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Allison BA, Ritter V, Lin FC, Flower KB, Perry MF. Trends in Continuation of Long-Acting Reversible Contraception Among Adolescents Receiving Medicaid. J Adolesc Health 2024; 75:487-495. [PMID: 38980246 PMCID: PMC11330372 DOI: 10.1016/j.jadohealth.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/28/2024] [Accepted: 04/25/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Despite increasing use of long-acting reversible contraception (LARC) among U.S. adolescents, there is limited literature on factors affecting intrauterine device (IUD) or subdermal implant use. This study aimed to describe statewide rates, and associated patient and provider factors of adolescent IUD or implant initiation and continuation. METHODS This retrospective cohort study used N.C. Medicaid claims data. 10,408 adolescents were eligible (i.e., 13-19 years, female sex, continuous Medicaid enrollment, had an IUD or implant insertion or removal code from January 1, 2013, to October 1, 2015). Bivariate analyses assessed differences in adolescents using IUD versus implant. Kaplan-Meier curves were created to assess IUD or implant discontinuation through December 31, 2018. RESULTS Adolescents initiated 8,592 implants and 3,369 IUDs (N = 11,961). There were significant differences in nearly all provider and patient factors for those who initiated implants versus IUDs. 16% of implants and 53% of IUDs were removed in the first year. Younger (i.e., age <18 years old), Hispanic, and Black adolescents had higher adjusted continuation of implants compared with older and White adolescents, respectively (both p < .001). Those whose IUD was inserted by an obstetrician/gynecologist provider had lower continuation of IUDs compared with non-obstetrician/gynecologist providers (p < .001). DISCUSSION We found that age-related, racial, and ethnic disparities exist in both implant and IUD continuation. Practice changes to support positive adolescent experiences with implant and IUD insertion and removals are needed, including patient-centered health care provider training in contraception counseling, LARC initiation and removal training for adolescent-facing providers, and broader clinic capacity for LARC services.
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Affiliation(s)
- Bianca A Allison
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Victor Ritter
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina; Quantitative Sciences Unit, Stanford School of Medicine, Palo Alto, California
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Martha F Perry
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's National, Washington, D.C
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Thornton M, Mann ES, Bullington BW, Hartheimer J, Arora KS, Allison BA. Exploring adolescent-facing US clinicians' perceptions of their contraceptive counseling and use of shared decision-making: A qualitative study. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024. [PMID: 39175306 DOI: 10.1111/psrh.12283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
BACKGROUND Adolescent contraceptive decision-making is influenced by a number of patient and clinician-driven factors. Although the AAP continues to endorse an efficacy-based model of contraceptive counseling, many professional organizations are shifting to a shared decision-making model as the optimal approach for providing unbiased and patient-driven contraceptive counseling. While SDM is intended to reduce the influence of clinician bias, it can exacerbate inequity if a clinician tailors a conversation based on their assumptions of a patient's goals or preferences. In this qualitative study, we explored self-reported contraceptive counseling practices among US-based clinicians who see adolescent patients to assess how these practices create barriers or facilitators to SDM and person-centered contraceptive care. METHODS We interviewed 16 clinicians at the 2022 AAP Annual Meeting who counsel adolescent patients about contraception. We used thematic content analysis to analyze interview transcripts using Dedoose. RESULTS We identified six aspects of contraceptive counseling that clinicians commonly employed with adolescent patients. These were: (1) sociodemographic characteristics driving counseling, (2) reliance on tiered effectiveness counseling, (3) initiating counseling conversations using "ask then explain" or "explain then ask" approaches, (4) emphasis on teen pregnancy prevention, (5) the influence of method accessibility on counseling, and (6) parental involvement in decision-making and patient confidentiality. We describe how these themes align with or diverge from each component of the SDM framework. CONCLUSION Clinicians in this study frequently engaged in non-patient-centered techniques during contraceptive counseling with adolescents. These findings can inform practice recommendations to support clinicians in providing high-quality contraceptive counseling using shared decision-making.
