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Nacht CL, Contreras J, Ehlenbach M, McGregory K, Houser L, Allen BJ. Long-Acting but Reversible: Opportunities to Address Provider Bias in Contraceptive Care. Hosp Pediatr 2024; 14:690-699. [PMID: 39005135 DOI: 10.1542/hpeds.2023-007673] [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: 12/04/2023] [Accepted: 05/09/2024] [Indexed: 07/16/2024]
Abstract
Jasmine is an 18-year-old Black female bringing her infant to the pediatrician for a newborn weight check. She asks her pediatrician's opinion about hormonal contraceptive injections, sharing that they were strongly recommended after she gave birth. The recommending health care provider told her, "We don't want you to end up back here any time soon." Rosita, a 16-year-old Latina female, visits her pediatrician for a well check. She reports a history of vaginal sex with 2 male partners and agrees to have a hormonal subcutaneous implant placed to avoid pregnancy. After 4 months of bothersome spotting, Rosita returns to have the implant removed. Rosita's provider strongly counsels against removal. Jasmine and Rosita are members of populations that have been systematically marginalized throughout American history. Their stories are derived from real cases and reveal how structural racism impacts modern contraceptive care. Specifically, their cases are examples of statistical discrimination, wherein the tendency to disproportionately recommend long-acting reversible contraception to historically marginalized communities does not follow the central tenants of sexual and reproductive justice, including acknowledging historical harms in health care and honoring bodily autonomy for all people. By sharing Jasmine and Rosita's stories, we use a reproductive justice lens to (1) examine the historical roots of disproportional prescription of long-acting reversible contraception to historically marginalized individuals, (2) discuss provider bias related to sexual and reproductive health care, and (3) illustrate how trauma-informed care with a recognition of historical trauma and the use of individuation can facilitate positive and equitable health outcomes.
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Affiliation(s)
- Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, California
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California
| | - Jenna Contreras
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mary Ehlenbach
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kelly McGregory
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Laura Houser
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Brittany J Allen
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Allison BA, Angelino A, Joshua KH, Strayhorn L, Rogers P, Mann ES. "It Means Being Safe, Having Power over One's Body": Black Female Adolescent Experiences with Reproductive Health Counseling in Primary Care. J Pediatr Adolesc Gynecol 2024; 37:389-395. [PMID: 38301797 PMCID: PMC11260252 DOI: 10.1016/j.jpag.2024.01.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/05/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024]
Abstract
STUDY OBJECTIVE There is limited research examining the sexual and reproductive health (SRH) care needs and experiences of Black adolescents who are assigned female at birth (AFAB). This study aimed to understand the perspectives of Black AFAB adolescents in their receipt of SRH counseling in primary care and elicit preferences for SRH-related communication with clinicians. METHODS We interviewed English-speaking Black AFAB adolescents, ages 13-17, living in North Carolina between February and June 2022 about their SRH care experiences. The interviews were conducted via video conferencing, audio-recorded, professionally transcribed, and analyzed using a thematic approach. RESULTS We interviewed 23 adolescents (mean age 15.8 years) across 10 geographically diverse counties in North Carolina. Most conveyed positive perceptions of clinicians regarding trust and comfort. However, many expressed concerns about clinicians not doing enough to ensure patient confidentiality, provide them with enough information to make informed and autonomous decisions, and destigmatize discussing SRH issues during the clinical encounter. Suggested improvements include sociodemographic congruence between patients and clinicians (eg, younger Black women), ensuring time alone with clinicians across adolescence, and proactively sharing information to promote respect and autonomy. CONCLUSION Although Black AFAB adolescents had positive perceptions of their health care providers regarding relational components of care, many participants shared significant gaps and areas for improvement in the quality of care received to better align services with their preferences for SRH care. These findings can inform the development of SRH counseling best practices and clinician education to support respect and autonomy, which are routinely denied to Black AFAB adolescents.
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Affiliation(s)
- Bianca A Allison
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Alessandra Angelino
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kaitlin H Joshua
- Department of Sociology, University of North Carolina College of Arts and Sciences, Chapel Hill, North Carolina
| | - Lydia Strayhorn
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Peyton Rogers
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Emily S Mann
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
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Schiff DM, Li WZM, Work EC, Goullaud L, Vazquez J, Paulet T, Dorfman S, Selk S, Hoeppner BB, Wilens T, Bernstein JA, Diop H. Multiple marginalized identities: A qualitative exploration of intersectional perinatal experiences of birthing people of color with substance use disorder in Massachusetts. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209346. [PMID: 38789329 DOI: 10.1016/j.josat.2024.209346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/29/2024] [Accepted: 03/01/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Racial and ethnic inequities persist in receipt of prenatal care, mental health services, and addiction treatment for pregnant and postpartum individuals with substance use disorder (SUD). Further qualitative work is needed to understand the intersectionality of racial and ethnic discrimination, stigma related to substance use, and gender bias on perinatal SUD care from the perspectives of affected individuals. METHODS Peer interviewers conducted semi-structured qualitative interviews with recently pregnant people of color with SUD in Massachusetts to explore the impact of internalized, interpersonal, and structural racism on prenatal, birthing, and postpartum experiences. The study used a thematic analysis to generate the codebook and double coded transcripts, with an overall kappa coefficient of 0.89. Preliminary themes were triangulated with five participants to inform final theme development. RESULTS The study includes 23 participants of diverse racial/ethnic backgrounds: 39% mixed race/ethnicity (including 9% with Native American ancestry), 30% Hispanic or Latinx, 26% Black/African American, 4% Asian. While participants frequently names racial and ethnic discrimination, both interpersonal and structural, as barriers to care, some participants attributed poor experiences to other marginalized identities and experiences, such as having a SUD. Three unique themes emerged from the participants' experiences: 1) Participants of color faced increased scrutiny and mistrust from clinicians and treatment programs; 2) Greater self-advocacy was required from individuals of color to counteract stereotypes and stigma; 3) Experiences related to SUD history and pregnancy status intersected with racism and gender bias to create distinct forms of discrimination. CONCLUSION Pregnant and postpartum people of color affected by perinatal SUD faced pervasive mistrust and unequal standards of care from mostly white healthcare staff and treatment spaces, which negatively impacted their treatment access, addiction medication receipt, postpartum pain management, and ability to retain custody of their children. Key clinical interventions and policy changes identified by participants for antiracist action include personalizing anesthetic plans for adequate peripartum pain control, minimizing reproductive injustices in contraceptive counseling, and addressing misuse of toxicology testing to mitigate inequitable Child Protective Services (CPS) involvement and custody loss.
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Affiliation(s)
- Davida M Schiff
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St. Suite 860, Boston, MA 02114, United States of America; Division of Newborn Medicine, MassGeneral for Children, Boston, MA, 02114, United States of America.
| | - William Z M Li
- Harvard Medical School, Boston, MA, United States of America
| | - Erin C Work
- University of California, Schools of Public Health and Social Welfare, Los Angeles, CA, United States of America
| | - Latisha Goullaud
- Institute for Health and Recovery, Watertown, MA, United States of America
| | | | - Tabhata Paulet
- Rutgers New Jersey Medical School, Newark, NJ, United States of America
| | - Sarah Dorfman
- Division of General Academic Pediatrics, MassGeneral for Children, 125 Nashua St. Suite 860, Boston, MA 02114, United States of America
| | - Sabrina Selk
- National Network of Public Health Initiatives, Washington, DC, United States of America
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Timothy Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Judith A Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States of America
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, MA, 02108, United States of America
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Hall B, Evans TA, Atrio JM, Danvers AA. Social Determinants of Health and Patient-Reported Difficult Discontinuation of Long-Acting Reversible Contraception. J Womens Health (Larchmt) 2024. [PMID: 39034886 DOI: 10.1089/jwh.2023.0857] [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: 07/23/2024] Open
Abstract
Background: Some individuals who receive long-acting reversible contraception (LARC) face barriers to discontinuation. The inability to discontinue a contraceptive method when desired negatively impacts a person's reproductive autonomy. Persons impacted by social determinants of health (SDH) may be disproportionately affected. The objective of this study is to evaluate the association of SDH with patient-reported difficult LARC discontinuation. Methods: A retrospective cross-sectional analysis of data from the 2017-2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. Results: A total of 754 respondents reported wanting to have their LARC removed, and 105 (11%) reported difficulty discontinuing LARC methods. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). After adjusting for age, race, education, geographic location, parity, and body mass index (BMI), persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficultly discontinuing LARCs compared with respondents without any SDH (2.11; 95% confidence interval [CI]: 1.21, 3.69). Transportation barriers demonstrated the largest aOR of 2.90 (95% CI: 1.07, 7.87). Conclusions: SDH are associated with challenges to LARC discontinuation. SDH are unique risk factors that can impact one's entire contraceptive experience. A nuanced discussion of SDH at the time of contraceptive counseling may be a critical step in addressing the intersectionality of method selection and reproductive agency.
