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Hale N, Lee J, de Jong J, Smith MG, Khoury AJ. Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative. JAMA Netw Open 2024; 7:e248262. [PMID: 38656576 PMCID: PMC11043899 DOI: 10.1001/jamanetworkopen.2024.8262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024] Open
Abstract
Importance Evaluating the impact of statewide contraceptive access initiatives is necessary for informing health policy and practice. Objective To examine changes in contraceptive method use among a cohort of women of reproductive age in South Carolina during the Choose Well contraceptive access initiative. Design, Setting, and Participants In this cohort study, baseline data from the initial Statewide Survey of Women administered from October 1, 2017, to April 30, 2018, to a probability-based sample of women of reproductive age in South Carolina and a peer state (Alabama) were linked with 3 follow-up surveys given in 2019, 2020, and 2021. Responses about contraception use from the initial survey were compared with responses across follow-up surveys using the regression-based differences-in-differences method. Data analysis was performed from October 2023 to February 2024. Exposure The South Carolina Choose Well contraceptive access initiative seeks to fill contraceptive access gaps and increase provision of a full range of contraceptive methods through engagement with a wide range of health care organizations across the state. Main Outcomes and Measures Changes in contraceptive method use, including long-acting reversible contraception (LARC), intrauterine devices (IUDs), implants, short-acting hormonal injection, and barrier or other methods between the baseline survey (2017-2018) and 3 subsequent surveys (2019-2021). Results A total of 1344 female participants (mean [SD] age, 34 [7] years) completed the first survey (667 in Alabama and 677 in South Carolina). Use of LARC significantly increased in South Carolina (119 [17.6%] to 138 [21.1%]) compared with Alabama (120 [18.0%] to 116 [18.1%]; P = .004). Use of IUDs increased in South Carolina (95 [14.0%] to 114 [17.4%]) compared with Alabama (92 [13.8%] to 102 [15.9%]; P = .003). These associations persisted in the adjusted analysis, with a significant increase in the odds of LARC (adjusted odds ratio, 1.24; 95% CI, 1.06-1.44) and IUD (adjusted odds ratio, 1.19; 95% CI, 1.06-1.32) use at follow-up in South Carolina compared with Alabama. Conclusions and Relevance In this cohort study of 1344 participants, increases in the use of IUDs in South Carolina were noted after the implementation of the South Carolina Choose Well initiative that were not observed in a peer state with no intervention. Our findings may provide support in favor of statewide contraceptive access initiatives and their role in promoting access to reproductive health services.
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Affiliation(s)
- Nathan Hale
- Center for Applied Research and Evaluation in Women’s Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
| | - Jusung Lee
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio
| | - Jordan de Jong
- Center for Applied Research and Evaluation in Women’s Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
| | - Michael G. Smith
- Center for Applied Research and Evaluation in Women’s Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
| | - Amal J. Khoury
- Center for Applied Research and Evaluation in Women’s Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
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Hale N, Manalew WS, Leinaar E, Smith M, Sen B, Khoury A. Impact of the Choose Well Contraceptive Access Initiative on Method Use Among Women Enrolled in South Carolina's Medicaid Program: A Mid-line Assessment. Womens Health Issues 2023; 33:626-635. [PMID: 37580186 DOI: 10.1016/j.whi.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION A six-year statewide contraceptive access initiative focused on equitable access to contraception, removing cost barriers, capacity building and training, raising consumer awareness, and expanding contraceptive care at safety net clinics was implemented in South Carolina beginning in 2017. This study assessed changes in contraceptive method use among women enrolled in the South Carolina Medicaid program during the first three years of Choose Well. METHODS Contraception use among a retrospective cohort of women aged 15 to 45 enrolled in South Carolina Medicaid from 2012 to 2020 was examined. Interrupted time series regression analysis was used to assess changes in the use of intrauterine devices (IUDs) and contraceptive implants between 2012 and 2016 and 2017 and 2020. Analyses were conducted for all women and stratified by age groups. RESULTS Long-acting reversible contraception use increased from 8.5% during the pre-Choose Well period to 10.9% during the Choose Well period (p < .001), with IUD use increasing from 4.3% to 5.2% (p < .001) and implant use increasing from 4.6% to 6.0% (p < .001). The interrupted time series analysis found a significant positive change in the average level of monthly IUD use after Choose Well began (0.493 percentage points; 95% confidence interval, 0.311-0.675). The effect was stronger among women 20 to 25 years of age. Choose Well significantly increased the trend in IUD use among all women by a positive 0.013 percentage points (95% confidence interval, 0.006-0.020) per month beyond expected values. CONCLUSIONS At the mid-point of the Choose Well Evaluation, the use of IUD methods increased significantly beyond what would be expected had pre-Choose Well trends continued. This was particularly evident among women 20 to 25 years of age. These findings suggest that Choose Well succeeded in reducing barriers to the use of IUDs.
