title: Postpartum Contraception and Interpregnancy Intervals Among Adolescent Mothers Accessing Public Services in California.
abstract: Objective To determine the association of age at index birth with postpartum contraceptive use and optimal interpregnancy interval (IPI, defined as delivery to next pregnancy >18 months), controlling for provider type and client demographics among adolescent mothers who have repeat pregnancies. Methods California's 2008 birth records were linked to California's Medi-Cal and Family PACT claims data to identify 26,393 women with repeat births between 2002 and 2008, whose index birth occurred as an adolescent, and who received publicly-funded services within 18 months after the index birth. Multivariable regression analyses were conducted to examine the relationship between timing of contraception provision and interpregnancy intervals, adjusting for socio-demographic factors. Results Seventy-eight percent of adolescent women did not receive contraception at their first postpartum visit, and twenty-eight percent of adolescent women never received contraception from a Family PACT or Medi-Cal provider. Adolescents who were older at their index birth had lower rates of optimal IPIs. Native American, Asian-Pacific Islander and Latina women had lower rates of optimal IPIs compared to white women. Compared to those using only barrier methods, adolescent women receiving highly effective contraceptive methods had a 4.25 times higher odds of having an optimal IPI than those receiving hormonal methods (OR 2.10), or using no method (OR 0.70). Conclusion Effective postpartum contraceptive use and being a Family PACT provider were associated with optimal birth spacing among adolescent mothers, yet racial and ethnic disparities persisted. A missed opportunity was the provision of contraception at the first postpartum visit. Providers should aim to remove barriers to initiation of contraception at this visit.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 550 16th St, 7th Floor, Box 0132, San Francisco, CA, 94158, USA. Sarah.Isquick@ucsf.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Isquick
authors.affiliation: Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.|Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Chang
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Heike
authors.initials: H
authors.lastname: Thiel de Bocanegra
authors.affiliation: Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Chabot
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.|Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Claire D
authors.initials: CD
authors.lastname: Brindis
mesh_terms: D000293:Adolescent; D000328:Adult; D001721:Birth Intervals / Q000523:psychology* / Q000706:statistics & numerical data; D002140:California; D003268:Contraception Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000523:psychology / Q000706:statistics & numerical data; D008423:Maternal Age; D008484:Medicaid / Q000706:statistics & numerical data; D009035:Mothers / Q000523:psychology*; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D013997:Time Factors; D014481:United States; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Adolescent mothers; Contraception; Interpregnancy intervals; Repeat pregnancy