title: The relationship of age and place of delivery with postpartum contraception prior to discharge in Mexico: A retrospective cohort study.
abstract: To test the association of age (adolescents vs. older women) and place of delivery with receipt of immediate postpartum contraception in Mexico.
  
  
  
  Retrospective cohort study, Mexico, nationally representative sample of women 12-39years old at last delivery. We used multivariable logistic regression to test the association of self-reported receipt of postpartum contraception prior to discharge with age and place of delivery (public, employment based, private, or out of facility). We included individual and household-level confounders and calculated relative and absolute multivariable estimates of association.
  
  
  
  Our analytic sample included 7022 women (population, N=9,881,470). Twenty percent of the population was 12-19years old at last birth, 55% aged 20-29 and 25% 30-39years old. Overall, 43% of women reported no postpartum contraceptive method. Age was not significantly associated with receipt of a method, controlling for covariates. Women delivering in public facilities had lower odds of receipt of a method (Odds Ratio=0.52; 95% Confidence Interval (CI)=0.40-0.68) compared with employment-based insurance facilities. We estimated 76% (95% CI=74-78%) of adolescents (12-19years) who deliver in employment-based insurance facilities leave with a method compared with 59% (95% CI=56-62%) who deliver in public facilities.
  
  
  
  Both adolescents and women ages 20-39 receive postpartum contraception, but nearly half of all women receive no method. Place of delivery is correlated with receipt of postpartum contraception, with lower rates in the public sector. Lessons learned from Mexico are relevant to other countries seeking to improve adolescent health through reducing unintended pregnancy.
  
  
  
  Adolescents receive postpartum contraception as often as older women in Mexico, but half of all women receive no method.
authors.affiliation: Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico; Oregon Health & Science University, Department of Obstetrics & Gynecology, Portland, OR. Electronic address: blair.darney@insp.mx.
authors.forename: Blair G
authors.initials: BG
authors.lastname: Darney
authors.affiliation: Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico.
authors.forename: Sandra G
authors.initials: SG
authors.lastname: Sosa-Rubi
authors.affiliation: Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico.
authors.forename: Edson
authors.initials: E
authors.lastname: Servan-Mori
authors.affiliation: Oregon Health & Science University, Department of Obstetrics & Gynecology, Portland, OR; World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Rodriguez
authors.affiliation: University of California, San Francisco, San Francisco, CA.
authors.forename: Dilys
authors.initials: D
authors.lastname: Walker
authors.affiliation: Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Lozano
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data; D016015:Logistic Models; D008800:Mexico; D015999:Multivariate Analysis; D016017:Odds Ratio; D049590:Postpartum Period; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012189:Retrospective Studies; D055815:Young Adult
keywords: Adolescents; IUD; Mexico; Postpartum contraception
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