Perceptions of contraception counseling and the role of health literacy and numeracy among low income postpartum patients in Chicago

Objective: Focused ante- and postpartum contraceptive counseling may reduce the risk of contraceptive nonuse and misuse, although optimal timing and content of such counseling remain controversial. This study examines patient perceptions of antepartum contraception counseling and the role of health literacy and numeracy in contraceptive education.

Methods: Short surveys and semi-structured individual interviews were conducted with 30 postpartum patients at Northwestern Memorial Hospital. Literacy and numeracy were assessed using REALM-7 and a validated 3-question numeracy scale. Qualitative analysis techniques were applied.

Results: In this cohort of Hispanic (50%) and African American (50%) young women, over 70% of patients had unplanned pregnancies due to contraceptive misuse or nonuse. Patients prefer frequent, short sessions of physician-initiated comprehensive contraceptive counseling throughout the antepartum period, with a review of options and reassessment of the patient's decision during the third trimester and postpartum hospitalization. Patients value the utilization of multiple learning methods, including lecture-style counseling, Q&A opportunities, use of visual aids, and use of written materials or websites. Many patients emphasize that counseling must be free of coercion or provider opinions and inclusive of all appropriate options, rather than narrowly focused on methods the provider perceives to be best. Finally, although health literacy rates on the REALM-7 were moderate to high, numeracy scores were alarmingly low in this population.

Conclusion: Frequent, physician-initiated, multiple modality discussions of appropriate contraceptive options should take place throughout pregnancy in a manner free of coercive language or intent and at an appropriate literacy and numeracy level.