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Bruce K, Stefanescu A, Romero L, Okoroh E, Cox S, Kieltyka L, Kroelinger C. Trends in Postpartum Contraceptive Use in 20 U.S. States and Jurisdictions: The Pregnancy Risk Assessment Monitoring System, 2015-2018. Womens Health Issues 2023; 33:133-141. [PMID: 36464580 DOI: 10.1016/j.whi.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/28/2022] [Accepted: 10/10/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION In the last decade, state and national programs and policies aimed to increase access to postpartum contraception; however, recent data on population-based estimates of postpartum contraception is limited. METHODS Using Pregnancy Risk Assessment Monitoring System data from 20 sites, we conducted multivariable-adjusted weighted multinomial regression to assess variation in method use by insurance status and geographic setting (urban/rural) among people with a recent live birth in 2018. We analyzed trends in contraceptive method use from 2015 to 2018 overall and within subgroups using weighted multinomial logistic regression. RESULTS In 2018, those without insurance had lower odds of using permanent methods (adjusted odds ratio [AOR], 0.72; 95% confidence interval [CI], 0.53-0.98), long-acting reversible contraception (LARC) (AOR, 0.67; 95% CI, 0.51-0.89), and short-acting reversible contraception (SARC) (AOR, 0.61; 95% CI, 0.47-0.81) than those with private insurance. There were no significant differences in these method categories between public and private insurance. Rural respondents had greater odds than urban respondents of using all method categories: permanent (AOR, 2.15; 95% CI, 1.67-2.77), LARC (AOR, 1.31; 95% CI, 1.04-1.65), SARC (AOR, 1.42; 95% CI, 1.15-1.76), and less effective methods (AOR, 1.38; 95% CI, 1.11-1.72). From 2015 to 2018, there was an increase in LARC use (odds ratio [OR], 1.03; 95% CI, 1.01-1.05) and use of no method (OR, 1.05; 95% CI, 1.02-1.07) and a decrease in SARC use (OR, 0.97; 95% CI, 0.95-0.99). LARC use increased among those with private insurance (OR, 1.05; 95% CI, 1.02-1.08) and in urban settings (OR, 1.04; 95% CI, 1.02-1.07), but not in other subgroups. CONCLUSIONS We found that those without insurance had lower odds of using effective contraception and that LARC use increased among those who had private insurance and lived in urban areas. Strategies to increase access to contraception, including increasing insurance coverage and investigating whether effectiveness of existing initiatives varies by geographic setting, may increase postpartum contraceptive use and address these differences.
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Affiliation(s)
- Katharine Bruce
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina; Louisiana Department of Health, Office of Public Health, Bureau of Family Health, New Orleans, Louisiana.
| | - Andrei Stefanescu
- Louisiana Department of Health, Office of Public Health, Bureau of Family Health, New Orleans, Louisiana
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ekwutosi Okoroh
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyn Kieltyka
- Louisiana Department of Health, Office of Public Health, Bureau of Family Health, New Orleans, Louisiana; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charlan Kroelinger
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Reeves JA, Zapata LB, Curtis KM, Whiteman MK. Intrauterine Device Training, Attitudes, and Practices Among U.S. Health Care Providers: Findings from a Nationwide Survey. Womens Health Issues 2023; 33:45-53. [PMID: 36123229 DOI: 10.1016/j.whi.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Provider training in intrauterine device (IUD) procedures is a key strategy for improving evidence-based IUD care. We examined the influence of IUD training on IUD attitudes and practices among U.S. family planning providers. METHODS In 2019, we conducted a cross-sectional survey of U.S. family planning providers. We performed logistic regression to examine associations between training in routine IUD placement and specific IUD safety attitudes, confidence performing IUD procedures, and specific IUD practices. RESULTS Among 1,063 physicians and advanced practice clinicians, 85.1% reported training in routine IUD placement. Overall, IUD training was associated with accurately stating IUDs are safe for queried groups, including patients immediately postpartum (prevalence ratio [PR] 4.22; 95% confidence interval [CI] 1.29-13.85). Trained providers reported higher confidence in routine IUD placement for parous (PR 7.71; 95% CI 1.31-45.3) and nulliparous (PR 7.12; 95% CI 1.17-43.5) women and in IUD removal (PR 2.06; 95% CI 1.12-3.81). Among providers with IUDs available onsite, IUD training was associated with frequent same-day IUD provision for adults (PR 7.32; 95% CI 2.16-24.79) and adolescents (PR 7.63; 95% CI 2.22-26.24). Trained providers were also less likely to routinely use misoprostol before IUD placement for nulliparous (PR 0.19; 95% CI 0.11-0.33) and parous women (PR 0.07; 95% CI 0.03-0.16). CONCLUSION Training in routine IUD placement was associated with evidence-based IUD safety attitudes, confidence in performing IUD procedures, and clinical practices aligned with Centers for Disease Control and Prevention contraception guidance. Expanding IUD training might increase evidence-based care and patient access to the full range of contraception, including IUDs.
