Online Program

Patterns of postpartum depot medroxyprogesterone administration among low income mothers

Monday, November 4, 2013

Ann M. Dozier, PhD, RN, Public Health Sciences/Social and Behavioral Sciences, University of Rochester, Rochester, NY
Alice Nelson, Public Healtlh Sciences, University of Rochester Medical Center, Rochester, NY
Elizabeth A. Brownell, MA PhD, Departments of Neonatology and Research, CT Childrens Medical Center, Hartford, CT
Cynthia Howard, MD, MPH, Department of Pediatrics, Rochester General Hospital; University of Rochester, Rochester, NY
Ruth Lawrence, MD DD(hon), Department of Pediatrics., University of Rochester School of Medicine, Rochester, NY
Background. While depot medroxyprogesterone (DMPA) can be administered postpartum, timing varies and can occur in the immediate postpartum period, prior to hospital discharge. Historically DMPA has been selectively administered to specific sub-groups including minority women and teens. Little is known about the actual patterns of postpartum DMPA administration. These analyses describe the patterns among low income mothers in an upstate New York community. Methods. Low income mothers attending urban pediatric practices (births 2009-2011) completed a mailed survey at approximately 5 months postpartum. The 83 survey items about pre-pregnancy, pregnancy, delivery and postpartum included questions about contraception and specifically timing DMPA administration. Results. These descriptive and exploratory analyses of 695 mothers identified that 49.3% reported the pregnancy associated with the index birth as unintended. Among the 31.e% that received postpartum DMPA, 62.2% received it prior to hospital discharge. Those receiving in-hospital DMPA (n=127; vs. other mothers) were significantly more likely be Black race, older, urban dwelling, non-high school graduates and multiparous. Their deliveries occurred across four different hospitals in the same community; among mothers receiving postpartum DMPA, rates of administration prior to hospital discharge varied from 50.7% to 75.6%. Conclusions. This study of postpartum DMPA administration among a convenience sample of low income mothers demonstrated rates of immediate postpartum administration greater than 50%. Additional studies of DMPA administration patterns are warranted to identify geographic or other trends as well as the impact of different approaches to screening for and communication with mothers about DMPA.

Learning Areas:

Clinical medicine applied in public health
Public health or related public policy
Public health or related research

Learning Objectives:
Describe the different patterns of Depot Medroxyprogesterone Administration during the postpartum period Describe the implications of these different patterns

Keyword(s): Contraceptives, Maternal Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a maternal health researcher with over 30 years of experience in women's health including a PhD in Nursing. I was the PI of the study that funded this analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.