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Affiliation(s)
- Bianca Hall
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Thomas A Evans
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Jessica M Atrio
- Division of Complex Family Planning, Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Antoinette A Danvers
- Division of Complex Family Planning, Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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Allison BA, Ritter V, Lin FC, Flower KB, Perry MF. Trends in Continuation of Long-Acting Reversible Contraception Among Adolescents Receiving Medicaid. J Adolesc Health 2024:S1054-139X(24)00238-6. [PMID: 38980246 DOI: 10.1016/j.jadohealth.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/28/2024] [Accepted: 04/25/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Despite increasing use of long-acting reversible contraception (LARC) among U.S. adolescents, there is limited literature on factors affecting intrauterine device (IUD) or subdermal implant use. This study aimed to describe statewide rates, and associated patient and provider factors of adolescent IUD or implant initiation and continuation. METHODS This retrospective cohort study used N.C. Medicaid claims data. 10,408 adolescents were eligible (i.e., 13-19 years, female sex, continuous Medicaid enrollment, had an IUD or implant insertion or removal code from January 1, 2013, to October 1, 2015). Bivariate analyses assessed differences in adolescents using IUD versus implant. Kaplan-Meier curves were created to assess IUD or implant discontinuation through December 31, 2018. RESULTS Adolescents initiated 8,592 implants and 3,369 IUDs (N = 11,961). There were significant differences in nearly all provider and patient factors for those who initiated implants versus IUDs. 16% of implants and 53% of IUDs were removed in the first year. Younger (i.e., age <18 years old), Hispanic, and Black adolescents had higher adjusted continuation of implants compared with older and White adolescents, respectively (both p < .001). Those whose IUD was inserted by an obstetrician/gynecologist provider had lower continuation of IUDs compared with non-obstetrician/gynecologist providers (p < .001). DISCUSSION We found that age-related, racial, and ethnic disparities exist in both implant and IUD continuation. Practice changes to support positive adolescent experiences with implant and IUD insertion and removals are needed, including patient-centered health care provider training in contraception counseling, LARC initiation and removal training for adolescent-facing providers, and broader clinic capacity for LARC services.
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Affiliation(s)
- Bianca A Allison
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Victor Ritter
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina; Quantitative Sciences Unit, Stanford School of Medicine, Palo Alto, California
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Martha F Perry
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's National, Washington, D.C
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Moulton JE, Arefadib N, Botfield JR, Freilich K, Tomnay J, Bateson D, Black KI, Norman WV, Mazza D. A nurse-led model of care to improve access to contraception and abortion in rural general practice: Co-design with consumers and providers. J Adv Nurs 2024. [PMID: 38953531 DOI: 10.1111/jan.16299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/17/2024] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
AIM To describe key features of a co-designed nurse-led model of care intended to improve access to early medication abortion and long-acting reversible contraception in rural Australian general practice. DESIGN Co-design methodology informed by the Experience-Based Co-Design Framework. METHODS Consumers, nurses, physicians and key women's health stakeholders participated in a co-design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six-step process for thematic analysis. RESULTS Fifty-two participants took part in the co-design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient-approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications. CONCLUSION Our approach to experience-based co-design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse-led model of care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The co-designed nurse-led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice. IMPACT Nurse-led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse-led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025. REPORTING METHOD Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist. PATIENT OR PUBLIC CONTRIBUTION Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.
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Affiliation(s)
- Jessica E Moulton
- SPHERE, NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Melbourne, Victoria, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Noushin Arefadib
- SPHERE, NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Melbourne, Victoria, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica R Botfield
- SPHERE, NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Melbourne, Victoria, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Family Planning NSW, Sydney, New South Wales, Australia
| | - Karen Freilich
- SPHERE, NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Melbourne, Victoria, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Bateson
- Daffodil Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten I Black
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health and Policy, Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, Melbourne, Victoria, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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St John M, Sullivan K, DeFranco EA, Kelly E. Influence of Pregnancy Intention on Postpartum Contraceptive Choice at an Urban Academic Medical Center. Am J Perinatol 2024. [PMID: 38810963 DOI: 10.1055/a-2335-2951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE This study aimed to describe postpartum contraception preferences in the context of pregnancy intention (PI). STUDY DESIGN A prospective cohort study analyzing postpartum contraceptive choice (PCC) in 431 postpartum women who delivered at a single academic medical center. PCC in women with an unintended or mistimed pregnancy was compared to contraceptive choice in women with an intended pregnancy using the adapted National Survey of Family Growth categorization. Mistimed and unintended pregnancies were grouped for analysis. Generalized linear modeling estimated the relative influence of PI on PCC adjusting for maternal age, race, and parity. RESULTS Nearly three out of four (71.9%) pregnancies were mistimed or unintended. These pregnancies were more likely in women who were non-Hispanic Black (62.3%), unmarried (86.3%), 18 to 24 years (51.3%), and insured by Medicaid or Medicare (82.1%), compared to women with an intended pregnancy, p-value <0.001. Women with mistimed or unintended pregnancy were 83% more likely to choose highly effective, user-independent methods compared to any other or no method, adjusted relative risk (aRR) = 1.83 (95% confidence interval [CI]: 1.36, 2.47), and more likely to desire voluntary sterilization, aRR = 2.70 (95% CI: 1.58, 4.59). Additionally, women with these pregnancies were 56% more likely to use user-independent methods compared to user-dependent methods, aRR = 1.56 (95% CI: 1.18, 2.06). CONCLUSION Women with mistimed or unintended pregnancies are 83% more likely to choose highly effective postpartum contraception or voluntary sterilization, and thus initiatives are necessary to increase access and affordability to these methods before hospital discharge after delivery. KEY POINTS · Nearly three out of four pregnancies in this study were mistimed or unintended.. · Women with mistimed or unintended pregnancies are more likely to choose highly effective postpartum contraception or voluntary sterilization.. · Public health initiatives to improve access to family planning services and postpartum contraception, including surgery for bilateral tubal ligation before discharge from the hospital postdelivery, are important areas of focus to help attenuate the rates of unintended pregnancy in the United States..
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Affiliation(s)
- Meghan St John
- Department of Obstetrics and Gynecology, Western Pennsylvania Hospital, Allegheny Health Network Medical Education Consortium, Pittsburgh, Pennsylvania
| | - Kirby Sullivan
- Department of Internal Medicine, George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - Emily A DeFranco
- Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Elizabeth Kelly
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Perinatal Institute Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Swan LET, Cannon LM. Healthcare Provider-Based Contraceptive Coercion: Understanding U.S. Patient Experiences and Describing Implications for Measurement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:750. [PMID: 38928996 PMCID: PMC11204180 DOI: 10.3390/ijerph21060750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/29/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
Despite growing concerns over coercion in contraceptive care, few studies have described its frequency and manifestations. Further, there is no established quantitative method of measuring this construct. We begin to fill this gap by detailing nuance in contraceptive coercion experiences and testing a novel measure: the Coercion in Contraceptive Care Checklist. In early 2023, we surveyed reproductive-aged people in the United States who were assigned female at birth about their contraceptive care. We describe the frequency of contraceptive coercion in our sample (N = 1197) and use open-ended descriptions to demonstrate nuances in these experiences. Finally, we debut our checklist and present psychometric testing results. Among people who had ever talked to a healthcare provider about contraception, over one in six participants (18.46%) reported experiencing coercion during their last contraceptive counseling, and over one in three (42.27%) reported it at some point in their lifetime. Being made to use or keep using birth control pills was the most common form of coercion reported by patients (14.62% lifetime frequency). Factor analysis supported the two-factor dimensionality of the Coercion in Contraceptive Care Checklist. Inter-item correlations were statistically significant (p < 0.001), providing evidence of reliability. The checklist was also related to measures of quality in family planning care (downward coercion: t[1194] = 7.54, p < 0.001; upward coercion: t[1194] = 14.76, p < 0.001) and discrimination in healthcare (downward coercion: t[1160] = -14.77, p < 0.001; upward coercion: t[1160] = -18.27, p < 0.001), providing evidence of construct validity. Findings provide critical information about the frequency and manifestations of contraceptive coercion. Psychometric tests reveal evidence of the Coercion in Contraceptive Care Checklist's validity, reliability, and dimensionality while also suggesting avenues for future testing and refinement.
