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Meille G, Monnet JN. Catholic Hospital Affiliation and Postpartum Contraceptive Care and Subsequent Deliveries. JAMA Intern Med 2024; 184:493-501. [PMID: 38436965 PMCID: PMC10912998 DOI: 10.1001/jamainternmed.2023.8425] [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: 09/12/2023] [Accepted: 12/18/2023] [Indexed: 03/05/2024]
Abstract
Importance In recent years, the number of Catholic hospitals has grown, raising concerns about access to contraception. The association between living in an area in which the closest hospital is Catholic and the probability of postpartum contraception and subsequent deliveries is unknown. Objective To assess whether living in an area in which the closest hospital was Catholic was associated with the probability of postpartum contraception and subsequent deliveries. Design, Setting, and Participants This cohort study used data from the Healthcare Cost and Utilization Project's State Inpatient Databases, State Emergency Department Databases, and State Ambulatory Surgery and Services Databases for 11 states (California, Florida, Georgia, Missouri, Nebraska, Nevada, New York, South Carolina, Tennessee, Vermont, and Wisconsin). Female patients with a delivery from 2016 to 2019 who lived within 20 miles of a nonfederal acute care hospital were included, with patients followed up for 1 to 3 years. Coarsened exact matching was used to match patients based on the county-level percentage of the population affiliated with Catholic churches and urbanicity, and the zip code-level number of hospitals within 5 and 20 miles, median household income, and percentage of the population by race and ethnicity. Data were analyzed from April 2022 to November 2023. Exposures Residence in a zip code in which the closest hospital was Catholic. Main Outcomes and Measures Probabilities of delivery at a Catholic hospital, surgical sterilization within 1 year of delivery, receipt of long-acting reversible contraception at delivery, and subsequent delivery within 3 years. Results The sample consisted of 4 101 443 deliveries (1 301 792 after matching), with 14.5% of patients living in exposed zip codes (ie, where the closest hospital was Catholic). Living in exposed zip codes was associated with a 21.26-percentage point (pp) increase in the probability of delivery at a Catholic hospital (95% CI, 19.50 to 23.02 pp; 237.3% relative to the mean in unexposed zip codes; P < .001). Additionally, comparing exposed vs unexposed zip codes, the probability of surgical sterilization at delivery decreased by 0.95 pp (95% CI, -1.14 to -0.76 pp; P < .001) and the probability of sterilization in the year after discharge further decreased by 0.21 pp (95% CI, -0.29 to -0.13; P < .001). Subsequent deliveries within 3 years increased 0.47 pp (95% CI, -0.03 to 0.97 pp; 2.3% relative to the mean in unexposed zip codes; P = .07). Conclusions and Relevance This cohort study finds that living in a zip code in which the closest hospital was Catholic was associated with a modest decrease in the probability of postpartum surgical sterilizations and a modest increase in the probability of subsequent deliveries.
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Affiliation(s)
- Giacomo Meille
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - Jessica N. Monnet
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
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Berg KA, Bullington BW, Gunzler DD, Miller ES, Boozer M, Serna T, Bailit JL, Arora KS. Neighbourhood socioeconomic position, prenatal care and fulfilment of postpartum permanent contraception: Findings from a multisite cohort study. REPRODUCTIVE, FEMALE AND CHILD HEALTH 2024; 3:e64. [PMID: 38737484 PMCID: PMC11087039 DOI: 10.1002/rfc2.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/10/2023] [Indexed: 05/14/2024]
Abstract
Introduction Research suggests neighbourhood socioeconomic vulnerability is negatively associated with women's likelihood of receiving adequate prenatal care and achieving desired postpartum permanent contraception. Receiving adequate prenatal care is linked to a greater likelihood of achieving desired permanent contraception, and access to such care may be critical for women with Medicaid insurance given that the federally mandated Medicaid sterilization consent form must be signed at least 30 days before the procedure. We examined whether adequacy of prenatal care mediates the relationship between neighbourhood socioeconomic position and postpartum permanent contraception fulfilment, and examined moderation of relationships by insurance type. Methods This secondary analysis of a retrospective cohort study examined 3012 Medicaid or privately insured individuals whose contraceptive plan at postpartum discharge was permanent contraception. Path analysis estimated relationships between neighbourhood socioeconomic position (economic hardship and inequality, financial strength and educational attainment) and permanent contraception fulfilment by hospital discharge, directly and indirectly through adequacy of prenatal care. Multigroup testing examined moderation by insurance type. Results After adjusting for age, parity, weeks of gestation at delivery, mode of delivery, race, ethnicity, marital status and body mass index, having adequate prenatal care predicted achieving desired sterilization at discharge (β = 0.065, 95% confidence interval [CI]: 0.011, 0.117). Living in neighbourhoods with less economic hardship (indirect effect -0.007, 95% CI: -0.015, -0.001), less financial strength (indirect effect -0.016, 95% CI: -0.030, -0.002) and greater educational attainment (indirect effect 0.012, 95% CI: 0.002, 0.023) predicted adequate prenatal care, in turn predicting achievement of permanent contraception by discharge. Insurance status conditioned some of these relationships. Conclusion Contact with the healthcare system via prenatal care may be a mechanism by which neighbourhood socioeconomic disadvantage affects permanent contraception fulfilment, particularly for patients with Medicaid. To promote reproductive autonomy and healthcare equity, future inquiry and policy might closely examine how neighbourhood social and economic characteristics interact with Medicaid mandates.