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Affiliation(s)
- Madeline Thornton
- School of Medicine, University of North Carolina, North Carolina, USA
| | - Emily S Mann
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Brooke W Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, North Carolina, USA
| | - Joline Hartheimer
- School of Medicine, University of North Carolina, North Carolina, USA
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, North Carolina, USA
| | - Bianca A Allison
- Department of Pediatrics, University of North Carolina School of Medicine, North Carolina, USA
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Cardona C, Sarnak D, Gemmill A, Gichangi P, Thiongo M, Anglewicz P. Are Contraceptive Method Preferences Stable? Measuring Change in the Preferred Method among Kenyan Women. Stud Fam Plann 2024. [PMID: 39010650 DOI: 10.1111/sifp.12271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Contraceptive preferences are important for reproductive outcomes, such as contraceptive continuation and pregnancy. Current approaches to measuring reproductive preferences in population surveys are limited to exploring only fertility preferences and implicitly assume that contracepting people are using a method they want. We know that people change their fertility preferences over the life course as a response to life events, but there is no information about changes in contraceptive preferences, given the limited evidence about the measurement and distribution of contraceptive preferences. In this study, we examined the extent of change in women's contraceptive preferences over one year and identified characteristics associated with this change in Kenya using three rounds of nationally representative longitudinal data. Over one year, 18 percent of contraceptive users and 46 percent of contraceptive nonusers reported changes in their preferred contraceptive. Experiencing a pregnancy or birth and changes in marital status were associated with changes in contraceptive preferences for users and nonusers. We found that contraceptive preferences are dynamic, suggesting that family planning programs should ensure people's access to various methods to respond to women's changing circumstances and preferences.
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Viswanathan AV, Bullington BW, Berg KA, Miller ES, Boozer M, Serna T, Bailit JL, Arora KS. Ongoing contraceptive goals of patients who did not achieve desired postpartum permanent contraception prior to hospital discharge. Contraception 2024:110533. [PMID: 38945351 DOI: 10.1016/j.contraception.2024.110533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE To evaluate reasons for non-fulfillment and ongoing contraceptive plans of patients who desired but did not receive inpatient postpartum permanent contraception (PC). STUDY DESIGN Multi-site retrospective cohort study of 1254 patients with unfulfilled inpatient postpartum PC. We analyzed the reason for PC non-fulfillment, documented contraceptive plan, and method prescription or provision at hospital discharge, six-weeks, and one-year postpartum. RESULTS In our cohort, 44.3% of patients with unfulfilled inpatient PC did not receive any highly- or moderately-effective contraception within one year postpartum. CONCLUSIONS Removing barriers to PC fulfillment as well as contraceptive counseling that acknowledges these barriers is imperative.
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Affiliation(s)
- Ambika V Viswanathan
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Brooke W Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kristen A Berg
- Center for Health Care Research and Policy, MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH, USA
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Margaret Boozer
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tania Serna
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | | | - Kavita S Arora
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
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Kavanaugh ML, Hussain R, Little AC. Unfulfilled and method-specific contraceptive preferences among reproductive-aged contraceptive users in Arizona, Iowa, New Jersey, and Wisconsin. Health Serv Res 2024; 59:e14297. [PMID: 38456362 PMCID: PMC11063095 DOI: 10.1111/1475-6773.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE To identify characteristics associated with unfulfilled contraceptive preferences, document reasons for these unfulfilled preferences, and examine how these unfulfilled preferences vary across specific method users. DATA SOURCES AND STUDY SETTING We draw on secondary baseline data from 4660 reproductive-aged contraceptive users in the Arizona, Iowa, New Jersey, and Wisconsin Surveys of Women (SoWs), state-representative surveys fielded between October 2018 and August 2020 across the four states. STUDY DESIGN This is an observational cross-sectional study, which examined associations between individuals' reproductive health-related experiences and contraceptive preferences, adjusting for sociodemographic characteristics. Our primary outcome of interest is having an unfulfilled contraceptive preference, and a key independent variable is experience of high-quality contraceptive care. We also examine specific contraceptive method preferences according to current method used, as well as reasons for not using a preferred method. DATA COLLECTION/EXTRACTION METHODS Survey respondents who indicated use of any contraceptive method within the last 3 months prior to the survey were eligible for inclusion in this analysis. PRINCIPAL FINDINGS Overall, 23% reported preferring to use a method other than their current method, ranging from 17% in Iowa to 26% in New Jersey. Young age (18-24), using methods not requiring provider involvement, and not receiving quality contraceptive care were key attributes associated with unfulfilled contraceptive preferences. Those using emergency contraception and fertility awareness-based methods had some of the highest levels of unfulfilled contraceptive preferences, while pills, condoms, partner vasectomy, and IUDs were identified as the most preferred methods. Reasons for not using preferred contraceptive methods fell largely into one of two buckets: system-level or interpersonal/individual reasons. CONCLUSIONS Our findings highlight that avenues for decreasing the gap between contraceptive methods used and those preferred to be used may lie with healthcare providers and funding streams that support the delivery of contraceptive care.