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Affiliation(s)
- Laura E. T. Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison 53706, WI, USA
| | - Lindsay M. Cannon
- Department of Sociology, Center for Demography and Ecology, University of Wisconsin-Madison, Madison 53706, WI, USA;
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Hartheimer JS, Allison BA, Perry MF. Increasing access to LARC removal in pediatrics to support adolescent reproductive justice in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:85-89. [PMID: 38837867 DOI: 10.1111/psrh.12270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND In the United States (U.S.), adolescents and young adults are increasingly using contraception, including long-acting reversible contraception (LARC) [e.g., subdermal implants (e.g., Nexplanon®) and intrauterine devices (IUDs)]; however, access to LARC device removal may be difficult for adolescents and young adults. Reproductive justice is the right to bodily autonomy, have children, not have children, and safely parent the children we have. METHODS In this commentary, we discuss that while the specialties of family medicine and obstetrics and gynecology have incorporated the principles of reproductive justice into their contraceptive care, further work is needed to ingrain this philosophy into pediatrics training. Since LARC devices are historically only removable by health care providers, pediatricians may act as gatekeepers to removing LARC, obstructing the reproductive justice of adolescents and young adults. RESULTS We describe that adolescents and young adults in the U.S. face unique barriers to LARC removal including limited access to the health care system, potential breaches in confidentiality, and provider bias. These barriers may lead adolescents and young adults to remove their own LARC device when experiencing unwanted side effects or desiring pregnancy. While IUD self-removal is a safe and accessible option, safety and efficacy data on subdermal implant self-removal is currently limited. CONCLUSION In order to promote reproductive justice in adolescents and young adults, we recommend that (1) pediatricians should address potential barriers to LARC removal prior to insertion, (2) pediatricians must offer unbiased LARC removal, (3) pediatricians who place LARC must be knowledgeable about complicated LARC removal, and (4) pediatricians should discuss LARC self-removal options with adolescents and young adults.
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Affiliation(s)
- Joline S Hartheimer
- The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Bianca A Allison
- Division of General Pediatrics and Adolescent Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Martha F Perry
- Division of General Pediatrics and Adolescent Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Zapata LB, Kortsmit K, Curtis KM, Romero L, Hurst S, Lathrop E, Acosta Perez E, Sánchez Cesáreo M, Whiteman MK. Continuation of Reversible Contraception Following Enrollment in the Zika Contraception Access Network (Z-CAN) in Puerto Rico, 2016-2020. Stud Fam Plann 2024; 55:105-125. [PMID: 38659169 DOI: 10.1111/sifp.12262] [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] [Indexed: 04/26/2024]
Abstract
The Zika Contraception Access Network (Z-CAN) provided access to high-quality client-centered contraceptive services across Puerto Rico during the 2016-2017 Zika virus outbreak. We sent online surveys during May 2017-August 2020 to a subset of Z-CAN patients at 6, 24, and 36 months after program enrollment (response rates: 55-60 percent). We described contraceptive method continuation, method satisfaction, and method switching, and we identified characteristics associated with discontinuation using multivariable logistic regression. Across all contraceptive methods, continuation was 82.5 percent, 64.2 percent, and 49.9 percent at 6, 24, and 36 months, respectively. Among continuing users, method satisfaction was approximately ≥90 percent. Characteristics associated with decreased likelihood of discontinuation included: using an intrauterine device or implant compared with a nonlong-acting reversible contraceptive method (shot, pills, ring, patch, or condoms alone); wanting to prevent pregnancy at follow-up; and receiving as their baseline method the same method primarily used before Z-CAN. Other associated characteristics included: receiving the method they were most interested in postcounseling (6 and 24 months) and being very satisfied with Z-CAN services at the initial visit (6 months). Among those wanting to prevent pregnancy at follow-up, about half reported switching to another method. Ongoing access to contraceptive services is essential for promoting reproductive autonomy, including supporting patients with continued use, method switching, or discontinuation.
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Grants
- The CDC Foundation secured large-scale donations, offers of contraceptive products, support tools, and services from Bayer, Allergan, Medicines360, Americares and Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Mylan, the Pfizer Foundation, Teva Pharmaceuticals, Church & Dwight Co., Inc., RB, Power to Decide (formerly The National Campaign to Prevent Teen and Unplanned Pregnancy), Upstream USA, and Market Vision, Culture Inspired Marketing.
- This data collection was funded by the Centers for Disease Control and Prevention (CDC).
- Funding for the Z-CAN program via the CDC Foundation was made possible by the Bill & Melinda Gates Foundation, Bloomberg Philanthropies, the William and Flora Hewlett Foundation, the Pfizer Foundation, and the American College of Obstetricians and Gynecologists.
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Affiliation(s)
- Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Kathryn M Curtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Stacey Hurst
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30303, USA
| | - Edna Acosta Perez
- Graduate School of Public Health, Medical Science Campus, University of Puerto Rico, PO Box 365067 San Juan, Puerto Rico 00936-5067, USA
| | - Marizaida Sánchez Cesáreo
- Graduate School of Public Health, Medical Science Campus, University of Puerto Rico, PO Box 365067 San Juan, Puerto Rico 00936-5067, USA
| | - Maura K Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
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11
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Sharma K, Cox S, Romero L, Ekwueme D, Whiteman M, Kroelinger C, Ouyang L. State variations in insertion of long-acting reversible contraception during delivery hospitalization. Contraception 2024:110509. [PMID: 38830389 DOI: 10.1016/j.contraception.2024.110509] [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: 03/07/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES This study aimed to describe immediate postpartum long-acting reversible contraception (IPP LARC) insertion rates during delivery hospitalizations at the state level and by payor type. STUDY DESIGN This is a cross-sectional study of 26 states and District of Columbia using 2020 State Inpatient Database. RESULTS In 2020, IPP LARC insertion rates varied widely by states, ranging from 2.55 to 637.25 per 10,000 deliveries. Rates were higher for deliveries with Medicaid as primary expected payor than with private insurance in all states but District of Columbia. CONCLUSIONS Rates of IPP LARC insertion varied in 2020 by state and were higher for deliveries with Medicaid as primary expected payor.
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Affiliation(s)
- Keshob Sharma
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
| | - Shanna Cox
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Lisa Romero
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Donatus Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Maura Whiteman
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Charlan Kroelinger
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Lijing Ouyang
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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12
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Hamilton FL, Pleasant V. Obstetrics and Gynecology Care in Latinx Communities. Obstet Gynecol Clin North Am 2024; 51:105-124. [PMID: 38267122 DOI: 10.1016/j.ogc.2023.11.007] [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] [Indexed: 01/26/2024]
Abstract
The Latinx community represents the largest racial minority population in the nation. There are significant barriers to care and treatment as it relates to obstetrics and gynecology. Understanding cultural considerations is essential to improving care in this community. Public health strategies as well as policies to address racial health disparities facing the Latinx community are explored in this article.
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Affiliation(s)
- Felicia L Hamilton
- Department of Obstetrics & Gynecology, OB/Gyn Practice Committee, MedStar Washington Hospital Center, Georgetown University Medical Center, 110 Irving Street, Northwest Room 5B-45A, Washington, DC 20010, USA.
| | - Versha Pleasant
- Department of Obstetrics and Gynecology, Cancer Genetics & Breast Health Clinic, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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13
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Armuand G, Grandahl M, Volgsten H, Stern J. Characteristics of good contraceptive counselling - An interview study. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100948. [PMID: 38244257 DOI: 10.1016/j.srhc.2024.100948] [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: 09/17/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE One key component in preventing unplanned pregnancies is to provide effective contraceptive counselling. This study aimed to investigate what characterises good contraceptive counselling from the woman's perspective. METHODS A qualitative study with a phenomenological approach. Twenty-four women aged 15-45 participated in semi-structured, individual, face-to-face interviews that lasted, on average, one hour. Data were analysed by latent content analysis. RESULTS One overall theme emerged, person-centred contraceptive counselling - an interactive process, with three main categories: (i) a trustworthy healthcare provider, (ii) creating a liaison and (iii) the right time and place. CONCLUSIONS The healthcare provider's attributes as well as what happened between the healthcare provider and the woman, and the surrounding context, had a bearing on the women's descriptions of good contraceptive counselling. The process of the counselling was described as more important than the actual outcome; thus, healthcare providers need to be aware that this seemingly straightforward consultation is rather multi-layered and has great health promoting potential.
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Affiliation(s)
- Gabriela Armuand
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Maria Grandahl
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Helena Volgsten
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jenny Stern
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden.
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14
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Owda R, Loder C. Achieving Reproductive Justice Within Family Planning. Obstet Gynecol Clin North Am 2024; 51:211-221. [PMID: 38267129 DOI: 10.1016/j.ogc.2023.11.006] [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] [Indexed: 01/26/2024]
Abstract
There is a long-standing history of reproductive oppression in the United States which impacts how patients, particularly those from marginalized communities, receive reproductive health services today. The reproductive justice (RJ) framework is a tool to support people to become pregnant, to not become pregnant, and to parent in safe communities. In this review, the authors provide essential background about this history and how those in reproductive health care can use the RJ framework through an intersectional lens to achieve inclusive reproductive goals and advocate for comprehensive access to family planning care, including contraceptive and abortion care.
