Integrating Maternal and Child Health Services: Development and Pilot Testing of a Pediatric Clinic-Based Postpartum Contraception Intervention

PROJECT SUMMARY/ABSTRACT While most postpartum women desire pregnancy prevention, fewer than half resume contraception in the postpartum period. Finding approaches to supporting women’s reproductive goals during this critical transition can promote reproductive health equity and prevent the adverse maternal and perinatal outcomes that are associated with undesired, short interval pregnancies. Postpartum women commonly do not attend a postpartum obstetric visit and face other unique barriers to getting their contraceptive needs met. A novel opportunity to augment the existing system for delivering postpartum contraceptive care is the pediatric clinic, where providers frequently and reliably interface with new mothers at infant visits. The proposed Aims will lead to the development and testing of a pediatric clinic-based approach to enhancing access to postpartum contraceptive care. A long-term goal of this research is to optimize how pediatricians incorporate evidence- based, child-relevant aspects of maternal health and social needs into practice. For this four-year K23 proposal, the objective is to develop and pilot test a scalable pediatric clinic-based intervention designed to meet the contraceptive needs of postpartum women and promote equitable access to contraceptive care. The central hypothesis is that the pediatric clinic is a feasible and acceptable setting to identify and address unmet postpartum contraceptive needs. The rationale for this study is that a postpartum contraception intervention, developed using implementation science principles and stakeholder-engagement methods, has the potential to prevent undesired pregnancies, support healthy birth spacing, and promote health equity for women and families. The central hypothesis will be tested by pursuing three Specific Aims: (1) Qualitatively assess intervention preferences for pediatric clinic-based postpartum contraceptive services among women and healthcare team members (n=50), (2) Develop a pediatric clinic-based postpartum contraception intervention through iterative focus groups and usability testing with patient and clinical stakeholders, and (3) Implement and pilot test the pediatric clinic-based postpartum contraception intervention, measuring feasibility and acceptability outcomes (n=50). The proposed Aims focus on postpartum contraceptive needs, but the approach will serve as a model for future efforts to integrate perinatal maternal and child health services to meet the health and social needs of women and children.