Fluidity in contraceptive decision-making throughout pregnancy and the postpartum period among patients at an urban county hospital in Ohio

Abstract

Objectives

Contraceptive decision-making is a complex, dynamic process influenced by personal values, experiences, and circumstances. Existing research often captures contraceptive decisions at a single time point, limiting understanding of how preferences evolve over time. This study prospectively examines the fluidity of contraceptive preferences and plans throughout pregnancy and postpartum among patients receiving care at an urban county hospital in Ohio.

Study design

We conducted a prospective, longitudinal study of pregnant patients (N = 123) in 2023 at five time points: three during pregnancy and two postpartum. Participants reported contraceptive method preferences, attitudes, and perceptions at each follow-up survey. We descriptively analyzed changes in planned postpartum contraceptive method and key factors, including contraceptive attributes and perceptions, influencing contraceptive decision-making.

Results

Method effectiveness was the most important contraceptive attribute for included participants at all time points, regardless of contraceptive plan. One-third of participants maintained a consistent contraceptive plan across all five visits. Participants’ contraceptive plans sometimes did not align with their stated method attribute preferences.

Conclusions

Contraceptive decision-making in the perinatal period is a fluid and evolving process. Our findings underscore the need for patient-centered counseling that acknowledges this variability and supports individuals in navigating changing preferences over time.

Implications

Contraceptive plans shift throughout pregnancy and postpartum and may not always align with patients’ stated priorities. Clinicians should provide ongoing, patient-centered counseling that acknowledges the fluidity of contraceptive decision-making and supports individuals in navigating evolving reproductive goals.