Dataset Information

The relationship of age and place of delivery with postpartum contraception prior to discharge in Mexico: A retrospective cohort study.

ABSTRACT:

Objectives

To test the association of age (adolescents vs. older women) and place of delivery with receipt of immediate postpartum contraception in Mexico.

Study design

Retrospective cohort study, Mexico, nationally representative sample of women 12-39years old at last delivery. We used multivariable logistic regression to test the association of self-reported receipt of postpartum contraception prior to discharge with age and place of delivery (public, employment based, private, or out of facility). We included individual and household-level confounders and calculated relative and absolute multivariable estimates of association.

Results

Our analytic sample included 7022 women (population, N=9,881,470). Twenty percent of the population was 12-19years old at last birth, 55% aged 20-29 and 25% 30-39years old. Overall, 43% of women reported no postpartum contraceptive method. Age was not significantly associated with receipt of a method, controlling for covariates. Women delivering in public facilities had lower odds of receipt of a method (Odds Ratio=0.52; 95% Confidence Interval (CI)=0.40-0.68) compared with employment-based insurance facilities. We estimated 76% (95% CI=74-78%) of adolescents (12-19years) who deliver in employment-based insurance facilities leave with a method compared with 59% (95% CI=56-62%) who deliver in public facilities.

Conclusion

Both adolescents and women ages 20-39 receive postpartum contraception, but nearly half of all women receive no method. Place of delivery is correlated with receipt of postpartum contraception, with lower rates in the public sector. Lessons learned from Mexico are relevant to other countries seeking to improve adolescent health through reducing unintended pregnancy.

Implications

Adolescents receive postpartum contraception as often as older women in Mexico, but half of all women receive no method.

SUBMITTER: Darney BG

PROVIDER: S-EPMC4863522 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The relationship of age and place of delivery with postpartum contraception prior to discharge in Mexico: A retrospective cohort study.

Darney Blair G BG Sosa-Rubi Sandra G SG Servan-Mori Edson E Rodriguez Maria I MI Walker Dilys D Lozano Rafael R

Contraception 20160130 6

<h4>Objectives</h4>To test the association of age (adolescents vs. older women) and place of delivery with receipt of immediate postpartum contraception in Mexico.<h4>Study design</h4>Retrospective cohort study, Mexico, nationally representative sample of women 12-39years old at last delivery. We used multivariable logistic regression to test the association of self-reported receipt of postpartum contraception prior to discharge with age and place of delivery (public, employment based, private, ...[more]

PMID: 26828625

Similar Datasets

Project description:BackgroundSevere acute post-cesarean delivery (CD) pain has been associated with an increased risk for persistent pain and postpartum depression. Identification of women at increased risk for pain can be used to optimize post-cesarean analgesia. The impact of labor prior to CD (intrapartum CD) on acute post-operative pain and opioid use is unclear. We hypothesized that intrapartum CD, which has been associated with both increased inflammation and affective distress related to an unexpected surgical procedure, would result in higher postoperative pain scores and increased opioid intake.MethodsThis is a secondary analysis of a prospective cohort study examining opioid use up to 2 weeks following CD. Women undergoing CD at six academic medical centers in the United States 9/2014-3/2016 were contacted by phone two weeks following discharge. Participants completed a structured interview that included questions about postoperative pain scores and opioid utilization. They were asked to retrospectively estimate their maximal pain score on an 11-point numeric rating scale at multiple time points, including day of surgery, during hospitalization, immediately after discharge, 1st week, and 2nd week following discharge. Pain scores over time were assessed utilizing a generalized linear mixed-effects model with the patient identifier being a random effect, adjusting for an a priori defined set of confounders. A multivariate negative binomial model was utilized to assess the association between intrapartum CD and opioid utilization after discharge, also adjusting for the same confounders. In the context of non-random prescription distribution, this model was constructed with an offset for the number of tablets dispensed.ResultsA total of 720 women were enrolled, 392 with and 328 without labor prior to CD. Patients with intrapartum CD were younger, less likely to undergo repeat CD or additional surgical procedures, and more likely to experience a complication of CD. Women with intrapartum CD consumed more opioid tablets following discharge than women without labor (median 20, IQR 10-30 versus 17, IQR 6-30; p = 0.005). This association persisted after adjustment for confounders (incidence rate ratio 1.16, 95% CI 1.05-1.29; p = 0.004). Pain scores on the day of surgery were higher in women with intrapartum CD (difference 0.91, 95% CI 0.52-1.30; adj. p = <0.001) even after adjustment for confounders. Pain scores at other time points were not meaningfully different between the two groups.ConclusionIntrapartum CD is associated with worse pain on the day of surgery but not other time points. Opioid requirements following discharge were modestly increased following intrapartum CD.

Project description:BackgroundImmediate postpartum long-acting reversible contraception (LARC) is an evidence-based practice, but hospitals face significant barriers to its adoption. Our objective was to examine how organizational context (e.g., size, employee attitudes toward the clinical practice) and implementation strategies (i.e., the actions taken to routinize a clinical practice) drive successful implementation of immediate postpartum LARC services, with a goal of informing the design of future implementation interventions.MethodsWe conducted a comparative case study of the implementation of inpatient postpartum contraceptive care at 11 US maternity hospitals. In 2017-2018, we conducted site visits that included semi-structured key informant interviews informed by the Consolidated Framework for Implementation Research. Qualitative measures of implementation success included stakeholder satisfaction, routinization, and sustainability of immediate postpartum LARC services. Qualitative content analysis and cross-case synthesis explored relationships among organizational context, implementation strategies, and implementation success.ResultsWe completed semi-structured interviews with 78 clinicians, nurses, residents, pharmacy and revenue cycle staff, and hospital administrators. Successful implementation required three essential conditions: effective implementation champions, an enabling financial environment, and hospital administrator engagement. Six other contextual conditions were influential: trust and effective communication, alignment with stakeholders' professional values, perception of meeting patients' needs, robust learning climate, compatibility with workflow, and positive attitudes and adequate knowledge about the clinical practice. On average, sites used 18 (range 11-22) strategies. Strategies to optimize the financial environment and train clinicians and staff were commonly used. Strategies to plan and evaluate implementation and to engage patients emerged as promising to address barriers to practice change, yet were often underused.ConclusionsImplementation efforts in maternity settings may be more successful if they select strategies to optimize local conditions for success. Our findings elucidate key contextual conditions to target and provide a menu of promising implementation strategies for incorporating recommended contraceptive services into routine maternity practice. Additional prospective research should evaluate whether these strategies effectively optimize local conditions for successful implementation in a variety of settings.

Dataset Information

The relationship of age and place of delivery with postpartum contraception prior to discharge in Mexico: A retrospective cohort study.

Objectives

Study design

Results

Conclusion

Implications

Publications

The relationship of age and place of delivery with postpartum contraception prior to discharge in Mexico: A retrospective cohort study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets