U.S. Medical Eligibility Criteria for Contraceptive Use, 2010

Maternal Cardiovascular Health Post-Dobbs

Maternal Cardiovascular Health Post-DobbsPregnancy is associated with increasing morbidity and mortality in the United States. In the post-Dobbs era, many pregnant patients at highest risk no longer have access to abortion, which has been a crucial component of standard medical care.

Go the Distance

This overview of reproductive and sexual health care concerns for people with sickle cell disease (SCD) addresses clinical concerns that can be complex and are inherently multidisciplinary. Clinicians must be prepared to initiate reproductive health care discussions, as these intimate concerns may not be volunteered by patients. SCD is associated with delayed onset of puberty, sickle pain during menstruation, disease-specific contraceptive considerations, high-risk pregnancy, priapism, erectile dysfunction, and offspring who inherit a hemoglobinopathy trait from affected parents. Reproductive health considerations are underrecognized, undertreated, and understudied. They need attention in primary care and specialty SCD, urology, and obstetrics and gynecology clinics.

Health Care Provider Perceptions of the Safety of IUDs for Women with HIV

CONTEXT

Women who are living with HIV use IUDs at a lower rate than the general population, and it is unclear whether health care providers' misconceptions about IUD safety contribute to this disparity.

METHODS

A 2013-2014 nationwide survey of 1,998 U.S. family planning providers assessed perceptions of IUD safety for women with HIV or other medical conditions. Multivariable logistic regression was used to examine associations between provider characteristics and whether individuals believed IUDs were safe for HIV-positive women. Data from public-sector providers and office-based physicians were analyzed separately.

RESULTS

Seven in 10 providers considered IUDs safe for women with HIV, and there were no differences by provider type. Among public-sector providers, some of the characteristics associated with believing that IUDs were unsafe for seropositive women were working at a clinic without Title X funding (odds ratio, 1.5), not being trained in IUD insertion (2.1) and not using the U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) for clinical guidance (1.8). Office-based physicians who did not use the guidelines also had an increased likelihood of believing that IUDs were unsafe for women with HIV (2.9), and physicians who had completed training 25 or more years ago were more likely than those who had done so less than five years ago to consider IUDs unsafe (3.3).

CONCLUSIONS

Greater use of evidence-based contraceptive guidance such as the U.S. MEC may help inform provider perceptions of IUD safety and hence contribute to increased contraceptive choice for women with HIV.

Choosing the Right Oral Contraceptive Pill for Teens

Oral contraceptive pills (OCPs) continue to be the most commonly used form of prescription contraceptives used by adolescents in the United States. With proper use, oral contraceptives provide safe and effective birth control. Broad categories of OCPs include progestin-only pills (POPs) and combined oral contraceptive pills (COCs). Certain types of progestins have more potent antiandrogenic properties and are more effective in treating acne, hirsutism, and polycystic ovary syndrome. This article reviews types of OCPs, discusses risks and benefits of OCPs, and provides guidance for how to choose the most beneficial and appropriate OCP for individual adolescent patients.

Use of the intrauterine device among adolescent and young adult women in the United States from 2002 to 2010

PURPOSE

Long-acting contraceptives, such as the intrauterine device (IUD), show potential for decreasing the incidence of unintended pregnancy. However, use among adolescent and young adult women remains low. We determined factors associated with IUD use among young women.

METHODS

We conducted an analysis of nationally representative, cross-sectional data from the 2002 and 2006-2010 National Surveys of Family Growth. We included sexually active women 15-24 years old. We used bivariate analysis to compare proportions of ever-use of any type of IUD in 2002 and in 2006-2010 and multivariable logistic regression to identify correlates of ever-use in 2006-2010.

RESULTS

We found an increase in IUD use in teens 15-19 years old, from .2% to 2.5% (p < .001), and among women 20-24 years old, 2.0% to 5.4% (p < .001). Use increased among nearly all subgroups of respondents. Compared with nulliparous young women, those with one prior delivery and with two or more deliveries were substantially more likely to have used an IUD (adjusted OR 11.43, 95% CI 3.61-36.16, and adjusted OR 13.60, 95% CI 4-46.48, respectively). Young black women were less likely to report IUD use (adjusted OR .32, 95% CI .16-.66), and women whose mothers received at least a high school education were more likely to report use (adjusted OR 2.56, 95% CI 1.22-5.43).

CONCLUSIONS

IUD use is increasing among adolescent and young adult women overall and among almost all sociodemographic subgroups. Nonetheless, use remains low, and nulliparous young women are highly unlikely to use the IUD.