Postpartum contraception use by urban/rural status: an analysis of the Michigan pregnancy risk assessment monitoring system (PRAMS) data
Awarded 2012
Complex Family Planning Fellowship Research
Katherine Damm, MD
The University of Chicago

Objective: We sought to examine rural/urban differences in postpartum contraceptive use, which are underexplored in the literature.
Methods: We analyzed phase 5 (2004–2008) of the Michigan Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Using Rural–Urban Commuting Area codes and weighted multinomial logistic regression, we examined the association between self-reported postpartum contraceptive method and rural/urban residence among postpartum women not desiring pregnancy ( n = 6,468).
Results: Postpartum (mean, 16.5 weeks after delivery), 14.4% of respondents were using sterilization, 6.7% long-acting reversible contraception (LARC), 37.3% moderately effective hormonal methods, 38.4% less effective methods or no method, and 3.2% abstinence. Multivariable analysis yielded sporadic geographic patterns. Odds of method use varied significantly by age, parity, body mass index, and breastfeeding status. Not discussing contraception with a prenatal healthcare provider decreased odds of postpartum LARC use (odds ratio, 0.52; 95% CI, 0.36–0.75). Number of prenatal visits and weeks since delivery were not associated with postpartum contraception method.
Conclusions: We did not observe strong variation in postpartum contraceptive use based on geography. Low uptake of highly effective contraception across rural and urban areas suggests a need for education and outreach regarding these methods.