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Affiliation(s)
- Kristen A. Berg
- Center for Health Care Research and Policy, Population Health Research Institute, MetroHealth Medical System, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Brooke W. Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Douglas D. Gunzler
- Center for Health Care Research and Policy, Population Health Research Institute, MetroHealth Medical System, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Emily S. Miller
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Margaret Boozer
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tania Serna
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, USA
| | - Jennifer L. Bailit
- Department of Obstetrics and Gynecology, MetroHealth Medical System, Cleveland, Ohio, USA
| | - Kavita S. Arora
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
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Viswanathan AV, Berg KA, Bullington BW, Miller ES, Boozer M, Serna T, Bailit JL, Arora KS. Documentation of prenatal contraceptive counseling and fulfillment of permanent contraception: a retrospective cohort study. Reprod Health 2024; 21:23. [PMID: 38355541 PMCID: PMC10865696 DOI: 10.1186/s12978-024-01752-x] [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: 08/12/2023] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Barriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling. METHODS This is a planned secondary analysis of a multi-site cohort study of patients with documented desire for permanent contraception at the time of delivery at four hospitals located in Alabama, California, Illinois, and Ohio over a two-year study period. Our primary exposure was initial timing of documented plan for contraception (first, second, or third trimester, or during delivery hospitalization). We used univariate and multivariable logistic regression to analyze fulfillment of permanent contraception before hospital discharge, within 42 days of delivery, and within 365 days of delivery between patients with a documented plan for permanent contraception in the first or second trimester compared to the third trimester. Covariates included insurance status, age, parity, gestational age, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index. RESULTS Of the 3103 patients with a documented expressed desire for permanent contraception at the time of delivery, 2083 (69.1%) had a documented plan for postpartum permanent contraception prenatally. After adjusting for covariates, patients with initial documented plan for permanent contraception in the first or second trimester had a higher odds of fulfillment by discharge (aOR 1.57, 95% C.I 1.24-2.00), 42 days (aOR 1.51, 95% C.I 1.20-1.91), and 365 days (aOR 1.40, 95% C.I 1.11-1.75), compared to patients who had their first documented plan in the third trimester. CONCLUSIONS Patients who had a documented prenatal plan for permanent contraception in trimester one and two experienced higher likelihood of permanent contraception fulfillment compared to those with documentation in trimester three. Given the barriers to accessing permanent contraception, it is imperative that comprehensive, patient-centered counseling and documentation regarding future reproductive goals begin early prenatally.
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Affiliation(s)
- Ambika V Viswanathan
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, 27516, USA
| | - Kristen A Berg
- Center for Health Care Research and Policy, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Brooke W Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27516, USA
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Margaret Boozer
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Tania Serna
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Jennifer L Bailit
- Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH, 44016, USA
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, 27516, USA.
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Permanent Contraception: Ethical Issues and Considerations: ACOG Committee Statement No. 8. Obstet Gynecol 2024; 143:e31-e39. [PMID: 38237165 DOI: 10.1097/aog.0000000000005474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Permanent contraception is the most used method of contraception among women aged 15-49 years and is one of the most straightforward surgical procedures an obstetrician-gynecologist can perform. At the same time, this therapeutic option is enormously complex when considered from a historical, sociological, or ethical perspective. This Committee Statement reviews ethical issues related to permanent contraception using a reproductive justice framework. Ethical counseling and shared decision making for permanent contraception should adopt a nonjudgmental, patient-centered approach, using up-to-date information about permanent contraception procedures and alternatives. Obstetrician-gynecologists should strive to avoid bringing into the clinical encounter biases around gender, race, age, and class that affect thoughts on who should or should not become a parent. Obstetrician-gynecologists should also ensure that permanent contraception requests reflect each patient's wishes, come from a desire to permanently end childbearing, and come from a preference for permanent contraception over all reversible methods as well as permanent contraception for the male partner. When difficulties in meeting a postpartum permanent contraception request are anticipated and permanent contraception is desired by the patient, transfer of care for the remainder of pregnancy should be offered. ACOG recognizes the right of all patients to unimpeded access to permanent contraception as a way of ensuring health equity, but it is unclear how to craft policies that protect from coercion but also do not create barriers to autonomously desired care. Determining the ethical balance between access and safeguards will require a collaborative interdisciplinary approach that involves a variety of stakeholders with varying perspectives.
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McCarley CB, Boitano TK, Dilley SE, Subramaniam A. Complete Compared With Partial Salpingectomy for Postpartum Sterilization. Obstet Gynecol 2023; 142:1347-1356. [PMID: 37884007 DOI: 10.1097/aog.0000000000005416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/24/2023] [Indexed: 10/28/2023]
Abstract
In this narrative review, we describe evidence regarding the associated risks, benefits, and cost effectiveness of postpartum complete salpingectomy compared with partial salpingectomy. Permanent contraception can be performed via several methods, but complete salpingectomy is becoming more common secondary to its coincident benefit of ovarian cancer risk reduction. Small prospective studies and larger retrospective cohort studies have demonstrated the feasibility and safety of complete salpingectomy in the postpartum period. Additionally, multiple cost-effectiveness analyses have demonstrated the cost effectiveness of this method secondary to ovarian cancer reduction over the life span. Although future larger cohort studies will allow for more precise estimates of the effect of complete salpingectomy on ovarian cancer risk and incidence of rare complications, current data suggest that complete salpingectomy should be offered to patients as a method of permanent contraception in the postpartum period.
