Family Physicians and Provision of Immediate Postpartum Contraception: A CERA Study.

BACKGROUND AND

OBJECTIVES

The Centers for Disease Control and Prevention (CDC) support the provision of intrauterine devices (IUDs) and the contraceptive implant to women immediately after childbirth. We aimed to assess perceived training needs and barriers to immediate postpartum contraceptive service delivery among US family physicians.

METHODS

We contributed items regarding postpartum contraception to the 2015 Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey of a national cohort of family medicine educators. We assessed self-estimated adequacy of training to insert IUDs and implants immediately postpartum, how often these services are provided, and barriers to service provision.

RESULTS

Our sample of 409 respondents who provide labor and delivery maternity care was primarily Caucasian (79.9%) and female (56.0%). Significantly fewer respondents felt comfortable counseling about long-acting reversible contraception (LARC), inserting an IUD, and inserting an implant immediately postpartum compared to at 6+ weeks postpartum (all comparisons P<0.001). Fewer respondents felt adequately trained to insert an immediate postpartum IUD (36.4%) than an implant (58.7%; P<0.001). Most respondents had never placed an immediate postpartum IUD (81.17%) or implant (80.1%). Device unavailability was the most commonly cited reason for never having placed an immediate postpartum IUD (67.8%) or implant (71.2%) at one's institution.

CONCLUSIONS

As reimbursement for immediate postpartum contraception becomes more common, family physicians are on the front lines to make these services available to patients who desire them. Training is necessary to enable family physicians to provide this evidence-based option to women.