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Rendall MS, Eeckhaut MCW, Gifford K, Hurtado-Acuna C. Long-Acting Reversible Contraception (LARC) and Early Childbearing Revisited: Births and Birth Intendedness After LARC Removal in a State Medicaid Population (2012-2020). Am J Public Health 2024:e1-e8. [PMID: 39388674 DOI: 10.2105/ajph.2024.307844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
Objectives. To analyze births and birth intendedness after long-acting reversible contraception (LARC) removal among Medicaid-insured women. Methods. We linked all Delaware women with a Medicaid-covered LARC removal in 2012 to 2020 (n = 8047) to birth records and to Pregnancy Risk Assessment Monitoring System (PRAMS) pregnancy intendedness survey responses (n = 241). Results. Births within 3 years of a Medicaid-covered LARC removal were much more likely to be to women in their 20s compared with all Medicaid births (63.5% vs 53.4%; P < .001). The intended proportion for births within 3 years of Medicaid-covered LARC removal (65.2%) was higher than for all Medicaid-covered births (58.8%; P = .08) and was consistently above 60% across all age groups younger than 30 years. Conclusions. A state Medicaid-insured population's use of highly effective reversible contraception was associated with births being concentrated among women in their 20s and with consistently high fractions of intended births across younger ages at birth. Public Health Implications. Programs and policies may consider LARC access for its potential to increase low-income women's reproductive autonomy by enhancing their ability to achieve births at the age of their choosing. (Am J Public Health. Published online ahead of print October 10, 2024:e1-e8. https://doi.org/10.2105/AJPH.2024.307844).
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Affiliation(s)
- Michael S Rendall
- Michael S. Rendall and Constanza Hurtado-Acuna are with the Department of Sociology and the Maryland Population Research Center, University of Maryland, College Park. Mieke C. W. Eeckhaut is with the Department of Sociology and Criminal Justice, University of Delaware, Newark. Katie Gifford is with the Center for Community Research & Service, University of Delaware, Newark
| | - Mieke C W Eeckhaut
- Michael S. Rendall and Constanza Hurtado-Acuna are with the Department of Sociology and the Maryland Population Research Center, University of Maryland, College Park. Mieke C. W. Eeckhaut is with the Department of Sociology and Criminal Justice, University of Delaware, Newark. Katie Gifford is with the Center for Community Research & Service, University of Delaware, Newark
| | - Katie Gifford
- Michael S. Rendall and Constanza Hurtado-Acuna are with the Department of Sociology and the Maryland Population Research Center, University of Maryland, College Park. Mieke C. W. Eeckhaut is with the Department of Sociology and Criminal Justice, University of Delaware, Newark. Katie Gifford is with the Center for Community Research & Service, University of Delaware, Newark
| | - Constanza Hurtado-Acuna
- Michael S. Rendall and Constanza Hurtado-Acuna are with the Department of Sociology and the Maryland Population Research Center, University of Maryland, College Park. Mieke C. W. Eeckhaut is with the Department of Sociology and Criminal Justice, University of Delaware, Newark. Katie Gifford is with the Center for Community Research & Service, University of Delaware, Newark
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Foster KN, Bright CF, Beatty K, de Jong J, Surles K, Ventura L, Kidd MJ. "Breaking Bread" With Respondents: Strategies to Increase Response Rates and Create Long-Term Cooperation With Health Clinic Administrators. FAMILY & COMMUNITY HEALTH 2024; 47:304-313. [PMID: 38874218 DOI: 10.1097/fch.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND OBJECTIVES To fully understand the impact of unintended pregnancy, as well as to evaluate the implementation and outcomes of programs targeted at reducing unintended pregnancy, it is critical that researchers be able to collect comprehensive data from health clinics that provide these services in vulnerable communities. METHODS Our paper details recruitment and incentive strategies, as well as the theories that guided them, which allowed us to achieve a high survey response rate among health clinic administrators in public health clinics in 2 Southeastern states-South Carolina and Alabama-both of which have high rates of unintended pregnancy. RESULTS Grounded in organizational theory, and utilizing the Tailored Design Method, we achieved a 68% response rate utilizing paper and web survey administration with multiple contact modes. Our incentive structure comprised both traditional cash-based and food-based incentives. CONCLUSIONS Findings indicate high response rates are achievable despite high survey burden (ie, detailed information, length of survey). We found that sample screening was critical and that food-based incentives made an impression on respondents that positively impacted the researcher-respondent relationship. Providing detailed methodology and additional literature will assist researchers working with similar populations-a gap in the applied methodological literature that was problematic at the project's onset.