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Affiliation(s)
- Jennifer A Reeves
- 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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Stein RA, Grayon A, Katz A, Chervenak FA. The Zika virus: an opportunity to revisit reproductive health needs and disparities. Germs 2022; 12:519-537. [PMID: 38021183 PMCID: PMC10660223 DOI: 10.18683/germs.2022.1357] [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: 08/30/2022] [Revised: 10/24/2022] [Accepted: 12/29/2022] [Indexed: 12/01/2023]
Abstract
First isolated in 1947, the Zika virus was initially connected only to limited or sporadic human infections. In late 2015, the temporal clustering of a Zika outbreak and microcephaly in newborn babies from northeastern Brazil, and the identification of a causal link between the two, led to the characterization of the congenital Zika syndrome. In the wake of the epidemic, several countries from Latin America advised women to postpone pregnancies for periods ranging from six months to two years. These recommendations initiated critical conversations about the challenges of implementing them in societies with limited access to contraception, widespread socioeconomic inequalities, and high rates of unplanned and adolescent pregnancies. The messaging targeted exclusively women, despite a high prevalence of imbalances in the relationship power, and addressed all women as a group, failing to recognize that the decision to postpone pregnancies will impact different women in different ways, depending on their age at the time. Finally, in several countries affected by the Zika epidemic, due to restrictive reproductive policies, legally terminating a pregnancy is no longer an option even at the earliest time when brain malformations as part of the congenital Zika syndrome can be detected by ultrasonography. The virus continued to circulate after 2016 in several countries. Climate change models predict an expansion of the geographical area where local Zika transmission may occur, indicating that the interface between the virus, teratogenesis, and reproductive rights is a topic of considerable interest for medicine, social sciences, and public health for years to come.
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Affiliation(s)
- Richard A. Stein
- MD, PhD, NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn 11201, NY, USA
| | - Alexis Grayon
- NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn 11201, NY, USA
| | - Adi Katz
- MD, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, 110 E 77th Street, New York, NY, 10075, USA
| | - Frank A. Chervenak
- MD, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, 110 E 77th Street, New York, NY, 10075, USA
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Emergency Contraception: Access and Challenges at Times of Uncertainty. Am J Ther 2022; 29:e553-e567. [PMID: 35998109 DOI: 10.1097/mjt.0000000000001560] [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
BACKGROUND The UN Commission on Life-Saving Commodities for Women's and Children's Health identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation. AREAS OF UNCERTAINTY Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access. DATA SOURCES PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetrician and Gynecologists, the World Health Organization, The United Nations. THERAPEUTIC ADVANCES A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device. CONCLUSIONS EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts, threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.
