Effective Communication:

Educating the Hispanic Population about Postpartum Birth Control

Birth Control Disparities in the Hispanic Population

The Hard Facts:

– Only 59% of Hispanic women reported using contraception compared to 65% of white women [1]

– About 50% of pregnancies by Hispanic women are unintended [1]

– Only 5.2% of Hispanic women use more than one method of contraception [1]

Source: Association of Reproductive Health Professionals [2]

Source: Association of Reproductive Health Professionals [2]

Source: Association of Reproductive Health Professionals [2]

Source: Association of Reproductive Health Professionals [2]

Proper Communication

http://townhall.mednet.ucla.edu/hs_news/jan2010/images/_c_i_care.jpg

http://www.publicspeakinginternational.com/Portals/124879/images/healthcare%20communication%201.jpg

Source: Association of Reproductive Health Professionals [2]

Hispanic Culture and Barriers to Care

• Religion

• Family Values

• Lack of Awareness/Knowledge

Benefits of Healthy Spacing of Pregnancy

Risks of Unhealthy Spacing of Pregnancy

For Newborn Child

• More likely to be born strong and healthy.

• May be breastfed for a longer period of time, which allows them to experience the health and nutritional benefits of breastfeeding.

• Mother-baby bonding is enhanced by breastfeeding, which facilitates the child’s overall development.

• Mothers who are not caring for another young child under the age of three may be better able to meet the needs of their newborns.

• Greater chance of a pre-term, low-birth-weight baby or the baby may be born too small for its gestational age.

• Higher risk of newborn and infant mortality.

• When breastfeeding stops before six months, the newborn does not experience the health and nutritional benefits of breast milk, and the mother-baby bond may be diminished, which may affect the baby’s development.

Source: USAID – ESD Project, 2nd Edition [14]

Benefits of Healthy Spacing of Pregnancy

Risks of Unhealthy Spacing of Pregnancy

For Mother

• Reduced risk of complications ,which are associated with closely spaced pregnancies.

• Have more time to take care of the youngest child without the demands of a new pregnancy.

• Longer duration of breastfeeding is linked to a reduced risk of breast and ovarian cancer.

• More rested and well-nourished so as to support the next healthy pregnancy.

• Women who experience closely spaced pregnancies are:

o At increased risk of miscarriage;

o More likely to induce an abortion; and

o At greater risk of maternal death.

Source: USAID – ESD Project, 2nd Edition [14]

What Should Be Done?

Affordable Care Act and its ImplicationsStarting from August 2012, those who are insured under a private insurance company will have access to preventative services such as birth control without having to pay co-pay or any out-of-pocket expenses. [7]

An important detail to note, however, is that the type of birth control mustbe generic, unless the generic form is unavailable, in order to be coveredunder this act. [7]

This will change the tide of birth control significantly as prior limitations willno longer hinder access to birth control.

Source: Association of Reproductive Health Professionals [2]

Birth Control OptionsBirth Control Type

Safe to Use When Breastfeeding? [8]

When to Use [9]

Effectiveness [10]

Useful for

Male/Female Sterilization

Yes Either during C-section or up to 48 hrs after vaginal delivery. Otherwise, must wait 4-6 weeks

>99% Those who are certain they do not want any more children

Birth Control Pill-Combination-Progestin Only

Combination: NoProgestin: Yes

4-6 weeks after delivery

92-99% Those who are adherent, want a reversible form

Patch No 4 weeks after delivery

92-99% Those who are adherent

Implant Yes 4 weeks after delivery

99% Those with difficulty adhering to care

Ring No 4 weeks after delivery

92-99% Those who are adherent

Birth Control Type

Safe to Use When Breastfeeding?[8]

When to Use [9]

Effectiveness [10]

Useful for

Injection (Depo) Yes 3-6 weeks after delivery

97-99% Those who are nonadherent to the pill or patch

IUD Yes Up to 48 hours after delivery, or at our 4 week postpartum visit

99% Those who want long-lasting birth control

Barrier Methods Yes Condoms – any time after pregnancyDiaphragm and cervical caps – after your 6 week postpartum visit

71-98% Those who do not want a permanent method of birth control, do not want hormonal contraception

Emergency Contraception

Yes Any time after pregnancy

58-94% When birth control fails or is not used

Birth Control Options (Cont.)

