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Karlin J, Newmark RL, Oberman N, Dehlendorf C. A Scoping Review of Patient-Centered Perinatal Contraceptive Counseling. Matern Child Health J 2024; 28:1454-1484. [PMID: 39088140 PMCID: PMC11358302 DOI: 10.1007/s10995-024-03946-y] [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] [Accepted: 05/19/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Contraceptive counseling during the perinatal period is an important component of comprehensive perinatal care. We synthesized research about contraceptive counseling during the perinatal period, which has not previously been systematically compiled. METHODS We developed search criteria to identify articles listed in PubMed, Embase, and Popline databases published between 1992 and July 2022 that address patients' preferences for, and experiences of, perinatal contraceptive counseling, as well as health outcomes associated with this counseling. Search results were independently reviewed by multiple reviewers to assess relevance for the present review. Methods were conducted in accordance with PRISMA guidelines. RESULTS Thirty-four articles were included in the final full text review. Of the included articles, 10 included implementation and evaluation of a contraceptive counseling method or protocol, and 24 evaluated preferences for or experiences of existing contraceptive counseling in the perinatal period. Common themes included the acceptability of contraceptive counseling in the peripartum and postpartum periods, and a preference for contraceptive counseling at some point during the antenatal period and before the inpatient hospital experience, and direct provider-patient discussion instead of video or written material. Multiple studies suggest that timing, content, and modality should be individualized. In general, avoiding actual or perceived directiveness and providing multi-modal counseling that includes both written educational materials and patient-provider conversations was desired. DISCUSSION The perinatal period constitutes a critical opportunity to provide contraceptive counseling that can support pregnant and postpartum people's management of their reproductive futures. The reviewed studies highlight the importance of patient-centered approach to providing this care, including flexibility of timing, content, and modality to accommodate individual preferences.
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Affiliation(s)
- Jennifer Karlin
- Family and Community Medicine, University of California, San Francisco, CA, 94110, USA.
| | - Rebecca L Newmark
- San Francisco School of Medicine, University of California, San Francisco, CA, USA
- San Francisco Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
| | - Nina Oberman
- Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | - Christine Dehlendorf
- Family and Community Medicine, University of California, San Francisco, CA, 94110, USA
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Singh R, Botfield JR. Postpartum contraception in Australia: opportunities for increasing access in the primary care setting. Aust J Prim Health 2024; 30:NULL. [PMID: 37879299 DOI: 10.1071/py23101] [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: 05/24/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
In Australia, 20% of pregnancies occur within the first year after birth and most are unintended. Both unintended pregnancies and short interpregnancy intervals (<12-18months) can have adverse effects on maternal, infant, and child health. Access to postpartum contraception reduces the risk of unintended pregnancies and short interpregnancy intervals, and supports women in pregnancy planning and birth spacing. In this forum article, we describe how postpartum contraception is currently provided in Australia and highlight opportunities for improving access in the primary care setting.
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Affiliation(s)
- Rhea Singh
- SPHERE NHMRC Centre of Research Excellence, Monash University, Melbourne, Vic., Australia; and
| | - Jessica R Botfield
- SPHERE NHMRC Centre of Research Excellence, Monash University, Melbourne, Vic., Australia; and
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3
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Knepper A, Zocchi A, Haider S, Caskey R. "An Act of Complete Care": Provider Perspectives on Linking Maternal Contraceptive Care With Well-Baby Visits in Community Health Centers. J Prim Care Community Health 2024; 15:21501319241277421. [PMID: 39245894 PMCID: PMC11382232 DOI: 10.1177/21501319241277421] [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: 09/10/2024] Open
Abstract
BACKGROUND Short inter-pregnancy interval (IPI) is associated with adverse health outcomes for women and infants, and low-income women experience disproportionate rates of short IPI. An essential solution is providing postpartum (PP) women with timely contraceptive care. However, patient-centered approaches for facilitating care access are needed. OBJECTIVE To explore Community Health Center (CHC) staff and provider perspectives on the implementation of a clinical trial offering co-scheduled well-infant/maternal contraceptive care for women with infants 0 to 6 months at the Well-Baby Visit (WBV). METHOD Eighteen participants (providers, staff, and administrators) representing 7 diverse CHC sites in 2 U.S. states completed semi-structured telephone interviews. Audio-recordings were transcribed and analyzed using hybrid thematic analysis. RESULTS Offering co-scheduled visits was perceived as beneficial for facilitating timely PP contraception, convenient care access, and encouraging family planning considerations during the PP period. However, provider and staff discomfort with initiating family planning and contraceptive care conversations at the WBV emerged as a salient barrier. CONCLUSION Paired approaches to well-infant/maternal contraceptive care may promote increased access to timely contraception for PP women, possibly reducing unintended short IPI. Comprehensive training, ongoing support, and patient-centered implementation strategies tailored to context and developed with care team input are needed to ensure competency and comfortability with facilitating contraceptive care conversations at the WBV.
