Am J Perinatol
DOI: 10.1055/a-2259-0304
Original Article

Factors Associated with the Uptake of Long-acting Reversible Contraception and Contraceptive Use in Postpartum People with HIV at a Single Tertiary Care Center

Lara Youniss*
1   Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Lilian Bui*
1   Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Helen Cejtin
1   Feinberg School of Medicine, Northwestern University, Chicago, Illinois
2   Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Cook County Health, Chicago, Illinois
Julie Schmidt
2   Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Cook County Health, Chicago, Illinois
3   Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
› Author Affiliations
Funding None.


Objective This study aimed to elucidate factors contributing to uptake of highly effective contraception, including permanent contraception, and no contraceptive plan among postpartum people with HIV (PWHIV).

Study Design A retrospective cohort analysis was conducted to correlate postpartum birth control (PPBC) with sociodemographic and biomedical variables among postpartum PWHIV who received care at The Ruth M. Rothstein CORE Center and delivered at John H. Stroger, Jr. Hospital of Cook County in Chicago, from 2012 to 2020.

Results Earlier gestational age (GA) at initiation of prenatal care, having insurance, and increased parity are associated with uptake of highly effective contraception. Meanwhile, later GA at presentation increased odds of having no PPBC plan.

Conclusion Early prenatal care, adequate insurance coverage, and thorough PPBC counseling are important for pregnant PWHIV.

Key Points

  • Contraceptive use among PWHIV is poorly understood.

  • Having insurance and increased parity are associated with long-acting reversible contraception use.

  • Earlier GA at first prenatal care visit is associated with increased PPBC uptake.


Portions of this manuscript were presented as posters at the Northwestern University Feinberg School of Medicine's Area of Scholarly Concentration poster session on December 2, 2022, and the 2022 Institute for Public Health & Medicine Population Health Forum on December 8, 2022.

* These authors contributed equally to this work.

Publication History

Received: 29 October 2023

Accepted: 30 January 2024

Accepted Manuscript online:
01 February 2024

Article published online:
16 February 2024

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  • References

  • 1 Sutton MY, Zhou W, Frazier EL. Unplanned pregnancies and contraceptive use among HIV- positive women in care. PLoS ONE 2018; 13 (05) e0197216
  • 2 Garcia PM, Kalish LA, Pitt J. et al; Women and Infants Transmission Study Group. Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. N Engl J Med 1999; 341 (06) 394-402
  • 3 Arab K, Spence AR, Czuzoj-Shulman N, Abenhaim HA. Pregnancy outcomes in HIV-positive women: a retrospective cohort study. Arch Gynecol Obstet 2017; 295 (03) 599-606
  • 4 Sun M, Peipert JF, Zhao Q. et al. Trends in contraceptive use among women with human immunodeficiency virus. Obstet Gynecol 2012; 120 (04) 783-790
  • 5 Lazenby G, Francis E, Brzozowski N, Rucker L, Dempsey A. Postpartum LARC discontinuation and short interval pregnancies among women with HIV: a retrospective 9-year cohort study in South Carolina. Contraception 2019; 100 (04) 279-282
  • 6 Daniels K, Abma JC. Current contraceptive status among women aged 15-49: United States, 2017-2019. NCHS Data Brief 2020; 388 (388) 1-8
  • 7 American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 736: Optimizing Postpartum Care. Obstet Gynecol 2018; 131 (05) e140-e150
  • 8 Meade CM, Badell M, Hackett S. et al. HIV care continuum among postpartum women living with HIV in Atlanta. Infect Dis Obstet Gynecol 2019; 2019: 8161495
  • 9 Oceguera S, Tulloch K, Tkachuk S. Post-partum contraception in women living with HIV. HIV Med 2022; 24 (03) 354-360
  • 10 Guttmacher Institute. Insurance Coverage of Contraceptives. Updated September 1, 2023. Accessed September 24, 2023 at:
  • 11 IG Assembly. Improving Health Care for Pregnant and Postpartum Individuals Act. 2021 . Accessed September 01, 2023 at:
  • 12 Lopez LM, Grey TW, Chen M, Denison J, Stuart G. Behavioral interventions for improving contraceptive use among women living with HIV. Cochrane Database Syst Rev 2016; 2016 (08) CD010243
  • 13 Chappell CA, Lamorde M, Nakalema S. et al. Efavirenz decreases etonogestrel exposure: a pharmacokinetic evaluation of implantable contraception with antiretroviral therapy. AIDS 2017; 31 (14) 1965-1972