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Affiliation(s)
- Kelly N Foster
- Applied Social Research Lab, East Tennessee State University, Johnson City, Tennessee (Drs Foster and Bright and Ms Kidd); and Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee (Drs Beatty and Surles and Mss de Jong and Ventura)
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Lewin A, Skracic I, Brown E, Roy K. "The thing in my arm": Providing contraceptive services for adolescents in primary care. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241248399. [PMID: 38778774 PMCID: PMC11113018 DOI: 10.1177/17455057241248399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/20/2024] [Accepted: 04/02/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Due to high rates of unintended pregnancies in Delaware, the state launched a public health initiative in 2014 to increase access to contraceptive services. OBJECTIVES This study was designed to assess the practice-level barriers and facilitators to providing contraceptive care, particularly long-acting reversible contraceptives (LARCs), to adolescents in primary care settings. DESIGN This qualitative study was part of a larger process evaluation of the Delaware Contraceptive Access Now (DelCAN) initiative. METHODS In-depth, semi-structured qualitative interviews were conducted with 16 practice administrators at 13 adolescent-serving primary care sites across the state of Delaware. A process of open, axial, and selective coding was used to analyze the data. RESULTS Despite the interest in LARC among their adolescent patients, administrators described numerous barriers to providing LARC for adolescents including confidentiality in patient visits and billing, preceptorship, and provider discomfort and assumptions about the need for contraception among adolescent patients. CONCLUSION Findings from this study reveal substantial barriers to providing contraception to adolescents, even in primary care practices that were committed to comprehensive contraceptive access for their adolescent patients. This study supports the need for contraceptive care to be integrated into training of pediatricians at every stage of their education. Such training must go beyond education about contraceptive options and the clinical skills necessary for LARC insertion and removal, to include counseling skills based in a reproductive justice framework. Additional changes in policies and practices for adolescent patients would further increase access to contraceptive care.
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Affiliation(s)
- Amy Lewin
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Izidora Skracic
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Ellie Brown
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Kevin Roy
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
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Beatty K, Smith MG, de Jong J, Weber A, Adelli R, Khoury A. Impact of the Choose Well Initiative on Contraceptive Access at Federally Qualified Health Centers in South Carolina: A Midline Evaluation. Am J Public Health 2023; 113:1167-1172. [PMID: 37651659 PMCID: PMC10568501 DOI: 10.2105/ajph.2023.307384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Choose Well (CW) is a statewide contraceptive access initiative to reduce unintended pregnancy among patients utilizing federally funded family planning services. We examined CW's impact on contraceptive access at South Carolina federally qualified health centers from 2016 to 2019, which reported significantly higher increases in providing the full range of contraceptive methods and training onsite. CW prioritized ensuring change sustainability through obtaining funding and institutionalizing changes. (Am J Public Health. 2023;113(11):1167-1172. https://doi.org/10.2105/AJPH.2023.307384).
