title: Personalized contraceptive assistance and uptake of long-acting, reversible contraceptives by postpartum women: a randomized, controlled trial.
abstract: BACKGROUND
  Many women who intend to use long-acting, reversible contraceptives (LARCs) postpartum do not follow through with initiating use. The objectives of this study were to determine whether support from a contraceptive personal assistant could increase the uptake of LARCs by 3 months postpartum, and to identify risk factors for nonuptake of LARCs among women who planned LARC use.
  
  
  METHODS
  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 3 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=.76]. More primiparous (86.4%) than multiparous (55.5%) women obtained LARC (p=.04). In addition, women with more prenatal visits were more likely to have initiated LARC (odds ratio, 95% confidence interval for each increased visit: 1.50, 1.15-1.96). No other demographic factors were related to LARC uptake.
  
  
  CONCLUSIONS
  Providing telephone assistance to help navigate barriers did not increase postpartum uptake of LARCs. A personal history of clinic visit no-shows and/or infrequent prenatal visits were related to poor uptake of LARCs postpartum.
authors.affiliation: Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, USA. simmonka@ohsu.edu
authors.forename: Katharine B
authors.initials: KB
authors.lastname: Simmons
authors.forename: Alison B
authors.initials: AB
authors.lastname: Edelman
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.forename: Keenan E
authors.initials: KE
authors.lastname: Yanit
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Jensen
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007434:Intrauterine Devices; D009922:Oregon; D010044:Outpatient Clinics, Hospital; D010298:Parity; D010349:Patient Compliance; D010353:Patient Education as Topic; D011181:Postnatal Care; D057285:Precision Medicine; D011247:Pregnancy; D011295:Prenatal Care; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants