Unmet demand for short-acting hormonal and long-acting reversible contraception among community college students in Texas

Mental Health Distress and Delayed Contraception Among Older Adolescents and Young Adults

Background: Symptoms of mental distress increased sharply during the COVID-19 pandemic, especially among older adolescents and young adults. Mental health distress may make it more challenging for young people to seek other needed health care, including contraception. This study explored the association of symptoms of depression, anxiety, and stress with delays in getting a contraceptive method or prescription. Materials and Methods: Data from a supplementary study (May 15, 2020-March 20, 2023) to a cluster randomized trial in 29 sites in Texas and California were used. The diverse study sample included community college students assigned female at birth of ages 18-29 years (n = 1,665 with 7,023 observations over time). We measured the association of depression (CES-D [Center for Epidemiologic Studies Depression Scale]) or anxiety and stress (DASS-21 [Depression Anxiety Stress Scales]) symptoms with delayed contraceptive care-seeking with mixed-effects multivariable regression with random effects for individual and site. We controlled for age and sociodemographic factors important for access to care. Results: Over one-third of participants (35%) reported they delayed getting the contraceptive method they needed. Multivariable regression results showed increased odds of delayed contraceptive care among participants with symptoms of depression (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.27-1.96). Likewise, delays were associated with anxiety and stress symptoms (aOR 1.46, 95% CI 1.17-1.82). Adolescents were more likely to delay seeking contraception than young adults (aOR 1.32, 95% CI 1.07-1.63). Conclusions: Results showed a strong association between mental distress and delayed contraception. Interventions are needed to increase contraceptive access for young people delaying care, along with supportive mental health care services, including for adolescents who face elevated odds of delay. ClinicalTrials.gov Identifier: NCT03519685.

Unfulfilled and method-specific contraceptive preferences among reproductive-aged contraceptive users in Arizona, Iowa, New Jersey, and Wisconsin

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.

Modern contraceptive utilization and its associated factors in East Africa: Findings from multi-country demographic and health surveys

BACKGROUND

The use of modern contraceptives has been low in most Sub-Saharan African countries despite high population growth and a sluggish economy. This study aimed to identify the prevalence and determinants of modern contraceptive use among married reproductive-age women in East Africa.

METHODS

For this study, the Demographic and health survey (DHS) data from nine countries in East Africa were analyzed, yielding a weighted sample of 32,925 married women. A multilevel mixed-effect logistic regression model was used to identify characteristics associated with the utilization of modern contraceptives at a p-value less than 0.05. For model comparison, we used the Akaike and Bayesian Information Criteria (AIC and BIC). For assessing variation (random effects), we used community-level variance with standard deviation and intra-cluster correlation coefficient (ICC).

RESULTS

The overall prevalence of modern contraceptive use was 45.68%, 95% CI (45.15, 46.21). Women's age, maternal education level, husband education level, media exposure, wealth status, occupation, religion, the total number of children ever born, distance to health facilities, history of termination of pregnancy, couple's desire for children, women's participation in decision making, living country and place of residence were significantly associated with modern contraceptive use in Eastern Africa.

CONCLUSIONS

Conferring to this study, utilization of modern contraceptives is low in East Africa. Interventions to improve the use of modern contraceptives should encompass disseminating awareness through mass media, enrolment of males in family planning, giving maternal education, building health facilities in remote areas, and encouraging family planning programs in rural areas.

Balancing career goals and parenthood desires: results from a survey of undergraduate pre-health students at a hispanic-serving institution in Texas

OBJECTIVE

To examine family planning and fertility experiences and views, as well as desired parenthood timing and career plans, of diverse undergraduate pre-health students.

PARTICIPANTS

266 pre-health undergraduate students attending a Hispanic-Serving Institution in South Texas.

METHODS

We conducted a cross-sectional, online survey with a purposive sample of undergraduate students and analyzed data descriptively.