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Romero L, Sappenfield OR, Uesugi K, Howland JF, Kroelinger CD, Okoroh EM, Erondu C, Cox S. Review of Publicly Available State Policies for Long-Acting Reversible Contraception Device Reimbursement. J Womens Health (Larchmt) 2022; 31:1048-1056. [PMID: 35041489 DOI: 10.1089/jwh.2021.0361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Provider challenges to accessing long-acting reversible contraception (LARC) include level of reimbursement for LARC device acquisition and cost to stock. State-level LARC device reimbursement policies that cover a greater proportion of the cost of the LARC device and enable providers to purchase LARC upfront may improve contraceptive access. Materials and Methods: To summarize state-level policies that include language on LARC device reimbursement in the outpatient setting, we conducted a systematic, web-based review among all 50 states of publicly available LARC device reimbursement policies that include coverage of LARC devices as a medical or pharmacy benefit, the use of the 340B Drug Pricing Program to purchase LARC devices, and separate payment for LARC devices outside of the Medicaid Prospective Payment System (PPS) payment rate for Federally Qualified Health Centers or Rural Health Clinics. Results: Forty-two percent (21/50) of states with publicly available state-level policies included language on LARC device reimbursement. Among the states, 24% (5/21) had coverage policies as a medical benefit, 33% (7/21) as a pharmacy benefit, and 19% (4/21) as both a medical benefit and pharmacy benefit; 38% (8/21) used the 340B Program to purchase LARC devices; and 62% (13/21) indicated separate payment for LARC devices outside of the Medicaid PPS payment rate. Conclusion: State-level policies for LARC device reimbursement vary, highlighting differences in reimbursement strategies across the U.S. Future research could explore how the implementation of these payment methods may impact LARC device reimbursement and whether increased reimbursement may improve access to the full range of contraceptive methods.
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Affiliation(s)
- Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Olivia R Sappenfield
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Keriann Uesugi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Julia F Howland
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Charlan D Kroelinger
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ekwutosi M Okoroh
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chioma Erondu
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Zapata LB, Pazol K, Curtis KM, Kane DJ, Jatlaoui TC, Folger SG, Okoroh EM, Cox S, Whiteman MK. Need for Contraceptive Services Among Women of Reproductive Age - 45 Jurisdictions, United States, 2017-2019. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:910-915. [PMID: 34166334 PMCID: PMC8224864 DOI: 10.15585/mmwr.mm7025a2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Freed B, Hillman S, Shantikumar S, Bick D, Dale J, Gauly J. The impact of disasters on contraception in OECD member countries: a scoping review. EUR J CONTRACEP REPR 2021; 26:429-438. [PMID: 34126834 DOI: 10.1080/13625187.2021.1934440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Review evidence is lacking about how contraception is affected by severe social disruption, such as that caused by the COVID-19 pandemic. The purpose of this scoping review was to explore the impact of natural and man-made disasters on contraception in OECD member countries. METHODS Manual searches and systematic searches in six electronic databases were conducted with no language restrictions. All articles were screened by at least two researchers. The data were analysed thematically. RESULTS 108 articles were included. Most focussed on the Zika virus outbreak (n = 50) and the COVID-19 pandemic (n = 28). Four key themes were identified: importance of contraception during disasters, impact of disasters on contraceptive behaviour, barriers to contraception during disasters and ways of improving use of contraception during disasters. Despite efforts to increase access to contraception including by transforming ways of delivery, barriers to use meant that unmet need persisted. CONCLUSIONS To prevent adverse health outcomes and reduce health costs as a result of failure to have access to contraception during disasters, there is a need to intensify efforts to remove barriers to use. This should include increasing access and information on methods of contraception and their side effects (e.g., menstrual suppression) and making contraception freely available.