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Affiliation(s)
- Rieham Owda
- Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Charisse Loder
- Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Garcia-Alexander G, Thompson M. Judgment, shame, and coercion: the criminal legal system and reproductive autonomy. HEALTH & JUSTICE 2024; 12:6. [PMID: 38363420 PMCID: PMC10870550 DOI: 10.1186/s40352-024-00259-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND A growing body of research has called attention to limitations to reproductive autonomy in both women who are socially disadvantaged and in those who have had contact with the criminal legal (CL) system. However, it is unclear whether CL system contact influences contraceptive use patterns and how these processes unfold. We utilize a mixed-methods approach to investigate whether history of arrest is associated with receipt of contraceptive counseling, use of long-term contraception, sterilization, and subsequent desire for reversal of sterilization. We further consider how agents in and around the CL system may influence women's reproductive decisions and outcomes (856 survey respondents; 10 interviewees). RESULTS We observe that women who have been arrested more commonly report receipt of contraceptive counseling and sterilization. They are also significantly more likely to want their sterilization reversed. Our in-depth interviews suggest that women with CL contact experience considerable shame, and in some cases, coercion to limit fertility from various agents in and outside the criminal legal system including medical providers, Parole/Probation Officers (POs), guards, and family members. CONCLUSIONS Our findings suggest the need for ongoing attention to how exposure to this system may promote uneven use of certain forms of contraception and dissatisfaction, i.e., desire for reversal of sterilization, among these women. Findings further suggest that de-emphasizing the CL system as a means through which to address reproductive needs should be considered.
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Affiliation(s)
- Ginny Garcia-Alexander
- Department of Sociology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
| | - Melissa Thompson
- Department of Sociology, Portland State University, P.O. Box 751, Portland, OR, 97201, USA
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16
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Dahl CM, Turok D, Heuser CC, Sanders J, Elliott S, Pangasa M. Strategies for obstetricians and gynecologists to advance reproductive autonomy in a post-Roe landscape. Am J Obstet Gynecol 2024; 230:226-234. [PMID: 37536485 DOI: 10.1016/j.ajog.2023.07.055] [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: 04/03/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
The monumental reversal of Roe vs Wade dramatically impacted the landscape of reproductive healthcare access in the United States. The decision most significantly affects communities that historically have been and continue to be marginalized by systemic racism, classism, and ableism within the medical system. To minimize the harm of restrictive policies that have proliferated since the Supreme Court overturned Roe, it is incumbent on obstetrician-gynecologists to modify practice patterns to meet the pressing reproductive health needs of their patients and communities. Change will require cross-discipline advocacy focused on advancing equity and supporting the framework of reproductive justice. Now, more than ever, obstetrician-gynecologists have a critical responsibility to implement new approaches to service delivery and education that will expand access to evidence-based, respectful, and person-centered family planning and early pregnancy care regardless of their practice location or subspecialty.
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Affiliation(s)
- Carly M Dahl
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT; Department of Obstetrics and Gynecology, Intermountain Health, Salt Lake City UT.
| | - David Turok
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT
| | - Cara C Heuser
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT; Department of Obstetrics and Gynecology, Intermountain Health, Salt Lake City UT
| | - Jessica Sanders
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT
| | - Sarah Elliott
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT
| | - Misha Pangasa
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT
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17
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Fox KR, Kameoka AM, Raidoo S, Soon R, Tschann M, Fontanilla T, Kaneshiro B. Patient Barriers to Discontinuing Long-Acting Reversible Contraception. Matern Child Health J 2024; 28:192-197. [PMID: 38158476 DOI: 10.1007/s10995-023-03878-z] [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] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To describe how frequently a national sample of patients with experience discontinuing or desiring discontinuation of long-acting reversible contraception (LARC) experienced barriers to discontinuation. METHODS We conducted an online survey of individuals ages 18 to 50 in the United States who had previously used and discontinued or attempted to discontinue LARC. We recruited respondents using the Amazon platform MTurk. Respondents provided demographic information and answered questions regarding their experience discontinuing LARC, including reasons removal was deferred or denied. We analyzed frequency of types of barriers encountered and compared these by demographic factors. RESULTS Of the 376 surveys analyzed, 99 (26%) described experiencing at least one barrier to removal. Barriers were disproportionately reported by those who had public health insurance, a history of abortion, and a history of birth compared to those who did not report barriers to removal. They also more frequently identified as Latinx, Asian, or Middle Eastern. Most barriers were provider-driven and potentially modifiable. CONCLUSIONS FOR PRACTICE Barriers to LARC discontinuation are common and may be provider- or systems-driven. Providers should be mindful of biases in their counseling and practices to avoid contributing to these barriers.
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Affiliation(s)
- Kacie R Fox
- Department of Obstetrics, Gynecology & Women's Health, John A. Burns School of Medicine, University of Hawaii, 1319 Punahou St. #824, Honolulu, HI, 96826, USA
| | - Alyssa M Kameoka
- Department of Obstetrics, Gynecology & Women's Health, John A. Burns School of Medicine, University of Hawaii, 1319 Punahou St. #824, Honolulu, HI, 96826, USA.
| | - Shandhini Raidoo
- Department of Obstetrics, Gynecology & Women's Health, John A. Burns School of Medicine, University of Hawaii, 1319 Punahou St. #824, Honolulu, HI, 96826, USA
| | - Reni Soon
- Department of Obstetrics, Gynecology & Women's Health, John A. Burns School of Medicine, University of Hawaii, 1319 Punahou St. #824, Honolulu, HI, 96826, USA
| | - Mary Tschann
- Department of Obstetrics, Gynecology & Women's Health, John A. Burns School of Medicine, University of Hawaii, 1319 Punahou St. #824, Honolulu, HI, 96826, USA
| | - Tiana Fontanilla
- Department of Obstetrics, Gynecology & Women's Health, John A. Burns School of Medicine, University of Hawaii, 1319 Punahou St. #824, Honolulu, HI, 96826, USA
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology & Women's Health, John A. Burns School of Medicine, University of Hawaii, 1319 Punahou St. #824, Honolulu, HI, 96826, USA
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18
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Wollum A, Moucheraud C, Sabasaba A, Gipson JD. Removal of long-acting reversible contraceptive methods and quality of care in Dar es Salaam, Tanzania: Client and provider perspectives from a secondary analysis of cross-sectional survey data from a randomized controlled trial. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002810. [PMID: 38261598 PMCID: PMC10805313 DOI: 10.1371/journal.pgph.0002810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
Access to removal of long-acting reversible contraception (LARCs) (e.g., implants and intrauterine devices (IUDs)) is an essential part of contraceptive care. We conducted a secondary analysis of cross-sectional survey data from a randomized controlled trial. We analyzed 5,930 client surveys and 259 provider surveys from 73 public sector facilities in Tanzania to examine the receipt of desired LARC removal services among clients and the association between receipt of desired LARC removal and person-centered care. We used provider survey data to contextualize these findings, describing provider attitudes and training related to LARC removals. All facilities took part in a larger randomized controlled trial to assess the Beyond Bias intervention, a provider-focused intervention to reduce provider bias on the basis of age, marital status, and parity. Thirteen percent of clients did not receive a desired LARC removal during their visit. Clients who were young, had lower perceived socioeconomic status, and visited facilities that did not take part in the Beyond Bias intervention were less likely to receive a desired removal. Clients who received a desired LARC removal reported higher levels of person-centered care (β = .07, CI: .02 - .11, p = < .01). Half of providers reported not being comfortable removing a LARC before its expiration (51%) or if they disagreed with the client's decision (49%). Attention is needed to ensure clients can get their LARCs removed when they want to ensure patient-centered care and protect client autonomy and rights. Interventions like the Beyond Bias intervention, may work to address provider-imposed barriers to LARC removals.
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Affiliation(s)
- Alexandra Wollum
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States of America
- The UCLA Bixby Center on Population and Reproductive Health, Los Angeles, California, United States of America
| | - Corrina Moucheraud
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City, New York, United States of America
| | - Amon Sabasaba
- Health for a Prosperous Nation (H-PON), Dar es Salaam, Tanzania
| | - Jessica D. Gipson
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States of America
- The UCLA Bixby Center on Population and Reproductive Health, Los Angeles, California, United States of America
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Lewin A, Skracic I, Brown E, Roy K. "The thing in my arm": Providing contraceptive services for adolescents in primary care. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241248399. [PMID: 38778774 PMCID: PMC11113018 DOI: 10.1177/17455057241248399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/20/2024] [Accepted: 04/02/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Due to high rates of unintended pregnancies in Delaware, the state launched a public health initiative in 2014 to increase access to contraceptive services. OBJECTIVES This study was designed to assess the practice-level barriers and facilitators to providing contraceptive care, particularly long-acting reversible contraceptives (LARCs), to adolescents in primary care settings. DESIGN This qualitative study was part of a larger process evaluation of the Delaware Contraceptive Access Now (DelCAN) initiative. METHODS In-depth, semi-structured qualitative interviews were conducted with 16 practice administrators at 13 adolescent-serving primary care sites across the state of Delaware. A process of open, axial, and selective coding was used to analyze the data. RESULTS Despite the interest in LARC among their adolescent patients, administrators described numerous barriers to providing LARC for adolescents including confidentiality in patient visits and billing, preceptorship, and provider discomfort and assumptions about the need for contraception among adolescent patients. CONCLUSION Findings from this study reveal substantial barriers to providing contraception to adolescents, even in primary care practices that were committed to comprehensive contraceptive access for their adolescent patients. This study supports the need for contraceptive care to be integrated into training of pediatricians at every stage of their education. Such training must go beyond education about contraceptive options and the clinical skills necessary for LARC insertion and removal, to include counseling skills based in a reproductive justice framework. Additional changes in policies and practices for adolescent patients would further increase access to contraceptive care.