RESULTS

Most students desired children in the future but were concerned about planning the timing of parenthood against their career training. The results highlight the need to improve both family planning and fertility knowledge, based on a high unmet need for contraceptives, low perceived knowledge about fertility/infertility treatment, and a desire to learn more about planning the timing of their career training alongside parenthood.

CONCLUSIONS

This study highlights potential gaps in reproductive health information and services among diverse, health-focused students needed to inform choices about the timing of their families and career training.

Use of preferred contraceptive method among young adults in Texas and California: A comparison by state and insurance coverage

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.

Pediatric Resident Perspectives on Long-Acting Reversible Contraception Training: A Cross-Sectional Survey of Accreditation Council for Graduate Medical Education Trainees

PURPOSE

Although pediatricians are primary care providers for most adolescents, pediatric residents receive limited training on long-acting reversible contraceptive (LARC) methods. This study aimed to characterize pediatric resident comfort with placing contraceptive implants and intrauterine devices (IUDs) and assess pediatric resident interest in obtaining this training.

METHODS

Pediatric residents in the United States were invited to participate in a survey assessing comfort with LARC methods and interest in LARC training during pediatric residency. Bivariate comparisons used Chi-square and Wilcoxon rank sum testing. Multivariate logistic regression was used to assess associations between primary outcomes and covariates including geographic region, training level, and career plans.

RESULTS

Six hundred twenty seven pediatric residents across the United States completed the survey. Participants were predominantly female (68.4%, n = 429), self-identified their race as White (66.1%, n = 412), and anticipated a career in a subspecialty other than Adolescent Medicine (53.0%, n = 326). Most residents were confident counseling patients on the risks and benefits, side effects, and effective use of contraceptive implants (55.6%, n = 344) and both hormonal and nonhormonal IUDs (53.0%, n = 324). Few residents reported comfort with inserting contraceptive implants (13.6%, n = 84) or IUDs (6.3%, n = 39), with most of these respondents having learned these skills as a medical student. Most participants believed that residents should receive training on insertion of contraceptive implants (72.3%, n = 447) and IUDs (62.5%, n = 374).

DISCUSSION

Although most pediatric residents believe LARC training should be a component of pediatric residency training, few pediatric residents are comfortable with provision of this care.

Contraceptive Access and Use Among Undergraduate and Graduate Students During COVID-19: Online Survey Study

BACKGROUND

The COVID-19 pandemic led to widespread college campus closures in the months of March to June 2020, endangering students' access to on-campus health resources, including reproductive health services.

OBJECTIVE

To assess contraceptive access and use among undergraduate and graduate students in North Carolina during the COVID-19 pandemic.

METHODS

We conducted a cross-sectional web-based survey of undergraduate and graduate students enrolled at degree-granting institutions in North Carolina. Participants were recruited using targeted Instagram advertisements. The survey queried several aspects of participants' sexual behavior, including sex drive, level of sexual experience, number of sexual partners, digital sexual experience, dating patterns, and types of contraception used. Participants were asked to compare many of these behaviors before and after the pandemic. The survey also assessed several sociodemographic factors that we hypothesized would be associated with contraceptive use based on prior data, including educational background, sexual orientation and gender minority status (ie, lesbian, gay, bisexual, transgender, queer), health insurance status, race, ethnicity, degree of sensation seeking, religiosity, and desire to become pregnant.

RESULTS

Over 10 days, 2035 Instagram users began our survey, of whom 1002 met eligibility criteria. Of these 1002 eligible participants, 934 completed the survey, for a 93% completion rate. Our respondents were mostly female (665/934, 71%), cisgender (877/934, 94%), heterosexual (592/934, 64%), white (695/934 75%), not Hispanic (835/934, 89%), and enrolled at a 4-year college (618/934, 66%). Over 95% (895/934) of respondents reported that they maintained access to their preferred contraception during the COVID-19 pandemic. In a multivariable analysis, participants who were enrolled in a 4-year college or graduate program were less likely to lose contraceptive access when compared to participants enrolled in a 2-year college (risk ratio [RR] 0.34, 95% CI 0.16-0.71); in addition, when compared to cisgender participants, nonbinary and transgender participants were more likely to lose contraceptive access (RR 2.43, 95% CI 1.01-5.87). Respondents reported that they were more interested in using telehealth to access contraception during the pandemic. The contraceptive methods most commonly used by our participants were, in order, condoms (331/934, 35.4%), oral contraception (303/934, 32.4%), and long-acting reversible contraception (LARC; 221/934, 23.7%). The rate of LARC use among our participants was higher than the national average for this age group (14%). Emergency contraception was uncommonly used (25/934, 2.7%).