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Affiliation(s)
- Benjamin Freed
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Sarah Hillman
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Debra Bick
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Julia Gauly
- Warwick Medical School, University of Warwick, Coventry, UK
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Romero L, Mendoza ZV, Croft L, Bhakta R, Sidibe T, Bracero N, Malave C, Suarez A, Sanchez L, Cordero D, Lathrop E, Monroe J. The Role of Public-Private Partnerships to Increase Access to Contraception in an Emergency Response Setting: The Zika Contraception Access Network Program. J Womens Health (Larchmt) 2021; 29:1372-1380. [PMID: 33196331 DOI: 10.1089/jwh.2020.8813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Zika Contraception Access Network (Z-CAN) program was a short-term emergency response intervention that used contraception to prevent unintended pregnancies to reduce Zika-related adverse birth outcomes during the 2016-2017 Zika virus outbreak in Puerto Rico. The Centers for Disease Control and Prevention (CDC) reported that a collaborative and coordinated response was needed from governments and private-sector partners to improve access to contraception during the Zika outbreak in Puerto Rico. In response, the National Foundation for the CDC, with technical assistance from CDC, established the Z-CAN program, a network of 153-trained physicians, that provided client-centered contraceptive counseling and same-day access to the full range of the Food and Drug Administration-approved reversible contraceptive methods at no cost for women who chose to prevent pregnancy. From May 2016 to September 2017, 29,221 women received Z-CAN services. Through Z-CAN, public-private partnerships provided a broad range of opportunities for partners to come together to leverage technical expertise, experience, and resources to remove barriers to access contraception that neither the public nor the private sector could address alone. Public-private partnerships focused on three areas: (1) the coordination of efforts among federal and territorial agencies to align strategies, leverage resources, and address sustainability; (2) the mobilization of private partnerships to secure resources from private corporations, domestic philanthropic organizations, and nonprofit organizations for contraceptive methods, physician reimbursement, training and proctoring resources, infrastructure costs, and a health communications campaign; and (3) the engagement of key stakeholders to understand context and need, and to identify strategies to reach the target population. Public-private partnerships provided expertise, support, and awareness, and could be used to help guide programs to other settings for which access to contraception could improve health outcomes.
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Affiliation(s)
- Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zipatly V Mendoza
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Croft
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Reema Bhakta
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Turquoise Sidibe
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nabal Bracero
- Puerto Rico Obstetrics and Gynecology, San Juan, Puerto Rico
| | - Claritsa Malave
- Health Resources and Services Administration, Office of Regional Operations, Region II, San Juan, Puerto Rico
| | - Alicia Suarez
- Puerto Rico Primary Care Association, San Juan, Puerto Rico
| | - Linette Sanchez
- Puerto Rico Obstetrics and Gynecology, San Juan, Puerto Rico
| | | | - Eva Lathrop
- Puerto Rico Primary Care Association, San Juan, Puerto Rico.,Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia, USA
| | - Judith Monroe
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Curtis KM, Zapata LB, Pagano HP, Nguyen A, Reeves J, Whiteman MK. Removing Unnecessary Medical Barriers to Contraception: Celebrating a Decade of the U.S. Medical Eligibility Criteria for Contraceptive Use. J Womens Health (Larchmt) 2020; 30:293-300. [PMID: 33370207 DOI: 10.1089/jwh.2020.8910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 2010, the Centers for Disease Control and Prevention (CDC) released the U.S. Medical Eligibility Criteria for Contraceptive Use, providing recommendations for health care providers on safe use of contraception for people with certain characteristics or medical conditions. Adapted from World Health Organization guidance, the goal of the recommendations is to remove unnecessary medical barriers to contraception. Over the past decade, CDC has updated recommendations based on new evidence, collaborated with national partners to disseminate and implement the guidelines, and conducted provider surveys to assess changes in attitudes and practices around contraception safety and provision. CDC remains committed to supporting evidence-based guidelines for safe use of contraception, as the basis for improving access to contraception and high-quality family planning services, reducing unintended pregnancy, and improving reproductive health in the United States.
