Failure to Receive Desired Postpartum Sterilization—One Year Contraceptive and Pregnancy Outcomes [15N]

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Abstract

INTRODUCTION:

Postpartum sterilization is a unique opportunity to provide effective, permanent contraception, but many women requesting postpartum sterilization do not receive it. We aimed to: 1) Identify risk factors for failure to receive postpartum sterilization; 2) Ascertain the proportion of women not receiving desired postpartum sterilization who plan on long-acting reversible contraception (LARC) 3); Analyze 1-year follow-up data on patients not receiving postpartum sterilization.

METHODS:

Women 21 and older with a live birth in 2011–12 at Duke University Hospital and documented evidence of desire for permanent sterilization were analyzed. Demographics were collected and records analyzed to determine receipt of sterilization and planned contraception if not received. Pregnancy and contraception status were reviewed one 1-year postpartum.

RESULTS:

735 patients met criteria. Black and Hispanic women were significantly less likely to receive desired sterilization (OR 0.60, P=.018 and 0.65, P=.0469, respectively), as were patients with Medicaid or no insurance (OR 0.51, P=.0007 and 0.53, P=.0026, respectively). Of women not receiving sterilization, 16.3% were pregnant within 1 year. 8.18% of those note receiving at delivery received interval sterilization, with 64% of those who expressed desire for sterilization at their postpartum visit receiving interval sterilization. Of women with postpartum follow-up, pregnancy rates were lowest (3.6%) in the group desiring LARC.

CONCLUSION:

Patients not receiving desired sterilization are at a high risk of pregnancy within 1-year postpartum, although this is lower than previously reported. The decrease is potentially due to an increase in the proportion of women choosing LARC methods.

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