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Affiliation(s)
| | - Rubina Hussain
- Research DivisionGuttmacher InstituteNew YorkNew YorkUSA
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Gomez AM, Bennett AH, Arcara J, Stern L, Bardwell J, Cadena D, Chaudhri A, Davis L, Dehlendorf C, Frederiksen B, Labiran C, McDonald-Mosley R, Rice WS, Stein TB, Valladares ES, Kavanaugh ML, Marshall C. Estimates of use of preferred contraceptive method in the United States: a population-based study. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100662. [PMID: 38304390 PMCID: PMC10831268 DOI: 10.1016/j.lana.2023.100662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/16/2023] [Accepted: 12/19/2023] [Indexed: 02/03/2024]
Abstract
Background In the U.S. and globally, dominant metrics of contraceptive access focus on the use of certain contraceptive methods and do not address self-defined need for contraception; therefore, these metrics fail to attend to person-centeredness, a key component of healthcare quality. This study addresses this gap by presenting new data from the U.S. on preferred contraceptive method use, a person-centered contraceptive access indicator. Additionally, we examine the association between key aspects of person-centered healthcare access and preferred contraceptive method use. Methods We fielded a nationally representative survey in the U.S. in English and Spanish in 2022, surveying non-sterile 15-44-year-olds assigned female sex at birth. Among current and prospective contraceptive users (unweighted n = 2119), we describe preferred method use, reasons for non-use, and differences in preferred method use by sociodemographic characteristics. We conduct logistic regression analyses examining the association between four aspects of person-centered healthcare access and preferred contraceptive method use. Findings A quarter (25.2%) of current and prospective users reported there was another method they would like to use, with oral contraception and vasectomy most selected. Reasons for non-use of preferred contraception included side effects (28.8%), sex-related reasons (25.1%), logistics/knowledge barriers (18.6%), safety concerns (18.3%), and cost (17.6%). In adjusted logistic regression analyses, respondents who felt they had enough information to choose appropriate contraception (Adjusted Odds Ratio [AOR] 3.31; 95% CI 2.10, 5.21), were very (AOR 9.24; 95% CI 4.29, 19.91) or somewhat confident (AOR 3.78; 95% CI 1.76, 8.12) they could obtain desired contraception, had received person-centered contraceptive counseling (AOR 1.72; 95% CI 1.33, 2.23), and had not experienced discrimination in family planning settings (AOR 1.58; 95% CI 1.13, 2.20) had increased odds of preferred contraceptive method use. Interpretation An estimated 8.1 million individuals in the U.S. are not using a preferred contraceptive method. Interventions should focus on holistic, person-centered contraceptive access, given the implications of information, self-efficacy, and discriminatory care for preferred method use. Funding Arnold Ventures.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Ariana H. Bennett
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Jennet Arcara
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Lisa Stern
- Coalition to Expand Contraceptive Access, Washington, DC, USA
| | | | | | | | | | - Christine Dehlendorf
- Person-Centered Reproductive Health Program, Departments of Family & Community Medicine, Obstetrics, Gynecology & Reproductive Sciences, and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | - Whitney S. Rice
- Center for Reproductive Health Research in the Southeast, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tara B. Stein
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | | | | | - Cassondra Marshall
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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Auerbach S, Agbemenu K, Lorenz R, Hequembourg A, Ely GE. Contraceptive Behavior in Appalachia: Exploring Use, Nonuse, and Contraceptive Attitudes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6862. [PMID: 37835132 PMCID: PMC10572216 DOI: 10.3390/ijerph20196862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Abstract
Very little is known about contraceptive behavior in Appalachia, a large geographic region in the eastern United States where even basic prevalence estimates of contraceptive use/nonuse are lacking. This study characterizes contraceptive behavior among Appalachians, including contraceptive use, reasons for use, and methods used; contraceptive nonuse and reasons for nonuse; and attitudes about contraception, including acceptability. This is a secondary analysis of a subsample of survey data collected on sexual and reproductive health attitudes, behaviors, and needs among reproductive-age women (18-49 years) living in the Appalachian region (n = 332). Results identify rates of contraceptive use (66.6%) and nonuse (33.1%) among Appalachian residents. Methods used most frequently included those that did not require prescription (i.e., external condoms and natural family planning methods) though many reported the use of intrauterine devices (IUDs). Among nonusers, fear of side effects from contraception and ambivalence towards pregnancy were most commonly selected as the most important reason for not using contraception. Contraception was considered acceptable by this sample overall, and these acceptability attitudes were significantly associated with contraceptive behavior.
