“I TAKE IT WHEN I WANT IT”: EXPLORING USE OF ADVANCE PROVISION OF ULIPRISTAL ACETATE AND ITS PROMOTION OF REPRODUCTIVE AUTONOMY FOR POSTPARTUM PATIENTS

Abstract

Objectives

Emergency contraception remains underutilized with barriers to access. We assess how advance provision of ulipristal acetate (UA) facilitates use and expands reproductive autonomy for postpartum people declining high-efficacy contraception

Methods

Participants choosing lower-efficacy contraception were recruited postpartum and received UA prior to discharge (n=73). Surveys were completed at baseline, 6 weeks, 3 months, and 6 months postpartum. Univariate logistic regression models examined the association between UA use and participant demographics. In-depth interviews were conducted at 6 weeks with early UA users and at 6 months with all participants, exploring topics around contraception and reproductive autonomy. Reflexivity and memo-writing enhanced data collection. Interviews were inductively coded in NVivo 12 and analyzed using grounded theory.

Results

Twelve participants (16%) reported using UA, with a mean of 2.6 UA uses per participant (SD: 2.4). Those who identified as Latinx had 5.3 greater odds of using UA (95% CI: [1.41, 20.5], p=0.013). Participants with lower income (<$100,000) also had higher odds of using UA (OR: 8.40, 95% CI: [1.37, 163], p=0.019). Semi-structured interviews (n=19) revealed strong approval of advance provision of UA. Participants endorsed improved access, ease and confidence in use, and greater control over their reproductive decision-making. This was especially relevant for those with prior negative experiences with contraception and/or unwanted or coercive counseling from providers.

Conclusions

Postpartum patients choosing lower-efficacy contraception valued advance provision of UA and reflected on UA as a user-controlled option, bolstering reproductive autonomy. Advance provision of UA can be a useful intervention to increase contraceptive access for postpartum patients prior to discharge.