Effect of Unplanned Pregnancy on Contraceptive Method Selection: Are Long-Acting Reversible Contraceptives Underutilized? [207]

Abstract

OBJECTIVE: Approximately 3.1 million pregnancies are considered unplanned in the United States, annually; approximately half are a result of contraceptive failure. We sought to determine whether having an unplanned pregnancy correlated with choosing a long-acting reversible contraceptive (LARC). METHODS: The Pregnancy Risk Assessment Monitoring System (PRAMS) database was used to assess antepartum contraceptive method and postpartum contraceptive method in women who experienced an unplanned pregnancy. Data collected between 2004 and 2009 from participating states, comprising Phases 5 and 6 of the PRAMS survey tool, were analyzed by univariable modeling to assess linkages between unplanned or planned pregnancy, method of contraception before pregnancy, and method of contraception postdelivery. Long-acting reversible contraception compared with non-LARC methods were compared in aggregate. RESULTS: Postpartum LARC was selected by 28.5% of participants in the unplanned pregnancy group (n=49,907); non-LARC, no contraception, or both was selected by 51.7%; and permanent sterilization was selected by 19.8%. In the planned pregnancy group (n=42,040), 18.4% selected LARC postpartum; 68.9% selected non-LARC, no contraception, or both; and permanent sterilization was selected by 12.7%. Our analysis showed a significant increase in postpartum LARC selection after unplanned pregnancy. Specifically, we found a 47.3% rate of change to postpartum LARC selection. Notably, 51.1% of women with an unplanned pregnancy reported no change in contraceptive method after delivery. CONCLUSION: The results of this study support current estimates of contraceptive failure and resultant unplanned pregnancies. The subsequent rate of change to LARC postpartum, although showing potential, reveals a gap between documented contraceptive failure rates and the uptake of reliable, reversible contraception.