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Policy impacts on contraceptive access in the United States: a scoping review. JOURNAL OF POPULATION RESEARCH 2023. [DOI: 10.1007/s12546-023-09298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
AbstractContraceptive access is influenced by policy decisions, which can expand and constrict the contraceptive options available. This study explored the impact of recent US federal policies on contraceptive access by identifying and reviewing empirical literature, which is then presented and discussed using Levesque et al.’s (2013) healthcare access framework. A scoping review was conducted to identify empirical studies (N = 96) examining the impact of recent federal policy (passed from 2009 to 2019) on contraceptive access. Most identified studies examined the role of the Affordable Care Act (n = 53) and Title X of the Public Health Service Act (n = 25), showing many benefits of both policies for contraceptive access, particularly through improved affordability, availability, and appropriateness of contraceptive care. Other identified studies examined the impact of policies funding abstinence-only sex education (n = 2) and the Teen Pregnancy Prevention Program (n = 3), military policies related to the availability of contraception (n = 1), guidelines for quality contraceptive care (n = 3), Title IX of the Education Amendments (n = 4), the Violence Against Women Act (n = 1), and the Veterans Access, Choice, and Accountability Act (n = 4). Through increased outreach efforts, normalising of care, availability of services, cost subsidies, and provider competencies, recent federal policy has, overall, enhanced contraceptive access across the dimensions of healthcare access. Numerous policy and practice gaps and needs are identified, and future directions for research, policy, and practice are suggested.
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Swan LET. Policy impacts on contraceptive access in the United States: a scoping review. JOURNAL OF POPULATION RESEARCH 2023; 40:5. [DOI: https:/doi.org/10.1007/s12546-023-09298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 06/22/2023]
Abstract
AbstractContraceptive access is influenced by policy decisions, which can expand and constrict the contraceptive options available. This study explored the impact of recent US federal policies on contraceptive access by identifying and reviewing empirical literature, which is then presented and discussed using Levesque et al.’s (2013) healthcare access framework. A scoping review was conducted to identify empirical studies (N = 96) examining the impact of recent federal policy (passed from 2009 to 2019) on contraceptive access. Most identified studies examined the role of the Affordable Care Act (n = 53) and Title X of the Public Health Service Act (n = 25), showing many benefits of both policies for contraceptive access, particularly through improved affordability, availability, and appropriateness of contraceptive care. Other identified studies examined the impact of policies funding abstinence-only sex education (n = 2) and the Teen Pregnancy Prevention Program (n = 3), military policies related to the availability of contraception (n = 1), guidelines for quality contraceptive care (n = 3), Title IX of the Education Amendments (n = 4), the Violence Against Women Act (n = 1), and the Veterans Access, Choice, and Accountability Act (n = 4). Through increased outreach efforts, normalising of care, availability of services, cost subsidies, and provider competencies, recent federal policy has, overall, enhanced contraceptive access across the dimensions of healthcare access. Numerous policy and practice gaps and needs are identified, and future directions for research, policy, and practice are suggested.
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Lukumay GG, Mgopa LR, Mushy SE, Rosser BRS, Massae AF, Mkonyi E, Mohammed I, Mwakawanga DL, Trent M, Wadley J, Ross MW, Bonilla Z, Leshabari S. Community myths and misconceptions about sexual health in Tanzania: Stakeholders' views from a qualitative study in Dar es Salaam Tanzania. PLoS One 2023; 18:e0264706. [PMID: 36763616 PMCID: PMC9916544 DOI: 10.1371/journal.pone.0264706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/15/2022] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Sexual and reproductive health problems are one of the top five risk factors for disability in the developing world. The rates of sexual health problems in most African countries are overwhelming, which is why HIV and other STIs are still such a challenge in sub-Saharan Africa. Talking about sex in most African countries is a taboo, leading to common myths and misconceptions that ultimately impact community sexual health. METHODS In this study, we conducted 11 key stakeholder individual interviews with community, religious, political, and health leaders (sexual health stakeholders) in Tanzania. Qualitative content analysis was used to analyze all the materials. RESULTS Two main categories merged from the analysis. The first category, "Ambiguities about sexual health" focused on societal and political misconceptions and identified ten myths or misconceptions common in Tanzania. Stakeholders highlighted the confusion that happens when different information about sexual health is presented from two different sources (e.g., community leaders/peers and political leaders), which leaves the community and community leaders unsure which one is reliable. The second category, "Practical dilemmas in serving clients", addressed a range of professional and religious dilemmas in addressing sexual health concerns. This included the inability of religious leaders and health care providers to provide appropriate sexual health care because of internal or external influences. CONCLUSION Myths and misconceptions surrounding sexual health can prevent communities from adequately addressing sexual health concerns, and make it more difficult for healthcare providers to comfortably provide sexual health care to patients and communities. Stakeholders affirmed a need to develop a sexual health curriculum for medical, nursing and midwifery students because of the lack of education in this area. Such a curriculum needs to address nine common myths which were identified through the interviews.
