Patterns of Postpartum Depot Medroxyprogesterone Administration among Low Income Mothers Ann M. Dozier, RN, PhD 1, Alice Nelson, MFT 2, Elizabeth A. Brownell,

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Patterns of Postpartum Depot Medroxyprogesterone Administration among Low Income Mothers Ann M. Dozier, RN, PhD 1, Alice Nelson, MFT 2, Elizabeth A. Brownell, MA, PhD 3, Cynthia R. Howard, MD MPH 4,5, Ruth A. Lawrence, MD 5 1 University of Rochester Department of Public Health Sciences, 2 Shelter Care, Eugene, OR; 3 Departments of Research and Neonatology, Connecticut Children’s Medical Center; 4 Rochester General Hospital; 5 University of Rochester Department of Pediatrics BACKGROUND While depot medroxyprogesterone (DMPA) can be administered postpartum little is known about the actual patterns of postpartum DMPA use. Immediate postpartum use may be due to concerns about short interval repeat or unintended pregnancy BACKGROUND While depot medroxyprogesterone (DMPA) can be administered postpartum little is known about the actual patterns of postpartum DMPA use. Immediate postpartum use may be due to concerns about short interval repeat or unintended pregnancy PURPOSE These analyses describe the patterns among low income mothers in an upstate New York community. PURPOSE These analyses describe the patterns among low income mothers in an upstate New York community. METHODS Mothers attending urban pediatric practices (births ) completed a mailed survey at approximately 5 months postpartum. Subset of 648 used in analysis 83 items about pre-pregnancy, pregnancy, delivery and postpartum included questions about breastfeeding and timing of DMPA receipt. METHODS Mothers attending urban pediatric practices (births ) completed a mailed survey at approximately 5 months postpartum. Subset of 648 used in analysis 83 items about pre-pregnancy, pregnancy, delivery and postpartum included questions about breastfeeding and timing of DMPA receipt. RESULTS 48.8% reported the pregnancy as unintended 31.3% reported receiving postpartum DMPA; 62.6% received it prior to discharge Other contraceptive use included: none (20.4%), IUD (17.1%), birth control pill (16.4%); barrier methods (14.0%) Those receiving in-hospital DMPA (n=127; vs. other mothers) were significantly more likely be Black race, older (age18/19), urban dwelling, non-high school graduates, multiparous and planning to formula feed Across the 4 hospitals, among respondents receiving DMPA at least 50% (and up to 73.8%) received DMPA prior to hospital discharge. No data on in-hospital administration are available for comparison. RESULTS 48.8% reported the pregnancy as unintended 31.3% reported receiving postpartum DMPA; 62.6% received it prior to discharge Other contraceptive use included: none (20.4%), IUD (17.1%), birth control pill (16.4%); barrier methods (14.0%) Those receiving in-hospital DMPA (n=127; vs. other mothers) were significantly more likely be Black race, older (age18/19), urban dwelling, non-high school graduates, multiparous and planning to formula feed Across the 4 hospitals, among respondents receiving DMPA at least 50% (and up to 73.8%) received DMPA prior to hospital discharge. No data on in-hospital administration are available for comparison. Backward Logistic Regression comparing characteristics of mothers who did and did not receive depot medroxyprogesterone (DMPA) All DMPA Recipients vs. All Others All In-Hospital DMPA Recipients vs. All Others Variable [ref]OR [CI]p valueOR [CI]p value Less than high school [High school or more] 1.45 [ ]0.09NA-- Black Race [No] 1.41 [ ] [ ]0.08 Age Continuous 0.97 [ ] [ ] 0.01 Inner-City Resident [No] 1.97 [ ] < [ ] 0.03 Wanted to be pregnant later or never [Now or sooner] 1.58 [ ] [ ]0.10 Primiparous [multiparous] NA [ ] < 0.01 Prenatal feeding plan a [just breastfeed] < 0.01 I planned to formula feed my baby 2.13 [ ] 2.40 [ ] I planned to both breastfeed &formula feed 1.01 [ ] 1.33 [ ] I wasn’t sure how I was going to feed my baby 0.94 [ ] 1.14 [ ] Birth Hospital [Hospital A] < 0.01 Hospital B 0.53 [ ] 0.61 [ ] Hospital C 1.31 [ ] 1.88 [ ] Hospital D 0.43 [ ] 0.49 [ ] Characteristics and Comparison of Mothers receiving or not receiving depot medroxyprogesterone (DMPA) All N (%) Only those Receiving DMPA (anytime) a n (%) All receiving DMPA 6 or more weeks PP n (%) Never received DMPA n (%) Only those