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Affiliation(s)
- Kate Beatty
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Michael G Smith
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Jordan de Jong
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Amy Weber
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Rakesh Adelli
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Amal Khoury
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
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McColl R, Gifford K, McDuffie MJ, Boudreaux M. Same-day long-acting reversible contraceptive utilization after a statewide contraceptive access initiative. Am J Obstet Gynecol 2023; 228:451.e1-451.e8. [PMID: 36565901 PMCID: PMC10065916 DOI: 10.1016/j.ajog.2022.12.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Same-day placement of long-acting reversible contraceptives, occurring when the device is requested and placed within a single visit, reduces barriers to the patient and reduces unintended pregnancies. Despite the safety and efficacy of same-day placement, access to same-day services remains low. OBJECTIVE This study aimed to evaluate the effects of the Delaware Contraceptive Access Now initiative, a statewide initiative in Delaware focused on increasing same-day access to effective contraception on same-day receipt of long-acting reversible contraceptives. STUDY DESIGN We used Medicaid claims and encounter data to identify instances of same-day and multivisit receipts of long-acting reversible contraceptives among Medicaid-enrolled individuals in Delaware and Maryland aged 15-44 years who were covered in a full-benefits or family planning Medicaid aid category during the month of the placement and the 2 previous months. We used a difference-in-differences design that compared changes in the outcome from before to after implementation of the initiative among placements at agencies that participated in the initiative (n=6676) vs 2 alternative comparison groups: placements at Delaware agencies that did not participate (n=688) and placements in Maryland (n=35,847). RESULTS We found that the intervention was associated with a 13.3 percentage point increase (95% confidence interval, 1.9%-24.7%) in receipt of same-day long-acting reversible contraceptives using a nonparticipating Delaware comparison group, a 21.1 percentage point increase (95% confidence interval, 13.7%-28.6%) using a Maryland comparison group, and a 21.0 percentage point increase (95% confidence interval, 14.1%-27.9%) using a pooled comparison group. The effects were larger for implants than intrauterine devices. CONCLUSION The Delaware Contraceptive Access Now initiative substantially increased the number of patients receiving long-acting reversible contraceptives through a single-visit encounter. Our findings suggested that coordinated interventions involving provider and staff training and capital investments that seed device stocking can increase the number of patients receiving same-day long-acting reversible contraceptives.
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Affiliation(s)
- Rebecca McColl
- Biden School of Public Policy and Administration, University of Delaware, Newark, DE.
| | - Katie Gifford
- Biden School of Public Policy and Administration, University of Delaware, Newark, DE
| | - Mary Joan McDuffie
- Biden School of Public Policy and Administration, University of Delaware, Newark, DE
| | - Michel Boudreaux
- University of Maryland School of Public Health, College Park, MD
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Yoder M, Boudreaux M. The effect of contraceptive access reform on privately insured patients: Evidence from Delaware Contraceptive Access Now. PLoS One 2023; 18:e0280588. [PMID: 36689399 PMCID: PMC9870137 DOI: 10.1371/journal.pone.0280588] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Many states are implementing comprehensive programs aimed at reducing persistent barriers to contraceptive care. Evidence on the effectiveness of these programs is essential for practice improvement and policy development. OBJECTIVE To evaluate changes in the probability of initiating a contraceptive method by women with employer sponsored insurance after implementation of Delaware Contraceptive Access Now (DelCAN), a statewide initiative that aimed to increase access to long-acting reversible contraceptives (LARCs). DESIGN, SETTING, AND PARTICIPANTS We used a difference-in-differences design to examine contraceptive initiation rates. Data came from IBM Marketscan and covered women age 15-44 enrolled in employer sponsored insurance. The primary outcome was insertion of a LARC, both in the overall study population and in the immediate postpartum (IPP) setting. Secondary analysis examined changes to other contraceptive method types. RESULTS The cohort of 4,550,459 enrollees generated a sample of 11,888,837 person-years and 615,670 childbirth hospitalizations. Difference-in-differences estimates suggested that DelCAN was associated with a 0.3 percentage point (95% CI [0.2, 0.5], p<0.001) increase in the LARC insertion rate in the overall study population and a 0.4 percentage point increase (95% CI [0.2, 0.6], p<0.001) in the percent of births adopting IPP LARC. Associations between DelCAN and LARC insertion appeared stronger for adolescents compared to older women. Results for other method types were less consistent. CONCLUSIONS A comprehensive statewide program was associated with increased LARC insertion rates among enrollees with employer sponsored insurance. Understanding the effect of these programs is critical for on-going policy development for states engaged in contraceptive access reform.
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Affiliation(s)
- Maranna Yoder
- Department of Economics, University of Maryland, College Park, Maryland, United States of America
| | - Michel Boudreaux
- Department of Health Policy and Management, University of Maryland, College Park, Maryland, United States of America
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Romer SE, Kennedy KI. The Colorado Initiative to Reduce Unintended Pregnancy: Contraceptive Access and Impact on Reproductive Health. Am J Public Health 2022; 112:S532-S536. [PMID: 35767790 PMCID: PMC10461486 DOI: 10.2105/ajph.2022.306891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/04/2022]
Abstract
The Colorado Initiative to Reduce Unintended Pregnancy, including its largest subproject, the Colorado Family Planning Initiative, had a significant impact on contraceptive access during and after the project period. This coordinated and multilevel initiative improved reproductive health outcomes by driving change in public health systems, advancing statewide policies, building capacity through training and technical assistance, and increasing public awareness and education. Lessons learned from the implementation and outcomes of the Colorado Initiative to Reduce Unintended Pregnancy continue to inform contraceptive access efforts. (Am J Public Health. 2022;112(S5):S532-S536. https://doi.org/10.2105/AJPH.2022.306891).