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Affiliation(s)
- Charlotte B McCarley
- Division of Maternal Fetal Medicine and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama; and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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Phaloprakarn C, Suthasmalee S. Effect of prenatal counseling on postpartum follow-up and contraceptive use in women with gestational diabetes mellitus: a randomized controlled trial. Am J Obstet Gynecol MFM 2023; 5:101107. [PMID: 37527735 DOI: 10.1016/j.ajogmf.2023.101107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Postpartum visit attendance for glucose screening and uptake of effective contraception is crucial after a pregnancy with gestational diabetes mellitus. Although postpartum women with recent gestational diabetes mellitus are generally advised in the early postnatal period to attend postpartum visits, data have shown suboptimal rates of postpartum glucose testing and of highly effective contraceptive use among these women. Compared with the early postnatal period, the antenatal period is when women and healthcare providers have more contact. This may facilitate a better relationship between the pregnant woman and her healthcare providers, thereby improving the women's trust in the providers' counseling. OBJECTIVE This study aimed to investigate if adding prenatal counseling to routine, early-postnatal counseling increases the rates of glucose screening and contraceptive use by 6 weeks postpartum among pregnant women with gestational diabetes mellitus. STUDY DESIGN A randomized controlled trial of 280 women diagnosed with gestational diabetes mellitus was conducted. Participants were randomly allocated (1:1, stratified using a permuted block method) to the intervention group (receiving prenatal counseling at 35-36 weeks of gestation plus routine, early-postnatal counseling) or the control group (receiving only routine, early-postnatal counseling). The 2 primary outcomes were glucose screening and highly effective contraceptive uptake by 6 weeks postpartum. The secondary outcome was the use of any contraceptive by 6 weeks postpartum. Data were analyzed according to the intention-to-treat principle. RESULTS The rate of postpartum glucose screening was 86.4% (121/140) in the intervention group, which was significantly higher than the rate of 50.7% (71/140) in the control group (adjusted relative risk, 1.70; 95% confidence interval, 1.27-2.28). The uptake of highly effective contraceptive methods was increased in the intervention group when compared with the control group (59.3% vs 30.7%; adjusted relative risk, 1.90; 95% confidence interval, 1.31-2.74). The uptake of any contraceptive method by 6 weeks postpartum was reported by 122 of 140 participants (87.1%) in the intervention group and by 77 of 140 participants (55.0%) in the control group (adjusted relative risk, 1.58; 95% confidence interval, 1.19-2.10). CONCLUSION Adding prenatal counseling to routine, early-postnatal counseling significantly increased the rates of glucose screening and contraceptive use by 6 weeks postpartum among pregnant women with gestational diabetes mellitus. Given that the incorporation of counseling on postpartum glucose testing and effective contraceptive use into standard prenatal care requires minimal increases in expenditure and manpower, implementation of this counseling strategy in clinical practice seems advisable.
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Affiliation(s)
- Chadakarn Phaloprakarn
- Faculty of Medicine Vajira Hospital, Department of Obstetrics and Gynecology, Navamindradhiraj University, Bangkok, Thailand.
| | - Sasiwan Suthasmalee
- Faculty of Medicine Vajira Hospital, Department of Obstetrics and Gynecology, Navamindradhiraj University, Bangkok, Thailand
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Thaxton L, Hofler LG. Prenatal Contraceptive Counseling. Obstet Gynecol Clin North Am 2023; 50:509-523. [PMID: 37500213 DOI: 10.1016/j.ogc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Pregnancy care should include open discussions with patients about their ideal family size and pregnancy spacing. With these patient-voiced goals in mind, clinicians should review contraceptive tools to meet these goals, including special considerations after birth. For patients that desire contraception, it is important to prioritize the provision of their chosen method as soon as safely possible and desired after birth.
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Affiliation(s)
- Lauren Thaxton
- Department of Women's Health, Dell Medical School, University of Texas, 2508 Greenlawn Parkway, Austin, TX 78757, USA
| | - Lisa G Hofler
- Department of Obstetrics & Gynecology, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC10 5580, Albuquerque, NM 87131, USA.
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Akintunde T, Howard J, Wilson D, Gore A, Morton C, Hebbar L, Goodier C, Alfred MC. Racial and ethnic disparities in long-term contraception use among the birthing population at an academic hospital in the Southeastern United States. PROCEEDINGS OF THE HUMAN FACTORS AND ERGONOMICS SOCIETY ... ANNUAL MEETING. HUMAN FACTORS AND ERGONOMICS SOCIETY. ANNUAL MEETING 2023; 67:609-613. [PMID: 38214000 PMCID: PMC10782179 DOI: 10.1177/21695067231192873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Ensuring women and birthing people have access to the contraceptive of their choice is essential for patient-centered care, health equity, and reproductive justice. While trends in national data in the United States reveal racial disparities in long-term contraceptive use, health-system and hospital-level investigations are essential to understand disparities and encourage interventions. We used data from 5011 patients who delivered at a large academic hospital to determine the effect of race/ethnicity and social vulnerability index (SVI) on the odds of undergoing a long-term contraceptive procedure. Results indicate that SVI substantially affects the odds of long-term contraception for non-Hispanic White women and birthing people. In contrast, Hispanic and non-Hispanic Black women and birthing people have significantly higher odds of undergoing a long-term contraceptive procedure due to race/ethnicity. Contributions to these disparities may be based on factors including healthcare providers, organizational and external policies. Interventions at all levels of care are essential to address disparities in contraceptive care, outcomes, and patient experience.