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Affiliation(s)
- Nathan Hale
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee.
| | - Wondimu S Manalew
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Edward Leinaar
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Michael Smith
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Bisakha Sen
- Department of Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amal Khoury
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
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Smith MG, Hale N, Kelley S, Satterfield K, Beatty KE, Khoury AJ. South Carolina's Choose Well Initiative to Reduce Unintended Pregnancy: Rationale, Implementation Design, and Evaluation Methodology. Am J Public Health 2022; 112:S484-S489. [PMID: 35767793 PMCID: PMC10490316 DOI: 10.2105/ajph.2022.306889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Michael G Smith
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Nathan Hale
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Sarah Kelley
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Katherine Satterfield
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Kate E Beatty
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Amal J Khoury
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
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Manalew W, Hale N, Leinaar E, Sen B, Smith M, Khoury A. Medicaid Cost Savings from Provision of Contraception to Beneficiaries in South Carolina, 2012–2018. Popul Health Manag 2022; 25:542-550. [DOI: 10.1089/pop.2021.0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- W.Samuel Manalew
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nathan Hale
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Edward Leinaar
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Bisakha Sen
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Michael Smith
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal Khoury
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
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Ventura LM, Beatty KE, Khoury AJ, Smith MG, Ariyo O, Slawson DL, Weber AJ. Contraceptive Access at Federally Qualified Health Centers During the South Carolina Choose Well Initiative: A Qualitative Analysis of Staff Perceptions and Experiences. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 2:608-620. [PMID: 35141709 PMCID: PMC8820399 DOI: 10.1089/whr.2021.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/20/2022]
Abstract
Introduction: Federally qualified health centers (FQHCs) provide essential contraceptive services to low-income individuals; yet, access to all method options, notably intrauterine devices (IUDs) and implants, may be limited at non-Title X FQHCs. The South Carolina (SC) Choose Well initiative is a statewide contraceptive access initiative that was launched in 2017 and extends into 2022. Choose Well established a collaborative network between training and clinical partners and is aimed at facilitating implementation of contraceptive care best practices through capacity-building and training of clinical and administrative staff in partner organizations. The initiative provided funding for workforce expansion and contraceptive methods. We examined perceptions of staff from Choose Well-participating FQHCs regarding contraceptive access during the first 2 years of the initiative, including factors that facilitated or posed access challenges as well as sustaining factors. This study informs the process evaluation of Choose Well while providing data critical for uncovering and scaling up contraceptive access initiatives. Materials and Methods: Interviews were conducted with FQHC staff (n = 34) in 2018 and 2019 to assess Choose Well implementation and were recorded, transcribed, and double-coded via at least 80% interrater reliability or consensus coding. Data were analyzed according to clinical and administrative factors influencing contraceptive access. Results: Increased capacity for contraceptive counseling and provision through training and external funding for IUDs and implants were the most noted clinical factors facilitating access. Streamlining workflow processes was also a facilitator. Buy-in and engagement among staff and leadership emerged as a facilitator at some clinics and as a barrier at others. Policy/structural factors related to costs of devices and insurance coverage were identified as threats to sustainability. Conclusions: The Choose Well initiative contributed to the perception of an increase in contraceptive access at participating FQHCs in SC. Statewide contraceptive access initiatives have the potential to support FQHCs in meeting their clients' contraceptive needs. Organizational buy-in, sustainability of funding, and training are key to realizing the full potential of these initiatives.
