Prenatal and Postpartum Home Visits and Postpartum Contraceptive Use: an analysis of PRAMS data Open Access

Abstract

Introduction: The postpartum period is a time of unmet contraceptive need for many women. Current literature suggests that home visits during pregnancy or after delivery can increase postpartum contraceptive use and decrease barriers to accessing postpartum care and contraception. In the United States, home visitation programs are funded through a mixture of government, private, and nonprofit sources. While a focus of home visitation programs is improving maternal health outcomes, few programs include contraceptive counseling and even fewer provide methods for postpartum contraception in the home. This study aims to investigate the association between prenatal or postpartum home visits and postpartum contraceptive use using a large, nationally representative sample of women.

Materials and Methods: We conducted a secondary cross-sectional analysis using weighted data from the 2012-2015 Phase 7 Pregnancy Risk Assessment and Monitoring Systems Core and Standard Questionnaires. Data were obtained for 141,296 mothers and weighted descriptive statistics and multivariate logistic regression models were used to estimate the association between having a prenatal or postpartum home visit and self-reported postpartum contraceptive use.

Results: Of the 141,296 women in our data set, approximately 17% of pregnant or postpartum women received home visits and 80% of women used postpartum contraception. After controlling for sociodemographic, reproductive-related, and health-related factors, women who received prenatal or postpartum home visits are more likely to use contraception postpartum (adjusted odds ratio 1.077, 95% CI 1.026-1.142, p=0.01). Nonwhite women, women with less than a high school education, women with income <$15,000/year, women who received inadequate prenatal care, and those who experienced partner abuse or multiple stressors during pregnancy were statistically less likely (p<0.05) to use postpartum contraception in adjusted analyses.

Conclusion: Home visits during pregnancy or after delivery were associated with increased postpartum contraceptive use. Given the benefits of appropriate inter-pregnancy intervals to both mother and baby, home visitation programs could be further strengthened by adding contraceptive counseling and offering a variety of postpartum contraceptive methods in the home, especially to women who are nonwhite, of low socioeconomic status or education level, do not receive adequate prenatal care, or who have multiple stressors during pregnancy.

Table of Contents

Table of Contents

Chapter I…………………....……………………………………………………………………………….1

Chapter II……………………………………………………………………………………………………7

                    References………………………………………………………………………………..24

                    Tables…………………………………………………………………………..………….31

Chapter III………………………………………………………………………………………………...38

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Obstetrics and Gynecology Health Sciences, Epidemiology
Keyword	Postpartum Care Public Health Epidemiology Obstetrics and Gynecology Postpartum Contraception OB/GYN Home Visits Postpartum Reproductive Epidemiology Contraception
Committee Chair / Thesis Advisor	Kristin Wall , Emory University
Committee Members	Melissa Kottke, Emory University

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