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Affiliation(s)
- Amy Lewin
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Izidora Skracic
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Ellie Brown
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Kevin Roy
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
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20
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Manze MG, Srinivasulu S, Jones HE. Patient perspectives of using reproductive autonomy to measure quality of care: a qualitative study. BMC Womens Health 2023; 23:647. [PMID: 38049782 PMCID: PMC10696671 DOI: 10.1186/s12905-023-02804-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/24/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Current measures of reproductive health care quality, such as rates of "unintended" pregnancies, neglect to incorporate patients' desires and center their reproductive autonomy. This study explores patients' perspectives on and receptivity to alternative metrics for measuring quality of such care. METHODS An online research recruitment firm identified eligible participants living in New York, ages 18-45, self-identifying as women, and having visited a primary care provider in the last year. We conducted five virtual focus groups and eight in-depth interviews with participants (N = 30) in 2021. Semi-structured guides queried on ideal clinic interactions when preventing or attempting pregnancy and their perspectives on how to measure the quality of such encounters, including receptivity to using our definition of reproductive autonomy to develop one such metric: "whether the patient got the reproductive health service or counseling that they wanted to get, while having all the information about and access to their options, and not feeling forced into anything." We employed an inductive thematic analysis. RESULTS Participants wanted care that was non-judgmental, respectful, and responsive to their needs and preferences. For pregnancy prevention, many preferred unbiased information about contraceptive options to help make their own decisions. For pregnancy, many desired comprehensive information and more provider support. There was considerable support for using reproductive autonomy to measure quality of care. CONCLUSIONS Patients had distinct desires in their preferred approach to discussions about preventing versus attempting pregnancy. Quality of reproductive health care should be measured from the patient's perspective. Given participants' demonstrated support, future research is needed to develop and test a new metric that assesses patients' perceptions of reproductive autonomy during clinical encounters.
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Affiliation(s)
- Meredith G Manze
- City University of New York, Graduate School of Public Health & Health Policy, 55 W 125th Street, New York, NY, 10027, USA.
| | - Silpa Srinivasulu
- City University of New York, Graduate School of Public Health & Health Policy, 55 W 125th Street, New York, NY, 10027, USA
| | - Heidi E Jones
- City University of New York, Graduate School of Public Health & Health Policy, 55 W 125th Street, New York, NY, 10027, USA
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21
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Hale N, Manalew WS, Leinaar E, Smith M, Sen B, Khoury A. Impact of the Choose Well Contraceptive Access Initiative on Method Use Among Women Enrolled in South Carolina's Medicaid Program: A Mid-line Assessment. Womens Health Issues 2023; 33:626-635. [PMID: 37580186 DOI: 10.1016/j.whi.2023.07.003] [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: 11/01/2022] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION A six-year statewide contraceptive access initiative focused on equitable access to contraception, removing cost barriers, capacity building and training, raising consumer awareness, and expanding contraceptive care at safety net clinics was implemented in South Carolina beginning in 2017. This study assessed changes in contraceptive method use among women enrolled in the South Carolina Medicaid program during the first three years of Choose Well. METHODS Contraception use among a retrospective cohort of women aged 15 to 45 enrolled in South Carolina Medicaid from 2012 to 2020 was examined. Interrupted time series regression analysis was used to assess changes in the use of intrauterine devices (IUDs) and contraceptive implants between 2012 and 2016 and 2017 and 2020. Analyses were conducted for all women and stratified by age groups. RESULTS Long-acting reversible contraception use increased from 8.5% during the pre-Choose Well period to 10.9% during the Choose Well period (p < .001), with IUD use increasing from 4.3% to 5.2% (p < .001) and implant use increasing from 4.6% to 6.0% (p < .001). The interrupted time series analysis found a significant positive change in the average level of monthly IUD use after Choose Well began (0.493 percentage points; 95% confidence interval, 0.311-0.675). The effect was stronger among women 20 to 25 years of age. Choose Well significantly increased the trend in IUD use among all women by a positive 0.013 percentage points (95% confidence interval, 0.006-0.020) per month beyond expected values. CONCLUSIONS At the mid-point of the Choose Well Evaluation, the use of IUD methods increased significantly beyond what would be expected had pre-Choose Well trends continued. This was particularly evident among women 20 to 25 years of age. These findings suggest that Choose Well succeeded in reducing barriers to the use of IUDs.
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Affiliation(s)
- Nathan Hale
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee.
| | - Wondimu S Manalew
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Edward Leinaar
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Michael Smith
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Bisakha Sen
- Department of Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amal Khoury
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
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22
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Brewer M, Clifton T. Religious affiliation and women's receipt of person-centered contraceptive care: Findings from the National Survey of Family Growth, 2017-2019. Contraception 2023; 127:110097. [PMID: 37343615 DOI: 10.1016/j.contraception.2023.110097] [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: 12/09/2022] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES To assess patient ratings of person-centered contraceptive care among women of different religious affiliations in the United States. STUDY DESIGN Data from the 2017-2019 National Survey of Family Growth and a sample of female respondents ages 15-49 years who received contraceptive services in the past year and completed the Person-Centered Contraceptive Counseling scale (N = 2226). RESULTS Catholic and Protestant women had higher odds of reporting overall person-centered contraceptive care (odds ratio [OR] = 1.77, OR = 1.54) compared to respondents without a religious affiliation and net sociodemographic characteristics. CONCLUSIONS Women's experiences with person-centered contraceptive care differ based on their religious affiliation. IMPLICATIONS Advancing research on the barriers to person-centered contraceptive care is essential for providing quality health care and reproductive autonomy. This analysis suggests that researchers and clinicians should consider how patient religious affiliation shapes patient-provider encounters and patient experiences of person-centered care to promote quality, equitable family planning care.
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Linton E, Mawson R, Hodges V, Mitchell CA. Understanding barriers to using long-acting reversible contraceptives (LARCs) in primary care: a qualitative evidence synthesis. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:282-292. [PMID: 36810206 DOI: 10.1136/bmjsrh-2022-201560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Long-acting reversible contraceptives (LARCs) are highly effective. In primary care, LARCs are prescribed less frequently than user-dependent contraceptives despite higher efficacy rates. Unplanned pregnancies are rising in the UK, and LARCs may have a role in reducing these through and redressing inequitable contraceptive access. To provide contraceptive services that offer maximal choice and patient benefit, we must understand what contraception users and healthcare professionals (HCPs) think about LARCs and uncover barriers to their use. METHODS A systematic search using CINAHL, MEDLINE via Ovid, PsycINFO, Web of Science and EMBASE identified research about LARC use for pregnancy prevention in primary care. The approach adhered to the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' methodology, critically appraised the literature, and used NVivo software to organise data and perform thematic analysis to determine key themes. RESULTS Sixteen studies met our inclusion criteria. Three themes were identified: (1) trustworthiness (where and from whom participants obtained information regarding LARCs), (2) control (whether LARCs detract from personal autonomy) and (3) systems (how HCPs influenced LARC access). Misgivings about LARCs frequently arose from social networks and fears of surrendering control over fertility were prominent. HCPs perceived access issues and lack of familiarity or training as the main barriers to prescribing LARCs. CONCLUSIONS Primary care plays a key role in improving access to LARC but barriers need to be addressed especially those involving misconception and misinformation. Access to LARC removal services are key to empower choice and prevent coercion. Facilitating trust within patient-centred contraceptive consult is essential.