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Affiliation(s)
| | - Jeffrey Howard
- The University of Texas at San Antonio, San
Antonio, TX, USA
| | - Dulaney Wilson
- Medical University of South Carolina,
Charleston, SC, USA
| | - Amartha Gore
- Children's Mercy Hospitals, Junction City,
KS, USA
| | | | - Latha Hebbar
- Medical University of South Carolina,
Charleston, SC, USA
| | - Chris Goodier
- Medical University of South Carolina,
Charleston, SC, USA
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Yusuf F, Leeder SR. Trends in female sterilisations in New South Wales, 2010-2019. Aust N Z J Obstet Gynaecol 2023; 63:571-576. [PMID: 37254784 DOI: 10.1111/ajo.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/24/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Female sterilisation remains a common contraceptive method in many countries. AIMS The aim is to analyse the recent changes in the incidence of female sterilisation in New South Wales (NSW). METHODS Data were obtained from the NSW Admitted Patients Data Collection for all female patients who had undergone one of the five sterilisation procedures in a public or private hospitals in NSW during 2010 and 2019. Denominators for calculating sterilisation rates were estimated using census and other population data. RESULTS The number of sterilisation cases dropped from 3407 in 2010 to 2561 in 2019, and the sterilisation rate declined from 22.6 per 10 000 females aged 20-49 in 2010 to 15.4 in 2019. Incidence was at its peak in the 35-39 age group in both years. Indigenous females had higher sterilisation rates than non-Indigenous females born in Australia or overseas. While some foreign-born females had higher sterilisation rates than for those who were in Australia or overseas on average their rates were lower than those who were born in Australia or overseas. There was a clear socio-economic gradient such that females living in the most disadvantaged areas had much higher sterilisation rates than those living in the least disadvantaged areas. The Indigenous, ethnic and socio-economic differences in sterilisation rates persisted in both years of this study. CONCLUSION Although fertility rates in NSW changed little over the 10-year interval a steady decline in sterilisation occurred, consistent with other forms of contraception (particularly long-acting reversible types) increasing concurrently in popularity.
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Affiliation(s)
- Farhat Yusuf
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Management, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Stephen Ross Leeder
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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An assessment of postpartum contraception rates with evolving care during the COVID-19 pandemic. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100844. [PMID: 37031561 PMCID: PMC10077763 DOI: 10.1016/j.srhc.2023.100844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 02/07/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023]
Abstract
Objective The COVID-19 pandemic presented new care delivery obstacles in the form of scheduling procedures and safe presentation to in-person visits. Contraception provision is an indispensable component of postpartum care that was not immune to these challenges. Given the barriers to care during the initial months of the pandemic, we sought to examine how postpartum contraception, sterilization, and visit attendance were affected during this period. Study Design. We performed a retrospective chart review to examine contraception initiation, sterilization, and postpartum virtual and in-person visit attendance rates during the first six months (March 15 to September 7, 2020) of the COVID-19 pandemic compared to the rates in the same period in the year prior at a single tertiary academic care center. We abstracted data from the first prenatal visit through twelve weeks postpartum. Results With the initiation of virtual appointments, postpartum visit attendance significantly increased (94.6 % vs 88.4 %, p < 0.001) during the pandemic with no difference in overall contraception uptake (51 % vs 54.1 %, p = 0.2) or sterilization (11.0 % vs 11.5 %, p = 0.88). During the pandemic, contraception prescribed differed significantly with a trend towards patient-administered methods including pills, patches, and rings (21 % vs 16 %, p = 0.02). In both periods, there was a significantly younger mean age (p < 0.001), higher proportion of non-White and non-Asian race (p < 0.001), public insurance (p = 0.003, 0.004), and an established contraceptive plan prenatally (p < 0.001) in the group that received contraception. Conclusion As virtual postpartum visits were instituted, contraception initiation and sterilization were maintained at pre-pandemic rates and visit attendance rose despite the obstacles to care presented by the COVID-19 pandemic. Provision of virtual postpartum visits may be a driver to maintain contraception and sterilization rates at a time, such as early in the COVID-19 pandemic, when patient care is at risk to be disrupted by social distancing, isolation, and avoidance of medical campuses.
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Gelsinger C, Palmsten K, Lipkind HS, Pfeiffer M, Ackerman-Banks C, Hutcheon JA, Ahrens KA. Provision of Postpartum Contraception Before and After the Start of the COVID-19 Pandemic in Maine. Public Health Rep 2023:333549231170198. [PMID: 37129355 DOI: 10.1177/00333549231170198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE Preliminary findings from selected health systems revealed interruptions in reproductive health care services due to the COVID-19 pandemic. We estimated changes in postpartum contraceptive provision associated with the start of the COVID-19 pandemic in Maine. METHODS We used the Maine Health Data Organization's All Payer Claims Database for deliveries from October 2015 through March 2021 (n = 45 916). Using an interrupted time-series analysis design, we estimated changes in provision rates of long-acting reversible contraception (LARC), permanent contraception, and moderately effective contraception within 3 and 60 days of delivery after the start of the COVID-19 pandemic. We performed 6- and 12-month analyses (April 2020-September 2020, April 2020-March 2021) as compared with the reference period (October 2015-March 2020). We used Poisson regression models to calculate level-change rate ratios (RRs) and 95% CIs. RESULTS The 6-month analysis found that provision of LARC (RR = 1.89; 95% CI, 1.76-2.02) and moderately effective contraception (RR = 1.51; 95% CI, 1.33-1.72) within 3 days of delivery increased at the start of the COVID-19 pandemic, while provision of LARC (RR = 0.95; 95% CI, 0.93-0.97) and moderately effective contraception (RR = 1.08; 95% CI, 1.05-1.11) within 60 days of delivery was stable. Rates of provision of permanent contraception within 3 days (RR = 0.70; 95% CI, 0.63-0.78) and 60 days (RR = 0.71; 95% CI, 0.63-0.80) decreased. RRs from the 12-month analysis were generally attenuated. CONCLUSION Disruptions in postpartum provision of permanent contraception occurred at the beginning of the COVID-19 pandemic in Maine. Public health policies should include guidance for contraceptive provision during public health emergencies and consider designating permanent contraception as a nonelective procedure.
