Factors associated with consistent contraceptive use among first-time, low income mothers in NYC

Background: Understanding the factors associated with inconsistent contraceptive use among low-income mothers in the postpartum period is critical to reducing unplanned pregnancies. Closely-spaced births (<12-months) are more likely to be unplanned. Methods: The sample comprised 735 first-time mothers enrolled in New York City Nurse-Family Partnership (NFP), at risk of pregnancy, and followed 12+ months postpartum. We used logistic regression to analyze factors associated with consistent contraceptive use at 12-months (“used contraception every/most of the time”) [n=477] vs. inconsistent/no use (“half of the time/some/none”) [n=191]; 67 women with missing data were excluded. Results: At 12-months postpartum, 65% of the sample used contraception consistently and 26% reported inconsistent/no use. Among consistent users, 52% used hormonal methods—including IUDs—and 37% used condoms alone. Among inconsistent/no users, 70% used no method; condoms were the most prevalent method (15%). In multivariate regression analysis, consistent contraception at 12-months was significantly associated with being both employed and enrolled in school (versus neither) (OR=2.8 [CI: 1.3,5.9]), enrolled in school only (versus not employed or in school) (1.7 [CI: 1.0,2.6]), and being married/cohabitating (1.6 [CI:1.1,2.4]). Women aged 30+ (0.5 [CI:0.3,0.8]) and black non-Hispanics (versus Hispanics) (0.6 [CI:0.4,0.9]) were less likely to contracept consistently. Conclusion: At 12-months postpartum, consistent contraceptive use was associated with participation in both school and work, marital/cohabitating status, younger age, and Hispanic race/ethnicity. Education and employment participation are amenable to intervention, while other factors are not. Programs like NFP that promote educational/professional goal attainment, along with contraceptive use, may have significant potential to prevent unplanned pregnancies.