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Affiliation(s)
- Emma Linton
- AUPMC, The University of Sheffield, Sheffield, UK
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Auerbach S, Agbemenu K, Lorenz R, Hequembourg A, Ely GE. Contraceptive Behavior in Appalachia: Exploring Use, Nonuse, and Contraceptive Attitudes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6862. [PMID: 37835132 PMCID: PMC10572216 DOI: 10.3390/ijerph20196862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Abstract
Very little is known about contraceptive behavior in Appalachia, a large geographic region in the eastern United States where even basic prevalence estimates of contraceptive use/nonuse are lacking. This study characterizes contraceptive behavior among Appalachians, including contraceptive use, reasons for use, and methods used; contraceptive nonuse and reasons for nonuse; and attitudes about contraception, including acceptability. This is a secondary analysis of a subsample of survey data collected on sexual and reproductive health attitudes, behaviors, and needs among reproductive-age women (18-49 years) living in the Appalachian region (n = 332). Results identify rates of contraceptive use (66.6%) and nonuse (33.1%) among Appalachian residents. Methods used most frequently included those that did not require prescription (i.e., external condoms and natural family planning methods) though many reported the use of intrauterine devices (IUDs). Among nonusers, fear of side effects from contraception and ambivalence towards pregnancy were most commonly selected as the most important reason for not using contraception. Contraception was considered acceptable by this sample overall, and these acceptability attitudes were significantly associated with contraceptive behavior.
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Affiliation(s)
- Samantha Auerbach
- School of Nursing, University at Buffalo, Buffalo, NY 14214, USA; (K.A.); (R.L.); (A.H.)
| | - Kafuli Agbemenu
- School of Nursing, University at Buffalo, Buffalo, NY 14214, USA; (K.A.); (R.L.); (A.H.)
| | - Rebecca Lorenz
- School of Nursing, University at Buffalo, Buffalo, NY 14214, USA; (K.A.); (R.L.); (A.H.)
| | - Amy Hequembourg
- School of Nursing, University at Buffalo, Buffalo, NY 14214, USA; (K.A.); (R.L.); (A.H.)
| | - Gretchen E. Ely
- College of Social Work, University of Tennessee, Knoxville, TN 37996, USA;
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Wemrell M, Gunnarsson L. Claims in the clinic: A qualitative group interview study on healthcare communication about unestablished side effects of the copper IUD. PLoS One 2023; 18:e0291966. [PMID: 37768919 PMCID: PMC10538671 DOI: 10.1371/journal.pone.0291966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Lay online communication about health-related issues has in recent years largely been associated with the spread of misinformation and decreased trust in healthcare. Such communication has included claims about systemic side effects of the copper IUD. In Sweden, a social media group centered on this issue now gathers around 8,700 members. This study aimed to use the case of reported yet unestablished side effects of the copper IUD to investigate experiences of and reasoning about healthcare encounters between caregivers and patients contesting established medical knowledge. METHODS We conducted qualitative, semi-structured, digital group interviews with members of the social media group (seven groups, n = 23) and with midwives and gynecologists (six groups, n = 15). We also gathered essays written by social media group members (n = 23). The material was analyzed thematically. RESULTS The participant accounts pointed towards tensions related to principles of evidence-based medicine, i.e., perceived insufficiency of research on the safety of the copper IUD and lack of clarity in routines for reporting and following up suspected side effects, and of patient-centered care, i.e., listening respectfully to patients. Tension between caregivers' obligation to adhere to evidence-based medicine while also providing patient-centered care was noted. CONCLUSION Healthcare providers' efforts to assess and address patient claims contesting established medical knowledge should include ensuring and communicating sufficient research, clarifying procedures for reporting suspected side effects, and improving person-centered care. This can increase the quality of care while contributing to the mitigation of distrust in healthcare and the spreading of health-related misinformation.
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Affiliation(s)
- Maria Wemrell
- Department of Social Work, Linnaeus University, Växjö, Sweden
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Lena Gunnarsson
- School of Humanities, Education and Social Sciences, Örebro University, Örebro, Sweden
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Darney BG, Biel FM, Oakley J, Coleman-Minahan K, Cottrell EK. Contraceptive Method Switching and Long-Acting Reversible Contraception Removal in U.S. Safety Net Clinics, 2016-2021. Obstet Gynecol 2023; 142:669-678. [PMID: 37535965 PMCID: PMC10424816 DOI: 10.1097/aog.0000000000005277] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To describe patterns of contraceptive method switching and long-acting reversible contraception (LARC) removal in a large network of community health centers. METHODS We conducted a retrospective cohort study using individual-level electronic health record data from 489 clinics in 20 states from 2016 to 2021. We used logistic regression models, including individual-, clinic-, and state-level covariates, to calculate adjusted odds ratios and predicted probabilities of any observed contraceptive method switching and LARC removal among those with baseline incident LARC, both over 4-year time periods. RESULTS Among 151,786 patients with 513,753 contraceptive encounters, 22.1% switched to another method at least once over the 4-year observation period, and switching patterns were varied. In patients with baseline LARC, the adjusted predicted probability of switching was 19.0% (95% CI 18.0-20.0%) compared with patients with baseline moderately effective methods (16.2%, 95% CI 15.1-17.3%). The adjusted predicted probability of switching was highest among the youngest group (28.6%, 95% CI 25.8-31.6% in patients aged 12-14 years) and decreased in a dose-response relationship by age to 8.4% (95% CI 7.4-9.4%) among patients aged 45-49 years. Latina and Black race and ethnicity, public or no insurance, and baseline Title X clinic status were all associated with higher odds of switching at least once. Among baseline LARC users, 19.4% had a removal (to switch or discontinue) within 1 year and 30.1% within 4 years; 97.6% of clinics that provided LARC also had evidence of a removal. CONCLUSION Community health centers provide access to method switching and LARC removal. Contraceptive switching and LARC removal are common, and clinicians should normalize switching and LARC removal among patients.
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Affiliation(s)
- Blair G Darney
- Oregon Health & Science University, the OHSU-PSU School of Public Health, and OCHIN, Portland, Oregon; the National Institute of Public Health, Center for Population Health, Cuernavaca, Morelos, Mexico; and the College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, and the University of Colorado Population Center and the Population Program and Geography Department, University of Colorado Boulder, Boulder, Colorado
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Wingo E, Sarnaik S, Michel M, Hessler D, Frederiksen B, Kavanaugh ML, Dehlendorf C. The status of person-centered contraceptive care in the United States: Results from a nationally representative sample. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:129-139. [PMID: 37654244 DOI: 10.1363/psrh.12245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
CONTEXT The Person-Centered Contraceptive Care measure (PCCC) evaluates patient experience of contraceptive counseling, a construct not represented within United States surveillance metrics of contraceptive care. We explore use of PCCC in a national probability sample and examine predictors of person-centered contraceptive care. METHODS Among 2228 women from the 2017-2019 National Survey of Family Growth who reported receiving contraceptive care in the last year, we conducted univariate and multivariable linear regression to identify associations between individual characteristics and PCCC scores. RESULTS PCCC scores were high (x ¯ : 17.84, CI: 17.59-18.08 on a 4-20 scale), yet varied across characteristics. In adjusted analyses, Hispanic identity with Spanish language primacy and non-Hispanic other or multiple racial identities were significantly associated with lower average PCCC scores compared to those of non-Hispanic white identity (B = -1.232 [-1.970, -0.493]; B = -0.792 [-1.411, -0.173]). Gay, lesbian, or bisexual identity was associated with lower average PCCC scores compared to heterosexual (B = -0.673 [-1.243, -0.103]). PCCC scores had a positive association with incomes of 150%-299% and ≥300% of the federal poverty level compared to those of income <150% (150%-299%: B = 0.669 [0.198, 1.141]; ≥300%: B = 0.892 [0.412, 1.372]). Cannabis use in the past year was associated with lower PCCC scores (B = -0.542 [-0.971, -0.113]). CONCLUSIONS The PCCC can capture differential experiences of contraceptive care to monitor patient experience and to motivate and track care quality over time. Differences in reported quality of care have implications for informing national priorities for contraceptive care improvements.
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Affiliation(s)
- Erin Wingo
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Shashi Sarnaik
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Martha Michel
- Health Service Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | | | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, 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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Manzer JL, Berndt VK, Bell AV. Intersections between culture, contraception, knowledge and the body in the USA. CULTURE, HEALTH & SEXUALITY 2023; 25:1164-1179. [PMID: 36327491 DOI: 10.1080/13691058.2022.2141330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Women's contraceptive use is a central feature of US culture around reproduction as evinced by high usage rates and nationwide public health efforts to further increase its use. Paradoxically, women know little about contraception within its biomedical framing, and successive public health-related educational campaigns have produced only moderate knowledge gains. Drawing on 86 in-depth interviews with a diverse sample of reproductive-age women, we set out to understand this persistent learning lag. In doing so, we found that women's limited contraceptive knowledge extended beyond simply being uneducated about various methods. Rather, these learning lags can be attributed to many women's lack of knowledge or misunderstandings about their anatomical bodies and reproductive processes. Employing feminist perspectives, we argue that these misunderstandings derive from factors beyond individual women's control. Indeed, they are rooted in cultural norms that stifle and stigmatise women's reproductive learning. Traditional public health efforts may inevitably fail to overcome these cultural barriers, perpetuating women's gaps in knowledge. Recognising the cultural dimensions of contraceptive knowledge and education reveals how critical action is needed around sexuality education in the USA as well as the limitations of on-going educational efforts.