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Affiliation(s)
- Amanda Knepper
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Alejandra Zocchi
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, Rush University, Chicago, IL, USA
| | - Rachel Caskey
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Phillips-Bell G, Roque M, Romero L. Mapping Long-acting Reversible Contraceptive Interventions to the Social Ecological Model: A Scoping Review. Womens Health Issues 2023; 33:497-507. [PMID: 37500420 PMCID: PMC10522259 DOI: 10.1016/j.whi.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Long-acting reversible contraception (LARC) is one option for preventing unintended pregnancies and short interpregnancy intervals. Efforts to increase access to contraception may benefit from applying the social ecological model (SEM), a framework that considers individual, interpersonal, organizational, community, and policy influences on behavior. We aimed to summarize findings from interventions on LARC use and map interventions to SEM levels. METHODS We conducted a scoping review of the 2010-2020 literature in PubMed/MEDLINE and Embase databases to summarize interventions that did and did not increase LARC use. Although increasing LARC use is not an appropriate goal from a reproductive autonomy standpoint, it is the stated goal of much of the research conducted to date and typically indicates an improvement in access. We mapped these interventions to SEM levels and categorized their strategies: cost support, patient counseling, administrative support, provider training, and other. RESULTS Of 27 interventions reviewed, 17 (63%) increased LARC use. We observed a greater proportion of interventions that increased LARC uptake among those with strategies implemented at policy (8/10 [80%]) or organizational (14/19 [74%]) SEM levels compared with interventions implemented at other SEM levels. When both individual and organizational SEM-level components were implemented, five of six interventions (83%) increased uptake. All five interventions with both organizational- and policy-level components increased LARC use. Among the 27 interventions, patient counseling (n = 12) and cost support (n = 12) were common strategies. Five of 12 interventions (42%) involving patient counseling and 11 of 12 (92%) involving cost support increased LARC use. CONCLUSIONS Organizational and policy SEM components and cost support strategies were most prevalent in interventions that increased LARC use. Future interventions to improve access to contraception, while respecting patient autonomy, could incorporate more than one SEM level.
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Affiliation(s)
- Ghasi Phillips-Bell
- Centers for Disease Control and Prevention, Chamblee Campus, Atlanta, Georgia.