CONCLUSIONS

Undergraduate and graduate students in North Carolina overwhelmingly reported that they maintained access to their preferred contraceptive methods during the COVID-19 pandemic and through changing patterns of health care access, including telehealth. Gender nonbinary and transgender students and 2-year college students may have been at greater risk of losing access to contraception during the first year of the COVID-19 pandemic.

Meeting Preferences for Specific Contraceptive Methods: An Overdue Indicator

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.

Modern contraceptive utilisation and its associated factors among reproductive age women in high fertility regions of Ethiopia: a multilevel analysis of Ethiopia Demographic and Health Survey

OBJECTIVE

This study is aimed to assess the magnitude of modern contraceptives utilisation and associated factors among reproductive age women in high fertility regions of Ethiopia.

DESIGN

Cross-sectional study.

SETTING

High fertility regions of Ethiopian.

PARTICIPANTS

A total weighted sample of 3822 married reproductive age women.

METHODS

In this study, data were obtained from the recent Ethiopian Demographic and Health Surveys. A total weighted sample of 3822 women of reproductive age was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of modern contraceptive utilisation. Statistical significance was determined using adjusted OR (AOR) with 95% CI.

RESULTS

The overall modern contraceptive utilisation was 29.75% (95% CI 28.2% to 31.2%). Among the factors associated with utilisation were women's age 25-34 years (AOR 1.3; 95% CI 1.01 to 1.66) and ≥35 (AOR 1.71; 95% CI 1.37 to 2.70), husband's occupation (AOR 1.49; 95% CI 1.03 to 1.99), number of alive children: 1-4 (AOR 2.20; 95% CI 1.47 to 3.30), 5-8 (AOR 1.74; 95% CI 1.09 to 2.77), husband's desired number of children (AOR 0.77; 95% CI 0.61 to 0 .96), residency (AOR 2.37; 95% CI 1.20 to 4.67), community media exposure (AOR 1.77; 95% CI 1.01 to 3.08), region (AOR 0.13; 95% CI 0.03 to 0.52) and religion (AOR 0.49; 95% CI 0.36 to 0.66) were significantly associated with modern contraceptive utilisation.

CONCLUSION

Modern contraceptives utilisation in high fertility regions of Ethiopia was low. Women age, husband occupation, number of living children, husband's desired number of children, residency, community media exposure, region and religion were significantly associated with modern contraceptive utilisation. Therefore, to improve the utilisation of modern contraceptives, public health policy makers should consider creating awareness through mass media, male involvement in family planning, as well as family planning programmes, should be encouraged in rural areas.

Multilevel Influences on Providers' Delivery of Contraceptive Services: A Qualitative Thematic Analysis

Introduction:

Access to a full range of contraceptive services is essential for quality health care. Contraceptive provision practices of primary care providers play an important role in patients' decision-making about their reproductive health care. Understanding the multilevel factors influencing contraceptive care delivery in primary care settings is critical for advancing quality care. This study offers an in-depth examination of influences on providers' delivery of contraceptive services across multiple primary care specialties and practice settings to identify issues and strategies to improve care.

Materials and Methods:

Twenty-four in-depth face-to-face interviews were conducted in 2017 with primary care providers, including family physicians, gynecologists, pediatricians, and nurse practitioners from academic settings, private practices, and health centers. Interviews were transcribed and analyzed thematically.

