By Melinda Young
A new study finds that patients who had preterm delivery were less likely to receive their desired permanent contraception when compared with patients who had at-term delivery.1 Contraceptive Technology Update (CTU) asked one of the study’s researchers about these findings via email. Claire Jensen, MD, MSCR, a maternal-fetal medicine fellow in the division of maternal-fetal medicine at the University of North Carolina at Chapel Hill, provided these answers.
CTU: Please describe your study’s findings. For instance, for all categories of patients, including cesarean delivery or Medicaid, did your study find that those with a preterm delivery were less likely to undergo desired contraception than were those with a term delivery?
Jensen: Patients who delivered preterm at less than 37 weeks’ gestation were less likely to undergo desired permanent contraception in adjusted analyses comparing to those delivering at term, extending from hospital discharge to one year postpartum. Notably, the odds of fulfillment of permanent contraception were lower among subsets of patients undergoing cesarean or among patients insured by Medicaid who delivered preterm. Among patients with an adverse neonatal outcome, including NICU [neonatal intensive care unit] admission or low APGAR scores at delivery, there was a higher prevalence of permanent contraception fulfillment.1
Because the Medicaid sterilization policy has been cited as a barrier to fulfillment of permanent contraception, we looked at when the form was signed during pregnancy and whether the form was valid at delivery to explore if this affected fulfillment of permanent contraception. These factors did not differ among patients delivering preterm compared to term; however, only about 60% of patients desiring permanent contraception had a valid consent form in both groups.1
CTU: What are the barriers to permanent contraception postpartum that patients face when delivering preterm? And if Medicaid’s waiting period requirement was a chief barrier, why do you think the findings persisted up to one year postpartum?
Jensen: The best time to address patients’ long-term contraceptive plans is prenatally. Following delivery, loss of pregnancy Medicaid, the physical and emotional challenges inherent to postpartum recovery, and competing personal/family demands may lead to lower prioritization among patients for fulfillment of permanent contraception.
Specifically, among patients who deliver preterm, a unique barrier is that an earlier and often unplanned delivery can further limit available opportunities for patients and their providers to engage in shared decision-making regarding planned permanent contraception, whether or not the Medicaid waiting period has been met.
CTU: How can OB/GYNs and health systems do a better job of prioritizing patients’ contraceptive goals and increase equitable access to all contraception, including permanent contraception — particularly among patients who may be at risk of preterm delivery?
Jensen: Given the existence of the Medicaid sterilization form, providers should prioritize signing the form with patients in a timely fashion during prenatal care. Additionally, hospital systems should have centralized documentation across sites regarding patients’ desire for contraception and universal screening for contraceptive goals performed multiple times during prenatal care and during inpatient hospitalization to best inform and allow for shared decision-making in advance of delivery.
Offering opportunities to increase contact with a healthcare system, including streamlining referral processes for elective postpartum sterilization procedures, may also improve post-discharge fulfillment. Patients at risk of preterm delivery should also receive counseling regarding the association between short interpregnancy intervals and recurrent preterm birth as part of contraceptive counseling.
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
Reference
1. Chalem A, Jensen CE, Bullington BW, et al. Association between preterm birth and fulfillment of desired permanent contraception. Matern Child Health J. 2025; Jan 29:10.1007/s10995-025-04063-0. [Online ahead of print].
A new study finds that patients who had preterm delivery were less likely to receive their desired permanent contraception when compared with patients who had at-term delivery.
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