receiving DMPA in hospital n (%) All minus those receiving DMPA in hospital n (%) Colum n B vs. D b Colum n E vs. F b Colum n C vs. D b ColumnABCDEF p-value Maternal Characteristics N=648n=203n=54n=445n=127n=521 Less than high school 148 (22.9)63 (31.2)15 (27.8)85 (19.1)40 (31.7)108 (20.8) < Black Race 299 (46.1)106 (52.2)25 (46.3)193 (43.4)70 (55.1)229 (44.0) Hispanic 154 (23.8)55 (27.1)16 (29.6)99 (22.2)32 (25.2)122 (23.4) Mean Age [ ] [ ] [ ] [ ] [ ] [ ] < Inner-City Resident 453 (69.9)166 (81.8)42 (77.8)287 (64.5)106 (83.5)347 (66.6) < Wanted to be pregnant Now or sooner 325 (51.2)81 (40.9)23 (42.6)244 (55.8)51 (41.8)274 (53.4) < Parity – Primip 264 (40.7)74 (36.5)25 (46.3)190 (42.7)36 (28.3)228 (43.8)0.13 < Prenatal plan to feed for the first few weeks c < just BF326 (51.0)82 (40.8)30 (55.6)244 (55.7)43 (34.4)283 (55.1) -formula feed 164 (25.7)74 (36.8)13 (24.1)90 (20.5)52 (41.6)112 (21.8) -both BF & formula feed 120 (18.8)38 (18.9)9 (16.7)82 (18.7)26 (20.8)94 (18.3) -wasn’t sure29 (4.5)7 (3.5)2 (3.7)22 (5.0)4 (3.2)25 (4.9) Where was this baby born d < Hospital A195 (30.1)67 (33.0)24 (44.4)128 (28.8)37 (29.1)158 (30.3) Hospital B187 (28.9)39 (19.2)13 (24.1)148 (33.3)21 (16.5)166 (31.9) Hospital C196 (30.2)80 (39.4)12 (22.2)116 (26.1)59 (46.5)137 (26.3) Hospital D70 (10.8)17 (8.4)5 (9.3)53 (11.9)10 (7.9)60 (11.5) a Includes mothers receiving DMPA in the hospital or any time post-discharge including the 23 mothers who received it post hospital discharge but before 6 weeks postpartum b Chi-square analyses; bolded values are significant at p<0.05 c Actual item wording: Before your baby was born, how did you plan to feed your baby for the first few weeks? d Low income births by hospital ( ): A: 46.1%; B: 44.5%; C: 47.4%; D: 59.1% ACKNOWLEDGEMENTS: Funding: NIH PHS Grant # RO1-HD055191, Community Partnership for Breastfeeding Promotion and Support Also the following individuals from the University of Rochester: Holly Widanka, MS, Barbara Suter, MPH, Joseph Duckett and Cynthia Childs, MFA, MPH. ADDITIONAL INFORMATION: ACKNOWLEDGEMENTS: Funding: NIH PHS Grant # RO1-HD055191, Community Partnership for Breastfeeding Promotion and Support Also the following individuals from the University of Rochester: Holly Widanka, MS, Barbara Suter, MPH, Joseph Duckett and Cynthia Childs, MFA, MPH. ADDITIONAL INFORMATION: LIMITATIONS Mothers with limited or no English or Spanish language capacity are likely underrepresented. All data are maternal self-report with no opportunity for cross checking or validation from other sources. No quantitative information on obstetrical practices or decision-making about timing of DMPA administration beyond anecdotal comments - we do not know the factors influencing the mothers’ or their providers’ selection of DMPA No corrections were made for multiple comparisons LIMITATIONS Mothers with limited or no English or Spanish language capacity are likely underrepresented. All data are maternal self-report with no opportunity for cross checking or validation from other sources. No quantitative information on obstetrical practices or decision-making about timing of DMPA administration beyond anecdotal comments - we do not know the factors influencing the mothers’ or their providers’ selection of DMPA No corrections were made for multiple comparisons CONCLUSIONS 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. CONCLUSIONS 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. ANALYSES Descriptive and exploratory. Outcome groups by DMPA administration: any postpartum DMPA vs. non-DMPA DMPA in hospital vs. all others DMPA at 6 weeks after hospitalization vs. all non-DMPA users Chi square or t-test statistics analyzed differences between groups Multivariable logistic regressions (backward selection) included characteristics associated with DMPA use in the bivariate analyses (p=<0.10). All p-values were two-sided Significance set at p≤0.05. ANALYSES Descriptive and exploratory. Outcome groups by DMPA administration: any postpartum DMPA vs. non-DMPA DMPA in hospital vs. all others DMPA at 6 weeks after hospitalization vs. all non-DMPA users Chi square or t-test statistics analyzed differences between groups Multivariable logistic regressions (backward selection) included characteristics associated with DMPA use in the bivariate analyses (p=<0.10). All p-values were two-sided Significance set at p≤0.05.