Barriers to immediate postpartum long-acting reversible contraceptive provision in China: A qualitative study from the perspective of service providers

Abstract

Objectives

This study aimed to explore the barriers to immediate postpartum long-acting reversible contraception provision (LARC) from the perspective of obstetric health care providers in China.

Study design

The qualitative study involved hospital deputy directors, obstetric department chiefs, doctors, and nurses from obstetric departments in four hospitals (two in the eastern and two in the western regions of China). Data were collected through semistructured interviews and analyzed using thematic analysis.

Results

The study included 46 participants recruited from four hospitals that all offered intrauterine devices (IUDs) and implants but not immediate postpartum LARC services. Findings reveal that while all four hospitals offered IUDs and implants, none of their obstetric departments provided immediate postpartum LARC services. Significant barriers identified were the immediate postpartum LARC provision was not within the providers job responsibilities; the reluctance of most providers to recommend hormonal contraceptive methods to postpartum people due to concerns about the impact on breastfeeding and infant health; the nonprovision of immediate postpartum IUD placement was primarily due to fears of increased side effects such as pain, bleeding, and expulsion rates; and the provision might lead to potential medicolegal concerns.

Conclusions

The study reaches the conclusion that there are substantial barriers to the provision of postpartum LARC. These barriers mainly consist of concerns about reluctance to get involved in unnecessary trouble due to extra work, side effects, lack of knowledge about immediate postpartum LARC placement, and apprehensions regarding the potential impact on the doctor-patient relationship.

Implications

This study identifies key barriers to immediate postpartum long-acting reversible contraception provision in China, including provider concerns about side effects, lack of motivations, and limited policy support. Addressing these challenges through targeted interventions could improve long-acting reversible contraception provision, benefiting postpartum people in clinical practice.