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Affiliation(s)
- Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - H Pamela Pagano
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Antoinette Nguyen
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Reeves
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maura K Whiteman
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Green C, Ntansah C, Frey MT, Krashin JW, Lathrop E, Romero L. Assessment of Contraceptive Needs and Improving Access in the U.S.-Affiliated Pacific Islands in the Context of Zika. J Womens Health (Larchmt) 2020; 29:139-147. [PMID: 32045325 DOI: 10.1089/jwh.2020.8302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Scientific evidence demonstrated a causal relationship between Zika virus infection during pregnancy and neurologic abnormalities and other congenital defects. The U.S. government's Zika Virus Disease Contingency Response Plan recognized the importance of preventing unintended pregnancy through access to high-quality family planning services as a primary strategy to reduce adverse Zika-related birth outcomes during the 2016-2017 Zika virus outbreak. The U.S.-affiliated Pacific Islands (USAPI) includes three U.S. territories: American Samoa, the Commonwealth of the Northern Mariana Islands, and Guam, and three independent countries in free association with the United States: the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. Aedes spp. mosquitoes, the primary vector that transmits Zika virus, are common across the Pacific Islands, and in 2016, laboratory-confirmed cases of Zika virus infection in USAPI were reported. CDC conducted a rapid assessment by reviewing available reproductive health data and discussing access to contraception with family planning providers and program staff in all six USAPI jurisdictions between January and May 2017. In this report, we summarize findings from the assessment; discuss strategies developed by jurisdictions to respond to identified needs; and describe a training that was convened to provide technical assistance to USAPI. Similar rapid assessments may be used to identify training and technical assistance needs in other emergency preparedness and response efforts that pose a risk to pregnant women and their infants.
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Affiliation(s)
- Caitlin Green
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | | | - Meghan T Frey
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Jamie W Krashin
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.,Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Eva Lathrop
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.,Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Pepe VLE, Albuquerque MVD, Osorio-de-Castro CGS, Pereira CCDA, Oliveira CVDS, Reis LGDC, Reis CDB, Dias HS, Miranda ES. Proposta de análise integrada de emergências em saúde pública por arboviroses: o caso do Zika vírus no Brasil. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-11042020e205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A mudança no padrão de ocorrência da microcefalia associada à infecção pelo Zika Vírus em gestantes no Brasil resultou na decretação de emergência em saúde pública de importância nacional e internacional. Esforços coordenados e multisetoriais foram demandados, mas nem sempre houve respostas efetivas ou preparação das populações afetadas. A epidemia de Zika repercutiu nas políticas públicas, incluindo a de saúde, seja na investigação científica, seja na proposição de medidas de controle, diagnóstico, prevenção e tratamento. Objetivou-se apresentar proposta de análise integrada para abordagem de futuras emergências sanitárias com foco nas arboviroses. Partindo da experiência brasileira da epidemia e literatura relacionada, articularam-se quatro dimensões: vulnerabilidades e risco; condições e impactos socioeconômicos na população; desenvolvimento e emprego de tecnologias e pesquisas; e resposta e reprogramação do sistema de saúde. Pretende-se viabilizar loci específicos de investigação, para mensuração de possíveis desfechos e geração de novas evidências sobre os efeitos da epidemia nos sistemas de saúde. O conhecimento científico e suas lacunas são considerados os principais elementos integradores dessas dimensões analíticas, de forma a contribuir com resposta mais oportuna e efetiva em futuras emergências. Além do conhecimento adquirido, faz-se necessário agregar capacidade de enfrentar futuras emergências relacionadas com as epidemias de arboviroses.