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Montt-Maray E, Adamjee L, Horanieh N, Witt A, González-Capella T, Zinke-Allmang A, Cislaghi B. Understanding ethical challenges of family planning interventions in sub-Saharan Africa: a scoping review. Front Glob Womens Health 2023; 4:1149632. [PMID: 37674903 PMCID: PMC10478786 DOI: 10.3389/fgwh.2023.1149632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
Background Improving the design of family planning (FP) interventions is essential to advancing gender equality, maternal health outcomes, and reproductive autonomy for both men and women. While progress has been made towards applying a rights-based approach to FP interventions in sub-Saharan Africa, the ethical implications of FP interventions has been underreported and underexplored. Several ethical challenges persist related to measuring success, choice, and target population. Methods We conducted a scoping review to understand if and how FP interventions published between 2000 and 2020 within sub-Saharan Africa address the ethical challenges raised within the literature. We identified a total of 1,652 papers, of which 40 were included in the review. Results Our review demonstrated that the majority of family planning interventions in sub-Saharan Africa place a strong emphasis, on measuring success through quantitative indicators such as uptake of modern contraception methods among women, specifically those that are married and visiting healthcare centres. They also tend to bias the provision of family planning by promoting long-acting reversible contraception over other forms of contraception methods potentially undermining individuals' autonomy and choice. The interventions in our review also found most interventions exclusively target women, not recognising the importance of gender norms and social networks on women's choice in using contraception and the need for more equitable FP services. Conclusion The results of this review highlight how FP interventions measured success through quantitative indicators that focus on uptake of modern contraception methods among women. Utilising these measures makes it difficult to break away from the legacy of FP as a tool for population control as they limit the ability to incorporate autonomy, choice, and rights. Our results are meant to encourage members of the global family planning community to think critically about the ethical implications of their existing interventions and how they may be improved. More public health and policy research is required to assess the effect of applying the new indicators with the FP community as well as explicitly outlining monitoring and evaluation strategies for new interventions to allow for programme improvement and the dissemination of lessons learned.
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Affiliation(s)
- Eloisa Montt-Maray
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lamiah Adamjee
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Nour Horanieh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alice Witt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thaïs González-Capella
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anja Zinke-Allmang
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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DiCenzo N, Gill P, Brandi K. Who gets to decide? Assessing contraceptive coercion in health care settings. Health Serv Res 2023; 58:767-771. [PMID: 37347540 PMCID: PMC10315370 DOI: 10.1111/1475-6773.14193] [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] [Indexed: 06/24/2023] Open
Abstract
See related article by Swan et al .
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Affiliation(s)
- Natalie DiCenzo
- Rutgers Robert Wood Johnson Medical School, Department of Obstetrics and GynecologyNew BrunswickNew JerseyUSA
| | - Puneet Gill
- New York Institute of Technology College of Osteopathic MedicineGlen HeadNew YorkUSA
| | - Kristyn Brandi
- American College of Obstetricians and GynecologistsWashingtonDCUSA
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Bolarinwa OA, Ajayi KV, Okeke SR, Hailegebreal S, Odimegwu C. Spatial distribution and multilevel analysis of factors associated with long-acting reversible contraceptive use among sexually active women of reproductive age in Nigeria. Arch Public Health 2023; 81:99. [PMID: 37269016 DOI: 10.1186/s13690-023-01110-6] [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: 05/14/2022] [Accepted: 05/16/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Long-acting reversible contraceptives (LARCs), including hormonal implants and intrauterine devices, are highly effective pregnancy prevention methods. Aside its advantages over other hormonal methods, LARCs are cost-effective, easy to maintain, and have a low risk of non-compliance-related method failure. Besides, LARCs are also relatively safe for all sexually active women in the postpartum or post-abortion period. However, despite its effectiveness, most sexually active women use other short-term methods, such as condoms and contraceptive pills, which are associated with high discontinuation rates. Thus, this study examines the spatial distribution and multilevel factors associated with LARC use among sexually active reproductive-age women in Nigeria. METHODS This is a cross-sectional analysis of a population-based study from the 2018 Nigeria Demographic Health Survey (NDHS). The NDHS is a nationally representative survey that collects data on socio-demographic characteristics, sexual and reproductive health-related indicators such as contraceptive use and child & maternal health. A sample of 3,978 sexually active reproductive-age women (15-49 years) in Nigeria was used in the analysis. Frequency distribution and spatial analysis of LARC use were displayed with tables and maps, respectively, while multilevel analysis at a 95% confidence interval (CI) and a p-value of less than 0.05 was used to determine factors associated with LARC use among the sample. RESULTS The spatial distribution of LARC use among sexually active women of reproductive age in Nigeria ranges between 20 and 34.8%. Fifteen of the 36 states (excluding the Federal Capital Territory, FCT) recorded low utilization of LARCs. These states include Adamawa, Lagos, Ogun, Enugu, Anambra, Imo, Abia, Rivers, Kogi, Taraba, Yobe, Gombe, Jigawa, Borno, and Kebbi. Besides, the likelihood of LARC use was lower among participants with a prior history of pregnancy termination [aOR = 0.62; 95%(CI = 0.48-0.80)] compared to their counterparts without pregnancy termination history. Also, participants with no fertility intention had a higher likelihood of using LARCs [aOR = 1.65; 95%(CI = 1.30-2.08)] compared to those with fertility intention. At the community level, women with higher socioeconomic status were less likely to use LARCs [aOR = 0.66; 95%(CI = 0.45-0.97)] compared to women with lower socioeconomic status. CONCLUSIONS This study showed a relatively low utilisation of LARC among sexually active reproductive-age women in Nigeria. Notably, this low utilisation is also common in states that could be described as cosmopolitan, indicating a need for closer investigation to understand context-specific factors associated with LARC use. Population-specific family planning education and counselling for this population are important to address common misconceptions about LARCs in particular and modern contraceptive use in general.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health & Well-being, Faculty of Health, Medicine & Society, Chester, CH1 1SL, UK.
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Kobi V Ajayi
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, 77843, USA
| | | | - Samuel Hailegebreal
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Clifford Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Rowley S, Broomfield C, Min J, Quinn S, Campbell K, Wood S. Racial Inequities in Adolescent Contraceptive Care Delivery: A Reproductive Justice Issue. J Pediatr Adolesc Gynecol 2023; 36:298-303. [PMID: 36423806 PMCID: PMC10149577 DOI: 10.1016/j.jpag.2022.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE The objective of this study was to examine racial/ethnic disparities in contraceptive delivery for adolescent patients within an adolescent medicine subspecialty clinical system before and during the COVID-19 pandemic. Secondarily, we aimed to assess the relationship between race and contraceptive delivery by telehealth. DESIGN Retrospective cohort study using electronic health record data SETTING: Three adolescent medicine subspecialty clinics in a large academic hospital system, including an urban location and 2 suburban locations PARTICIPANTS: Patients assigned female sex at birth prescribed hormonal contraception between January 1st, 2018, and May 31st, 2021. MAIN OUTCOME MEASURES Method and type of contraceptive prescribed (short-acting, medium-acting, long-acting reversible contraception [LARC]) RESULTS: There were 2453 patients in the study; 47.5% were White, 36.0% were Black, and 8.1% identified as Hispanic. After controlling for insurance and age, Black patients, compared with non-Black patients, had twofold higher odds of receiving LARC compared with a short-acting method across the study period (aOR = 2.0; 95% CI, 1.52-2.62). We identified effect modification with significant interaction between Black race and the pandemic period, with evidence of a higher marginal probability of Black patients receiving LARCs during the pandemic. Additionally, during the pandemic, patients receiving new contraceptive prescriptions via telehealth were less likely to be Black (aOR = 0.63; 95% CI, 0.41-0.94) or publicly insured (aOR = 0.56; 95% CI, 0.38-0.81). CONCLUSION Our data show significantly higher prescribing of LARCs to Black adolescents by clinicians, which could suggest differences in physician contraceptive counseling with a bias toward preferentially counseling Black patients toward LARCs. Our data also show that Black and publicly insured patients had decreased utilization of contraceptive care by telehealth during the pandemic.
