Patterns of Postpartum Depot Medroxyprogesterone Administration among Low Income Mothers

1. Patterns of Postpartum Depot Medroxyprogesterone Administration among Low Income Mothers Ann M. Dozier, RN, PhD1, Alice Nelson, MFT2, Elizabeth A. Brownell, MA, PhD3, Cynthia R. Howard, MD MPH4,5, Ruth A. Lawrence, MD5 1University of Rochester Department of Public Health Sciences, 2Shelter Care, Eugene, OR; 3Departments of Research and Neonatology, Connecticut Children’s Medical Center; 4Rochester General Hospital; 5University of Rochester Department of Pediatrics • BACKGROUND • While depot medroxyprogesterone (DMPA) can be administered postpartum little is known about the actual patterns of postpartum DMPA use. • Immediate postpartum use may be due to concerns about short interval repeat or unintended pregnancy • RESULTS • 48.8% reported the pregnancy as unintended • 31.3% reported receiving postpartum DMPA; • 62.6% received it prior to discharge • Other contraceptive use included: • none (20.4%), IUD (17.1%), birth control pill (16.4%); barrier methods (14.0%) • Those receiving in-hospital DMPA (n=127; vs. other mothers) were significantly more likely be Black race, older (age18/19), urban dwelling, non-high school graduates, multiparous and planning to formula feed • Across the 4 hospitals, among respondents receiving DMPA at least 50% (and up to 73.8%) received DMPA prior to hospital discharge. No data on in-hospital administration are available for comparison. PURPOSE These analyses describe the patterns among low income mothers in an upstate New York community. • METHODS • Mothers attending urban pediatric practices (births 2009-2011) completed a mailed survey at approximately 5 months postpartum. Subset of 648 used in analysis • 83 items about pre-pregnancy, pregnancy, delivery and postpartum included questions about breastfeeding and timing of DMPA receipt. • LIMITATIONS • Mothers with limited or no English or Spanish language capacity are likely underrepresented. • All data are maternal self-report with no opportunity for cross checking or validation from other sources. • No quantitative information on obstetrical practices or decision-making about timing of DMPA administration beyond anecdotal comments - we do not know the factors influencing the mothers’ or their providers’ selection of DMPA • No corrections were made for multiple comparisons • ANALYSES • Descriptive and exploratory. • Outcome groups by DMPA administration: • any postpartum DMPA vs. non-DMPA • DMPA in hospital vs. all others • DMPA at 6 weeks after hospitalization vs. all non-DMPA users • Chi square or t-test statistics analyzed differences between groups • Multivariable logistic regressions (backward selection) included characteristics associated with DMPA use in the bivariate analyses (p=<0.10). • All p-values were two-sided • Significance set at p≤0.05. • CONCLUSIONS • Postpartum DMPA administration among a convenience sample of low income mothers demonstrated rates of immediate postpartum administration greater than 50%. • Additional studies of DMPA administration patterns are warranted to identify geographic or other trends as well as the impact of different approaches to screening for and communication with mothers about DMPA. ACKNOWLEDGEMENTS: Funding: NIH PHS Grant # RO1-HD055191, Community Partnership for Breastfeeding Promotion and Support Also the following individuals from the University of Rochester: Holly Widanka, MS, Barbara Suter, MPH, Joseph Duckett and Cynthia Childs, MFA, MPH. ADDITIONAL INFORMATION:ann_dozier@urmc.rochester.edu