| | - Maria Roque
- Texas A&M University, School of Public Health, College Station, Texas
| | - Lisa Romero
- Centers for Disease Control and Prevention, Chamblee Campus, Atlanta, Georgia
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Saldanha IJ, Adam GP, Kanaan G, Zahradnik ML, Steele DW, Chen KK, Peahl AF, Danilack-Fekete VA, Stuebe AM, Balk EM. Delivery Strategies for Postpartum Care: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:529-542. [PMID: 37535967 DOI: 10.1097/aog.0000000000005293] [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: 04/12/2023] [Accepted: 06/05/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To systematically review the effects of postpartum health care-delivery strategies on health care utilization and maternal outcomes. DATA SOURCES We searched Medline, EMBASE, CENTRAL, CINAHL, and ClinicalTrials.gov for studies in the United States or Canada from inception to November 16, 2022. METHODS OF STUDY SELECTION We used duplicate screening for studies comparing health care-delivery strategies for routine postpartum care on health care utilization and maternal outcomes. We selected health care utilization, clinical, and harm outcomes prioritized by stakeholder panels. TABULATION, INTEGRATION, AND RESULTS We found 64 eligible studies (50 randomized controlled trials, 14 nonrandomized comparative studies; N=543,480). For general postpartum care, care location (clinic, at home, by telephone) did not affect depression or anxiety symptoms (low strength of evidence), and care integration (by multiple types of health care professionals) did not affect depression symptoms or substance use (low strength of evidence). Providing contraceptive care earlier (compared with later) was associated with greater implant use at 6 months (summary effect size 1.36, 95% CI 1.13-1.64) (moderate strength of evidence). Location of breastfeeding care did not affect hospitalization, other unplanned care utilization, or mental health symptoms (all low strength of evidence). Peer support was associated with higher rates of any or exclusive breastfeeding at 1 month and any breastfeeding at 3-6 months (summary effect size 1.10-1.22) but not other breastfeeding measures (all moderate strength of evidence). Care by a lactation consultant was associated with higher breastfeeding rates at 6 months (summary effect size 1.43, 95% CI 1.07-1.91) but not exclusive breastfeeding (all moderate strength of evidence). Use and nonuse of information technology for breastfeeding care were associated with comparable rates of breastfeeding (moderate strength of evidence). Testing reminders for screening or preventive care were associated with greater adherence to oral glucose tolerance testing but not random glucose or hemoglobin A 1c testing (moderate strength of evidence). CONCLUSION Various strategies have been shown to improve some aspects of postpartum care, but future research is needed on the most effective care delivery strategies to improve postpartum health. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022309756 .
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Affiliation(s)
- Ian J Saldanha
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; the Center for Evidence Synthesis in Health, the Department of Health Services, Policy, and Practice, and the Department of Epidemiology, Brown University School of Public Health, and the Departments of Emergency Medicine, Pediatrics, Medicine, and Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, Rhode Island; the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; the Center for Outcomes Research and Evaluation, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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6
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Congdon JL, Bardach NS, Franck LS, Brindis CD, Boscardin WJ, Carrasco Z, Cabana MD, Dehlendorf C. Postpartum Family Planning in Pediatrics: A Survey of Parental Contraceptive Needs and Health Services Preferences. Acad Pediatr 2023; 23:1417-1425. [PMID: 36958531 PMCID: PMC11166476 DOI: 10.1016/j.acap.2023.03.009] [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: 09/30/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE Infant well-child visits are increasingly being explored as opportunities to address parental postpartum health needs, including those related to reproductive health. To inform potential pediatric clinic-based interventions, this study assessed postpartum contraceptive needs and health services preferences. METHODS We surveyed postpartum individuals attending 2 to 6-month well-child visits at three Northern California pediatric clinics (2019-20). We examined unmet contraceptive needs; the acceptability of contraceptive education, counseling, and provision at well-child visits; and sociodemographic and clinical correlates. We conducted univariate and multivariable regression modeling to assess associations between sociodemographic and clinical variables, the status of contraceptive needs, and acceptability measures. RESULTS Study participants (n = 263) were diverse in terms of race and ethnicity (13% Asian, 9% Black, 37% Latinx, 12% Multi-racial or Other, 29% White), and socioeconomic status. Overall, 25% had unmet contraceptive needs. Unmet need was more common among participants who had delivered more recently, were multiparous, or reported ≥ 1 barrier to obtaining contraception; postpartum visit attendance, education, race, and ethnicity were not associated with unmet need. Most participants deemed the following acceptable in the pediatric clinic: receiving contraceptive information (85%), discussing contraception (86%), and obtaining a contraceptive method (81%). Acceptability of these services was greater among participants with unmet contraceptive needs, better self-rated health, and private insurance (all P < .05). CONCLUSIONS A quarter of participants had unmet contraceptive needs beyond the early postpartum period. Most considered the pediatric clinic an acceptable place to address contraception, suggesting the pediatric clinic may be a suitable setting for interventions aiming to prevent undesired pregnancies and their sequelae.