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Pepe VLE, Albuquerque MVD, Osorio-de-Castro CGS, Pereira CCDA, Oliveira CVDS, Reis LGDC, Reis CDB, Dias HS, Miranda ES. Proposal for integrated analysis of public health emergencies involving arboviruses: the case of the Zika virus in Brazil. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-11042020e205i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A mudança no padrão de ocorrência da microcefalia associada à infecção pelo Zika Vírus em gestantes no Brasil resultou na decretação de emergência em saúde pública de importância nacional e internacional. Esforços coordenados e multisetoriais foram demandados, mas nem sempre houve respostas efetivas ou preparação das populações afetadas. A epidemia de Zika repercutiu nas políticas públicas, incluindo a de saúde, seja na investigação científica, seja na proposição de medidas de controle, diagnóstico, prevenção e tratamento. Objetivou-se apresentar proposta de análise integrada para abordagem de futuras emergências sanitárias com foco nas arboviroses. Partindo da experiência brasileira da epidemia e literatura relacionada, articularam-se quatro dimensões: vulnerabilidades e risco; condições e impactos socioeconômicos na população; desenvolvimento e emprego de tecnologias e pesquisas; e resposta e reprogramação do sistema de saúde. Pretende-se viabilizar loci específicos de investigação, para mensuração de possíveis desfechos e geração de novas evidências sobre os efeitos da epidemia nos sistemas de saúde. O conhecimento científico e suas lacunas são considerados os principais elementos integradores dessas dimensões analíticas, de forma a contribuir com resposta mais oportuna e efetiva em futuras emergências. Além do conhecimento adquirido, faz-se necessário agregar capacidade de enfrentar futuras emergências relacionadas com as epidemias de arboviroses.
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Kirk Sell T, Ravi SJ, Watson C, Meyer D, Pechta LE, Rose DA, Lubell KM, Podgornik MN, Schoch-Spana M. A Public Health Systems View of Risk Communication About Zika. Public Health Rep 2020; 135:343-353. [PMID: 32243762 DOI: 10.1177/0033354920912215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The spread of Zika virus throughout Latin America and parts of the United States in 2016 and 2017 presented a challenge to public health communicators. The objective of our study was to describe emergency risk communication practices during the 2016-2017 Zika outbreak to inform future infectious disease communication efforts. METHODS We conducted semi-structured telephone interviews with 13 public health policy makers and practitioners, 10 public information officers, and 5 vector-control officials from May through August 2017. RESULTS Within the public health macro-environment, extended outbreak timeframe, government trust, US residence status, and economic insecurity set the backdrop for Zika communication efforts. Limited resources, staffing, and partnerships negatively affected public health structural capacity for communication efforts. Public health communicators and practitioners used a range of processes and practices to engage in education and outreach, including fieldwork, community meetings, and contact with health care providers. Overall, public health agencies' primary goals were to prevent Zika infection, reduce transmission, and prevent adverse birth outcomes. CONCLUSIONS Lessons learned from this disease response included understanding the macro-environment, developing partnerships across agencies and the community, and valuing diverse message platforms. These lessons can be used to improve communication approaches for health officials at the local, state, and federal levels during future infectious disease outbreaks.
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Affiliation(s)
- Tara Kirk Sell
- 1466 Johns Hopkins Center for Health Security, Baltimore, MD, USA.,Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sanjana J Ravi
- 1466 Johns Hopkins Center for Health Security, Baltimore, MD, USA.,Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Crystal Watson
- 1466 Johns Hopkins Center for Health Security, Baltimore, MD, USA.,Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Diane Meyer
- 1466 Johns Hopkins Center for Health Security, Baltimore, MD, USA.,Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura E Pechta
- 1242 Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dale A Rose
- 1242 Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Keri M Lubell
- 1242 Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michelle N Podgornik
- 1242 Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Monica Schoch-Spana
- 1466 Johns Hopkins Center for Health Security, Baltimore, MD, USA.,Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Vector control in Zika-affected communities: Local views on community engagement and public health ethics during outbreaks. Prev Med Rep 2020; 18:101059. [PMID: 32154093 PMCID: PMC7052511 DOI: 10.1016/j.pmedr.2020.101059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/18/2019] [Accepted: 01/23/2020] [Indexed: 11/21/2022] Open
Abstract
Public health authorities can mitigate community resistance to aerial spraying. Zika-affected persons favor autonomy, transparency, reasonableness, and solidarity. Proliferating social media and skepticism toward government present challenges.
