Long-acting reversible contraception uptake tied to residential distance from hospital
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Key takeaways:
- Women living farther from vs. closer to the hospital had more cesarean deliveries and shorter gestational age.
- Long-acting reversible contraception uptake was higher for those living farther from the hospital.
SAN FRANCISCO — Postpartum women who live farther from their delivery hospital are more likely to choose long-acting reversible contraception than those who live closer, according to study data.
At the 2-week postpartum visit, women who lived more than 10 miles from the delivery hospital more often chose an IUD, an etonogestrel implant or and medroxyprogesterone acetate injection than those who lived closer, according to data presented at the ACOG Annual Clinical & Scientific Meeting.
“But at the 6-week visit, this difference went away, and they were less likely to attend their 6-week follow up visit,” L. Olivia Barbee, BS, a medical student at the University of Illinois College of Medicine, and Quetzal Athena Class, PhD, research associate professor in the department of obstetrics and gynecology at the University of Illinois College of Medicine Chicago. told Healio.
Barbee and colleagues obtained electronic medical record data from 3,640 births (53.5% Black; 73.7% with public health insurance) that occurred from 2020 to 2022 at an inner-city academic hospital and used a location-based web service to identify residential distance to the hospital. At delivery and 2 and 6 weeks postpartum, researchers compared contraceptive choice, focusing on long-acting reversible contraception compared with other contraceptive options.
Residential distance to the hospital ranged from 0 to 1,724 miles. Overall, 74.2% of pregnant women lived within 10 miles of the hospital.
Pregnant women living within 10 miles of the hospital had a higher likelihood of being non-Black (P = .01), Hispanic (P = .001), single (P = .001) and experiencing a first pregnancy (P = .01). Women who lived farther than 10 miles from the hospital had more cesarean deliveries (32.5% vs. 28.1%; P = .01) and shorter gestational age (P = .05) compared with those living within 10 miles of the hospital.
Researchers observed no difference in postpartum tubal ligation among those living closer to or farther from the hospital. However, uptake of long-acting reversible contraception at delivery and 2 weeks postpartum was higher among pregnant women who lived farther from compared with closer to the hospital (adjusted OR = 1.15; 95% CI, 0.96-1.39).
At 6 weeks, postpartum visits were higher for women who lived less than vs. farther than 10 miles from the hospital, and this association persisted after adjusting for age, race, cesarean delivery and parity (OR = 0.57; 95% CI, 0.43-0.77).
“We're going to look at transport modes of transportation and travel distance within the same population,” Barbee and Quetzal said. “Then we also want to expand to rural areas and see if there is a greater difference in rural America.”