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Affiliation(s)
- Jayme L Congdon
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies (JL Congdon and NS Bardach), University of California San Francisco.
| | - Naomi S Bardach
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies (JL Congdon and NS Bardach), University of California San Francisco.
| | - Linda S Franck
- Department of Family Health Care Nursing (LS Franck), University of California San Francisco, School of Nursing.
| | - Claire D Brindis
- Adolescent and Young Adult Health National Resource Center and Philip R. Lee Institute for Health Policy Studies (CD Brindis), University of California, San Francisco.
| | - W J Boscardin
- Departments of Medicine and Epidemiology and Biostatistics (WJ Boscardin), University of California San Francisco.
| | - Zoe Carrasco
- School of Nursing (Z Carrasco), University of California San Francisco.
| | - Michael D Cabana
- Department of Pediatrics (MD Cabana), Albert Einstein College of Medicine and the Children's Hospital at Montefiore (CHAM), Bronx, NY.
| | - Christine Dehlendorf
- Department of Family and Community Medicine (C Dehlendorf), University of California San Francisco.
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Averbach S, Thomas EE, Kully G, Nazarbegian M, Ghule M, Rabin BA, Raj A, Bhan N. Understanding feasibility and acceptability of implementation of linking delivery of family planning and infant vaccination care in rural Maharashtra, India: a qualitative study. BMC Pregnancy Childbirth 2023; 23:519. [PMID: 37454051 PMCID: PMC10349507 DOI: 10.1186/s12884-023-05830-z] [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: 03/10/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Linking family planning with infant vaccination care has the potential to increase contraceptive use among postpartum women in rural settings. We explored the multilevel factors that can facilitate or impede uptake of contraception at the time of infant vaccination among postpartum women and couples in rural Maharashtra, India. METHODS We conducted 60 semi-structured interviews with key stakeholders including: postpartum married women (n = 20), husbands (n = 10), and mothers-in-law (n = 10) of postpartum women, frontline healthcare workers (auxiliary nurse midwives (ANMs) and Accredited Social Health Activists (ASHAs), (n = 10), and community leaders (physician medical officers and village panchayat leaders) (n = 10). We sought to assess the feasibility and acceptability of delivering community-based postpartum family planning care in rural India at the time of infant vaccination. The Consolidated Framework for Implementation Research (CFIR) was used to design a structured interview guide and codebook. Data were analyzed via directed content analysis. RESULTS Three major themes emerged: (1) Social fertility and gender norms including son preference and male control over contraceptive decision-making influence postpartum contraceptive access and choice. (2) Linking contraceptive care and infant vaccination is perceived as potentially feasible and acceptable to implement by families, health workers, and community leaders. The intervention provides care to women and families in a convenient way where they are in their community. (3) Barriers and facilitators to linked infant postpartum contraception and infant vaccination were identified across the five CFIR domains. Key barriers included limited staff and space (inner setting), and contraceptive method targets for clinics and financial incentives for clinicians who provide specific methods (outer setting). Key facilitators included convenience of timing and location for families (intervention characteristics), the opportunity to engage husbands in decision-making when they attend infant vaccination visits (participant characteristics), and programmatic support from governmental and community leaders (process of implementation). CONCLUSIONS Linked provision of family planning and infant vaccination care may be feasible and accessible in rural India utilizing strategies identified to reduce barriers and facilitate provision of care. A gender-transformative intervention that addresses gender and social norms has greater potential to impact reproductive autonomy and couples' contraceptive decision-making.
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Affiliation(s)
- Sarah Averbach
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 9300 Campus Point Drive #7433, San Diego, La Jolla, CA 92037-7433, 92037, USA.
- Center on Gender Equity and Health, University of California San Diego School of Medicine, San Diego, La Jolla, CA, USA.
