New research suggests that pregnant patients who are interested in permanent contraception (PC) are offered information and counseling on this option late in their pregnancy, making it less likely they will access that option.1
Investigators analyzed a cohort of patients who expressed a desire for permanent contraception at the time of delivery at four hospitals in four states — Alabama, California, Illinois, and Ohio — over two years. They looked at when a documented plan for contraception was created — the first, second, or third trimester, or during delivery and hospitalization. Investigators found that of 3,103 patients with a documented expressed desire for permanent contraception, 69% had a documented plan for postpartum permanent contraception. Those with an initial documented plan in the first or second trimester were more likely to receive permanent contraception by discharge than were those who had their first documented plan in the third trimester.
“There are likely a number of factors and barriers that contributed to the 1.5 times higher odds of undergoing surgery for PC if the plan was documented in the first/second vs. the third trimester,” says Kavita Shah Arora, MD, MBE, MS, study co-author and division director in the division of general obstetrics, gynecology, and midwifery, and an associate professor with tenure at the University of North Carolina at Chapel Hill. “Patients who were more interested in permanent contraception may have expressed these goals earlier in prenatal care. A clinician’s perception of how strongly held this desire for PC may be also [might] impact their practice patterns toward fulfillment.”
Another barrier is that patients with Medicaid must sign a Medicaid sterilization consent form 30 days in advance. “Those who desired permanent contraception earlier in pregnancy may have been more likely to fulfill this waiting period,” Arora adds.
There are systemic barriers to permanent contraception as well. “There are barriers to accessing postpartum contraception at the community, clinician, hospital, and policy levels,” Arora explains. “We know people in communities with fewer resources are less likely to receive desired permanent contraception.”
Surgical fulfillment is affected by clinician biases, competing clinical demands, and the availability of long-acting reversible contraception. “Hospital policies surrounding operating room availability as well as limitations from religiously affiliated healthcare facilities are known barriers to care,” Arora says. “At the policy level, the Medicaid sterilization policy is a barrier to care.”
Family planning providers, OB/GYNs, and other clinicians could make comprehensive, patient-centered counseling and documentation regarding future reproductive goals a routine part of patient care early in patients’ pregnancies.
“Ideally, contraceptive counseling should occur via shared decision-making in a longitudinal format throughout prenatal care in a manner that promotes autonomy, reduces contraceptive coercion, acknowledges fluidity in decision-making, informs regarding the structural barriers listed above, and centers the patients’ goals and values,” Arora says.
REFERENCE
- Viswanathan AV, Berg KA, Bullington BW, et al. Documentation of prenatal contraceptive counseling and fulfillment of permanent contraception: A retrospective cohort study. Reprod Health 2024;21:23.
New research suggests that pregnant patients who are interested in permanent contraception are offered information and counseling on this option late in their pregnancy, making it less likely they will access that option.
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