Date of Award

12-2023

Document Type

Doctoral Dissertation - Open Access

Degree Name

Doctor of Public Health

Department

Public Health

First Advisor

Kenneth Knapp, PhD

Second Advisor

Julian Lee, DrPH

Third Advisor

Nicholas Mercado, DrPH

Abstract

Background: In the United States, 45% of all pregnancies are unintended and occur when contraception is not used or is used inconsistently. Among those pregnancies, 1 in 10 women will experience a preterm birth, which is defined as a birth occurring before 37 weeks gestation. Women who have delivered preterm are at an increased risk for preterm birth in future pregnancies and are encouraged to wait at least 18 months between giving birth and getting pregnant again. Among women who have experienced a preterm birth, the desire to delay future pregnancy or avoiding it all together often becomes a necessity rather than a preference. Objective: The primary objective was to determine if there was a link between pregnancy intent and postpartum contraception use among respondents who delivered preterm. The secondary objective is whether an earlier gestational age among preterm births leads to higher utilization of tier1 (most effective) forms of contraception among postpartum respondents. Methods: A cross-sectional study was conducted and analyzed Pregnancy Risk Assessment Monitoring System (PRAMS) data between 2018 and 2019 in New York. Bivariate analysis and logistic regression were used to discover whether gestational age at birth or pregnancy intent contributed to postpartum contraception use. Results: The logistic regression revealed no statistically significant difference in postpartum contraception use among preterm or unintended pregnancies. Previous preterm birth and parity as well as marital status, income, health insurance coverage, and race showed no statistical significance. Respondents who reported that their newborn died had statistically significant lower odds of using postpartum contraception than those whose newborn was still alive. Respondents who received a college degree of 4+ years had 2.62 times the odds of using postpartum contraception than those who had not graduated from high school. Lastly, respondents who fell into the 40+ age group had statistically significant lower odds of using postpartum contraception than those between the ages of 30-34. Conclusion: Though no significant differences in postpartum contraception use were found among preterm births or unintended pregnancies, the percentage of unintended pregnancies in the U.S. remains high. Evidence-based programs and policies focused on maternal health remain a public health priority and must include preconception health and early prenatal care.

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