| | | | - Gennifer Kully
- Center on Gender Equity and Health, University of California San Diego School of Medicine, San Diego, La Jolla, CA, USA
| | - Melody Nazarbegian
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Mohan Ghule
- Center of Gender Equity and Health, University of California San Diego, Delhi, India
| | - Borsika A Rabin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, San Diego, La Jolla, CA, USA
| | - Nandita Bhan
- Center of Gender Equity and Health, University of California San Diego, Delhi, India
- Jindal School of Public Health and Human Development, OP Jindal Global University, Sonipat, Haryana, India
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Averbach S, Kully G, Hinz E, Dey A, Berkley H, Hildebrand M, Vaida F, Haider S, Hofler LG. Early vs Interval Postpartum Intrauterine Device Placement: A Randomized Clinical Trial. JAMA 2023; 329:910-917. [PMID: 36943214 PMCID: PMC10031390 DOI: 10.1001/jama.2023.1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/05/2023] [Indexed: 03/22/2023]
Abstract
Importance The early postpartum period, 2 to 4 weeks after birth, may be a convenient time for intrauterine device (IUD) placement; the placement could then coincide with early postpartum or well-baby visits. Objective To determine expulsion rates for IUDs placed early postpartum compared with those placed at the standard interval 6-week visit. Design, Setting, and Participants In this randomized noninferiority trial, people who had a vaginal or cesarean birth were randomly assigned to undergo early (14-28 days) or interval (42-56 days) postpartum IUD placement. Clinicians blinded to participant study group used transvaginal ultrasonography to confirm IUD presence and position at the 6-month postpartum follow-up. The study assessed 642 postpartum people from 4 US medical centers, enrolled a consecutive sample of 404 participants from March 2018 to July 2021, and followed up each participant for 6 months postpartum. Interventions Early postpartum IUD placement, at 2 to 4 weeks postpartum, vs standard interval placement 6 to 8 weeks postpartum. Main Outcomes and Measures The primary outcome was complete IUD expulsion by 6 months postpartum; the prespecified noninferiority margin was 6%. Secondary outcomes were partial IUD expulsion, IUD removal, pelvic infection, patient satisfaction, uterine perforation, pregnancy, and IUD use at 6 months postpartum. IUD malposition was an exploratory outcome. Results Among 404 enrolled participants, 203 participants were randomly assigned to undergo early IUD placement and 201 to undergo interval IUD placement (mean [SD] age, 29.9 [5.4] years; 46 [11.4%] were Black, 228 [56.4%] were White, and 175 [43.3%] were Hispanic). By 6 months postpartum, 53 participants (13%) never had an IUD placed and 57 (14%) were lost to follow-up. Among the 294 participants (73%) who received an IUD and completed 6-month follow-up, complete expulsion rates were 3 of 149 (2.0% [95% CI, 0.4%-5.8%]) in the early placement group and 0 of 145 (0% [95% CI, 0.0%-2.5%]) in the interval placement group (between-group difference, 2.0 [95% CI, -0.5 to 5.7] percentage points). Partial expulsion occurred in 14 (9.4% [95% CI, 5.2%-15.3%]) participants in the early placement group and 11 (7.6% [95% CI, 3.9%-13.2%]) participants in the interval placement group (between-group difference, 1.8 [95% CI, -4.8 to 8.6] percentage points). IUD use at 6 months was similar between the groups: 141 (69.5% [95% CI, 62.6%-75.7%]) participants in the early group vs 139 (67.2% [95% CI, 60.2%-73.6%]) in the interval group. Conclusions and Relevance Early IUD placement at 2 to 4 weeks postpartum compared with 6 to 8 weeks postpartum was noninferior for complete expulsion, but not partial expulsion. Understanding the risk of expulsion at these time points may help patients and clinicians make informed choices about the timing of IUD placement. Trial Registration ClinicalTrials.gov Identifier: NCT03462758.
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Affiliation(s)
- Sarah Averbach
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Complex Family Planning, University of California, San Diego, La Jolla
- Center on Gender Equity and Health, University of California, San Diego, La Jolla
| | - Gennifer Kully
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Complex Family Planning, University of California, San Diego, La Jolla
- Center on Gender Equity and Health, University of California, San Diego, La Jolla
| | - Erica Hinz
- Department of Obstetrics and Gynecology, Division of Complex Family Planning, University of Illinois at Chicago
| | - Arnab Dey
- Center on Gender Equity and Health, University of California, San Diego, La Jolla
| | - Holly Berkley
- Department of Gynecologic Surgery and Obstetrics, Naval Medical Center, San Diego, California
| | - Marisa Hildebrand
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Complex Family Planning, University of California, San Diego, La Jolla
| | - Florin Vaida
- School of Public Health, Division of Biostatistics, University of California, San Diego, La Jolla
| | - Sadia Haider
- Department of Obstetrics and Gynecology, Division of Complex Family Planning, University of Chicago, Chicago, Illinois
- Department of Obstetrics and Gynecology, Division of Complex Family Planning, Rush University, Chicago, Illinois
| | - Lisa G. Hofler
- Department of Obstetrics and Gynecology, Division of Complex Family Planning, University of New Mexico, Albuquerque
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Abstract
Equitable access to contraception and contraceptive education has the potential to mitigate health disparities related to unintended pregnancy. Pregnancy and the postpartum window frequently offer reduced insurance barriers to healthcare, increased interaction with healthcare systems and family planning providers, and an opportune time for many individuals to receive contraception; however, there are additional considerations in method type for postpartum individuals, and contraceptive counseling must be thoughtfully conducted to avoid coercion and promote shared decision-making. This commentary reviews method-specific considerations and suggests priorities for achieving equity in postpartum contraceptive access.
