587 - Identifying Parental Contraceptive Needs in Pediatric Clinics

Infant well-child visits are increasingly being explored as opportunities to address parental postpartum health needs, including contraceptive needs. Clinical interventions have largely relied upon the assessment of pregnancy intentions over the next year, commonly referred to as One Key Question® (OKQ), to identify the need for contraceptive counseling or referrals. Individuals who are ambivalent about pregnancy plans or are planning pregnancy may still desire to use contraception, which clinicians could potentially miss if solely using pregnancy intention to identify care needs.

Objective:

This study compared a question about pregnancy intention in the next year with a question about desire to prevent pregnancy, to inform health services interventions aiming to identify contraceptive care needs among parents in pediatric clinics.

Design/Methods:

We surveyed English or Spanish-speaking birth parents attending 2-6 month well-child visits at three Northern California pediatric clinics. We assessed (1) pregnancy intention in the next year, using OKQ, and (2) current desire to prevent pregnancy (Table 1). For both measures, we categorized responses as Yes, Ambivalent, or No and cross-tabulated frequencies (n) and relative frequencies (%).

Results:

We surveyed 234 postpartum birth parents, who were diverse in terms of age, race, ethnicity, and socioeconomic status. Of 234 respondents, 63 (27%) were either ambivalent about pregnant intentions (n=48; 21%) or intended become pregnant (n=16; 6%) in the next year (Table 2). The majority of these 63 individuals (n=51; 81%) reported a current desire to prevent pregnancy. The rate of ambivalence found with OKQ was substantially higher than the rate of ambivalence found in the desire to prevent pregnancy measure (21% vs. 5%).

Conclusion(s):

These results demonstrate that screening for pregnancy intention using OKQ may not effectively detect contraceptive care needs among the large proportion of parents who are ambivalent about or are planning pregnancy in the next year. Missing the need for postpartum contraception puts families at risk for undesired or mistimed pregnancy, close birth spacing, and related health and social impacts. In addition, directly assessing desire to prevent pregnancy is likely more clinically expedient than OKQ for identifying contraceptive needs, given the high degree of complexity and ambivalence around pregnancy intentions.