Postpartum contraception plans among a cohort of pregnant incarcerated individuals.

OBJECTIVE: Our objective was to describe patterns of postpartum contraception plan documentation and fulfillment among patients receiving prenatal care in a state prison system. STUDY DESIGN: This is a retrospective chart review of patients over age 21 who accessed prenatal care in a state prison clinic between January 1, 2016 and December 31, 2021. We described demographic characteristics, contraception plans documented during prenatal care, and fulfillment of contraception method by hospital discharge for patients who delivered while incarcerated. For patients who had prenatal care for two or more trimesters, we also assessed the consistency of documented contraception plans. RESULTS: Of the total 890 patients, only 44.2% of all patients had documentation of a postpartum contraception plan while incarcerated. Overall, long-acting reversible contraception (9.1%) and permanent contraception (8.9%) were the most commonly documented plans. Of the 74 patients with a contraceptive plan documented in two or three trimesters, 64.9% consistently had one plan documented at all visits. Over half, 472 (53.0%), delivered while incarcerated and the most common type of contraception method provided at delivery was depot medroxyprogesterone acetate (13.1%) despite only 2.8% of patients having documentation of this method as their contraception plan during prenatal care visits while incarcerated. CONCLUSIONS: Less than half of the patients in the study sample had documentation of their desired goal for postpartum contraception. Patterns of documentation and fulfillment were likely a byproduct of a combination of individual preferences, anticipated length of incarceration, clinician practice patterns, and facility policies. IMPLICATIONS: There may be misalignment between patient preferences for postpartum contraception method and what is discussed, documented, or provided during incarceration.