Contraceptive personal assistant services to increase the use of LARC among postpartum women
Awarded 2011
Trainee Grants
Katharine Simmons, MD
Oregon Health & Science University

Background: Many women who intend to use long-acting reversible contraceptives (LARCs) postpartum do not follow through with placement. The objectives of this study were to determine whether support from a contraceptive personal assistant could increase the uptake of LARCs by three months postpartum, and to identify risk factors for non-uptake of LARCs among women who planned LARC use. Study Design: This is a randomized, controlled trial of 50 low-income postpartum women who desired LARC. The intervention group received telephone contact from a personal assistant who provided contraception education, facilitation of insurance coverage, appointment scheduling, and assistance with childcare and transportation. The control group received routine follow up. Women were surveyed immediately and three months postpartum regarding contraceptive use and anticipated barriers to LARC use. Results: A similar proportion of women in both groups received LARC [control 16/24 (67%), intervention 18/25 (72%), p = 0.76]. However, there was a non-significant trend toward a positive impact of the intervention among those subjects with better prenatal clinic attendance. Although no demographic factors were related to LARC uptake, women with frequent prenatal visits were more likely to have LARC placed (OR, 95% CI for each increased visit: 1.50, 1.15-1.96). In addition, more primiparous (86.4%) than multiparous (55.5%) women obtained a LARC (p=0.04). Conclusions: Providing telephone assistance to help navigate barriers did not increase postpartum uptake of LARCs. A personal history of visit no-shows and/or infrequent prenatal visits were related to poor uptake of LARCs postpartum.