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Affiliation(s)
- Samantha Auerbach
- School of Nursing, University at Buffalo, Buffalo, NY 14214, USA; (K.A.); (R.L.); (A.H.)
| | - Kafuli Agbemenu
- School of Nursing, University at Buffalo, Buffalo, NY 14214, USA; (K.A.); (R.L.); (A.H.)
| | - Rebecca Lorenz
- School of Nursing, University at Buffalo, Buffalo, NY 14214, USA; (K.A.); (R.L.); (A.H.)
| | - Amy Hequembourg
- School of Nursing, University at Buffalo, Buffalo, NY 14214, USA; (K.A.); (R.L.); (A.H.)
| | - Gretchen E. Ely
- College of Social Work, University of Tennessee, Knoxville, TN 37996, USA;
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Hopkins K, Yarger J, Rossetto I, Sanchez A, Brown E, Elmes S, Mantaro T, White K, Harper CC. Use of preferred contraceptive method among young adults in Texas and California: A comparison by state and insurance coverage. PLoS One 2023; 18:e0290726. [PMID: 37651402 PMCID: PMC10470945 DOI: 10.1371/journal.pone.0290726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Young people's ability to use their preferred contraceptive method is an indicator of reproductive autonomy and healthcare access. State policies can hinder or facilitate access to a preferred contraceptive method. OBJECTIVE This study compared use of preferred contraceptive method in Texas and California, states with contrasting health policy contexts that impact health insurance coverage and access to subsidized family planning services. METHODS We used baseline survey data from an ongoing cluster randomized controlled trial of sexually active students, assigned female at birth, ages 18-25, at 29 community colleges in Texas and California (N = 1,974). We described contraceptive preferences and use, as well as reasons for nonuse of a preferred method. We conducted multivariable-adjusted mixed-effects logistic regression analyses for clustered data, and then calculated the predicted probability of using a preferred contraceptive method in Texas and California by insurance status. RESULTS More Texas participants were uninsured than Californians (30% vs. 8%, p<0.001). Thirty-six percent of Texas participants were using their preferred contraceptive method compared to 51% of Californians. After multivariable adjustments, Texas participants had lower odds of using their preferred method (adjusted odds ratio = 0.62, 95% confidence interval = 0.48-0.81) compared to those in California. Texas participants in all insurance categories had a lower predicted probability of preferred method use compared to California participants. In Texas, we found a 12.1 percentage-point difference in the predicted probability of preferred method use between the uninsured (27.5%) and insured (39.6%) (p<0.001). Texans reported financial barriers to using their preferred method more often than Californians (36.7% vs. 19.2%, p<0.001) as did the uninsured compared to the insured (50.9% vs. 18.7%, p<0.001). CONCLUSION These findings present new evidence that state of residence plays an important role in young people's ability to realize their contraceptive preference. Young people in Texas, with lower insurance coverage and more limited access to safety net programs for contraceptive care than in California, have lower use of preferred contraception. It has become urgent in states with abortion bans to support young people's access to their preferred methods.
