fulfillment of women's requests for progesterone-containing LARCs in the form of the Medroxyprogesterone injection, Etonogestrel implant, or progestin intrauterine device in the immediate postpartum period. The subset of participants included in this qualitative analysis were those who changed their minds regarding contraceptive choice between the time of admission and the time of postpartum discharge. Specifically, women who changed their minds and opted out of a LARC were asked the following open-ended question: “how did you come to the original decision to use Depo/Nexplanon/Mirena?” Content analysis was used to classify participant responses.

Results: Twenty-eight patients who met the aforementioned criteria were approached. Many respondents described multiple influencing factors. The most commonly endorsed consideration was duration of effectiveness (32%). The second-largest grouping (28%) consisted of respondents whose decisions were based on desirable side-effect profiles, perceived safety, and/or ease of use associated with LARCs. Other responses indicated apprehension over non-LARC birth control methods or confidence in LARCs based on personal experience.

Conclusion/Implications: Among the women surveyed, the dominant motivator to initially request IPP LARC was the duration of action for these types of contraception, followed by a collection of features beyond the measure of efficacy. These factors do not appear to differ substantially from those enumerated in the literature among women who have IPP LARC methods administered.
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