Results:

Providers described a complex set of influences on their provision of contraception across multiple ecological contexts. Seven major themes emerged from the qualitative analysis, including six types of influence on provision of contraception: organizational, individual provider-related, structural and policy, individual patient-related, community, and the lack of influences or barriers. Providers also discussed the sources they access for information about evidence-based contraception counseling.

Conclusions:

A diverse set of providers described a complex system in which multiple concentric ecological contexts both positively and negatively influence the ways in which they provide contraceptive services to their patients. To close the gaps in contraceptive service delivery, it is important to recognize that both barriers and facilitators to patient-centered contraceptive counseling exist simultaneously across multiple ecological contexts.

How NPs can eliminate practice barriers to intrauterine device use

ABSTRACT

Barriers to intrauterine device use include cost, absence of qualified providers, the lack of simplified insertion protocols, cultural hesitation, and misconceptions of appropriateness of use. This article outlines how NPs can eliminate practice barriers to intrauterine device use and prevent unintended pregnancy.

Addressing long-acting reversible contraception access, bias, and coercion: supporting adolescent and young adult reproductive autonomy

PURPOSE OF REVIEW

Long-acting reversible contraception (LARC) is comprised of highly effective methods (the subdermal implant and intrauterine devices) available to adolescents and young adults (AYAs). Professional medical societies endorse LARC use in AYAs and, more recently, have emphasized the importance of using a reproductive justice framework when providing LARC. This article reviews reproductive justice, discusses contraceptive coercion, examines bias, and highlights interventions that promote equitable reproductive healthcare.

RECENT FINDINGS

Research indicates that both bias and patient characteristics influence provider LARC practices. AYA access to comprehensive LARC services is limited, as counseling, provision, management, and removal are not offered at all sites providing reproductive healthcare to AYAs. Interventions aimed at addressing provider bias and knowledge, clinic policies, confidentiality concerns, insurance reimbursement, and systems of oppression can improve AYA access to equitable, comprehensive contraceptive care. Additionally, the COVID-19 pandemic has exacerbated inequities in reproductive healthcare, as well as provided unique innovations to decrease barriers, including telemedicine LARC services.

SUMMARY

Clinicians who care for AYAs should honor reproductive autonomy by approaching contraceptive services with a reproductive justice lens. This includes implementing patient-centered contraceptive counseling, increasing access to LARC, eliminating barriers to LARC removal, and committing to systemic changes to address healthcare inequities.

Concerns About the Cost of Contraception Among Young Women Attending Community College

INTRODUCTION

Contraceptive use is lower among students attending community college than 4-year college students, which may be due to financial barriers to accessing contraceptives. This study examined insurance coverage, access to free or low-cost birth control, and concerns about contraceptive costs among women in community college.

METHODS

We analyzed data from a study conducted at five community colleges in California and Oregon, which have expanded Medicaid coverage of family planning services for low-income individuals. Participants were students aged 18-25 years who self-identified as female, had vaginal sex, and were not pregnant or trying to become pregnant (N = 389). Multivariate analyses were conducted to examine concerns about the cost of contraception among these young women and how cost concerns varied by insurance coverage and access to free or low-cost birth control.

RESULTS

Nearly one-half of participants (49%) were concerned about the cost of contraception. In multivariate models, privately insured women had lower odds of being concerned about the cost of birth control than the uninsured (adjusted odds ratio, 0.42; 95% confidence interval, 0.22-0.83), yet women with public insurance had cost concerns similar to those of women without insurance. Women who reported they knew where to get free or low-cost birth control had lower odds of reporting cost concerns (adjusted odds ratio, 0.42; 95% confidence interval, 0.24-0.75), as did the few women enrolled in a state family planning program (adjusted odds ratio, 0.56; 95% confidence interval, 0.32-1.00).

CONCLUSIONS

Even in states with publicly funded services for young people, concerns about the affordability of contraception were common among women, particularly the uninsured or publicly insured. Addressing students' cost concerns is an important aspect of ensuring access to contraception during their pursuit of higher education.

