Larissa R. Brunner Huber

Objective: The purpose of this study was to evaluate factors associated with postpartum contraceptive use among women with short and moderate-to-long birth intervals using population-based data from the Pregnancy Risk Assessment and Monitoring System. Methods: Because only Mississippi and Tennessee include a question about birth interval length on their Pregnancy Risk Assessment and Monitoring System survey, this analysis was limited to women from those states who reported information on this variable (N = 2198). Demographic, lifestyle, and reproductive data, including information on postpartum contraceptive use, were obtained from surveys and birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Results: Nearly 90% of women reported currently using a form of contraception during the postpartum period. In the unadjusted model, among women with short birth intervals, there was no association between alcohol consumption during pregnancy and postpartum contraceptive use (OR 1.03, 95% CI 0.15-7.31); however, smoking during pregnancy was associated with a decreased odds of postpartum contraceptive use (OR 0.70, 95% CI 0.25-1.96). Among women with moderate-to-long birth intervals, alcohol use during pregnancy was associated with a decreased odds (OR 0.71, 95% CI 0.28-1.80) and smoking during pregnancy was associated with an increased odds (OR 1.18, 95% CI 0.60-2.30) of postpartum contraceptive use. Regardless of birth interval length, women with no health insurance had a decreased odds of postpartum contraceptive use when compared with women with health insurance (short birth interval: OR 0.89, 95% CI 0.32-2.49 and moderate-to-long birth interval: OR 0.85, 95% CI 0.52-1.39). Among women with short birth intervals, non-Hispanic black women had a decreased odds of postpartum contraceptive use (OR 0.14, 95% CI 0.03-0.64) and women who were unmarried or had a history of preterm delivery had an increased odds of postpartum contraceptive use (unmarried: OR 5.81, 95% CI 1.26-26.69 and preterm delivery: OR 4.19, 95% CI 1.42-12.37, respectively) after adjustment for confounders. Among women with moderate-to-long birth intervals, individuals who identified as Hispanic/mixed race/other had a statistically significant decreased odds of postpartum contraceptive use after adjustment (OR 0.43, 95% CI 0.18-0.99). Conclusions: Findings underscore the importance of postpartum medical visits for all women, regardless of birth interval length. Certain groups of women may need additional counseling regarding the importance of using contraceptives to prevent another closely spaced or unintended pregnancy.

Introduction: Although the definition of a short interbirth interval has been inconsistent in the literature, Healthy People 2020 recommends that women wait at least 18 months after a live birth before attempting their next pregnancy. In the United States, approximately 33% of pregnancies are conceived within 18 months of a previous birth. Pregnancies that result from short interbirth intervals can pose serious risks. The objective of this study was to determine the association between interbirth interval and understudied pregnancy complications and outcomes, including small for gestational age (SGA) infants, premature rupture of membranes (PROM), preterm PROM (PPROM), placenta previa, and gestational diabetes, using Pregnancy Risk Assessment and Monitoring System data from Mississippi and Tennessee.Methods: This study collected self‐reported information from 2212 women on interbirth interval (≤18 months, ie, short; 19‐35 months, ie, intermediate; and ≥36 months, ie, long; referent), PPROM, placenta previa, and gestational diabetes. SGA and PROM data were obtained from birth certificates. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs.Results: After adjustment, there were no strong associations between interbirth interval and PPROM, gestational diabetes, or SGA infants. However, women with shorter intervals had increased odds of PROM (short: OR, 3.54; 95% CI, 1.22‐10.23 and intermediate: OR, 4.09; 95% CI, 1.28‐13.03) and placenta previa (short: OR, 2.58; 95% CI, 1.10‐6.05 and intermediate: OR, 1.69; 95% CI, 0.94‐3.05).Discussion: The study's findings provide further support for encouraging women to space their pregnancies appropriately. Moreover, findings underscore the need to provide women with family planning services so that closely spaced pregnancies and unintended pregnancies can be avoided. Additional studies of the role of interbirth interval on these understudied pregnancy complications and outcomes are warranted.

We evaluated access to primary health care for older women and men in Barbados, a developing country, using a widely accepted access indicator, hospitalization for ambulatory care sensitive conditions. Using 2003–2008 data, we calculated gender-specific total annual population-based rates of these hospitalizations per 1,000 older women and men and individual rates for the six most prevalent conditions. Across the 6 years, these hospitalizations increased 33.6% for women, 30.6% for men (both P < .0001). However, the average rate for diabetes fell 32% for women, 36% for men. Findings suggest an opportunity to improve access to primary health care, particularly for older women.

Measurements of sexual intercourse frequency are informative for research on pregnancy, contraception, and the transmission of sexually transmitted infections; however, efficiently collecting data on this sensitive topic is complex. The purpose of this study was to determine whether retrospective recall of sexual intercourse frequency was consistent with information obtained through the use of prospective daily diary methods corresponding to the same time period in a diverse sample of women. A total of 185 women participated in a longitudinal, prospective cohort study of oral contraceptive users and 98 of these women provided complete information on sexual intercourse frequency on diaries (prospective) and postcards (retrospective). Linear mixed models were used to test for variation in response within categories of demographic and other variables. The mean number of days women had sexual intercourse per week was 1.5 days using prospective diary information versus 2.0 days when using 3-month retrospective recall (p < 0.001). Mean differences for the various sociodemographic subgroups were positive for all groups indicating that women consistently reported a higher frequency of sexual intercourse on the retrospective postcards than they recorded on their prospective diaries; however, these mean differences did not vary significantly. If confirmed in other samples, the use of retrospective methods may be adequate to accurately collect data on sexual intercourse frequency—and may be preferable. Using only retrospective measurements could decrease study costs, the burden to participants, and have a higher response rate.