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Affiliation(s)
- Catherine Gelsinger
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| | - Kristin Palmsten
- Pregnancy and Child Health Research Center, HealthPartners Institute, Minneapolis, MN, USA
| | - Heather S Lipkind
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Mariah Pfeiffer
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| | | | - Jennifer A Hutcheon
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, BC, Canada
| | - Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
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Chapman HL, Chase D, Bhattarai B, Sutton M, Meyer I, Schofield C. Association of quality of prenatal care with contraceptive planning in a United States population: a retrospective cohort study. BMC Womens Health 2023; 23:214. [PMID: 37131190 PMCID: PMC10155310 DOI: 10.1186/s12905-023-02368-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Understanding how prenatal care influences planned postpartum contraception can help guide shared decision-making. This study looks to examine the association of the quality of prenatal care with planned postpartum contraception. METHODS This is a retrospective cohort study conducted in a single tertiary, academic urban institution in the southwest United States. The institutional review board (IRB) for human research at Valleywise Health Medical Center approved this study. Using a validated measure of prenatal care, the Kessner index, prenatal care was classified as adequate, intermediate, or inadequate. The World Health Organization (WHO) protocol for contraceptive effectiveness was used to classify contraceptives as very effective, effective, and less effective. The planned contraceptive choice was determined at the time of hospital discharge after delivery by discharge summary. Chi-squared testing and logistic regression were used to measure associations between the adequacy of prenatal care and contraceptive planning. RESULTS This study included 450 deliveries, 404 (90%) patients with adequate prenatal care, and 46 (10%) patients without adequate (intermediate or inadequate) prenatal care. There was not a statistically significant difference in planning for very effective or effective methods of contraception at hospital discharge between adequate (74%) and non-adequate (61%) prenatal care groups (p = 0.06). There was no association between the adequacy of prenatal care and the effectiveness of contraceptive planning after controlling for age and parity (aOR = 1.7, 95% CI 0.89-3.22). CONCLUSIONS Many women chose very effective and effective methods of postpartum contraception; however, there was no statistically significant association between the quality of prenatal care and planned contraception at hospital discharge.
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Affiliation(s)
- Hannah L Chapman
- Department of Obstetrics, Gynecology & Women's Health, District Medical Group, Valleywise Health System, 2601 E Roosevelt St Phoenix, Phoenix, AZ, 85008, USA.
| | - Dana Chase
- Department of Obstetrics, Gynecology & Women's Health, District Medical Group, Valleywise Health System, 2601 E Roosevelt St Phoenix, Phoenix, AZ, 85008, USA.
| | - Bikash Bhattarai
- Department of Obstetrics, Gynecology & Women's Health, District Medical Group, Valleywise Health System, 2601 E Roosevelt St Phoenix, Phoenix, AZ, 85008, USA.
| | - Maureen Sutton
- Department of Obstetrics, Gynecology & Women's Health, District Medical Group, Valleywise Health System, 2601 E Roosevelt St Phoenix, Phoenix, AZ, 85008, USA.
| | - Isuzu Meyer
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Birmingham, USA.
| | - Caleb Schofield
- Department of Obstetrics, Gynecology & Women's Health, District Medical Group, Valleywise Health System, 2601 E Roosevelt St Phoenix, Phoenix, AZ, 85008, USA
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Arora KS, Chua A, Miller E, Boozer M, Serna T, Bullington BW, White K, Gunzler DD, Bailit JL, Berg K. Medicaid and Fulfillment of Postpartum Permanent Contraception Requests. Obstet Gynecol 2023; 141:918-925. [PMID: 37103533 PMCID: PMC10154035 DOI: 10.1097/aog.0000000000005130] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/12/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To evaluate the association between Medicaid insurance and fulfillment of postpartum permanent contraception requests. METHODS We conducted a retrospective cohort study of 43,915 patients across four study sites in four states, of whom 3,013 (7.1%) had a documented contraceptive plan of permanent contraception at the time of postpartum discharge and either Medicaid insurance or private insurance. Our primary outcome was permanent contraception fulfillment before hospital discharge; we compared individuals with private insurance with individuals with Medicaid insurance. Secondary outcomes were permanent contraception fulfillment within 42 and 365 days of delivery, as well as the rate of subsequent pregnancy after nonfulfillment. Bivariable and multivariable logistic regression analyses were used. RESULTS Patients with Medicaid insurance (1,096/2,076, 52.8%), compared with those with private insurance (663/937, 70.8%), were less likely to receive desired permanent contraception before hospital discharge (P≤.001). After adjustment for age, parity, weeks of gestation, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index, private insurance status was associated with higher odds of fulfillment at discharge (adjusted odds ratio [aOR] 1.48, 95% CI 1.17-1.87) and 42 days (aOR 1.43, 95% CI 1.13-1.80) and 365 days (aOR 1.36, 95% CI 1.08-1.71) postpartum. Of the 980 patients with Medicaid insurance who did not receive postpartum permanent contraception, 42.2% had valid Medicaid sterilization consent forms at the time of delivery. CONCLUSION Differences in fulfillment rates of postpartum permanent contraception are observable between patients with Medicaid insurance and patients with private insurance after adjustment for clinical and demographic factors. The disparities associated with the federally mandated Medicaid sterilization consent form and waiting period necessitate policy reassessment to promote reproductive autonomy and to ensure equity.