Are rural Malawian women using their preferred contraceptive method and that of their male partners?

OBJECTIVES

To measure the agreement between women's current contraceptive use and her preferred method, as well as her partner's preferred method.

STUDY DESIGN

We used the fourth wave of survey data (2017-2018) from the Umoyo wa Thanzi (UTHA) cohort study of sexual and reproductive health decision making. The prevalence of concordance between women's current method and her preferred method was calculated (n = 818). Among partnered women, we calculated prevalence of concordance between women's current method and her partner's preferred method (n = 719). We used multivariate logistic regression analyses to assess the relationship between women's characteristics and the outcomes.

RESULTS

Despite high prevalence of modern contraceptive use (74.4%), many women were using methods that did not match their preferences (62.6%) or those of their partners (62.3%). Fifty-five percent of women with preference-use discordance preferred methods that were more effective than theirs. Satisfaction with current family planning choice (adjusted odds ratio [aOR], > 5.5 each) and pregnancy desires (aOR, >1.5 each) were strong predictors of both concordance between women's current method and her preferred method and her partner's preferred method. Women who reported higher sexual frequency in past month had elevated odds of concordance between her current and preferred method (aOR: 1.97 for 9+times in past months) than women who had not had sex.

CONCLUSIONS

Many Malawian women are not using methods they or their partners prefer. Women desiring pregnancy, women reporting infrequent sex, and women who are not satisfied with their method are likely to prefer a different method than the one they are currently using.

IMPLICATIONS

Understanding women's preferences can assist with family planning service provision. Health care providers and researchers should consider the specific methods that women and their partners prefer to use, besides whether they are using any method.

Use of nonpreferred contraceptive methods among women in Ohio

OBJECTIVES

We describe the prevalence and correlates of nonuse of preferred contraceptive method among women 18-44 years of age in Ohio using contraception.

STUDY DESIGN

The population-representative Ohio Survey of Women had 2529 participants in 2018-2019, with a response rate of 33.5%. We examined prevalence of preferred method nonuse, reasons for nonuse, and satisfaction with current method among current contraception users (n = 1390). We evaluated associations between demographic and healthcare factors and preferred method nonuse.

RESULTS

About 25% of women reported not using their preferred contraceptive method. The most common barrier to obtaining preferred method was affordability (13%). Those not using their preferred method identified long-acting methods (49%), oral contraception (33%), or condoms (21%) as their preferred methods. The proportion using their preferred method was highest among intrauterine device (IUD) users (86%) and lowest among emergency contraception users (64%). About 16% of women using permanent contraception reported it was not their preferred method. Having the lowest socioeconomic status (versus highest) (prevalence ratio [PR]: 1.47, 95% CI: 1.11-1.96), Hispanic ethnicity (versus non-Hispanic white) (PR: 1.83, 95% CI: 1.15-2.90), reporting poor provider satisfaction related to contraceptive care (PR: 2.33, 95% CI: 1.02-5.29), and not having a yearly women's checkup (PR: 1.31, 95% CI: 1.01-1.68) were significantly associated with nonuse of preferred method. Compared to preferred-method nonusers, higher proportions of preferred-method users reported consistent contraceptive use (89% vs. 73%, p < 0.001) and intent to continue use (79% vs. 58%, p < 0.001).

CONCLUSIONS

Affordability and poor provider satisfaction related to contraceptive care were associated with nonuse of preferred contraceptive method. Those using their preferred method reported more consistent use.

IMPLICATIONS

Cost is an important barrier for women in obtaining their preferred contraceptive methods. Low quality birth control care may also be a barrier to preferred-method use. Removal of cost barriers and improvement in contraceptive counseling strategies may increase access to preferred contraceptive methods.

Improving Capacity at School-based Health Centers to Offer Adolescents Counseling and Access to Comprehensive Contraceptive Services

STUDY OBJECTIVES

Many pediatric providers serving adolescents are not trained to offer comprehensive contraceptive services, including intrauterine devices (IUDs) and implants, despite high safety and satisfaction among adolescents. This study assessed an initiative to train providers at school-based health centers (SBHCs) to offer students the full range of contraceptive methods.

