If you’ve recently had a baby, you may remember your doctor advising you to wait at least a year before trying for your next little bundle. And, if you were a day or two post-delivery, you probably wholeheartedly agreed! After all, delivering a baby is no easy task, never mind caring for a newborn. There are also known health benefits to spacing pregnancies to give your body enough time to recover from the first pregnancy before starting in on the second.
Dr. Potter and his colleagues at the University of Texas at Austin wanted to know if women who want to wait at least 2 years between pregnancies were able to do so and whether access to contraception was an important factor. The researchers interviewed 103 women who were postpartum at their hospital. They included women who wanted to wait to have another baby for at least two years or didn’t want any more children. 49% of the women wanted to wait at least two years before their next child, and 51% didn’t want any more children. The authors then undertook the very intensive task of surveying all of the women 3, 6, 9, 12, 18, and 24 months after their delivery. At 24 months, 83% of the women were still responding to the surveys.
Two thirds of the women experienced a barrier to accessing their preferred contraception. At the end of 24 months, 89 women reported a pregnancy, and 71 of these pregnancies were unintended. Not surprisingly, women who encountered a barrier to obtaining their preferred method of contraception were more likely to become pregnant than women who could access the contraceptive method of their choice.
67% of the women experienced a barrier in accessing contraception. These women were more likely to be younger, single, have at least two children, want no more children at all, and be born in the United States. Women who experienced no barrier to contraception had a 12% risk of becoming pregnant within those two years. Women who had experienced any kind of barrier had a 34% pregnancy rate. Women who experienced barriers due to the health system had a 47% rate of pregnancy, and women who experienced financial barriers had a 38% risk of pregnancy.
The authors also looked at the kinds of contraception women wanted to use and what they were actually able to access. Three fourth of women with no barrier to accessing contraception were using permanent methods (like getting their tubes tied) or highly effective long-acting reversible contraception (known as LARC). In contrast, women who experienced barriers to their preferred contraception were relying on less effective methods (like condoms and the pill).
The authors were also able to examine the relationship between an unintended pregnancy and the type of contraception being used. As you might expect, LARC or permanent methods had low pregnancy rates at 7%. Hormonal methods had higher rates at 27%. Less effective methods such as condoms or no method had a 43% risk of pregnancy. It is surprising that four of the women using a copper IUD and one woman who reported being sterilized reported pregnancies. Unfortunately the authors were not able to access medical records so they could not confirm if these reports were correct. At least one of the IUD failures was the result of the IUD coming out (expulsion).
It is important to note that the women who took part in this study are not generalizable to the US population as a whole. The participants were 63% Hispanic, and 38% of them were born in Mexico. Only 10% were Caucasian, 23% African American, and 4% other race. The authors also included more women who use Medicaid than the general population. 75% of participants in the study used Medicaid, but only 55% of women in the US use Medicaid for prenatal care.
Nevertheless, this study contributes important information in our understanding of ways to enable women to time their pregnancies in the safest and healthiest way. Three barriers that hinder women from accessing the contraception they want are: insurance that does not cover the cost of placing IUDs immediately after delivery, the 30 day waiting period between consent and sterilization with Medicaid, and lack of insurance coverage for contraception for some women with Medicaid. The results of this study suggest that breaking down healthcare barriers would enable women to make the healthiest choices for them.