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Affiliation(s)
- Kavita Shah Arora
- Department of Obstetrics and Gynecology, the Department of Epidemiology, Gillings School of Global Public Health, and the Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the Department of Obstetrics and Gynecology and the Center for Health Care Research and Policy, Population Health Research Institute, MetroHealth Medical System, Cleveland, Ohio; the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; the Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; the Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, California; and the Department of Sociology, Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
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Minns A, Dehlendorf C, Peahl AF, Heisler M, Owens LE, van Kainen B, Bonawitz K, Moniz MH. Elevating the patient voice in contraceptive care quality improvement: A qualitative study of patient preferences for peripastum contraceptive care. Contraception 2023; 121:109960. [PMID: 36736716 DOI: 10.1016/j.contraception.2023.109960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 01/13/2023] [Accepted: 01/22/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Patient-centeredness is an important indicator of peripartum contraceptive care quality. Prior work demonstrates how care fragmentation, provider biases, and other factors sometimes undermine the patient-centeredness and quality of this care. To guide the design of future quality improvement interventions, we explored patient preferences for peripartum contraceptive care. STUDY DESIGN For this qualitative study, we recruited a convenience sample of individuals receiving prenatal care at the study site and participating in an online survey about their experience of peripartum contraceptive care during February-July 2020. We conducted individual, in-depth, semistructured interviews to assess patients' preferences for peripartum contraceptive care. Using inductive and deductive qualitative content analysis, we evaluated interview data for patient preferences for peripartum contraceptive counseling and organized preferences into domains to inform future quality measurement. RESULTS Interviews (lasting 7-26 min) included 21 postpartum individuals, who were largely White with high levels of formal education. Many participants described suboptimal care experiences characterized by insufficient information, inadequate centering of patient values, and, occasionally, disrespectful care. We identified four key themes describing patients' desire for (1) comprehensive, anticipatory information from one's peripartum provider; (2) counseling and decision-making that (a) prioritize patient preferences and values and (b) avoid pressure; (3) care that respects patient feelings and wishes; and (4) provider responsiveness to individual patient preferences regarding timing and frequency of counseling. CONCLUSIONS We newly identify four key domains of patient preferences for peripartum contraceptive care. Additional research is needed to understand peripartum contraceptive care preferences among diverse patient populations. Future research should develop validated measures for evaluating the patient experience of peripartum contraceptive care at scale, as part of ongoing efforts to improve the quality and respectfulness of peripartum care. IMPLICATIONS Patients want peripartum contraceptive care to provide comprehensive, anticipatory information; elicit and respond to their counseling and decision-making preferences; and demonstrate respect for their wishes.
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Affiliation(s)
- Annie Minns
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, USA
| | - Christine Dehlendorf
- San Francisco Department of Family and Community Medicine, University of California, 1001 Potrero Ave., San Francisco CA, USA
| | - Alex F Peahl
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Program on Women's Healthcare Effectiveness Research, University of Michigan, Ann Arbor, MI, USA
| | - Michele Heisler
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, USA; School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lauren E Owens
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, USA
| | - Barbara van Kainen
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, USA
| | - Kirsten Bonawitz
- Medical School, University of Michigan, 1301 Catherine St., Ann Arbor, MI, USA
| | - Michelle H Moniz
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Program on Women's Healthcare Effectiveness Research, University of Michigan, Ann Arbor, MI, USA.
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15
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Uaamnuichai S, Phutrakool P, Thammasitchai N, Sathitloetsakun S, Santibenchakul S, Jaisamrarn U. Does socioeconomic factors and healthcare coverage affect postpartum sterilization uptake in an urban, tertiary hospital? Reprod Health 2023; 20:23. [PMID: 36707807 PMCID: PMC9881507 DOI: 10.1186/s12978-023-01572-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Postpartum sterilization in Thailand has relatively few barriers compared to other countries. The procedure is covered by some healthcare plans, and paid out-of-pocket for others. We aim to determine if healthcare coverage and other socioeconomic factors affect the rate of postpartum sterilization in an urban, tertiary hospital. METHODS We conducted a secondary analysis of data from a retrospective cohort of 4482 postpartum women who delivered at our hospital. Multivariable logistic regression was conducted to determine if sterilization reimbursement affects immediate postpartum sterilization rate. RESULTS Overall immediate postpartum sterilization rate was 17.8%. Route of delivery and parity were similar in those who were reimbursed and those who were not. Women aged over 25 were more likely to have a healthcare plan that does not cover postpartum sterilization. Women whose healthcare plan reimbursed the procedure trended towards postpartum sterilization when compared to women who were not (aOR 1.05, 95% CI 0.86-1.28, p-value = 0.632). Women who delivered via cesarean section were more likely to undergo sterilization at the time of delivery (aOR = 5.87; 95% CI 4.77-7.24, p-value = < 0.001). Women aged 40-44 years were 2.70 times as likely to choose sterilization than those aged 20-24 years (aOR = 2.70; 95% CI 1.61-4.53, p-value < 0.001). CONCLUSIONS Healthcare coverage of the procedure was not associated with increased postpartum sterilization in our setting.