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Affiliation(s)
- Kristine Hopkins
- Population Research Center, The University of Texas at Austin, Austin, Texas, United States of America
| | - Jennifer Yarger
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
| | - Irene Rossetto
- Population Research Center, The University of Texas at Austin, Austin, Texas, United States of America
| | - Audrey Sanchez
- Population Research Center, The University of Texas at Austin, Austin, Texas, United States of America
| | - Elisa Brown
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Odessa, Texas, United States of America
| | - Sarah Elmes
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Thaddeus Mantaro
- Health Services and Promotion, Dallas College, Dallas, Texas, United States of America
| | - Kari White
- Population Research Center, The University of Texas at Austin, Austin, Texas, United States of America
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, United States of America
| | - Cynthia C. Harper
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
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Kavanaugh ML, Zolna MR. Where Do Reproductive-Aged Women Want to Get Contraception? J Womens Health (Larchmt) 2023. [PMID: 37099807 DOI: 10.1089/jwh.2022.0406] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Background: People's preferences regarding how they want to obtain contraception should be considered when building and refining high-quality contraceptive care programs, especially in light of recent shifts to incorporate more telehealth options into contraceptive care due to the coronavirus disease 2019 (COVID-19) pandemic. Methods: Our study is a cross-sectional analysis of population-representative surveys conducted between November 2019 and August 2020 among women aged 18-44 years in Arizona (N = 885), New Jersey (N = 952), and Wisconsin (N = 967). We use multivariable logistic regression to identify characteristics associated with each of five contraception source preference groups (in-person via health care provider, offsite with a provider via telemedicine, offsite without a provider via telehealth, at a pharmacy, or via innovative strategies), and we examine associations between contraceptive care experiences and perceptions and each preference group. Results: Across states, most respondents (73%) expressed preferences for obtaining contraception via more than one source. One quarter indicated a narrow preference for obtaining contraception in-person from a provider, 19% expressed interest in doing so offsite with a provider via telemedicine, 64% for doing so offsite without a provider via telehealth, 71% reported interest in pharmacy-based contraception, and 25% indicated interest in getting contraception through innovative strategies. Those who had experienced nonperson-centered contraceptive counseling reported higher levels of interest in telehealth and innovative sources, and those who expressed mistrust in the contraceptive care system had higher levels of preferring to obtain contraception offsite, via telemedicine, telehealth, and other innovative avenues. Conclusions: Policies that ensure access to a diversity of contraceptive sources, which acknowledge and address people's past experiences of contraceptive care, have the greatest likelihood of closing the gap between people's contraceptive access preferences and realities.
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Affiliation(s)
| | - Mia R Zolna
- Research Division, Guttmacher Institute, New York, New York, USA
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10
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Swan LET, Senderowicz LG, Lefmann T, Ely GE. Health care provider bias in the Appalachian region: The frequency and impact of contraceptive coercion. Health Serv Res 2023. [DOI: http:/doi.org/10.1111/1475-6773.14157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Affiliation(s)
- Laura E. T. Swan
- Department of Population Health Sciences University of Wisconsin‐Madison Madison Wisconsin USA
- Collaborative for Reproductive Equity University of Wisconsin‐Madison Madison Wisconsin USA
| | - Leigh G. Senderowicz
- Collaborative for Reproductive Equity University of Wisconsin‐Madison Madison Wisconsin USA
- Department of Gender and Women's Studies University of Wisconsin‐Madison Madison Wisconsin USA
- Department of Obstetrics and Gynecology University of Wisconsin‐Madison Madison Wisconsin USA
| | - Tess Lefmann
- Department of Social Work University of Mississippi Oxford Mississippi USA
| | - Gretchen E. Ely
- College of Social Work University of Tennessee Knoxville Tennessee USA
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11
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Burke KL, Potter JE. Meeting Preferences for Specific Contraceptive Methods: An Overdue Indicator. Stud Fam Plann 2023; 54:281-300. [PMID: 36705876 DOI: 10.1111/sifp.12218] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Fertility surveys have rarely asked people who are using contraception about the contraceptive method they would like to be using, implicitly assuming that those who are contracepting are using the method they want. In this commentary, we review evidence from a small but growing body of work that oftentimes indicates this assumption is untrue. Discordant contraceptive preferences and use are relatively common, and unsatisfied preferences are associated with higher rates of method discontinuation and subsequent pregnancy. We argue that there is opportunity to center autonomy and illuminate the need for and quality of services by building on this research and investing in the development of survey items that assess which method people would like to use, as well as their reasons for nonpreferred use. The widespread adoption of questions regarding method preferences could bring indicators of reproductive health services into closer alignment with the needs of the people they serve.
