Postpartum Contraception and Interpregnancy Intervals Among Adolescent Mothers Accessing Public Services in California

• Published in: Maternal and child health journal Vol. 21; no. 4; pp. 752 - 759
• Main Authors: Isquick, Sarah, Chang, Richard, Thiel de Bocanegra, Heike, Chabot, Marina, Brindis, Claire D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2017; Springer; Springer Nature B.V
• Subjects: Adolescent; Adolescents; Adult; Birth control; Birth Intervals - psychology; Birth Intervals - statistics & numerical data; Birth weight; Births; California; Contraception Behavior - psychology; Contraception Behavior - statistics & numerical data; Contraceptive drugs; Control; Cultural differences; Delivery (Childbirth); Education; Enrollments; Ethnic Groups - psychology; Ethnic Groups - statistics & numerical data; Ethnicity; European Continental Ancestry Group - psychology; European Continental Ancestry Group - statistics & numerical data; Family planning; Female; Gynecology; Health aspects; Hispanic Americans - psychology; Hispanic Americans - statistics & numerical data; Human subjects; Humans; Indians, North American - psychology; Indians, North American - statistics & numerical data; Maternal Age; Maternal and Child Health; Medicaid; Medicaid - statistics & numerical data; Medicine; Medicine & Public Health; Methods; Mothers; Mothers - psychology; Multivariate analysis; Pediatrics; Population Economics; Postpartum period; Postpartum Period - psychology; Pregnancy; Public Health; Race; Social aspects; Sociology; Teenage parents; Teenage pregnancy; Teenagers; Time Factors; Transplants & implants; United States; Womens health; Young Adult; California; United States > US; Interpregnancy intervals; Contraception; Adolescent mothers; Repeat pregnancy
• ISSN: 1092-7875; 1573-6628; 1573-6628
• DOI: 10.1007/s10995-016-2164-0

Objective To determine the association of age at index birth with postpartum contraceptive use and optimal interpregnancy interval (IPI, defined as delivery to next pregnancy >18 months), controlling for provider type and client demographics among adolescent mothers who have repeat pregnancies. Methods California’s 2008 birth records were linked to California’s Medi-Cal and Family PACT claims data to identify 26,393 women with repeat births between 2002 and 2008, whose index birth occurred as an adolescent, and who received publicly-funded services within 18 months after the index birth. Multivariable regression analyses were conducted to examine the relationship between timing of contraception provision and interpregnancy intervals, adjusting for socio-demographic factors. Results Seventy-eight percent of adolescent women did not receive contraception at their first postpartum visit, and twenty-eight percent of adolescent women never received contraception from a Family PACT or Medi-Cal provider. Adolescents who were older at their index birth had lower rates of optimal IPIs. Native American, Asian-Pacific Islander and Latina women had lower rates of optimal IPIs compared to white women. Compared to those using only barrier methods, adolescent women receiving highly effective contraceptive methods had a 4.25 times higher odds of having an optimal IPI than those receiving hormonal methods (OR 2.10), or using no method (OR 0.70). Conclusion Effective postpartum contraceptive use and being a Family PACT provider were associated with optimal birth spacing among adolescent mothers, yet racial and ethnic disparities persisted. A missed opportunity was the provision of contraception at the first postpartum visit. Providers should aim to remove barriers to initiation of contraception at this visit.