Understanding factors associated with postpartum visit attendance and contraception choices: Listening to low-income postpartum women and health care providers

Low-income women are at increased risk of not attending the 4-6 week postpartum visit, resulting in a clear gap in women’s health care during the postpartum period. Additionally, while there is great variation among providers regarding postpartum visit and contraceptive care recommendations, few studies examine provider practices. In order to increase women’s utilization of both postpartum care and contraception, it is essential to explore women’s and provider’s perspectives with respect to the timing, content, and site of postpartum care. We examined the perceptions of low-income postpartum women in one university hospital setting with respect to barriers to and preferences for the timing and location of the postpartum visit and receipt of postpartum contraception. We also examined the perspectives of providers’ from multiple hospital settings with respect to the delivery of postpartum contraceptive counseling and services with particular attention to use of a Reproductive Life Plan Tool (RLPT) and the potential to deliver aspects of postpartum contraceptive care at the Well-Baby Visit (WBV). Face-to-face interviews were completed with 20 postpartum women and in-depth phone interviews were completed with 12 health care providers who had regular contact with postpartum women. Analysis was conducted using Atlas.ti software. Women indicated that receiving care during the postpartum period was an important resource for monitoring their physical and mental health and provided substantial support for the provision of contraception earlier than the 6-week postpartum visit. Providers noted that barriers to postpartum care utilization exist on the patient, provider, and system levels. However, providers were receptive to exploring new clinical practices (e.g., RLPT, care at WBV) that may widen the reach of postpartum care for women. Approaches that increase the flexibility and convenience of postpartum care and postpartum contraception are more likely to meet women where they are at and increase the likelihood that women will take advantage of essential postpartum services.