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Affiliation(s)
- Gift G. Lukumay
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Lucy R. Mgopa
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Stella E. Mushy
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - B. R. Simon Rosser
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - Agnes F. Massae
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ever Mkonyi
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - Inari Mohammed
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | | | - Maria Trent
- Johns Hopkins Medicine, Baltimore, MD, Washington, DC, United States of America
| | - James Wadley
- School of Adult and Continuing Education, Lincoln University, Baltimore Pike, PA, United States of America
| | - Michael W. Ross
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - Zobeida Bonilla
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - Sebalda Leshabari
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Pagano HP, Zapata LB, Curtis KM, Whiteman MK. Changes in U.S. Healthcare Provider Practices Related to Emergency Contraception. Womens Health Issues 2021; 31:560-566. [PMID: 34511322 PMCID: PMC11079952 DOI: 10.1016/j.whi.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Emergency contraception (EC), including EC pills (ECPs) and the copper intrauterine device, can prevent pregnancy after sexual encounters in which contraception was not used or used incorrectly. The U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), initially released in 2013, provides evidence-based clinical recommendations on the provision of EC. The objective of this analysis was to assess the percentage of health care providers reporting frequent provision of select EC practices around the time of and after the release of the U.S. SPR. METHODS We conducted two cross-sectional mailed surveys using different nationwide samples of office-based physicians and public-sector providers in 2013 and 2014 (n = 2,060) and 2019 (n = 1,420). We compared the percentage of providers reporting frequent provision of select EC practices by time period, overall, and by provider type. RESULTS In 2019, few providers frequently provided an advance prescription for ECPs (16%), an advance supply of ECPs (7%), or the copper intrauterine device as EC (8%), although 41% frequently provided or prescribed regular contraception at the same time as providing ECPs. Providers in 2019 were more likely than providers in 2013 and 2014 to provide or prescribe contraception at the same time as providing ECPs (adjusted prevalence ratio, 1.26; 95% confidence interval, 1.001-1.59) and to provide a copper intrauterine device as EC (adjusted prevalence ratio, 3.87; 95% confidence interval 2.10-7.15); there were no other significant differences by time period. CONCLUSIONS Few providers report frequent implementation of recommended EC practices. Understanding the barriers faced by providers and clinics in implementing these practices may improve access to EC.
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Affiliation(s)
- H Pamela Pagano
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Lauren B Zapata
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathryn M Curtis
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maura K Whiteman
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Contraceptive use among sexually active women living with HIV in western Ethiopia. PLoS One 2020; 15:e0237212. [PMID: 32760140 PMCID: PMC7410321 DOI: 10.1371/journal.pone.0237212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 07/22/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Contraception can help to meet family planning goals for women living with HIV (WLHIV) as well as to support the prevention of mother to child transmission of HIV (PMTCT). However, there is little research into the contraceptive practice among sexually active WLHIV in Ethiopia. Therefore, we aimed to examine contraceptive practice among sexually active WLHIV in western Ethiopia and identify the factors that influenced such practice using the Health Belief Model (HBM). Methods A facility-based cross-sectional survey of 360 sexually active WLHIV was conducted from 19th March to 22nd June 2018 in western Ethiopia. The eligible participants were WLHIV aged between 18 and 49 years who reported being fecund and sexually active within the previous six months but were not pregnant and not wanting to have another child within two years. Modified Poisson regression analyses were conducted to identify factors that influenced contraceptive practice among sexually active WLHIV in western Ethiopia. Results Among sexually active WLHIV (n = 360), 75% used contraception with 25% having unmet needs. Of the contraceptive users, 44.8% used injectables, 37.4% used condoms and 28.5% used implants. Among 152 recorded births in the last five years, 17.8% were reported as mistimed and 25.7% as unwanted. Compared to WLHIV having no child after HIV diagnosis, having two or more children after HIV diagnosis (Adjusted Prevalence Ratio [APR] = 1.31; 95%CI 1.09–1.58) was associated with increased risk of contraceptive practice. However, sexually active unmarried WLHIV (APR = 0.69; 95%CI 0.50–0.95) were less likely to use any contraception compared to their sexually active married counterparts. Importantly, high perceived susceptibility (APR = 1.49; 95%CI 1.20–1.86) and medium perceived susceptibility (APR = 1.55; 95%CI 1.28–1.87) towards unintended pregnancy were associated with higher risk of contraceptive use than WLHIV with low perceived susceptibility. Conclusions Although contraceptive use amongst sexually active WLHIV was found to be high, our findings highlight the need for strengthening family planning services given the high rate of unintended pregnancies, the high rate of unmet needs for contraception, as well as the lower efficacy with some of the methods. Our findings also suggest that the HBM would be a valuable framework for healthcare providers, programme planners and policymakers to develop guidelines and policies for contraceptive counselling and choices.
