title: Unmet demand for highly effective postpartum contraception in Texas.
abstract: OBJECTIVE
  We aimed to assess women's contraceptive preferences and use in the first 6 months after delivery. The postpartum period represents a key opportunity for women to learn about and obtain effective contraception, especially since 50% of unintended pregnancies to parous women occur within 2 years of a previous birth.
  
  
  METHODS
  We conducted a prospective cohort study of 800 postpartum women recruited from three hospitals in Austin and El Paso, TX. Women aged 18-44 who wanted to delay childbearing for at least 24 months were eligible for the study and completed interviews following delivery and at 3 and 6 months postpartum. Participants were asked about the contraceptive method they were currently using and the method they would prefer to use at 6 months after delivery.
  
  
  RESULTS
  At 6 months postpartum, 13% of women were using an intrauterine device or implant, and 17% were sterilized or had a partner who had had a vasectomy. Twenty-four percent were using hormonal methods, and 45% relied on less effective methods, mainly condoms and withdrawal. Yet 44% reported that they would prefer to be using sterilization, and 34% would prefer to be using long-acting reversible contraception (LARC).
  
  
  CONCLUSIONS
  This study shows a considerable preference for LARC and permanent methods at 6 months postpartum. However, there is a marked discordance between women's method preference and actual use, indicating substantial unmet demand for highly effective methods of contraception.
  
  
  CONCLUSIONS
  In two Texas cities, many more women preferred long-acting and permanent contraceptive methods (LAPM) than were able to access these methods at 6 months postpartum. Women's contraceptive needs could be better met by counseling about all methods, by reducing cost barriers and by making LAPM available at more sites.
authors.affiliation: Population Research Center, University of Texas at Austin, TX, USA. Electronic address: joe@prc.utexas.edu.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Potter
authors.affiliation: Population Research Center, University of Texas at Austin, TX, USA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Hopkins
authors.affiliation: Population Research Center, University of Texas at Austin, TX, USA; LBJ School of Public Affairs, University of Texas at Austin, TX, USA.
authors.forename: Abigail R A
authors.initials: AR
authors.lastname: Aiken
authors.affiliation: Population Research Center, University of Texas at Austin, TX, USA.
authors.forename: Celia
authors.initials: C
authors.lastname: Hubert
authors.affiliation: Population Research Center, University of Texas at Austin, TX, USA.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Stevenson
authors.affiliation: Health Care Organization and Policy, University of Alabama at Birmingham, AL, USA.
authors.forename: Kari
authors.initials: K
authors.lastname: White
authors.affiliation: Ibis Reproductive Health, Oakland, CA, USA; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossman
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D057240:Patient Preference / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011446:Prospective Studies; D013781:Texas; D055815:Young Adult
keywords: Female sterilization; Hispanic; LARC; Postpartum contraception; Texas