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Affiliation(s)
- Sarah E Romer
- Sarah E. Romer is with the Department of Pediatrics, Section of Adolescent Medicine, University of Colorado School of Medicine, Aurora. Kathy I. Kennedy is with the Colorado School of Public Health, Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Kathy I Kennedy
- Sarah E. Romer is with the Department of Pediatrics, Section of Adolescent Medicine, University of Colorado School of Medicine, Aurora. Kathy I. Kennedy is with the Colorado School of Public Health, Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora
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Hopkins K, Remington C, Eilers MA, Rivas SD, Wallace Huff C, Moore LD, Hampton RM, Ogburn T. Obtaining buy-in for immediate postpartum long-acting reversible contraception programs in Texas hospitals: A qualitative study. Contraception 2022; 108:32-36. [PMID: 34748748 PMCID: PMC9098369 DOI: 10.1016/j.contraception.2021.10.016] [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: 03/09/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To understand the specific ways in which champions lead efforts to obtain and sustain buy-in for immediate postpartum long-acting reversible contraception (LARC) programs. METHODS We conducted a qualitative study with 60 semistructured interviews at 3 teaching hospitals in Texas with physicians, nurses, administrators and other staff who participated in the implementation of immediate postpartum LARC. Physicians self-identified as champions and identified other champion physicians and administrators. Two researchers analyzed and coded interview transcripts for content and themes. RESULTS We found that champions draw on institutional knowledge and relationships to build awareness and support for immediate postpartum LARC implementation. To obtain buy-in, champions needed to demonstrate financial sustainability, engage key stakeholders from multiple departments, and obtain nurse buy-in. Champions also created buy-in by communicating goals for the service that focused on expanding reproductive autonomy, improving maternal health, and improving access to postpartum contraception. Some staff, especially nurses, identified reasons for the program that run counter to reproductive justice principles: reducing birth rates, poverty, and/or unplanned pregnancy among young women and high-parity women. Respondents at 2 hospitals noted that not all women had equitable access to immediate postpartum LARC. CONCLUSION Physician and non-physician champions must secure long-term support across multiple hospital departments to successfully implement an immediate postpartum LARC program. For programs to equitably serve all women in need of postpartum contraceptive care, champions and other program leaders need to implement strategies to address access issues. They should also explicitly focus on reproductive justice principles during program introduction and training. IMPLICATIONS Successfully implementing immediate postpartum long-acting reversible contraception programs requires champions with institutional networking connections, administrative and nursing support, and clearly communicated goals. Champions need to address access issues and focus on reproductive justice principles during program introduction and training to equitably serve all women in need of postpartum contraceptive care.
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Affiliation(s)
- Kristine Hopkins
- Texas Policy Evaluation Project, The University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States.
| | - Courtney Remington
- Dell Seton Medical Center, The University of Texas at Austin, Austin, TX, United States
| | - Michelle A Eilers
- Texas Policy Evaluation Project, The University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States
| | - Saul D Rivas
- School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Cristina Wallace Huff
- The University of Texas Health Science Center at San Antonio, Department of Obstetrics, Gynecology and Reproductive Sciences, San Antonio, TX, United States
| | - Lee David Moore
- HSC School of Medicine at the Permian Basin, Texas Tech University, Odessa, TX, United States
| | - Raymond Moss Hampton
- HSC School of Medicine at the Permian Basin, Texas Tech University, Odessa, TX, United States
| | - Tony Ogburn
- School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
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A Real-World Comparison of In-Person vs. Virtual Contraceptive Care Trainings for Clinicians and Support Staff. Contraception 2022; 112:74-80. [DOI: 10.1016/j.contraception.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/18/2022]
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