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Affiliation(s)
- Sutira Uaamnuichai
- grid.411628.80000 0000 9758 8584Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama IV Road, Patum Wan, Bangkok, 10330 Thailand
| | - Phanupong Phutrakool
- grid.7922.e0000 0001 0244 7875Chula Data Management Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nareerat Thammasitchai
- grid.411628.80000 0000 9758 8584Nursing Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sarochinee Sathitloetsakun
- grid.7922.e0000 0001 0244 7875Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somsook Santibenchakul
- grid.411628.80000 0000 9758 8584Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama IV Road, Patum Wan, Bangkok, 10330 Thailand
| | - Unnop Jaisamrarn
- grid.7922.e0000 0001 0244 7875Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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16
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Songkanha P, Chanprapaph P, Lertbunnaphong T, Supapueng O, Naimsiri U. The efficacy of postpartum tubal sterilization training program with minilaparotomy approach in Ob/Gyn residents. Heliyon 2022; 9:e12722. [PMID: 36632094 PMCID: PMC9826832 DOI: 10.1016/j.heliyon.2022.e12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/18/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022] Open
Abstract
Objectives To evaluate the efficacy of postpartum tubal sterilization training program with minilaparotomy approach (PTSMA). Study design From September 2020 to November 2021, 24 first-year Obstetrics and Gynecology (Ob/Gyn) residents were randomly allocated into 2 groups of traditional apprenticeship learning (watching video clip) versus apprenticeship learning plus PTSMA attending. The program consisted of didactics followed by self-practicing with 2 stations of postpartum tubal sterilization simulators (PTSS). All participants were allowed to perform their first tubal sterilization under supervision within a few days after training. Their surgical skills were blindly evaluated by 2 experts through the recorded videos. Five domains of direct observation of procedural skills (DOPS) score introduced by Royal Thai College of Obstetricians and Gynecologists were assessed. DOPS score, operative time, blood loss and post-op complication were analyzed and compared. Results Median of total DOPS score in the PTSMA group was higher than the non-PTSMA group (93 vs. 73, p = 0.020). Concerning 2 domains of DOPS score (tubal fishing and tubal sterilization), the PTSMA group had the higher median score than the non-PTSMA group (36 vs. 24, p = 0.045 and 40 vs. 32, p = 0.020). There was no significant difference observed in the median score of 3 other domains (peritoneal cavity accessing, abdominal wall closure and complication prevention), estimated blood loss and operative time. Conclusion Postpartum tubal sterilization training program with minilaparotomy approach using instructive simulators significantly improved the total DOPS score especially tubal fishing and tubal ligation skills in Ob/Gyn residents. Implications The study evidently showed the benefit of PTSMA with an inexpensive and simple to prepare models. In unexperienced operators, practicing in model prior to surgery should be encouraged to improve their operative skills.
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Affiliation(s)
- Panaya Songkanha
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pharuhas Chanprapaph
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand,Corresponding author. Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang, Siriraj, Bankoknoi, Bangkok 10700, Thailand.
| | - Tripop Lertbunnaphong
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Orawan Supapueng
- Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Udom Naimsiri
- Medical Education Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
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Bullington BW, Sata A, Arora KS. Shared Decision-Making: The Way Forward for Postpartum Contraceptive Counseling. Open Access J Contracept 2022; 13:121-129. [PMID: 36046227 PMCID: PMC9423116 DOI: 10.2147/oajc.s360833] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/15/2022] [Indexed: 12/04/2022] Open
Abstract
There are multi-level barriers that impact uptake of postpartum contraception and result in disparities, including clinical barriers such as provider bias. Fortunately, clinicians have direct control over their contraceptive counseling practices, and thus reducing structural barriers is actionable through high quality contraceptive counseling that equips patients with the knowledge and guidance they need to fulfill their reproductive desires. Yet, many commonly employed contraceptive counseling strategies, like One Key Question and WHO tiered contraceptive counseling, are not patient-driven, do not account for the important nuances of contraceptive choices, and are not focused specifically on the postpartum period. Given the history of eugenics and reproductive coercion in the US, supporting patient through their contraceptive decision-making process is especially vital. Additionally, contraceptive preferences vary based on patient-level factors and fluctuate over time and counseling should account for such differences. Shared contraceptive decision-making occurs when patients provide input on their values, desires, and preferences and clinicians share medical knowledge and evidence-based information without judgement. This approach is considered the most ethically sound form of counseling, as it maximizes patient autonomy. Shared decision-making also has clinical benefits, including increased patient satisfaction. In sum, shared contraceptive decision-making should be universally adopted to promote ethical, high-quality care and reproductive autonomy.
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Affiliation(s)
- Brooke W Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27516, USA.,Carolina Population Center, University of North Carolina, Chapel Hill, NC, 27516, USA
| | - Asha Sata
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, 27516, USA
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, 27516, USA
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18
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Landau R, Burgart AM, Sutton CD. Loss of access to legal abortion in America: history, implications, and action items for anesthesiologists. Anaesth Crit Care Pain Med 2022; 41:101125. [PMID: 35803575 DOI: 10.1016/j.accpm.2022.101125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Ruth Landau
- Virginia Apgar Professor of Anesthesiology, Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York, USA.
| | - Alyssa M Burgart
- Clinical Associate Professor, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford Center for Biomedical Ethics, Stanford University School of Medicine, California, USA
| | - Caitlin D Sutton
- Assistant Professor in Anesthesiology, Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Division of Maternal-Fetal Anesthesia, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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19
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Fang NZ, Advaney SP, Castaño PM, Davis A, Westhoff CL. Female permanent contraception trends and updates. Am J Obstet Gynecol 2022; 226:773-780. [PMID: 34973178 DOI: 10.1016/j.ajog.2021.12.261] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022]
Abstract
Permanent contraception remains one of the most popular methods of contraception worldwide. This article has reviewed recent literature related to demographic characteristics of users, prevalence of use and trends over time, surgical techniques, and barriers to obtain the procedure. We have emphasized the patient's perspective as a key element of choosing permanent contraception. This review has incorporated sections on salpingectomy, hysteroscopy, unmet need, impact of policies at religiously affiliated institutions, and reproductive coercion.
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Affiliation(s)
- Nancy Z Fang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Center, Aurora, CO.
| | - Simone P Advaney
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Anne Davis
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
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20
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Racial and ethnic disparities in access to gynecologic care. Curr Opin Anaesthesiol 2022; 35:267-272. [PMID: 35671011 DOI: 10.1097/aco.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite efforts to minimize patient barriers to equitable care, health disparities persist in gynecology. This paper seeks to highlight racial and ethnic disparities in gynecologic care as represented by recent literature. RECENT FINDINGS Disparities exist among many areas including preventive screenings, vaccination rates, contraception use, infertility, and oncologic care. These can be identified at the patient, physician, and institutional levels. SUMMARY As we identify these social disparities in healthcare, we gain valuable knowledge of where our efforts are lacking and where we can further improve the health of women. Future research should focus on identifying and combating such disparities with measurable changes in health outcomes.