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Mayhew A, Ermias Y, Zapata LB, Pagano HP, Tepper NK. Health Care Provider Attitudes Toward Safety of Selected Hormonal Contraceptives in Breastfeeding Women. Matern Child Health J 2019; 23:1079-1086. [PMID: 31069600 PMCID: PMC10983027 DOI: 10.1007/s10995-019-02743-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Little is known about provider attitudes regarding safety of selected hormonal contraceptives among breastfeeding women. METHODS Using a nationwide survey, associations were analyzed between provider characteristics and perception of safety of combined oral contraceptives (COCs) in breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors and depot medroxyprogesterone acetate (DMPA) in breastfeeding women < 1 month postpartum and ≥ 1 month postpartum. RESULTS Approximately 68% of public-sector providers considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among non-physicians versus physicians (adjusted odds ratios [aOR] range 0.34-0.51) and those with a focus on adolescent health/pediatrics versus reproductive health (aOR 0.68, 95% confidence interval [CI] 0.47-0.99). Most public-sector providers considered DMPA safe for breastfeeding women during any time postpartum, with lower odds among non-physicians versus physicians (aOR range 0.20-0.54) and those with primary clinical focus other than reproductive health (aOR range 0.26-0.65). The majority of office-based physicians considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among those who did not use, versus those who used, CDC's contraceptive guidance (aOR 0.40, 95% CI 0.21-0.77). Most office-based physicians also considered DMPA safe for breastfeeding women during any time postpartum. CONCLUSIONS FOR PRACTICE A high proportion of providers considered use of selected hormonal contraceptives safe for breastfeeding women, consistent with evidence-based guidelines. However, certain provider groups might benefit from education regarding the safety of these methods for breastfeeding women.
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Affiliation(s)
- Allison Mayhew
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Yokabed Ermias
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA
| | - H Pamela Pagano
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA.
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Morgan IA, Zapata LB, Curtis KM, Whiteman MK. Health Care Provider Attitudes about the Safety of "Quick Start" Initiation of Long-Acting Reversible Contraception for Adolescents. J Pediatr Adolesc Gynecol 2019; 32:402-408. [PMID: 30731216 PMCID: PMC6717043 DOI: 10.1016/j.jpag.2019.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/30/2018] [Accepted: 01/27/2019] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To identify characteristics associated with provider attitudes on the safety of "Quick Start" initiation of long-acting reversible contraception (LARC) for adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cross-sectional survey of providers in public-sector health centers and office-based physicians (n = 2056) during 2013-2014. RESULTS Overall, the prevalence of considering "Quick Start" initiation of LARC for adolescents as safe was 70.9% for implants and 64.5% for intrauterine devices (IUDs). Among public-sector providers, those not trained in implant or IUD insertion had lower odds of perceiving the practice safe (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.25-0.41 for implants; aOR 0.42; 95% CI, 0.32-0.55 for IUDs), whereas those practicing at health centers that did not receive Title X funding had lower odds of perceiving the practice safe for IUDs (aOR, 0.77; 95% CI, 0.61-0.98). Among office-based physicians, lack of training in LARC insertion was associated with lower odds of perceiving "Quick Start" initiation to be safe for IUDs (aOR, 0.31; 95% CI, 0.12-0.77). Those specializing in adolescent medicine had higher odds of reporting "Quick Start" initiation of LARC as safe (implants: aOR, 2.21; 95% CI, 1.23-3.98; IUDs: aOR, 3.37; 95% CI, 1.39-8.21) compared with obstetrician-gynecologists. CONCLUSION Approximately two-thirds of providers considered "Quick Start" initiation of LARC for adolescents safe; however, there were differences according to provider characteristics (eg, Title X funding, training in LARC insertion, specialty). Targeted LARC insertion training and dissemination of evidence-based family planning guidance and implementation into facility and practice-level policies might increase access to "Quick Start" initiation of LARC for adolescents.