DESIGN

Surveys were administered at baseline pre-training and at follow-up 3 months post-training. Data were analyzed using generalized estimating equations for clustered data to examine clinical practice changes.

SETTING

Eleven contraceptive trainings at SBHCs across the United States from 2016-2019.

PARTICIPANTS

A total of 260 providers from 158 SBHCs serving 135,800 students.

INTERVENTIONS

On-site training to strengthen patient-centered counseling and to equip practitioners to integrate IUDs and implants into contraceptive services.

MAIN OUTCOME MEASURES

The outcomes included counseling experience on IUDs and implants, knowledge of patient eligibility, and clinician method skills.

RESULTS

At follow-up, providers were significantly more likely to report having enough experience to counsel on IUDs (adjusted odds ratio [aOR], 4.08; 95% confidence interval [CI], 2.62-6.36]) and implants (aOR, 3.06; 95% CI, 2.05-4.57). Provider knowledge about patient eligibility for IUDs, including for adolescents, increased (P < .001). Providers were more likely to offer same-visit IUD (aOR, 2.10; 95% CI, 1.41-3.12) and implant services (aOR, 1.66; 95% CI, 1.44-1.91). Clinicians' skills with contraceptive devices improved, including for a newly available low-cost IUD (aOR, 2.21; 95% CI, 1.45-3.36).

CONCLUSIONS

Offering evidence-based training is a promising approach to increase counseling and access to comprehensive contraceptive services at SBHCs.

Differences in abortion rates by race-ethnicity after implementation of a restrictive Texas law

OBJECTIVE

To evaluate the association between a restrictive Texas law, House Bill 2 (HB2), and receipt of in-clinic abortion by patient's race-ethnicity.

STUDY DESIGN

In this retrospective cohort study, we collected Texas state statistics on number of abortions, abortions per county, and abortions per county by race-ethnicity for 2012, before HB2 was enacted, and 2015, after HB2 was in effect. Using female reproductive-aged population estimates, we calculated the abortion rate and percent change in the abortion rate between the two time periods by county, patient residence in a county with an open clinic or HB2-related clinic closure, and change in distance to an open clinic for each race-ethnicity. We also used geospatial analyses to depict the greatest decrease in abortion rate by race-ethnicity and county.

RESULTS

In Texas, there were 64,716 reported abortions in 2012 and 54,253 in 2015. Statewide, there was a 20% decrease in the abortion rate affecting all racial-ethnic groups, yet the reduction was greater among Hispanic women compared to White women (-25% vs. -16%, respectively). The abortion rate also decreased more among those living in a county with an HB2-related clinic closure, especially for Hispanic women (-41% Hispanic vs. -29% White vs. -30% Black vs. -3% Other). Hispanic women whose travel distance increased 100+ miles had the greatest reduction in the abortion rate (-43%). Geospatial mapping confirmed our quantitative findings.

CONCLUSION

HB2 led to a disproportionate reduction in the abortion rate among Hispanic women in Texas, including those living in counties with a closed clinic or traveling long distances to obtain in-clinic abortion care.

IMPLICATIONS

Restrictive abortion policies in Texas may disproportionately burden Hispanic women and those affected by clinic closures.

