title: Barriers to Postpartum Contraception in Texas and Pregnancy Within 2 Years of Delivery.
abstract: OBJECTIVE
  To assess pregnancies that could have been averted through improved access to contraceptive methods in the 2 years after delivery.
  
  
  METHODS
  In this cohort study, we interviewed 403 postpartum women in a hospital in Austin, Texas, who wanted to delay childbearing for at least 2 years. Follow-up interviews were completed at 3, 6, 9, 12, 18, and 24 months after delivery; retention at 24 months was 83%. At each interview, participants reported their pregnancy status and contraceptive method. At the 3- and 6-month interviews, participants were also asked about their preferred contraceptive method 3 months in the future. We identified types of barriers among women unable to access their preferred method and used Cox models to analyze the risk of pregnancy from 6 to 24 months after delivery.
  
  
  RESULTS
  Among women interviewed 6 months postpartum (n=377), two thirds had experienced a barrier to accessing their preferred method of contraception. By 24 months postpartum, 89 women had reported a pregnancy; 71 were unintended. Between 6 and 24 months postpartum, 77 of 377 women became pregnant (20.4%), with 56 (14.9%) lost to follow-up. Women who encountered a barrier to obtaining their preferred method were more likely to become pregnant less than 24 months after delivery. They had a cumulative risk of pregnancy of 34% (95% confidence interval [CI] 0.25-0.43) as compared with 12% (95% CI 0.05-0.18) for women with no barrier. All but three of the women reporting an unintended pregnancy had earlier expressed interest in using long-acting reversible contraception or a permanent method.
  
  
  CONCLUSIONS
  In this study, most unintended pregnancies less than 24 months after delivery could have been prevented or postponed had women been able to access their desired long-acting and permanent methods.
authors.affiliation: Population Research Center, University of Texas at Austin, Austin, Texas; National Institute of Public Health of Mexico, Mexico, DF; Office of Population Research, Princeton University, Princeton, New Jersey; Health Care Organization & Policy, University of Alabama at Birmingham, Birmingham, Alabama; and Ibis Reproductive Health and ANSIRH, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Potter
authors.forename: Celia
authors.initials: C
authors.lastname: Hubert
authors.forename: Amanda Jean
authors.initials: AJ
authors.lastname: Stevenson
authors.forename: Kristine
authors.initials: K
authors.lastname: Hopkins
authors.forename: Abigail R A
authors.initials: AR
authors.lastname: Aiken
authors.forename: Kari
authors.initials: K
authors.lastname: White
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossman
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003267:Contraception / Q000706:statistics & numerical data*; D005193:Family Planning Services; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D013781:Texas; D055815:Young Adult