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 45 ID: 931482
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Patterns of Postpartum Depot Medroxyprogesterone Administration among Low Income MothersAnn M. Dozier, RN, PhD1, Alice Nelson, MFT2, Elizabeth A. Brownell, MA, PhD3, Cynthia R. Howard, MD MPH4,5, Ruth A. Lawrence, MD51University of Rochester Department of Public Health Sciences, 2Shelter Care, Eugene, OR; 3Departments of Research and Neonatology, Connecticut Children’s Medical Center; 4Rochester General Hospital; 5University of Rochester Department of Pediatrics
BACKGROUNDWhile 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
PURPOSEThese analyses describe the patterns among low income mothers in an upstate New York community.
METHODSMothers attending urban pediatric practices (births 2009-2011) completed a mailed survey at approximately 5 months postpartum. Subset of 648 used in analysis83 items about pre-pregnancy, pregnancy, delivery and postpartum included questions about breastfeeding and timing of DMPA receipt.
RESULTS48.8% reported the pregnancy as unintended31.3% reported receiving postpartum DMPA;62.6% received it prior to dischargeOther 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 feedAcross 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 valueLess than high school [High school or more] 1.45 [0.95-2.22]0.09NA--Black Race [No]1.41 [0.96-2.06]0.081.49 [0.96-2.33]0.08Age Continuous0.97 [0.93-0.99]0.040.94 [0.90-0.99]0.01Inner-City Resident [No]1.97 [1.26-3.09]< 0.011.85 [1.05-3.24]0.03Wanted to be pregnant later or never [Now or sooner]1.58 [1.10-2.28]0.021.45 [0.94-2.25]0.10Primiparous [multiparous]NA--0.41 [0.24-0.69]< 0.01Prenatal feeding plana [just breastfeed] < 0.01 < 0.01I planned to formula feed my baby2.13 [1.39-3.27] 2.40 [1.46-3.96] I planned to both breastfeed &formula feed1.01 [0.62-1.67] 1.33 [0.74-2.39] I wasn’t sure how I was going to feed my baby0.94 [0.37-2.36] 1.14 [0.36-3.59] Birth Hospital [Hospital A] < 0.01 < 0.01Hospital B0.53 [0.33-0.87] 0.61 [0.33-1.13] Hospital C1.31 [0.84-2.04] 1.88 [1.12-3.16] Hospital D0.43 [0.22-0.85] 0.49 [0.22-1.12]
Characteristics and Comparison of Mothers receiving or not receiving depot medroxyprogesterone (DMPA) All N (%) Only those Receiving DMPA (anytime)an (%) All receiving DMPA 6 or more weeks PPn (%) Never receivedDMPAn (%) Only those receiving DMPA in hospitaln (%)All minus those receiving DMPA in hospital n (%) Column B vs. Db Column E vs. F b ColumnC vs. D bColumnABCDEFp-valueMaternal CharacteristicsN=648n=203n=54n=445n=127n=521 Less than high school148 (22.9)63 (31.2)15 (27.8)85 (19.1)40 (31.7)108 (20.8)< 0.01< 0.010.14Black Race299 (46.1)106 (52.2)25 (46.3)193 (43.4)70 (55.1)229 (44.0)0.040.020.68Hispanic154 (23.8)55 (27.1)16 (29.6)99 (22.2)32 (25.2)122 (23.4)0.180.670.22Mean Age26.08[14.0-46.0]24.94[15.0-45.0]24.70[15.0-45.0]26.60[14.0-46.0]25.19[16.0-42.0]26.30[14.0-46.0]< 0.010.050.03Inner-City Resident453 (69.9)166 (81.8)42 (77.8)287 (64.5)106 (83.5)347 (66.6)< 0.01< 0.010.05Wanted to be pregnant Now or sooner325 (51.2)81 (40.9)23 (42.6)244 (55.8)51 (41.8)274 (53.4)< 0.010.020.07Parity – Primip264 (40.7)74 (36.5)25 (46.3)190 (42.7)36 (28.3)228 (43.8)0.13< 0.010.61Prenatal plan to feed for the first few weeks c < 0.01< 0.010.90 -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 feed120 (18.8)38 (18.9)9 (16.7)82 (18.7)26 (20.8)94 (18.3) -wasn’t sure 29 (4.5)7 (3.5)2 (3.7)22 (5.0)4 (3.2)25 (4.9) Where was this baby born d < 0.01< 0.010.13Hospital 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 postpartumb Chi-square analyses; bolded values are significant at p<0.05c 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 (2010-2011): 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 SupportAlso the following individuals from the University of Rochester: Holly Widanka, MS, Barbara Suter, MPH, Joseph Duckett and Cynthia Childs, MFA, MPH.ADDITIONAL INFORMATION: ann_dozier@urmc.rochester.edu
LIMITATIONSMothers 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 DMPANo 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.
ANALYSESDescriptive and exploratory. Outcome groups by DMPA administration:any postpartum DMPA vs. non-DMPADMPA in hospital vs. all othersDMPA at 6 weeks after hospitalization vs. all non-DMPA usersChi square or t-test statistics analyzed differences between groupsMultivariable logistic regressions (backward selection) included characteristics associated with DMPA use in the bivariate analyses (p=<0.10). All p-values were two-sidedSignificance set at p≤0.05.