A qualitative analysis of postpartum contraceptive choice

ABSTRACT

Background: The World Health Organization recommends a minimum 24-month birth-to-pregnancy interval to improve maternal and child health. Postpartum contraception is a mechanism to achieve optimal birth spacing and prevent unintended pregnancy, which may reduce health disparities and inequalities in health status among new mothers and their children. This study investigated women’s communication channel preferences, as well as patient engagement and shared decision making about contraceptive method choice and use in the postpartum period.

Method: Researchers conducted six focus groups with 47 women receiving postpartum care at an outpatient clinic. A semi-structured focus group protocol was created and tested. A constant comparative approach provided an inductive method of analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated coding based on the health belief model.

Results: Participants included women 18–39 years of age with an average of 1.7 children. The majority of participants utilized Medicaid (53%) and self-identified as Black (49%) or White (43%). Participants discussed interpersonal, mass media, and new media channels featuring messages about contraception, including long-acting reversible contraception (LARC). These women negotiated complex social norms, including preferring the Internet as a primary source of information and avoiding mass media. Participants balanced messages from social networks, including physician counseling and the power of personal experiences of friends and family in contraceptive decision making.

Conclusions: This study demonstrated women perceive the voices of lay experts online as the most influential source of information and prefer to receive contraceptive information online and in-person during the prenatal and postpartum period.

KEYWORDS:

• Contraception
• healthcare communication
• shared decision making
• patient engagement

Disclosure statement

No potential conflict of interest was reported by the authors.

Acknowledgement

The authors thank the Medical University South Carolina (MUSC) Center for Women’s Health Research, including JacKetta Cobbs, Erica Ellington, Alison Line, Linda Mohler, Amanda Siabi, and Kristin Zaks for their assistance.

Notes on contributors

Kathleen Booth (B.S., B.A., College of Charleston) is a recent Honors College graduate from the College of Charleston in Charleston, SC. She is currently a Research Assistant at Public Health Management Corporation, a nonprofit public health institute that builds healthier communities through partnerships with government, foundations, businesses and community-based organizations, in Philadelphia, PA.

Beth Sundstrom (Ph.D., University of Maryland, College Park; M.P.H., Brown University) is an assistant professor of communication and public health at the College of Charleston in Charleston, South Carolina. Dr. Sundstrom is a member of the graduate faculty and the Director of the Women’s Health Research Team (WHRT). She also holds an adjunct assistant professor appointment in the Department of Public Health Sciences at the Medical University of South Carolina (MUSC) and is an affiliate member of the Hollings Cancer Center Cancer Control Program. Dr. Sundstrom serves as a SmartState faculty associate in the Technology Center to Promote Healthy Lifestyles at the Arnold School of Public Health at the University of South Carolina (USC). Her research interests include health communication, social marketing, and women’s health.

Andrea L. DeMaria (Ph.D., Texas A&M University; M.S., University of North Texas) is an assistant professor of public health within the College of Health and Human Sciences at Purdue University in West Lafayette, IN and member of the Health Disparities Research Lab within the Department of Consumer Science at Purdue University. Her research has encompassed an interdisciplinary approach to understanding women’s sexual and reproductive health behaviors and issues, nationally and internationally. She is committed to a comprehensive approach to women’s health research, drawing from the behavioral, social, and clinical science fields. Dr. DeMaria’s research methodology has largely focused on the importance of incorporating qualitative and quantitative methods, specifically to inform program development, implementation, and evaluation in community and clinical settings.

Angela Dempsey (M.D., Medical University of South Carolina, M.P.H., Columbia University) is a board certified obstetrician gynecologist (OB/GYN), associate professor in the Department of Obstetrics and Gynecology, and director of the MUSC Health Women’s Care Family Planning Services clinic at the Medical University of South Carolina (MUSC) in Charleston, SC. Dr. Dempsey completed her residency in Obstetrics and Gynecology at the University of Colorado and subsequently completed fellowship training as well as a Master of Public Health with a concentration in Epidemiology at Columbia University in New York. Her research has examined the impact of estrogen supplementation on continuation of progestin-only contraception, the ability of the Transtheoretical Model of Health Behavior Change to predict continuation of oral contraception, and the impact of timing of implant insertion on use of Implanon among postpartum adolescents. She recently completed a study demonstrating that knowledge of intrauterine devices is a strong predictor of use of long-acting reversible contraception among young women and men at risk of unintended pregnancy.

Special note

Beth Sundstrom and Angela Dempsey conceptualized the study. Andrea L. DeMaria conducted data collection, including moderating all focus groups. Kathleen led the analyses, interpreting of findings, and manuscript composition. All authors drafted and edited the article, and approved the final version.

ORCID

Kathleen Booth http://orcid.org/0000-0002-2359-8135

Additional information

Funding

This research was supported in part by the Society of Family Planning/Research Fund (SFP Fellows).