Objective
The COVID-19 pandemic has led to health systems changes, including shifting many postpartum visits to telehealth. While this approach minimizes the risk of infection, it may have negative repercussions on contraception utilization, such as long acting reversible contraceptives (LARCs).
Study Design
This retrospective cohort study included all women who underwent prenatal care with an academic obstetric practice and delivered at Northwestern Memorial Hospital either during (2/1/20-5/15/20) or before (9/1/18-1/1/19) the COVID-19 pandemic. The method of contraception decided upon was ascertained from the postpartum clinical documentation. Women were classified as initiating LARC if they received Nexplanon or an IUD during the delivery hospitalization or within three months following delivery. Other contraceptive utilization was categorized by either prescriptions provided (e.g., oral contraceptive pills) or by patient-reported intention of use (e.g., condoms). Bivariable and multivariable analyses were used.
Results
Of the 2375 women included in this study, 1120 (47%) delivered during the COVID-19 pandemic. Compared to women who delivered before the pandemic, women who delivered during the COVID-19 pandemic were less likely to be married or have diabetes (either pre-existing or gestational) and more likely to be obese or have a hypertensive disorder of pregnancy. Distributions of contraceptive plans comparing women who delivered before versus during the COVID-19 pandemic are shown in Table 1. After controlling for confounders, women who delivered during the COVID-19 pandemic were significantly less likely to use LARC methods within three months of delivery (aOR 0.67, 95% CI 0.53-0.84) (Table 2).
Conclusion
Health systems modifications during the COVID-19 pandemic are associated with changes in postpartum contraception utilization, with fewer women receiving LARC methods. Anticipating an ongoing need to adjust health care delivery in response to the enduring pandemic, these data can inform policies to maintain access to effective contraception.
