Long-Acting Reversible Contraception Initiation With a 2- to 3-Week Compared With a 6-Week Postpartum Visit

    loading  Checking for direct PDF access through Ovid



To evaluate whether a department policy changing the scheduling of the postpartum visit from 6 weeks to 2–3 weeks after delivery is associated with higher long-acting reversible contraception initiation at the postpartum visit.


We conducted a quasiexperimental before–after study to evaluate long-acting reversible contraception initiation, specifically an intrauterine device or contraceptive implant, at the postpartum visit between women scheduled for follow-up at 6 weeks (before policy change) and 2–3 weeks after delivery (after policy change). Secondary outcomes included postpartum visit completion, overall contraception initiation at the postpartum visit, overall contraceptive use at 6 months after delivery, and repeat pregnancies by 6 months postpartum. We obtained delivery and postpartum information using the electronic medical record and contacted participants 3 and 6 months after delivery to assess contraception use and repeat pregnancies.


We enrolled 586 participants between December 2014 and November 2015, of whom 512 women (256 in each cohort) continued to meet eligibility criteria after delivery. Long-acting reversible contraception initiation rates at the postpartum visit were lower in the 2- to 3-week (16.5%, 95% CI 12.2–21.8) compared with the 6-week group (31.1%, 95% CI 25.2–37.7, P<.01), primarily as a result of patient and health care provider preferences for delaying intrauterine device insertion to a later visit. More women completed a scheduled 2- to 3-week postpartum visit (90.2%, 95% CI 86.0–93.3) compared with a 6-week visit (81.6%, 95% CI 76.4–85.9, P<.01). Deferral of any contraception initiation was higher in the 2- to 3-week group (27.3%, 95% CI 21.9–33.4) compared with the 6-week group (15.8%, 95% CI 11.5–21.4, P<.01), but there were no differences in overall contraceptive use patterns at 6 months postpartum. No intrauterine device perforations or expulsions were observed in women who underwent insertion at 2–3 weeks postpartum. Five pregnancies were reported in each cohort by 6 months after delivery.


Scheduling a visit at 2–3 weeks after delivery was not associated with increased long-acting reversible contraception initiation at this visit despite higher postpartum visit attendance.

Related Topics

    loading  Loading Related Articles