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Affiliation(s)
- Kristen Lagasse Burke
- Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, 78712, USA
| | - Joseph E Potter
- Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, 78712, USA
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Swan LE, Vu H, Higgins JA, Bui LM, Malecki K, Green TL. Exploring financial stress and resource deprivation as barriers to preferred contraceptive use in Wisconsin in 2021. Contraception 2022; 115:22-26. [DOI: https:/doi.org/10.1016/j.contraception.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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Burke KL, Raley RK. Declines in Non-marital Births Among Black Women Between 2004 and 2014: Are Recent Trends the Result of Increases in Contraception? POPULATION RESEARCH AND POLICY REVIEW 2022; 41:2267-2288. [PMID: 39006865 PMCID: PMC11244848 DOI: 10.1007/s11113-022-09724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/05/2022] [Indexed: 11/27/2022]
Abstract
Non-marital birth rates for women in their twenties began declining in 2008, but the mechanisms driving this decline are not yet well understood. Using a proximate determinants of fertility framework and decomposition techniques, we consider the importance of changes in relationship status, contraceptive use, and other dimensions of deliberate fertility control in understanding trends in the non-marital fertile pregnancy rate between 2004 and 2014. We use data from several cycles of the National Survey of Family Growth to identify relationship and contraceptive use status at the time of conception for pregnancies that resulted or were likely to result in live births (i.e., fertile pregnancies), and focus our analysis on non-Hispanic Black women in their twenties. We find that changes in relationship status and sexual activity did not contribute to the decline in fertile pregnancy rates, nor did changes in the distribution of contraceptive method use. Instead, changing fertile pregnancy rates within contraceptive use categories, including among those who report using no method of contraception, account for the observed trend. Though contraceptive method mix is an insufficient explanation for recent trends, our results suggest that considering the sources of within-method variation in fertile pregnancy rates over time is key to understanding declines in non-marital births, and that some women not using contraception likely engaged in a form of deliberate fertility control not captured by the National Survey of Family Growth.
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Affiliation(s)
- Kristen Lagasse Burke
- Department of Sociology & Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - R Kelly Raley
- Department of Sociology & Population Research Center, University of Texas at Austin, Austin, TX, USA
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Kavanaugh ML, Zolna M, Pliskin E, MacFarlane K. A Prospective Cohort Study of Changes in Access to Contraceptive Care and Use Two Years after Iowa Medicaid Coverage Restrictions at Abortion-Providing Facilities Went into Effect. POPULATION RESEARCH AND POLICY REVIEW 2022; 41:2555-2583. [PMID: 36092460 PMCID: PMC9440451 DOI: 10.1007/s11113-022-09740-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 08/19/2022] [Indexed: 11/07/2022]
Abstract
Inequities in access to contraception based on ability to pay can interfere with individuals’ reproductive autonomy. This study examines the impact of a 2017 state-level policy in Iowa restricting Medicaid coverage at abortion-providing health care centers on patients’ access to contraceptive care and subsequent contraceptive use. We draw on a unique panel dataset of individuals who originally sought care at a publicly supported family planning site in Iowa in 2018–2019 and then participated in subsequent follow-up surveys every 6 months for 2 years to examine an effect of access to care on contraceptive use. Among our final analytic sample of 368 individuals, our findings indicate that receipt of recent contraceptive care decreased over the study period; this coincided with patients shifting away from getting contraceptive care at sites potentially impacted by the 2017 Iowa Medicaid policy restriction while those getting this care at non-impacted sites remained relatively steady over the study period. At the same time, nonuse of contraception increased while use of a contraceptive method that carries cost, use of a provider-involved method, and satisfaction with one’s method decreased. We find that, after controlling for patient characteristics, those who shifted toward receiving contraceptive care experienced increases in these three contraceptive outcomes. We interpret this as preliminary descriptive evidence demonstrating an impact of disruptions in access to contraceptive care on contraceptive outcomes. Supportive payment and funding strategies for contraception, rather than policies that impede or restrict access, are needed to enable people to realize full reproductive autonomy.
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Fay KE, Corry S, Simmons RG, Baayd J. Coerced Choice: Resigned Contraceptive Usership Among Individuals Affected by Reproductive Coercion. J Midwifery Womens Health 2022; 67:593-597. [PMID: 35861284 PMCID: PMC9561046 DOI: 10.1111/jmwh.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 05/14/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Partner-mediated reproductive coercion is a common form of violence that affects individuals' sexual and reproductive health goals. Clinicians' understanding of the scope of reproductive coercion continues to grow with direct implications for clinical interventions. The purpose of this study was to generate a more comprehensive set of reproductive coercion tactics used by intimate partners for recognition in a clinical setting. METHODS This was a qualitative study using grounded theory. Individuals were recruited through an established statewide community network to participate in videoconferencing focus groups regarding reproductive coercion. Discussions were moderated and recorded. Data were coded and then subjected to qualitative content analysis. RESULTS Twenty community members participated. Participants described partner interference with reproductive and sexual health goals, including limitation of their contraceptive options. Although participants were able to access health care and use contraception as part of a goal to avoid pregnancy, they also reported dissatisfaction with their methods. Some participants described being forced to use an undesired form of contraception in the setting of reproductive coercion from abusive partners. DISCUSSION Individuals affected by reproductive coercion may be able to access and exercise limited choice over their contraceptive options, but some may be unable to use the preferred method because of partners' behavior. Clinician awareness of the diversity of presentations of reproductive coercion, including individuals using long-acting reversible contraceptives, may facilitate individualized counseling and realignment of care with patient preferences.
