Objectives: The research extended an ongoing prospective cohort study of 400 women in Texas to assess the risk of an unintended pregnancy during the two years following childbirth, and how that risk varies according to both the type of contraception being used and whether a woman’s method is the method that she would like to be using. Methods: We interviewed 403 postpartum women who wanted to delay childbearing for >=2 years. Follow-up interviews were completed at 3, 6, 9, and 12 months after delivery under another grant and at 18 and 24 months under this grant; retention at 24 months was 83%. At each interview, participants reported pregnancy status and contraceptive method. Types of barriers among women unable to access their preferred method were identified and Cox models were used to analyze the risk of pregnancy from 6 to 24 months after delivery. Results: Among women interviewed six months postpartum (n=381), two thirds experienced a barrier to accessing their preferred method or had expressed interest in using a more effective method. Financial barriers were the most common (21%). By 24 months postpartum, 89 women had reported a pregnancy (71 unintended). Women who encountered a barrier obtaining their preferred method were more likely to become pregnant <24 months after delivery (p<0.001). All but three of the women reporting an unintended pregnancy had earlier expressed interest in using LARC or a permanent method. Conclusion: In this study, most unintended pregnancies <24 months after delivery could have been prevented or postponed if women had access to their desired long-acting and permanent methods.