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21
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Byrne JJ, Smith EM, Saucedo AM, Doody KA, Holcomb D, Spong CY. Accessibility to postpartum tubal ligation after a vaginal delivery: When the Medicaid policy is not a limiting factor. Contraception 2022; 109:52-56. [PMID: 34971610 DOI: 10.1016/j.contraception.2021.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe rates of postpartum sterilization and indications for unfulfilled requests when Medicaid policy is not a limiting factor. STUDY DESIGN We conducted a single-institution, retrospective review. Women who requested postpartum tubal ligation after vaginal delivery from August 2015 to March 2019 were studied. Select demographic characteristics were compared between those who did and did not undergo the procedure. Reasons for why the procedure was cancelled, alternate contraceptive plans, and subsequent pregnancies were collected. Statistical analysis included the t test and chi-squared test, with p < 0.05 considered significant. RESULTS A total of 4103 patients requested postpartum tubal ligation following vaginal delivery. About 3670 (89.4%) procedures were performed and 433 (10.6%) were canceled. Of the 433, 423 (98%) were not performed at patient request; 10 (2 %) were cancelled based on physician recommendation. Of these, 3 were due to significant maternal anemia in the setting of refusal of blood products, 1 due to anesthesia concerns, 1 for increased body mass index, and 1 due to delivery events. Alternative contraception methods were offered; 72 (28% of patients not receiving a tubal ligation) received Depo Provera prior to discharge. One-fourth (n = 110, 25.4%) did not keep the postpartum follow-up appointment. 83 (19.2%) of the 433 patients had at least one subsequent pregnancy. Although over half expressed interest at the time of discharge in long-acting reversible contraceptives, only 20% obtained this method at the postpartum visit. CONCLUSIONS Postpartum sterilization was predominantly achieved, among women whose requests were unfulfilled, the majority (98%) were at patient request with a minority by physician recommendation. IMPLICATIONS When the availability of postpartum tubal ligation is independent of Medicaid reimbursement and the hospital system and providers are organized to support timely access to permanent postpartum contraception, the majority of tubal ligations requests can be fulfilled following vaginal delivery.
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Affiliation(s)
- John J Byrne
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas.
| | - Emma M Smith
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas
| | - Alexander M Saucedo
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas
| | - Kaitlin A Doody
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas
| | - Denisse Holcomb
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas
| | - Catherine Y Spong
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas
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22
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Henkel A, Beshar I, Goldthwaite LM. Postpartum permanent contraception: updates on policy and access. Curr Opin Obstet Gynecol 2021; 33:445-452. [PMID: 34534995 DOI: 10.1097/gco.0000000000000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe barriers to provision of postpartum permanent contraception at patient, hospital, and insurance levels. RECENT FINDINGS Permanent contraception remains the most commonly used form of contraception in the United States with the majority of procedures performed during birth-hospitalization. Many people live in regions with a high Catholic hospital market share where individual contraceptive plans may be refused based on religious doctrine. Obesity should not preclude an individual from receiving a postpartum tubal ligation as recent studies find that operative time is clinically similar with no increased risk of complications in obese compared with nonobese people. The largest barrier to provision of permanent contraception remains the federally mandated consent for sterilization for those with Medicaid insurance. State variation in enforcement of the Medicaid policy additionally contributes to unequal access and physician reimbursement. Although significant barriers exist in policy that will take time to improve, hospital-based interventions, such as listing postpartum tubal ligation as an 'urgent' procedure or scheduling interval laparoscopic salpingectomy prior to birth-hospitalization discharge can make a significant impact in actualization of desired permanent contraception for patients. SUMMARY Unfulfilled requests for permanent contraception result in higher rates of unintended pregnancies, loss of self-efficacy, and higher costs. Hospital and federal policy should protect vulnerable populations while not preventing provision of desired contraception.
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Affiliation(s)
- Andrea Henkel
- Division of Family Planning Services & Research, Department of Obstetrics & Gynecology, Stanford University, Stanford, California, USA
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23
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Website Review of Variation in Individual State Medicaid Sterilization Policies. Obstet Gynecol 2021; 138:578-579. [PMID: 34623070 DOI: 10.1097/aog.0000000000004537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
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Obstetrician-Gynecologists' Practices in Postpartum Sterilization Without a Valid Medicaid Consent Form. Obstet Gynecol 2021; 138:66-72. [PMID: 34259465 DOI: 10.1097/aog.0000000000004413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the practices of obstetrician-gynecologists (ob-gyns) in the United States surrounding postpartum sterilization when the Medicaid consent form was not valid. METHODS Using the American College of Obstetricians and Gynecologists' online directory, we conducted a qualitative study where we recruited ob-gyns practicing in 10 geographically diverse U.S. states for a qualitative study using semi-structured interviews conducted by telephone. We analyzed interview transcripts using the constant comparative method and principles of grounded theory. RESULTS Thirty ob-gyns (63% women, 77% nonsubspecialized, and 53% academic setting) were interviewed. Although most physicians stated that they did not perform sterilizations without a valid Medicaid sterilization form, others noted that they sometimes did due to a sense of ethical obligation toward their patient's health, being in a role with more authority or seniority, interpreting the emergency justification section of the form more broadly, or backdating the form. The physicians who said that they never went ahead without a signed form tended to work at large institutions and were concerned with losing funding and engaging in potentially illegal or fraudulent behavior. CONCLUSION Physicians' varied behaviors related to providing postpartum sterilization without a valid Medicaid consent form demonstrate that the policy is in need of revision. Unclear terminology and ramifications of the Medicaid sterilization policy need to be addressed to ensure equitable care.
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