title: Postpartum Contraception Use by Urban/Rural Status: An Analysis of the Michigan Pregnancy Risk Assessment Monitoring System Data.
abstract: 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.
authors.affiliation: The Section of Family Planning & Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Starr
authors.affiliation: The Section of Family Planning & Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois.
authors.forename: Summer L
authors.initials: SL
authors.lastname: Martins
authors.affiliation: Department of Health Studies, University of Chicago, Chicago, Illinois.
authors.forename: Sydeaka
authors.initials: S
authors.lastname: Watson
authors.affiliation: The Section of Family Planning & Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois. Electronic address: mgilliam@bsd.uchicago.edu.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Gilliam
mesh_terms: D000328:Adult; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data; D003276:Contraceptives, Oral / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data; D016015:Logistic Models; D008824:Michigan; D049590:Postpartum Period; D011247:Pregnancy; D018570:Risk Assessment; D012424:Rural Population; D013245:Sterilization, Reproductive / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014505:Urban Population
chemical_list: D003271:Contraceptive Agents, Female; D003276:Contraceptives, Oral