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Affiliation(s)
- Isabel A Morgan
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maura K Whiteman
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Zapata LB, Morgan IA, Curtis KM, Folger SG, Whiteman MK. Changes in US health care provider attitudes related to contraceptive safety before and after the release of National Guidance. Contraception 2019; 100:413-419. [PMID: 31369735 DOI: 10.1016/j.contraception.2019.07.142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The US Medical Eligibility Criteria for Contraceptive Use (USMEC) is the first national guidance containing evidence-based recommendations for contraception. We describe provider attitudes about contraceptive safety before and after the 2010 USMEC release. STUDY DESIGN We conducted two cross-sectional mailed surveys using different nationwide samples of office-based physicians and Title X clinic providers before (2009-2010) and after (2013-2014) the USMEC release. We compared the proportion of providers reporting select contraceptive methods as safe for women with specific characteristics or medical conditions before and after the USMEC release and conducted multivariable logistic regression to adjust for provider characteristics. RESULTS For the following select characteristics for which the USMEC classifies specific contraceptive methods as safe (Category 1 or 2), a significantly (p<.05) higher proportion of providers reported the method safe after versus before the USMEC release: intrauterine devices (IUDs) for adolescents (79.8% versus 60.2%), IUDs for women with HIV (72.4% versus 50.6%), depot medroxyprogesterone acetate (DMPA) for women with obesity (89.5% versus 76.1%), and DMPA for women with history of bariatric surgery (87.6% versus 73.9%). These differences remained significant after adjustment for provider characteristics. CONCLUSIONS While we observed many positive changes in health care provider attitudes related to contraception safety after the USMEC release, gaps remain. Continuing education and evidence-based training for providers, and ensuring office and health center protocols address medical eligibility for contraception for the full range of characteristics included in the USMEC might bridge remaining gaps and increase delivery of high-quality contraception care. IMPLICATIONS Gaps between evidence and provider attitudes remain that can inform future efforts to improve contraceptive service delivery.
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Affiliation(s)
- Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-74, Chamblee, Georgia 30341-3717.
| | - Isabel A Morgan
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-74, Chamblee, Georgia 30341-3717; Oak Ridge Institute for Science and Education (ORISE), 1299 Bethel Valley Road, Oak Ridge, TN 37830
| | - Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-74, Chamblee, Georgia 30341-3717
| | - Suzanne G Folger
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-74, Chamblee, Georgia 30341-3717
| | - Maura K Whiteman
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-74, Chamblee, Georgia 30341-3717
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Ermias Y, Morgan IA, Curtis KM, Whiteman MK, Horton LG, Zapata LB. Factors associated with provision of depot medroxyprogesterone acetate to adolescents by US health care providers. Contraception 2019; 99:300-305. [PMID: 30763582 PMCID: PMC10966425 DOI: 10.1016/j.contraception.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/18/2018] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Identify factors associated with healthcare providers' frequency of depot medroxyprogesterone acetate (DMPA) provision to adolescents. STUDY DESIGN We analyzed data from surveys mailed to a nationally representative sample of public-sector providers and office-based physicians (n=1984). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of factors associated with frequent DMPA provision to adolescents in the past year. RESULTS Although most providers (>95%) considered DMPA safe for adolescents, fewer reported frequent provision (89% of public-sector providers; 64% of office-based physicians). Among public-sector providers, factors associated with lower odds of frequent provision included working in settings without Title X funding (aOR 0.44, 95% CI 0.30-0.64), reporting primary care as their primary clinical focus versus reproductive or adolescent health (aOR 0.42, 95% CI 0.28-0.61), and providing fewer patients with family planning services. Among office-based physicians, factors associated with lower odds of frequent provision included specializing in obstetrics/gynecology (aOR 0.50, 95% CI 0.27-0.91) and family medicine (aOR 0.21, 95% CI 0.09-0.47) versus adolescent medicine, completing training ≥15 versus <5 years ago (aOR 0.27, 95% CI 0.09-0.83), and reporting that 0-24% of patients pay with Medicaid or other government healthcare assistance versus ≥50% (aOR 0.23, 95% CI 0.09-0.61). The reason most commonly reported by providers for infrequent DMPA provision was patient preference for another method. CONCLUSIONS While most providers reported frequently providing DMPA to adolescents, training on evidence-based recommendations for contraception, focused on subgroups of providers with lower odds of frequent DMPA provision, may increase adolescents' access to contraception. IMPLICATIONS Although >95% of providers considered depot medroxyprogesterone (DMPA) a safe contraceptive for adolescents, only 89% of public-sector providers and 64% of office-based physicians reported frequently providing DMPA to adolescents. Provider training on evidence-based recommendations for contraception counseling and provision may increase adolescents' access to DMPA and all methods of contraception.
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Affiliation(s)
- Y Ermias
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, United States, 30341; Association of Schools and Programs of Public Health (Fellow), 1900 M Street NW, Suite 710, Washington, DC, United States, 20036.
| | - I A Morgan
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, United States, 30341; Association of Schools and Programs of Public Health (Fellow), 1900 M Street NW, Suite 710, Washington, DC, United States, 20036.
| | - K M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, United States, 30341.
| | - M K Whiteman
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, United States, 30341.
| | - L G Horton
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, United States, 30341; Association of Schools and Programs of Public Health (Fellow), 1900 M Street NW, Suite 710, Washington, DC, United States, 20036.
| | - L B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, United States, 30341.
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