Patterns of postpartum depot medroxyprogesterone administration among low income mothers

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.