Postpartum Contraception Use by Urban/Rural Status: An Analysis of the Michigan Pregnancy Risk Assessment Monitoring System Data

Objective: We sought to examine rural/urban differences in postpartum contraceptive use, which are underexplored in the literature. Methods: We analyzed phase 5 (2004-2008) of the Michigan Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Using Rural-Urban Commuting Area codes and weighted multinomial logistic regression, we examined the association between self-reported postpartum contraceptive method and rural/urban residence among postpartum women not desiring pregnancy (n = 6,468). Results: Postpartum (mean, 16.5 weeks after delivery), 14.4% of respondents were using sterilization, 6.7% long-acting reversible contraception (LARC), 37.3% moderately effective hormonal methods, 38.4% less effective methods or no method, and 3.2% abstinence. Multivariable analysis yielded sporadic geographic patterns. Odds of method use varied significantly by age, parity, body mass index, and breastfeeding status. Not discussing contraception with a prenatal healthcare provider decreased odds of postpartum LARC use (odds ratio, 0.52; 95% CI, 0.36-0.75). Number of prenatal visits and weeks since delivery were not associated with postpartum contraception method. Conclusions: We did not observe strong variation in postpartum contraceptive use based on geography. Low uptake of highly effective contraception across rural and urban areas suggests a need for education and outreach regarding these methods. Copyright (C) 2015 by the Jacobs Institute of Women's Health. Published by Elsevier Inc.