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Satisfaction, Resignation, and Dissatisfaction with Long-Acting Reversible Contraception among Low-Income Postpartum Texans

  • Elizabeth J. Ela
    Correspondence
    Correspondence to: Elizabeth J. Ela, PhD, Population Research Center, The University of Texas at Austin, 305 E. 23rd St, Austin, TX 78712.
    Affiliations
    Population Research Center, The University of Texas at Austin, Austin, Texas
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  • Kathleen Broussard
    Affiliations
    Population Research Center, The University of Texas at Austin, Austin, Texas

    Department of Sociology, The University of Texas at Austin, Austin, Texas
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  • Author Footnotes
    1 Present address: Department of Obstetrics & Gynecology, Oregon Health & Science University School of Medicine, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239.
    Katie Hansen
    Footnotes
    1 Present address: Department of Obstetrics & Gynecology, Oregon Health & Science University School of Medicine, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239.
    Affiliations
    Dell Medical School, The University of Texas at Austin, Austin, Texas
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  • Kristen L. Burke
    Affiliations
    Population Research Center, The University of Texas at Austin, Austin, Texas

    Department of Sociology, The University of Texas at Austin, Austin, Texas
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  • Lauren Thaxton
    Affiliations
    Population Research Center, The University of Texas at Austin, Austin, Texas

    Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, Texas
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  • Joseph E. Potter
    Affiliations
    Population Research Center, The University of Texas at Austin, Austin, Texas

    Department of Sociology, The University of Texas at Austin, Austin, Texas

    Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, Texas
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  • Author Footnotes
    1 Present address: Department of Obstetrics & Gynecology, Oregon Health & Science University School of Medicine, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239.
Published:April 19, 2022DOI:https://doi.org/10.1016/j.whi.2022.02.006

      Abstract

      Introduction

      Prior longitudinal studies of long-acting reversible contraception (LARC) satisfaction and continuation guaranteed their participants access to LARC removal. Under real-world conditions, LARC users who wish to discontinue may experience barriers to LARC removal.

      Methods

      A prospective cohort study recruited 1,700 postpartum Texans without private insurance from 8 hospitals in 6 cities. Our analysis included the 418 respondents who initiated LARC in the 24 months after childbirth. A content analysis of open-ended survey responses identified three categories of LARC users: satisfied, resigned, and dissatisfied. Satisfied LARC users were using their method of choice. Resigned users were using LARC as an alternative method when their preferred method was inaccessible. Dissatisfied users were unhappy with LARC. Multinomial logistic regression models identified risk factors for resignation and dissatisfaction. Cox proportional hazards models assessed differences in LARC discontinuation by satisfaction and sociodemographic characteristics.

      Results

      Participants completed 1,505 surveys while using LARC. LARC users were satisfied in 83.46% of survey responses, resigned in 5.25%, and dissatisfied in 11.30%. Resignation was more likely if respondents were uninsured or wanted sterilization at the time of childbirth. The risk of dissatisfaction increased with time using LARC and was higher among uninsured respondents. U.S.-born Hispanic LARC users were more likely than foreign-born Hispanic LARC users to be dissatisfied and less likely to discontinue when dissatisfied. Dissatisfaction—but not resignation—predicted discontinuation. Cost, lack of insurance, and difficulty obtaining an appointment were frequent barriers to LARC removal.

      Conclusions

      Most postpartum LARC users were satisfied, but users who wished to discontinue frequently encountered barriers.
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      Biography

      Elizabeth J. Ela, PhD, completed this research as a postdoctoral fellow with the Texas Policy Evaluation Project at the University of Texas at Austin. She studies contraceptive use, reproductive health, and maternal health.

      Biography

      Kathleen Broussard, MA, is a doctoral candidate in the Department of Sociology at the University of Texas at Austin. Her research focuses on reproductive health-seeking behaviors and how medicine and health care shape the meaning and experience of abortion, pregnancy, and childbearing.

      Biography

      Kristen L. Burke, MA, is a graduate student in the department of Sociology and a trainee in the Population Research Center at the University of Texas at Austin. Her research interests include access to reproductive health services and U.S. fertility trends.

      Biography

      Katie Hansen, MD, is a resident physician in the Department of Obstetrics and Gynecology at Oregon Health & Science University.

      Biography

      Lauren Thaxton, MD, MBA, MSBS, is an Obstetrician-Gynecologist with subspecialty in Complex Family Planning. She is also an Assistant Professor at the Dell Medical School Department of Women's Health and studies novel, patient-centered interventions for reproductive health.

      Biography

      Joseph E. Potter, PhD, is Professor of Sociology and Faculty Research Associate, The University of Texas at Austin Population Research Center. His research focuses on postpartum contraception and the impact of changes in family planning funding on births, abortions, and contraceptive use.