Too far to follow up: associations between residential distance and social vulnerability on immediate postpartum contraceptive uptake.

Abstract

Background: Postpartum contraception plays a vital role in extending interpregnancy intervals and reducing adverse maternal and neonatal outcomes. However, patients at elevated risk due to geographic and social barriers may experience disruptions in postpartum care. We examine associations between residential distance to the delivery hospital and social determinants of health (SDoH) with contraception uptake at delivery discharge.

Methods: We conducted a retrospective cohort study of live births born at 22.0 gestational age and greater at a single urban academic center from March 2020 to March 2022. Demographic, obstetric, and SDoH data were extracted from electronic medical records. Contraceptive method recorded for all births as part of the delivery discharge note was manually reviewed classified into long-acting reversible contraception (LARC) or non-LARC methods. Univariate analyses were used to compare characteristics across groups living within 10.0 miles and those living 10.1 miles or further from the hospital. Logistic regression was used to identify predictors of LARC uptake.

Results: A total of 3,644 births were included; 54.6% of patients were Black, 30.3% Hispanic, and 73.7% utilized public insurance. A total of 74.2% of patients resided within 10.0 miles of the delivery hospital. Patients living farther away were more likely to face transportation barriers, lower educational attainment, and higher SDoH personal risk scores. Overall, 18.6% living closer and 22.3% living further from the delivery hospital received LARC at discharge [X² (2) = 7.45, p < .05]. After adjustment for race, ethnicity, insurance, maternal age, partnership status, and a combined risk factor that assigned a positive binary indicator if the neonate was delivered via cesarean section, had a NICU stay, and/or, the maternal length of hospital stay was greater than 3 days, odds for LARC uptake at delivery discharge was elevated for those living further from the hospital as compared to those living closer to the delivery hospital (OR = 1.20, 95% CI = 1.01-1.43). Those with high personal SDoH risk also had significantly higher odds of LARC uptake at discharge (OR = 1.24, 95% CI 1.02-1.50) as compared to those without SDoH personal risk noted.

Conclusion: Several factors remained associated with LARC uptake at delivery discharge including residential distance, SDoH, and insurance. Our findings support the importance of inpatient contraceptive counseling and provision, particularly for socially vulnerable populations.