Purpose: Past studies examining Social Determinants of Health (SDH) and contraceptive use report mixed findings. One possible explanation is the omission of key mediating factors. This study explores whether contraceptive self-efficacy is a mediating factor between SDH domains and contraception use.

Methods: We utilized data from National Longitudinal Study of Adolescent to Adult Health, Eleven measures related to five SDH domains were extracted from Wave I. Contraceptive self-efficacy measure was extracted from Wave II. Wave III contraception use included both any contraceptive use in the past 12 month and consistency of use. The mediation relationship was tested using path analysis.

Results: Of the 11,575 participants (mean age at Wave III= 22.02 years (SD:1.78), 53.77% female, 52.5% White), past year ever-use of contraception and consistent use was reported by 75.14% and 45.33% respectively. Within the social and community context domain, contraceptive self-efficacy mediated the effects of history of civic participation (B=0.005, 95%CI: 0.001, 0.011), perceived discrimination (B=-0.002, 95%CI: -0.005, -0.001) and perceived social cohesion (B=0.002, 95%CI: 0.001, 0.005) on contraceptive ever-use. Under health domain, contraceptive self-efficacy mediated the effects of access to health services (B=0.007, 95%CI: 0.002, 0.015) on contraceptive ever-use. Additionally, within education domain, contraceptive self-efficacy also mediated the relationships between language spoken at home and consistency of contraception use (B=-0.013, 95%CI: -0.026, -0.001).

Conclusions: Contraceptive self-efficacy is a key mediator between SDH domains and contraceptive use. Results suggest that interventions focused on boosting contraceptive self-efficacy may be a promising strategy for empowering young adults to use contraception more frequently.

Background and Purpose: The past few years have seen a dramatic decrease in the ability of individuals to exercise their reproductive rights, particularly related to abortion and contraceptive access. These changes have often especially impacted people living in rural areas, who have decreased access to reproductive and sexual healthcare resources to begin with. While concerns have often focused on the increased physical distance people face in accessing reproductive healthcare, less attention has focused on other spatial factors, such as lack of transportation or the impact of weather conditions that also contribute to contraceptive access.

Methods: A qualitative descriptive research methodology was used to conduct qualitative semi-structured interviews with 25 self-identified women from across Montana. Interviews were conducted from January to March 2023, took place via zoom, and averaged 45 minutes in length. They were transcribed verbatim and analyzed with NVivo software.

Results: In describing their experiences accessing contraceptive services, the following themes were identified: (1) Impact of stigma in accessing care; (2) Physical barriers to accessing care; and (3) Provider-related barriers.

Conclusions and Implications: The reproductive justice framework is used to contextualize these findings and they are being used to develop StoryMaps to illustrate barriers to holistic contraceptive care for rural populations. These results showcase the experiences of rural perinatal people in accessing contraceptive services and highlight how barriers such as a lack of providers are compounded by additional barriers such as stigma and winter weather. Opportunities to increase access to contraceptive care are also described.

Introduction

Postpartum contraception provides future pregnancy intention choice and can decrease maternal stress. In this study, we examined the association between psychosocial stressors and depression with postpartum contraception. We also examined whether pregnancy intention was associated with postpartum depression.

Methods

We used data from the 2016-2019 Pregnancy Risk Assessment Monitoring System from four states and a large city (n = 22,935). We used logistic regression models to examine a) the association between psychosocial stressors (any stressor; and emotional, financial, partner-related, and traumatic stressors, specifically) and postpartum depression with use of postpartum contraception, and b) the association between pregnancy intention (intended, unintended, unsure) and postpartum depression.

Results

Approximately 56% reported of the sample reported at least one psychosocial stressor, 76% reported postpartum contraception use, and 14% reported postpartum depression. Women who experienced any psychosocial stressor (aOR = 0.91, 95% CI 0.85-0.97, p≤0.01), partner-related stressors (aOR=0.83, 95% CI=0.77-0.89, p≤0.001), or trauma-related stressors (aOR=0.85, 95% CI=0.77-0.94, p≤0.001) had lower odds of postpartum contraception than their counterparts. Postpartum depression was negatively associated with postpartum contraception (aOR=0.80, 95% CI=0.73-0.87, p≤0.001). Women reporting unintended (aOR=1.73, 95% CI=1.50-2.00, p≤0.001) or unsure pregnancies (aOR=1.32, 95% CI=1.19-1.46, p≤0.001) had higher odds of postpartum depression than those who reported their pregnancy was intended.

Conclusions

Maternal stress and depression are associated with postpartum contraception use, and pregnancy intention is associated with postpartum depression. Family planning and reproductive health counseling for postpartum individuals should include assessments for psychosocial stressors, postpartum depression, and pregnancy intention for improved health.

Background: The onset of the COVID-19 pandemic interrupted reproductive healthcare provision in the US. About 33% of women reported delay or cancellation of reproductive health care visits or had trouble getting contraception (Lindberg et al., 2020). This study examines the association between emergency contraception utilization and social vulnerability in Texas using the CDC social vulnerability index by zip code.

Methods: Own Every Piece collaborated with a local pharmacy to distribute Just In Case Kits with emergency contraception pills at no cost to women living in the Greater Houston area. Individuals requested emergency contraception online between March 2021 and July 2022. We conducted a social vulnerability analysis by zip code within Houston, TX and surrounding areas.

Results: Over 2200 Just In Case Kits were mailed out. The highest demands coincided with policy changes. Approximately 33.6% of requests also wanted follow-up from the pharmacy. The social vulnerability index analysis indicated a significant correlation between socioeconomic status and emergency contraption requests. There was also a significant association between minority status & language, and emergency contraception requests.

Conclusion: Women living in Houston, TX have unique socioeconomic needs that put them at risk for unplanned pregnancy. Our findings suggest that the immediate effects of the Texas Senate Bill 8 and the Supreme court ruling to overturn Roe vs. Wade likely influenced more women in Texas to seek emergency contraception. Sustainable programs should be implemented within communities to ensure that they are adequately prepared to provide contraception to vulnerable populations in future pandemics or natural disasters.