Strategies for Effective Communication

• Active listening

• Patient-centered interviewing

• Shared decision making

Strategies • GATHER [13]

–Greet–Ask–Tell–Help–Explain–Return

For more information: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_for_Underserved_Women/Cultural_Sensitivity_and_Awareness_in_the_Delivery_of_Health_Care

Strategies

• RESPECT [13]

– Rapport– Empathy– Support– Partnership– Explanations– Cultural Competency– Trust

For more information: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_for_Underserved_Women/Cultural_Sensitivity_and_Awareness_in_the_Delivery_of_Health_Care

Case Study # 1

• Gloria– Age: 21– Native Spanish speaker– Marital Status: Married – 6 week postpartum visit

Case Study # 2

• Eliza– Age: 24– Speaks English– 6 week postpartum visit– Skeptical about safety of birth control options

Case Study #3

• Maria– Age: 25– 6 week postpartum visit– Native Spanish speaker– Has one other child

Summary

• Promote healthy family planning in Hispanic community

• Be knowledgeable of new ACA and current postpartum birth control options

• GATHER and RESPECT strategies

References 1. National Latina Institute for Reproductive Health (2009).Birth control 101: A primer on birth control and

emergency contraception for Latinas. Retrieved from http://latinainstitute.org/sites/default/files/publications/special-reports/BirthControlPrimer-v2009.pdf

2. Association of Reproductive Health Professionals. (2010).Core organizer for reproductive health education. Retrieved from http://core.arhp.org/search/searchResults.aspx?c=2

3. National Center for Cultural Competence (2006). Cultural and linguistic competence policy assessment . Retrieved from http://www.clcpa.info/documents/CLCPA.pdf

4. National Latina Institute for Reproductive Health (2012).Just the facts: Latinas and birth control coverage. Retrieved from http://latinainstitute.org/sites/default/files/publications/fact-sheets/NLIRH-Fact-Sheet-Latinas-and-Contraception-020912.pdf

5. Sangi-Haghpeykar, H. (2005, December 15). Disparities in contraceptive knowledge, attitude and use between hispanic and non-hispanic whites. Retrieved from http://www.contraceptionjournal.org/article/S0010-7824(06)00076-X/abstract

6. Hicks, L. (2008, April 15). Experiences with hospital care: Perspectives of black and hispanic patients. Retrieved from http://www.ncbi.nlm.nih.gov.proxy.libraries.rutgers.edu/pmc/articles/PMC2517954/?tool=pmcentrez

References (Continued)

7. Teen Pregnancy Statistics (2012, August ). Free birth control under affordable care act. Retrieved from http://www.teenpregnancystatistics.org/content/free-birth-control-under-affordable-care-act.html

8. Health matters facts sheets . (2009, December). Retrieved from http://www.arhp.org/publications-and-resources/patient-resources/fact-sheets

9. Baby Center Medical Advisory Board. (2012). Birth control choices after you have a baby. Retrieved from http://www.babycenter.com/0_birth-control-choices-after-you-have-a-baby_3755.bc

10. Reproductive Health Access Project. (n.d.). Your birth control choices . Retrieved from http://www.reproductiveaccess.org/fact_sheets/bc_choices.htm

11. Family Health International. (2008). Improving family planning counseling . Retrieved from http://archive.k4health.org/system/files/Improving Family Planning Counseling - FHI Briefs.pdf

12. Blumenthal, P. (2007). Cultural competency in the provision of contraceptive service delivery: Overcoming barriers. Retrieved from http://www.baylorcme.org/cme/contraception/monographs/cultural-competency/cultural_competency.pdf

References (Continued)

13. The American College of Obstetricians and Gynecologists. (2011, May). Cultural sensitivity and awareness in the delivery of health care. Retrieved from http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_for_Underserved_Women/Cultural_Sensitivity_and_Awareness_in_the_Delivery_of_Health_Care

14. USAID: ESD - Extending Service Delivery. (2010, October). Healthy timing and spacing of pregnancy: A trainer's guide. Retrieved from http://archive.k4health.org/system/files/HTSP Trainers Reference Guide version 2010-v7 Mar 2011 Final.pdf