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Abstract
PURPOSE OF REVIEW This review will focus on those who are at greatest risk of maternal and neonatal morbidity from a subsequent unplanned or short interval pregnancy and the interventions to increase contraceptive uptake in the postpartum period. RECENT FINDINGS Populations at highest risk of maternal or neonatal morbidity - those with a history of preterm birth or those with complex medical conditions - are also those at the highest risk for unintended pregnancies attributed to low-efficacy contraceptive failure/ noncontraceptive use, and many are discharged from birth hospitalization without understanding the importance of birth spacing related to their high-risk pregnancies. Current innovative strategies to improve postpartum contraception access and uptake among high-risk populations include utilizing the antenatal period to initiate contraception counseling, developing multidisciplinary teams, and incorporating multimedia-based educational tools. However, ongoing challenges that continue to pose barriers to contraception access include racial and economic disparities and the restructuring of obstetric care during the COVID-19 pandemic. SUMMARY Preventing an unintended short interval pregnancy by providing contraception in the postpartum period is one of the most modifiable risk factors for those at highest risk of subsequent maternal or neonatal morbidity and therefore should be prioritized by clinicians, hospitals, and insurance coverage.
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Scott E, Casavan K, Swigonski N. Interconception Care and Safe Sleep: Adapting the IMPLICIT Toolkit for Pediatrics. Pediatrics 2021; 148:peds.2020-016253. [PMID: 34642233 DOI: 10.1542/peds.2020-016253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A woman's health in the interconception period has an impact on birth outcomes. Pediatric visits offer a unique opportunity to provide interconception care (ICC). Our aim was to screen and provide interconception and safe sleep screening, counseling, and interventions for 50% of caregivers of children <2 years of age in a pediatric medical setting. METHODS Two pediatric clinics implemented the March of Dimes' Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques (IMPLICIT) toolkit, in addition to standardized safe sleep assessments. A quality improvement learning collaborative was formed with a local "infant mortality champion" leading quality improvement efforts. Monthly webinars with the clinic teams reviewed project successes and challenges. Framework for Reporting Adaptations and Modifications was used to document adaptations. RESULTS For each individual IMPLICIT domain, clinics screened and provided needed interventions for ICC and safe sleep in >50% of eligible encounters. Over the course of the quality improvement learning collaborative, the number of caregivers screened for at least 4 of the 5 IMPLICIT domains increased from 0% to 95%. CONCLUSIONS To successfully implement the IMPLICIT toolkit in pediatrics, adaptations were made to the existing model, which had previously been used in family medicine clinics. Pediatricians should consider providing ICC as an innovative way to impact infant mortality rates in their community. Framework for Reporting Adaptations and Modifications can be used to systematically describe the adaptations needed to improve the fit of IMPLICIT in the pediatric clinic, understand the process of change and potential application to local context.