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Affiliation(s)
- Liane M Ventura
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kate E Beatty
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal J Khoury
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Michael G Smith
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Oluwatosin Ariyo
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Deborah L Slawson
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amy J Weber
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
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Hale N, Manalew WS, Leinaar E, Smith M, Sen B, Sharma P, Khoury A. Contraceptive Use and Pregnancy Outcomes Among Women Enrolled in South Carolina Medicaid Programs. Matern Child Health J 2021; 25:1960-1971. [PMID: 34637063 DOI: 10.1007/s10995-021-03260-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE State medicaid programs provide access to effective contraception for people with lower incomes. This study examined contraception use and pregnancy among reproductive-age women enrolled in the South Carolina Medicaid, by eligibility program and socio-demographic sub-groups. METHODS A retrospective cohort of women aged 15-45 who were newly eligible for South Carolina Medicaid from 2012 to 2016 was examined. Log-binomial regression and average marginal effects assessed relationships between contraception use and pregnancies ending in live and non-live births. Contraception was categorized as permanent, long acting reversible contraception (LARC), short-acting hormonal contraception (SAC), or no contraceptive claims. Women with family planning or full-benefit medicaid coverage were included. RESULTS Approximately 11% of women used LARC methods, 41% used SAC methods, and 46% had no evidence of contraceptive claims. Method utilization varied by eligibility program, race/ethnicity and age. The likelihood of pregnancy was lower among SAC users and lowest among LARC users compared to women with no evidence of contraception across all three programs (family planning APR = 0.44; 95% CI 0.41-0.49 and APR = 0.13, 95% CI 0.10-0.17; Low income families APR = 0.82; 95% CI 0.77-0.88 and APR = 0.33, 95% CI 0.28-0.38; Partners for Healthy Children APR = 0.72; 95% CI 0.68-0.77 and APR = 0.35, 95% CI 0.30-0.43, respectively). Non-Hispanic Black and Hispanic teens were less likely to experience a pregnancy than non-Hispanic white teens. CONCLUSIONS FOR PRACTICE The likelihood of pregnancy was lower among women using SAC methods and markedly lower among women using LARC. Variation in contraceptive use among racial/ethnic groups was noted despite Medicaid coverage. As new policies and initiatives emerge, these findings provide important context for understanding the role of Medicaid programs in reducing financial barriers to contraceptive services and ensuring access to effective contraception, while fostering reproductive health autonomy among women.
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Affiliation(s)
- Nathan Hale
- Department of Health Services Management & Policy, College of Public Health, Center for Applied Research & Evaluation in Women's Health, East Tennessee State University, PO Box 70264, Johnson, TN, 37614, USA.
| | - Wondimu S Manalew
- Department of Health Services Management & Policy, College of Public Health, Center for Applied Research & Evaluation in Women's Health, East Tennessee State University, PO Box 70264, Johnson, TN, 37614, USA
| | - Edward Leinaar
- Department of Health Services Management & Policy, College of Public Health, Center for Applied Research & Evaluation in Women's Health, East Tennessee State University, PO Box 70264, Johnson, TN, 37614, USA
| | - Michael Smith
- Department of Health Services Management & Policy, College of Public Health, Center for Applied Research & Evaluation in Women's Health, East Tennessee State University, PO Box 70264, Johnson, TN, 37614, USA
| | - Bisakha Sen
- Department of Health Care Organization and Policy, The University of Alabama at Birmingham School of Public Health, 1665 University Blvd, RPHB 330F, Birmingham, AL, 35294, USA
| | - Pradeep Sharma
- Department of Health Care Organization and Policy, The University of Alabama at Birmingham School of Public Health, 1665 University Blvd, RPHB 320C, Birmingham, AL, 35294, USA
| | - Amal Khoury
- Department of Health Services Management & Policy, College of Public Health, Center for Applied Research & Evaluation in Women's Health, East Tennessee State University, PO Box 70264, Johnson, TN, 37614, USA
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