Aerial spraying of products to kill larvae or adult mosquitoes is a public health measure used to control vector-borne diseases. In some outbreaks, the intervention has evoked controversy and community resistance. This study evaluated how local opinion leaders in US localities affected by Zika think about community engagement in public health policies for outbreak response. In December 2017 through March 2018, 4 focus groups were convened in Houston, TX, New Orleans, LA, Miami, FL, and Brooklyn, NY. They discussed a hypothetical scenario that featured vector control by aerial spraying. Participants (N = 20) more readily accepted this vector control method under 4 conditions: They were informed of alternatives, benefits, and risks for human health and the environment. Public health claims were backed by objective evidence and an authority figure genuinely working in the community’s interests. They received timely notice about how to mitigate toxin exposure. And, aerial spraying helped to protect vulnerable individuals. The community engagement requirements of the local opinion leaders resonate with core principles of recent public health ethics frameworks: namely, personal autonomy, transparency, reasonableness, and solidarity. Participants foresaw problems with community consent in an era of growing social media use and mistrust in governmental and scientific authority. They also debated whether health authorities should use moral-based arguments, in addition to science-based ones, to communicate aerial spraying’s risks and benefits.
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15
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Kroelinger CD, Rice ME, Cox S, Hickner HR, Weber MK, Romero L, Ko JY, Addison D, Mueller T, Shapiro-Mendoza C, Fehrenbach SN, Honein MA, Barfield WD. State Strategies to Address Opioid Use Disorder Among Pregnant and Postpartum Women and Infants Prenatally Exposed to Substances, Including Infants with Neonatal Abstinence Syndrome. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:777-783. [PMID: 31513558 PMCID: PMC6753967 DOI: 10.15585/mmwr.mm6836a1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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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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Oduyebo T, Zapata LB, Boutot ME, Tepper NK, Curtis KM, D'Angelo DV, Marchbanks PA, Whiteman MK. Factors associated with postpartum use of long-acting reversible contraception. Am J Obstet Gynecol 2019; 221:43.e1-43.e11. [PMID: 30885772 DOI: 10.1016/j.ajog.2019.03.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/14/2019] [Accepted: 03/11/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Contraception use among postpartum women is important to prevent unintended pregnancies and optimize birth spacing. Long-acting reversible contraception, including intrauterine devices and implants, is highly effective, yet compared to less effective methods utilization rates are low. OBJECTIVES We sought to estimate prevalence of long-acting reversible contraception use among postpartum women and examine factors associated with long-acting reversible contraception use among those using any reversible contraception. STUDY DESIGN We analyzed 2012-2015 data from the Pregnancy Risk Assessment Monitoring System, a population-based survey among women with recent live births. We included data from 37 sites that achieved the minimum overall response rate threshold for data release. We estimated the prevalence of long-acting reversible contraception use in our sample (n = 143,335). We examined maternal factors associated with long-acting reversible contraception use among women using reversible contraception (n = 97,013) using multivariable logistic regression (long-acting reversible contraception vs other type of reversible contraception) and multinomial regression (long-acting reversible contraception vs other hormonal contraception and long-acting reversible contraception vs other nonhormonal contraception). RESULTS The prevalence of long-acting reversible contraception use overall was 15.3%. Among postpartum women using reversible contraception, 22.5% reported long-acting reversible contraception use, which varied by site, ranging from 11.2% in New Jersey to 37.6% in Alaska. Factors associated with postpartum long-acting reversible contraception use vs use of another reversible contraceptive method included age ≤24 years (adjusted odds ratio = 1.43; 95% confidence interval = 1.33-1.54) and ≥35 years (adjusted odds ratio = 0.87; 95% confidence interval = 0.80-0.96) vs 25-34 years; public insurance (adjusted odds ratio = 1.15; 95% confidence interval = 1.08-1.24) and no insurance (adjusted odds ratio = 0.73; 95% confidence interval = 