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Affiliation(s)
- Kathryn E Fay
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Summer Corry
- College of Science, Utah Valley University, Orem, Utah
| | - Rebecca G Simmons
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jami Baayd
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
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16
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Swan LE, Vu H, Higgins JA, Bui LM, Malecki K, Green TL. Exploring financial stress and resource deprivation as barriers to preferred contraceptive use in Wisconsin in 2021. Contraception 2022; 115:22-26. [DOI: 10.1016/j.contraception.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/03/2022]
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17
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Racial and ethnic disparities in access to gynecologic care. Curr Opin Anaesthesiol 2022; 35:267-272. [PMID: 35671011 DOI: 10.1097/aco.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite efforts to minimize patient barriers to equitable care, health disparities persist in gynecology. This paper seeks to highlight racial and ethnic disparities in gynecologic care as represented by recent literature. RECENT FINDINGS Disparities exist among many areas including preventive screenings, vaccination rates, contraception use, infertility, and oncologic care. These can be identified at the patient, physician, and institutional levels. SUMMARY As we identify these social disparities in healthcare, we gain valuable knowledge of where our efforts are lacking and where we can further improve the health of women. Future research should focus on identifying and combating such disparities with measurable changes in health outcomes.
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18
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Kavanaugh ML, Pliskin E, Hussain R. Associations between unfulfilled contraceptive preferences due to cost and low-income patients' access to and experiences of contraceptive care in the United States, 2015-2019. Contracept X 2022; 4:100076. [PMID: 35620731 PMCID: PMC9126850 DOI: 10.1016/j.conx.2022.100076] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/21/2022] Open
Abstract
Objective To identify prevalence of unfulfilled contraceptive preferences due to cost among low-income United States female contraceptive method users and nonusers, and associations between access to, and experience with, contraceptive care and this outcome. Methods We drew on data from the 2015-2019 National Surveys of Family Growth to conduct simple and multivariable logistic regression analyses on unfulfilled contraceptive preferences due to cost among nationally representative samples of low-income women ages 15 to 49 who were current contraceptive users (N = 3178) and nonusers (N = 1073). Results Overall, 23% of female contraceptive users reported they would use a different method, and 39% of nonusers reported they would start using a method, if cost were not an issue. Controlling for user characteristics, low-income contraceptive users who received recent publicly supported contraceptive care reported significantly higher levels of unfulfilled contraceptive preferences due to cost than those without any access to SRH care (aOR = 1.6, CI 1.0-2.5), while having private (aOR = 0.6, CI 0.4-0.9) or public (aOR = 0.7, CI 0.5-1.0) health insurance was associated with significantly lower levels of this outcome. Nonusers of contraception who had recently received publicly supported contraceptive care also reported marginally higher levels of this outcome (aOR = 2.2, CI 1.0-5.1). Contraceptive users who received recent person-centered contraceptive counseling had marginally lower odds of unfulfilled contraceptive preferences due to cost (aOR = 0.6, CI 0.4-1.0). Conclusions Cost is a barrier to using preferred contraception for both contraceptive users and nonusers; health insurance coverage and person-centered contraceptive counseling may help contraceptive users to overcome cost barriers and realize their contraceptive preferences. Implications Factors related to contraceptive access at the systems level-specifically the subsidization and experience of contraceptive care-impact whether cost serves as a barrier to individuals' contraceptive preferences. Delivery of patient-centered care and shoring up health insurance coverage for all can help to mitigate cost barriers and enable individuals to realize their contraceptive preferences.
