Association Between Preterm Birth and Fulfillment of Desired Permanent Contraception.

Abstract

Objectives: In cases of preterm delivery, the Medicaid sterilization policy mandates a signed consent form at least 72 h before surgery for permanent contraception, which is less than the 30 day minimum waiting period for term births. This study evaluated the association between preterm birth and fulfillment of planned permanent contraception.

Study design: This was a secondary analysis of a multi-center retrospective cohort study of 3013 patients with a postpartum contraceptive plan of permanent contraception. Primary outcomes were permanent contraception fulfillment, compared between preterm and term deliveries. Secondary analyses examined moderation by delivery mode and insurance type.

Results: At hospital discharge, patients who had a preterm delivery were less likely to undergo desired permanent contraception than those with a term delivery (adjusted odds ratio (aOR): 0.67, 95% CI: 0.53-0.84), and this finding persisted up to one year postpartum (aOR: 0.65, 95% CI: 0.53-0.8). For patients with cesarean deliveries, the odds of permanent contraception fulfillment were significantly lower among those with preterm compared to term deliveries (aOR: 0.54, 95% CI: 0.39-0.76). Among patients with Medicaid insurance, those who delivered preterm were less likely than those who delivered term to undergo desired permanent contraception (aOR: 0.66, 95% CI: 0.59-0.88).

Conclusions for practice: Patients delivering preterm face barriers to fulfillment of desired permanent contraception postpartum. Prioritization of contraceptive goals is important for patient autonomy and increasing equitable access to contraception for all.