0.55-0.96) vs private insurance at delivery; having a recent unintended pregnancy (adjusted odds ratio = 1.44; 95% confidence interval = 1.34-1.54) or being unsure about the recent pregnancy (adjusted odds ratio = 1.29; 95% confidence interval = 1.18-1.40) vs recent pregnancy intended; having ≥1 previous live birth (adjusted odds ratio = 1.40; 95% confidence interval = 1.31-1.48); and having a postpartum check-up after recent live birth (adjusted odds ratio = 2.70; 95% confidence interval = 2.35-3.11). Hispanic and non-Hispanic black postpartum women had a higher rate of long-acting reversible contraception use (26.6% and 23.4%, respectively) compared to non-Hispanic white women (21.5%), and there was significant race/ethnicity interaction with educational level. CONCLUSION Nearly 1 in 6 (15.3%) postpartum women with a recent live birth and nearly 1 in 4 (22.5%) postpartum women using reversible contraception reported long-acting reversible contraception use. Our analysis suggests that factors such as age, race/ethnicity, education, insurance, parity, intendedness of recent pregnancy, and postpartum visit attendance may be associated with postpartum long-acting reversible contraception use. Ensuring all postpartum women have access to the full range of contraceptive methods, including long-acting reversible contraception, is important to prevent unintended pregnancy and optimize birth spacing. Contraceptive access may be improved by public health efforts and programs that address barriers in the postpartum period, including increasing awareness of the availability, effectiveness, and safety of long-acting reversible contraception (and other methods), as well as providing full reimbursement for contraceptive services and removal of administrative and logistical barriers.
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Affiliation(s)
- Titilope Oduyebo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA.
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Maegan E Boutot
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Kathryn M Curtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Denise V D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Polly A Marchbanks
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Maura K Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
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Pazol K, Ellington SR, Fulton AC, Zapata LB, Boulet SL, Rice ME, Cox S, Romero L, Lathrop E, Hurst S, Kroelinger CD, Goldberg H, Shapiro-Mendoza CK, Simeone RM, Warner L, Meaney-Delman DM, Barfield WD. Contraceptive Use Among Women at Risk for Unintended Pregnancy in the Context of Public Health Emergencies - United States, 2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:898-902. [PMID: 30114001 PMCID: PMC6095651 DOI: 10.15585/mmwr.mm6732a6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ensuring access to and promoting use of effective contraception have been identified as important strategies for preventing unintended pregnancy (1). The importance of ensuring resources to prevent unintended pregnancy in the context of public health emergencies was highlighted during the 2016 Zika virus outbreak when Zika virus infection during pregnancy was identified as a cause of serious birth defects (2). Accordingly, CDC outlined strategies for state, local, and territorial jurisdictions to consider implementing to ensure access to contraception (3). To update previously published contraceptive use estimates* among women at risk for unintended pregnancy† and to estimate the number of women with ongoing or potential need for contraceptive services,§,¶ data on contraceptive use were collected during September–December 2016 through the Behavioral Risk Factor Surveillance System (BRFSS). Results from 21 jurisdictions indicated that most women aged 18–49 years were at risk for unintended pregnancy (range across jurisdictions = 57.4%–76.8%). Estimates of the number of women with ongoing or potential need for contraceptive services ranged from 368 to 617 per 1,000 women aged 18–49 years. The percentage of women at risk for unintended pregnancy using a most or moderately effective contraceptive method** ranged from 26.1% to 65.7%. Jurisdictions can use this information to estimate the number of women who might seek contraceptive services and to plan and evaluate efforts to increase contraceptive use. This information is particularly important in the context of public health emergencies, such as the recent Zika virus outbreak, which have been associated with increased risk for adverse maternal-infant outcomes (2,4–6) and have highlighted the importance of providing women and their partners with resources to prevent unintended pregnancy.
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