Pregnancy planning and barriers to accessing postnatal contraception in New Zealand.

Abstract

To estimate rates of pregnancy and contraceptive planning and to identify barriers and enablers to postnatal contraceptive use. Face-to-face survey of patients during their immediate postnatal stay at Middlemore Hospital, Auckland, or associated primary birthing units. Patients were approached by study investigators over designated 2-week study periods in 2019 and 2020. The primary outcome was the rate of pregnancy and contraceptive planning. The descriptive analysis explored differences between ethnicities. We were able to approach 332 of 497 eligible women (67%), and 313 of 332 (94%) of those who approached completed the survey. Fifty-three percent of pregnancies were reported to have been planned. Pregnancy was more often planned by European (72%), Indian (68%), and Other Asian patients (72%) compared with Māori (33%) and Pacific patients (39%) (p < 0.001). Thirty-seven percent of patients reported an antenatal contraceptive discussion, and these were more commonly reported by Māori and Pacific patients (p < 0.001). A quarter of patients reported never having a conversation about contraception during or immediately after pregnancy, a third of whom said they would have valued one. Fifty-nine percent of patients reported having made a contraceptive plan immediately after birth. Concern about the side effects of contraception was a barrier reported by 51% of patients. Cost, travel, finding time, and family views were less frequent barriers. Rates of pregnancy planning reported postnatally are consistent with previous NZ research at approximately 50%, and we also found ethnic differences. Concerns about side effects were the most significant barrier for patients accessing contraception and this needs to be addressed in a culturally useful format. Postpartum patients report low rates of pregnancy planning. A significant proportion of postpartum patients report having no conversations about contraception with clinicians, and concerns about side effects are their most common barrier to contraception.