Changes in young women’s contraceptive use in the Netherlands: findings from three sex under the age of 25 surveys

Prevention of unintended pregnancy among adolescents and young adults under 25 years is pivotal from an individual as well as societal perspective. In the USA, the use of long-acting reversible contraceptive (LARC) has been shown to increase, with no or little change in the use of short-acting reversible contraceptive (SARC). We assessed trends in no contraceptive, SARC, and LARC use by young women, aged between 12 and 25 years, and differences in trends within demographic groups (age, religion, ethnic background, and educational level) among these young women in the Netherlands. Data of sexually active young women aged 12–25 years from three cross-sectional representative surveys, 2005, 2012, and 2017, were used for this study. In total, 11,229 Dutch young women were included with a median age of 20 years (interquartile range 18–23 years). Overall, the proportion of young women using SARC decreased significantly between 2005 and 2017 from 88 to 76%. LARC use increased significantly between 2005 and 2017 from 3 to 16%. These trends varied by religious groups and educational level, emphasizing potential for tailored preventative measures for these groups. A shift towards LARC use might eventually lead to a further decrease in unwanted pregnancy and potentially abortion because of the lower risk of user errors.

Agreement between Self-Reported "Ideal" and Currently Used Contraceptive Methods among Women Veterans Using the Veterans Affairs Healthcare System

BACKGROUND

Women veterans who use the Veterans Affairs Healthcare System theoretically have access to the full range of contraceptive methods. This study explores match between currently used and self-reported "ideal" methods as a potential marker of contraceptive access and preference matching.

METHODS

This mixed methods study uses data from a nationally representative survey of reproductive-aged women veterans who use the Veterans Affairs Healthcare System for primary care, including 979 participants at risk of unintended pregnancy. Women reported all contraceptive methods used in the past month and were asked, "If you could choose any method of contraception or birth control to prevent pregnancy, what would be your ideal choice?" and selected a single "ideal" method. If applicable, participants were additionally asked, "Why aren't you currently using this method of contraception?" We used adjusted logistic regression to identify patient-, provider-, and system-level factors associated with ideal-current method match. We qualitatively analyzed open-ended responses about reasons for ideal method nonuse.

RESULTS

Overall, 58% were currently using their ideal method; match was greatest among women selecting an IUD as ideal (73%). Non-White race/ethnicity (adjusted odds ratio, 0.68; 95% confidence interval, 0.52-0.89) and mental illness (adjusted odds ratio, 0.69; 95% confidence interval, 0.52-0.92) were negatively associated with ideal-current match in adjusted analyses; the presence of a gynecologist at the primary care site was associated with an increased odds of match (adjusted odds ratio, 1.35; 95% confidence interval, 1.03-1.75). Modifiable barriers to ideal method use were cited by 23% of women, including access issues, cost concerns, and provider-level barriers; 79% of responses included nonmodifiable reasons for mismatch including relationship factors and pregnancy plans incongruent with ideal method use, suggesting limitations of our measure based on differential interpretation of the word "ideal."

CONCLUSIONS

Many women veterans are not currently using the contraceptive method they consider ideal. Results emphasize the complexity of contraceptive method selection and of measuring contraceptive preference matching.

Pregnancy Intentions, Contraceptive Knowledge And Educational Aspirations Among Community College Students

CONTEXT

Community college students, representing more than one-third of U.S. undergraduates, are a diverse population of young people motivated to seek higher education who are at elevated risk of unintended pregnancy. However, it is unknown how well prepared they are to prevent pregnancy and what they think about it in terms of their educational aspirations.

METHODS

In-depth interviews were conducted with 57 students aged 18-25, inclusive of all genders, in three community colleges in California in 2015. Content analysis was used to code data and identify themes.

RESULTS

All participants reported strong desires to prevent pregnancy in the next year and perceived their pregnancy risk as low, but many reported unprotected sex with opposite-sex partners. Participants had specific timelines for completing their degrees and believed pregnancy would make that far more challenging, but would not ultimately prevent them from achieving their goals. Female students expressed concern about the risks of exacerbated poverty, housing instability and unachieved career goals. Participants had little knowledge of their pregnancy risks and of the health benefits, side effects or effectiveness of contraceptives. They held negative beliefs about hormonal contraception (including emergency contraception, IUDs and the implant), fearing long-lasting effects and infertility. Gay or bisexual students shared concerns about contraceptives, although several were using methods for noncontraceptive reasons.

CONCLUSION

Many community college students not desiring pregnancy have limited awareness of pregnancy risk and prevention.