Background: The postpartum period is a critical window for addressing women's contraceptive needs. Sub-Saharan African immigrant and refugee women living in the United State face unique barriers to postpartum contraception due to cultural norms, religious beliefs, migration-related challenges, and systemic inequalities, yet there is limited evidence on their postpartum contraceptive preferences and use. This scoping review mapped the existing literature on postpartum contraception among this population and identified key factors influencing uptake.
Methods: Following Joanna Briggs Institute guidelines, we conducted a scoping review of studies published in English from January 2000-June 2024. Eligible studies focused on sub-Saharan African immigrant and refugee women aged 15-49 living in the US, and examined postpartum contraception, including predisposing factors, facilitators, and barriers. A systematic search of five databases (PubMed/MEDLINE, PsychInfo, CINAHL, EMBASE, Global Health Database) identified 410 studies; 10 studies were included. Data were coded and synthesized thematically using the PEN-3 Model as an analytic framework; findings were interpreted through an intersectionality lens.
Results: Postpartum contraceptive behaviors were shaped by predisposing factors, facilitators, and barriers. Cultural and religious norms favored natural methods like lactational amenorrhea, due to religious support for birth spacing but not limiting. Migration experiences were influential barriers, with challenges including language barriers, limited health literacy, and loss of insurance, postpartum. Facilitators were inclusive Medicaid policies, long-acting methods availability, and culturally sensitive counseling.
Conclusions: Culturally responsive, equity-focused policies are essential to meet the postpartum contraceptive needs of sub-Saharan African immigrant and refugee women. Expanding Medicaid coverage, training providers in cultural competency, and engaging community leaders can improve access and trust.
Background: Telehealth services for contraception expanded significantly during the COVID-19 pandemic, but continued coverage for these services is uncertain. This study assessed providers' recent experiences delivering contraceptive care via telehealth to improve these services.
Methods: We conducted semi-structured qualitative interviews with healthcare practitioners in the U.S. providing contraceptive services (N = 41) from August 2022 to August 2024 to investigate telehealth practices for contraceptive care. We used thematic analysis to code the data and identify barriers and facilitators of telehealth use by providers. We identified themes using a modified Consolidated Framework for Implementation Research (CFIR) to assess factors that affected provision of telehealth contraceptive care.
Results: We identified and mapped three main themes across CFIR domains: the incompatibility of telehealth with clinic systems and need for additional clinic support; varying preferences for in-person versus telehealth care; and the mixed impact of telehealth on patient privacy, agency, and rapport. Overall, participants enthusiastically discussed telehealth benefits for contraceptive care delivery. Some, however, limited their use of telehealth due to clinic requirements for Pap tests or onsite blood pressure readings for hormonal contraceptives. Many participants noted that judgment is needed to ensure privacy and caution in situations such as intimate partner violence and with certain patients such as adolescents.
Conclusion: Results reflected the enduring benefits of telehealth for contraceptive care. The reported barriers highlight changes needed to efficiently expand the scope of telehealth services. Our findings point to the importance of prioritizing and investing in telehealth services to reach patients who otherwise face challenges completing in-person care. Additionally, these findings may inform ongoing policy debates about continued coverage for this innovative method of service delivery.
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