Immediate postpartum LARC placement: Patient perceptions of autonomy
Awarded 2015
Complex Family Planning Fellowship Research
Katharine Raisler Sznajder, MD
Johns Hopkins University

Background: Placement of long-acting reversible contraception (LARC) immediately postpartum is becoming increasingly popular. This practice provides highly effective contraception, which may be especially beneficial for women with barriers to contraceptive use such as lack of insurance coverage outside of pregnancy or loss to follow-up postpartum. While increasing access to LARC is an important goal, it is critical to evaluate the patient perception of immediate postpartum LARC counseling and placement, especially considering that the peripartum period can be a vulnerable time. Given that providers may differentially counsel women based on conscious and unconscious judgments that inform unintended pregnancy risk stratification, further study is needed to explore whether LARC provision is occurring without undue influence.
Objectives: The primary objective is to characterize the patient perception of the peripartum contraceptive counseling experience, specifically with regard to autonomy and autonomy support. Secondary objectives are to compare perceptions based on patient age, race, ethnicity, and socioeconomic status and to explore the correlation between perceived autonomous decision-making and method satisfaction and continuation.
Methods: The study uses a mixed methods design and has two components. A qualitative portion of the study uses semi-structured in-depth interviews with women who had LARC placed immediately postpartum to explore the topic more deeply. A quantitative portion of the study with three consecutive cross-sectional surveys compares two groups of women: those with immediate postpartum LARC placement and postpartum women without immediate LARC placement. The surveys, administered immediately postpartum, at 6-weeks postpartum, and at 6-months postpartum, measure patient autonomy in contraceptive decision-making, perceived competence, and patient perceptions of autonomy support of the healthcare environment as well as from the important people in their lives. The 1-7 Likert scales are rooted in Self-Determination Theory and have been validated in other health behavior contexts. A facility-based convenience sample of 300 women will enable detection of a significant difference in autonomy scores between the two groups.