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Affiliation(s)
| | - Emma Pliskin
- Guttmacher Institute, New York, NY, United States
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19
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Kramer RD, Higgins JA, Everett B, Turok DK, Sanders JN. A prospective analysis of the relationship between sexual acceptability and contraceptive satisfaction over time. Am J Obstet Gynecol 2022; 226:396.e1-396.e11. [PMID: 34656551 PMCID: PMC8916969 DOI: 10.1016/j.ajog.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/19/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Contraceptives are used to prevent unwanted pregnancies and treat certain gynecologic conditions, but many women report non-use or inconsistent use because of method dissatisfaction. The sexual acceptability of contraception-how birth control methods affect users' sexual well-being-is likely an important component of contraceptive satisfaction but has yet to be systematically examined. OBJECTIVE This study aimed to assess contraceptive satisfaction among new-start contraceptive users and examine whether sexual acceptability measures predict contraceptive satisfaction at 3 months while controlling for more commonly measured contraceptive side effects. STUDY DESIGN This analysis used data derived from the baseline, 1-month, and 3-month surveys of the HER Salt Lake Contraceptive Initiative, a prospective cohort study of new contraceptive clients. From March 2016 to March 2017, enrolled participants received their desired contraceptive method at no cost and could switch or discontinue at any time (up to 3 years). This analysis included individuals who continued their new contraceptive method for at least 1 month and completed all relevant survey measures. We used ordered logistic regression modeling to predict contraceptive satisfaction at 3 months. Primary predictor variables included changes in sexual functioning (6-item Female Sexual Function Index), sexual satisfaction (New Sexual Satisfaction Scale), and perceived impact of the contraceptive method on sex life at 1 month. Covariates included vaginal bleeding changes, physical side effects, and mood-related side effects. RESULTS Our analytical sample included 1879 individuals. At 3 months, 52.1% of participants were "completely satisfied" with their contraceptive method, 30.7% were "somewhat satisfied," 4.2% were "neither satisfied nor dissatisfied," 6.9% were "somewhat dissatisfied," and 6.2% were "completely dissatisfied." Compared with patients who said their contraceptive method made their sex life "a lot" worse at 1 month, patients whose method improved their sex life "a lot" had a 7.7 times increased odds of greater satisfaction at 3 months (95% confidence interval, 4.02-14.60; P<.0001) and patients whose method improved their sex life a "little" had a 5.88 times increased odds of greater satisfaction (confidence interval, 3.12-11.11; P<.001). To a much lesser degree, experiencing less or no bleeding was significantly associated with increased satisfaction, whereas worsening of physical side effects was linked to decreased satisfaction. The only other factors significantly associated with satisfaction were changes in bleeding and physical side effects. CONCLUSION Our findings suggest that patients' sexual experiences of their contraceptive methods are important correlates of satisfaction. Clinicians may wish to underscore that sexual experiences of birth control methods matter and encourage patients to find a contraceptive method that works for them sexually.
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Affiliation(s)
- Renee D Kramer
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI.
| | - Jenny A Higgins
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI; Departments of Gender and Women's Studies, University of Wisconsin-Madison, Madison, WI
| | - Bethany Everett
- Department of Sociology, The University of Utah, Salt Lake City, UT
| | - David K Turok
- Departments of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Jessica N Sanders
- Departments of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
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Cartwright AF, Alspaugh A, Britton LE, Noar SM. mHealth Interventions for Contraceptive Behavior Change in the United States: A Systematic Review. JOURNAL OF HEALTH COMMUNICATION 2022; 27:69-83. [PMID: 35255773 PMCID: PMC9133092 DOI: 10.1080/10810730.2022.2044413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Ensuring people have access to their preferred method of contraception can be key for meeting their reproductive goals. A growing number of mHealth interventions show promise for improving access to contraception, but no literature review has identified the effects of mHealth interventions among both adolescents and adults in the United States. The purpose of this systematic review was to describe the format, theoretical basis, and impact of mHealth interventions for contraceptive behavior change (contraceptive initiation and continuation) among people of all ages in the US. A systematic review of the literature was conducted using six electronic databases guided by Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data on study design, frequency, duration, mHealth modality, contraceptive method, behavior change theory, and behavioral outcome were extracted to facilitate comparison. Eighteen studies met eligibility criteria. The majority (11; 61%) used SMS (short message service). Twelve studies focused on contraceptive initiation, most (n = 8) of which also measured continued use over time. The remaining six interventions focused on continuation alone, generally through appointment reminders. Very little contraceptive behavior change was identified across studies. Current mHealth interventions may hold promise for some health areas but there is little evidence that they change contraceptive behavior. Future mHealth interventions should focus on assessing person-centered outcomes, including satisfaction, side effects, and reasons for discontinuation, to best support people to use their preferred contraceptive method.
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Affiliation(s)
- Alice F. Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy Alspaugh
- ACTIONS Program, University of California, San Francisco – School of Nursing, San Francisco, CA, USA
| | | | - Seth M. Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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