Inequities in pre-pregnancy folic acid use in Central and South Auckland: secondary analysis from a postpartum contraception survey.

Introduction In Aotearoa New Zealand (NZ), there is inequity in rates of neural tube defects (NTDs). Among Maaori, NTD occur in 4.58/10 000 live births, and for Pacific peoples, it is 4.09/10 000 live births; this is compared to 2.81/10 000 live births for non-Maaori, non-Pacific peoples. Aim To describe self-reported pre-pregnancy folic acid supplementation and to determine the association between pregnancy intendedness, ethnicity, parity, maternal age, care provider and pre-pregnancy folic acid supplementation. Methods Secondary analysis of postpartum survey data collected at Te Whatu Ora Te Toka Tumai and Counties Manukau birthing facilities in 2020 was conducted. Descriptive analyses explored pregnancy intendedness and self-reported folic acid use by demographic variables. Multivariable logistic regression explored independent associations between demographic variables and folic acid use among intended pregnancies. Results In total, 398 participants completed the survey. The response rate was (140/149) 94% at Counties Manukau and (258/315) 82% at Te Toka Tumai. Pre-pregnancy supplementation was reported by 182 of 398 participants (46%). Use was higher among those who intended their pregnancy (151/262, 58%) compared to those who were 'pregnancy ambivalent' (9/33, 27%) or did not intend to become pregnant (22/103, 21%). Factors independently associated with supplementation among intended pregnancies included: 'Other ethnicity' (European, Middle Eastern, Latin American, African) compared to Maaori (aOR 5.3 (95% CI 1.3, 21.8)), age ≥30 years compared to Discussion Low rates of pre-pregnancy folic acid supplementation exist in Auckland with significant ethnic disparity. Mandatory fortification of non-organic wheat is important, but supplementation is still recommended to maximally reduce risk.

How well do we support whanau with postpartum contraception? Comparison of two Auckland maternity hospitals.

AIM: To compare the rates of recall of contraceptive discussion and provision of chosen contraceptive method before discharge among patients who recently birthed in two tertiary maternity units in Auckland, New Zealand. METHOD: A cross-sectional survey of recently postpartum patients at tertiary and associated primary birthing units aligned with Auckland and Counties Manukau maternity services was undertaken in 2019 and 2020. RESULTS: Five hundred and seventy-one patients took part in the survey. Overall recall around contraceptive discussions was low, as was the number of patients leaving hospital with their preferred method of contraception. Compared to Counties Manukau, almost twice as many patients at Auckland were unable to recall either an antenatal or postpartum discussion with a health professional about contraception (77% vs 39%, p<0.001). Those birthing at Counties Manukau were also more likely to recall seeing a hospital contraceptive brochure than those at Auckland (42% vs 20%, p<0.001). Twice as many patients at Counties Manukau left hospital with their chosen method compared to those at Auckland (31% vs 14%, p<0.001). In addition, long-acting reversible contraceptives (LARCs) were more often chosen for contraception at Counties Manukau (31% vs 22%, p=0.01) and more patients left hospital with their LARC compared to Auckland (13% vs 7%, p=0.03). CONCLUSION: These differences between two large tertiary maternity services suggests an opportunity for quality improvement around contraception provision.

Factors associated with postpartum contraceptive planning in New Zealand.

OBJECTIVE: To identify factors associated with contraceptive planning in the immediate postpartum period. STUDY DESIGN: Survey of those receiving inpatient postpartum care in two tertiary hospitals/associated birthing units (Auckland, New Zealand). Multivariable analyses using logistic regression examined independent predictors of contraceptive planning. RESULTS: Of 571 participants, those who recalled both antenatal and postpartum contraception discussions were more likely to have a contraceptive plan than those who recalled neither (aOR 5.6(2.8-11.5)). CONCLUSION: Both antenatal and postpartum contraceptive discussions are associated with postpartum contraceptive planning. IMPLICATIONS: Both antenatal and postpartum discussions around contraception were independently associated with increased rates of established contraceptive plan postpartum, however patients who recalled both were more likely to have made a plan. Clinicians should provide multiple opportunities for discussing contraception throughout pregnancy and post-pregnancy to facilitate informed decision making.