How Did the Pandemic Impact Postpartum Birth Control Use?

Women were more likely to choose long-term contraceptive methods in the immediate postpartum period during the COVID-19 crisis, according to a retrospective cohort study.

During the pandemic, a higher percentage of women chose long-acting reversible contraception (LARC) methods -- such as an intrauterine device or contraceptive implant -- in the immediate postpartum period compared to the year prior (13% v.s. 4%, respectively), reported Emily Chin, a medical student at the University of Massachusetts (UMass) Medical School in Worcester, and colleagues.

Among all women who received birth control right after delivery, patients who gave birth in 2020 were three times more likely choose LARC methods than they were in 2019 (aOR 3.01, 95% CI 1.39-6.98), Chin said in a presentation at the American College of Obstetricians and Gynecologists (ACOG) virtual meeting.

The researchers also found that the number of women who attended an outpatient postpartum visit was unchanged, likely because of an increase in the portion of women who attended this visit via telehealth.

"Our hypothesis that contraceptive access, especially highly effective forms, would be increased during the SARS-CoV-2 pandemic to address perinatal persons' contraceptive needs during this challenging time, was supported by this study," Chin stated.

She added that increased financial strain, unprecedented stress around labor and delivery, and heightened public fear of going to medical facilities due to SARS-CoV-2 exposure all may have contributed to higher usage of long-term contraceptive methods.

Chin stated that this study "highlights the importance of expanding immediate postpartum LARC access, as a cost-effective way to improve maternal and child health outcomes."

Nearly half of pregnancies in the U.S. are unplanned, Chin stated. She added that around a third of women have short interpregnancy intervals (less than 18 months), which can cause adverse outcomes such as small-for-gestational-age birth, preterm delivery, and infant mortality. Immediate postpartum contraception can decrease both unplanned pregnancies and short intervals between births.

Chin and colleagues investigated the impact of the COVID-19 pandemic on postpartum contraception and sterilization. They included women who gave birth at UMass Memorial Medical Center, comparing those who delivered between March and May 2019 to the same time period in 2020. Births in 2020 coincided with the first wave of the pandemic, which had the most stringent restrictions on in-person labor and delivery.

Researchers compared patients' contraception choice at delivery discharge and at their first outpatient postpartum visit. They controlled for maternal age, illicit drug use, insurance type, and mode of delivery.

Chin's group included 495 women in the study. Women who gave birth in 2020 were slightly older, and had a greater portion of illicit drug use versus women who gave birth in 2019.

While LARC use increased during the COVID-19 pandemic, sterilization and non-LARC use was unchanged. Additionally, there was no change in contraceptive choice overall at 10 weeks postpartum.

There were no significant differences in attendance of an outpatient postpartum visit within 10 weeks between 2019 and 2020. However, use of telehealth for the postpartum visit jumped from 0 to 39% during the study time period.

Comment