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Affiliation(s)
- Emily Scott
- School of Medicine, Indiana University, Indianapolis, Indiana .,Riley Children's Health, Indianapolis, Indiana
| | - Kara Casavan
- School of Medicine, Indiana University, Indianapolis, Indiana
| | - Nancy Swigonski
- School of Medicine, Indiana University, Indianapolis, Indiana.,Riley Children's Health, Indianapolis, Indiana.,Division of Health Policy and Management, Fairbanks School of Public Health, Indianapolis, Indiana
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12
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Handler A, Bergo C, Dominik B, Bier E, Caskey R. A two-generation approach to postpartum care: Building on the well-baby visit. Birth 2021; 48:347-356. [PMID: 33694183 DOI: 10.1111/birt.12544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although postpartum (PP) care is essential for the health and well-being of women and their infants, many women in the United States do not receive PP care. In order to ensure that women's PP needs are met, it is essential to develop delivery models that address their barriers to care. The objective of the current study was to obtain women's feedback and perspectives about delivering women's health care at the well-baby visit (WBV) using a modified mixed-methods approach including open-ended interviews and surveys. METHODS Twenty brief open-ended interviews were conducted with PP women at a large urban medical center in Chicago. The interviews were recorded, transcribed, and coded following a mixed deductive and inductive approach and analyzed using Dedoose. Following the interview analysis, surveys with 50 immediate PP women and 50 who were 2-4 months PP were conducted. Statistical analyses included frequencies and chi-square tests to determine differences between participants interviewed at the two time periods. RESULTS Key themes that emerged from the open-ended interviews include the tension between the desire for continuity of care (prenatal to PP) and the desire for convenient care. The surveys found that 86%-94% of women would be interested in receiving PP care at the same clinic site and time as their new baby. CONCLUSIONS One approach to addressing women's PP health and need for convenient care is the provision of components of women's health care at the WBV. Therefore, we present an innovative two-generation model for PP care focusing on needs of both the woman and infant.
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Affiliation(s)
| | - Cara Bergo
- University of Illinois at Chicago, Chicago, IL, USA
| | | | - Esther Bier
- University of Illinois at Chicago, Chicago, IL, USA
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Caskey RN, Olender SE, Zocchi A, Bergo CJ, Uesugi KH, Haider S, Handler AS. Addressing Women's Health Care Needs During Pediatric Care. WOMEN'S HEALTH REPORTS 2021; 2:227-234. [PMID: 34318292 PMCID: PMC8310745 DOI: 10.1089/whr.2021.0016] [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] [Accepted: 05/24/2021] [Indexed: 11/16/2022]
Abstract
Objective: To determine if the use of a simple self-administered Postpartum Questionnaire for Mothers (PQM) at the well-baby visit (WBV) increased the proportion of women who received health care and contraception by 6 months postpartum (PP). Methods: This was a single-site, system-level, intervention. Women were recruited from the pediatric clinic when presenting with their infants for a 2-month WBV. During phase 1 of the study, a control group was enrolled, followed by an 8-week washout period; then enrollment of the intervention group (phase 2). During phase 2, the PQM was administered and reviewed by the pediatrician during the infant's visit; the tool prompted the pediatrician to make a referral for the mother's primary or contraceptive care as needed. Data were collected at baseline and at 6 months PP, and additional data were extracted from the electronic medical record. Results: We found that PP women exposed to the PQM during their infant's WBV were more likely to have had a health care visit for themselves between 2 and 6 months PP, compared with the control group (relative risk [RR] 1.66, [confidence interval (CI) 0.91–3.03]). In addition, at 6 months PP, women in the intervention group were more likely to identify a primary care provider (RR 1.84, [CI 0.98–3.46]), and more likely to report use of long-acting reversible contraception (LARC) (RR 1.24, [CI 0.99–1.58]), compared with women in the control group. Conclusion: A simple self-administered PQM resulted in an increase in women's receipt of health care and use of LARC by 6 months PP. Clinical Trial Registration: Use of a reproductive life planning tool at the pediatric well-baby visit with postpartum women, NCT03448289.
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Affiliation(s)
- Rachel N Caskey
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sarah E Olender
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alejandra Zocchi
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cara J Bergo
- Center of Excellence in Maternal and Child Health, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Keriann H Uesugi
- Center of Excellence in Maternal and Child Health, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Arden S Handler
- Center of Excellence in Maternal and Child Health, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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Chor J, Haider S. Optimizing Access to Preventive Reproductive Health Care: Meeting Patients Where They Are At. Am J Public Health 2021; 111:209-211. [PMID: 33439700 PMCID: PMC7811098 DOI: 10.2105/ajph.2020.306043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Julie Chor
- The authors are with the Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Sadia Haider
- The authors are with the Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
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