(105) Postpartum Contraception Access and Adherence in a Texas Adolescent Population Following the Dobbs Decision

Background: In June 2022 Roe v Wade was overturned in the Dobbs v Jackson Women’s Health Organization decision and abortion was banned after 6 weeks in Texas. Adolescents have a high rate of unintended pregnancy and are less likely to use contraception, and according to CDC data, Texas has the ninth highest teenage birth rate in the United States. The purpose of this study is to examine how this decision has affected access and adherence to postpartum contraception in an adolescent postpartum population at a large safety net academic center in Texas.

Methods: The study is a retrospective chart review with IRB approval for exempt status. Subjects include patients aged 12-21 who delivered at University of Texas Medical Branch (UTMB) Galveston in one of two time periods, 7/1/2021-1/1/2022 or 7/1/2022-1/1/2023. Patient data in both groups were reviewed for postpartum contraception initiation and for up to 12 months postpartum. An Epic extraction tool was used to determine patient population for initial analysis. Variables including number of adolescent deliveries, short interval pregnancies, initiation of contraception and LARC initiation were assessed in each population. A chi-square test was used to determine whether there was a significant change between the two populations.

Results: Initial analysis showed no change in the number of adolescent deliveries (469/2305 (20.3%) vs 428/2143 (20.0%)) or short-interval pregnancies (50/468 (10.7%) vs 47/428 (11.0%)) after the Dobbs Decision. The same proportion of patients initiated contraception (264/468 (56.4%) vs 235/428 (54.9%)), however after the Dobbs Decision, more patients are choosing LARCs (74/468 (15.8%) vs 91/428 (21.3%); p=.027). Further analysis for potential confounders including age at delivery, race/ethnicity, parity, route of delivery, pregnancy complications, postpartum visit adherence and insurance status will be completed.

Conclusions: Initial analysis showed no change in adolescent deliveries, short interval pregnancies or contraceptive initiation after the Dobbs Decision. Data showed that the same proportion of patients are initiating contraception postpartum, however they are choosing more effective methods (LARCs). The lack of change may indicate analysis too close to the decision versus an underlying need for improved contraception regardless of the Dobbs decision. Further analysis of chart review data as well as provider survey is planned to design an intervention to improve the initiation and adherence to adolescent postpartum contraception at UTMB.