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Affiliation(s)
- Sarah Rowley
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | | | - Jungwon Min
- Department of Biomedical and Health Informatics, Children...s Hospital of Philadelphia
| | - Sheila Quinn
- Craig-Dalsimer Division of Adolescent Medicine, Children...s Hospital of Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Kenisha Campbell
- Policy Lab, Children...s Hospital of Philadelphia; Craig-Dalsimer Division of Adolescent Medicine, Children...s Hospital of Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Sarah Wood
- Policy Lab, Children...s Hospital of Philadelphia; Craig-Dalsimer Division of Adolescent Medicine, Children...s Hospital of Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
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Durante JC, Sims J, Jarin J, Gold MA, Messiah SE, Francis JKR. Long-Acting Reversible Contraception for Adolescents: A Review of Practices to Support Better Communication, Counseling, and Adherence. Adolesc Health Med Ther 2023; 14:97-114. [PMID: 37181329 PMCID: PMC10167958 DOI: 10.2147/ahmt.s374268] [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: 01/31/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.
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Affiliation(s)
- Julia C Durante
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
| | - Jessica Sims
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
| | - Jason Jarin
- Children’s Health System of Texas, Dallas, TX, USA
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Melanie A Gold
- Department of Pediatrics and Department of Population & Family Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Sarah E Messiah
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, TX, USA
- Center for Pediatric and Population Health, UTHealth School of Public Health, Dallas, TX, USA
- Department of Pediatrics, McGovern Medical School, Houston, TX, USA
| | - Jenny K R Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
- Peter O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Morison T. Patient-provider power relations in counselling on long-acting reversible contraception: a discursive study of provider perspectives. CULTURE, HEALTH & SEXUALITY 2023; 25:537-553. [PMID: 35510833 DOI: 10.1080/13691058.2022.2067593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Contraceptive providers play an essential role in shaping contraceptive decision-making and care, with the potential to constrain patients' agency. This is a particular concern given the rising hegemony of Long-Acting Reversible Contraception (LARC) and growing evidence of negative patient experiences of LARC promotion and provision. Despite this evidence, little research has considered health providers' perspectives. Drawing on interviews with 22 contraceptive health providers in Aotearoa New Zealand, this paper explored their professional identity construction, focusing on meaning-making in instances of conflict between providers' and patients' priorities and agendas. Guided by feminist poststructuralist theory, the discursive analysis highlights common rhetorical strategies used by participants to (1) justify the use of coercive practices to encourage LARC uptake, and (2) in turn, negotiate positive identities. Findings show how participants grapple with the reproductive politics structuring contraceptive care, including established understandings of the purpose of (long-acting) contraception and contraceptive providers' roles vis-à-vis provision and promotion. The findings point to limitations on contraceptive agency, despite the unanimous endorsement of rights-based voluntary care. Extending the critical literature on LARC and contributing to the under-researched area of contraceptive coercion and agency, the findings of this study have important implications for the delivery of contraceptive care.
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Affiliation(s)
- Tracy Morison
- School of Psychology, Massey University, Palmerston North, New Zealand
- Critical Studies in Sexualities and Reproduction, Rhodes University, Makhanda, South Africa
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Swan LET, Senderowicz LG, Lefmann T, Ely GE. Health care provider bias in the Appalachian region: The frequency and impact of contraceptive coercion. Health Serv Res 2023. [DOI: http:/doi.org/10.1111/1475-6773.14157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Affiliation(s)
- Laura E. T. Swan
- Department of Population Health Sciences University of Wisconsin‐Madison Madison Wisconsin USA
- Collaborative for Reproductive Equity University of Wisconsin‐Madison Madison Wisconsin USA
| | - Leigh G. Senderowicz
- Collaborative for Reproductive Equity University of Wisconsin‐Madison Madison Wisconsin USA
- Department of Gender and Women's Studies University of Wisconsin‐Madison Madison Wisconsin USA
- Department of Obstetrics and Gynecology University of Wisconsin‐Madison Madison Wisconsin USA
| | - Tess Lefmann
- Department of Social Work University of Mississippi Oxford Mississippi USA
| | - Gretchen E. Ely
- College of Social Work University of Tennessee Knoxville Tennessee USA
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Increasing Access to Intrauterine Devices and Contraceptive Implants: ACOG Committee Statement No. 5. Obstet Gynecol 2023; 141:866-872. [PMID: 36961974 DOI: 10.1097/aog.0000000000005127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Indexed: 03/25/2023]
Abstract
Everyone who desires long-acting reversible contraception should have timely access to contraceptive implants and intrauterine devices. Obstetrician-gynecologists and other reproductive health care clinicians can best serve those who want to delay or avoid pregnancy by adopting evidence-based practices and offering all medically appropriate contraceptive methods. Long-acting reversible contraceptive devices should be easily accessible to all people who want them, including adolescents and those who are nulliparous and after spontaneous or induced abortion and childbirth. To achieve equitable access, the American College of Obstetricians and Gynecologists supports the removal of financial barriers to contraception by advocating for coverage and appropriate payment and reimbursement for all contraceptive methods by all payers for all eligible patients.
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Qureshey EJ, Chen HY, Wagner SM, Chauhan SP, Fishel Bartal M. Factors associated with long-acting reversible contraception usage: Results from the National Survey of Family Growth. Int J Gynaecol Obstet 2023; 161:71-78. [PMID: 36181291 DOI: 10.1002/ijgo.14485] [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: 02/24/2022] [Revised: 09/10/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to identify factors associated with long-acting reversible contraception (LARC) usage. METHODS The current cross-sectional study used data from the National Survey of Family Growth from 2011 to 2019. Respondents aged 15 to 44 years were included. Those with previous sterilization, infertility, or pregnant were excluded. The outcome evaluated was use of a LARC. RESULTS Of 61 543 814 women, 44 287 911 (72.0%) met inclusion criteria. The rate of LARC use was 13.4%. Factors associated with an increased likelihood of LARC usage were married/living with a partner (adjusted relative risk [aRR], 1.18 [95% CI, 1.02-1.37]), perceived good health (aRR, 1.44 [95% CI, 1.13-1.84]), year of survey 2017 to 2019 (aRR, 1.53, [95% CI, 1.28-1.83]), one or two past pregnancies (aRR, 1.62 [95% CI, 1.24-2.12]) or three or more past pregnancies (aRR, 1.67 [95% CI, 1.22-2.28]), age at first live birth <20 years (aRR, 1.58 [95% CI, 1.20-2.08]) or 20 to 24 years (aRR, 1.45 [95% CI, 1.13-1.87]), age at onset of sexual activity 13-19 years (aRR, 1.50 [95% CI, 1.26-1.78]), and a 0- to 5-month period of nonintercourse in the past year (aRR, 1.63 [95% CI, 1.40-1.90]). Factors associated with decreased LARC usage were age ≥ 35 years (aRR, 0.74 [95% CI, 0.65-0.85]), being non-Hispanic Black (aRR, 0.75 [95% CI, 0.62-0.89]) or non-Hispanic other (aRR, 0.72 [95% CI, 0.59-0.88]), intending to have children (aRR, 0.65 [95% CI, 0.57-0.74]), and never being sexually active (aRR, 0.10 [95% CI, 0.06-0.16]). CONCLUSIONS Using a nationally representative sample of women in the United States, the authors identified modifiable factors associated with LARC use. Results may be used to plan interventional trials to increase LARC usage.
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Affiliation(s)
- Emma J Qureshey
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Han-Yang Chen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Stephen M Wagner
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michal Fishel Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Cooke-Jackson A, Rubinsky V, Gunning JN. "Wish I Would Have Known that before I Started Using It": Contraceptive Messages and Information Seeking among Young Women. HEALTH COMMUNICATION 2023; 38:834-843. [PMID: 34544296 DOI: 10.1080/10410236.2021.1980249] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In recent decades, women's use of contraception has evolved. Women not only utilize contraceptives to prevent pregnancy, but also to manage menstruation and other factors related to their personal agency. Despite an abundance of available contraceptive options, many women struggle to navigate and address their contraceptive needs. A hundred and thirty-four female participants responded to an open-ended questionnaire about contraceptive messages and decision making in an online survey. Using Uncertainty Management Theory as a framework, we illustrate how the women make sense of and manage uncertainty from multiple contraceptive messages. Results highlighted the absence of desired information, and identified messages that women wish they had received from healthcare providers and others. Our findings suggest that women's understanding of contraceptives' side effects is a communicative process in which anecdotal evidence is often treated as medical fact and healthcare providers are viewed as ineffective and dismissive in relaying and addressing information about contraception. In the absence of satisfying healthcare interactions, women seek information elsewhere to make their contraceptive choices.
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Canning D, Karra M. Unwanted Family Planning: Prevalence Estimates for 56 Countries. Stud Fam Plann 2023; 54:75-93. [PMID: 36705943 DOI: 10.1111/sifp.12230] [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: 01/28/2023]
Abstract
While there is a large literature on the prevalence of unmet need for family planning, there is no matching quantitative evidence on the prevalence of unwanted family planning; all contraceptive use is assumed to represent a "met need." This lack of evidence raises concerns that some observed contraceptive use may be undesired and coercive. We provide estimates of unwanted family planning using Demographic and Health Survey data collected from 1,546,987 women in 56 low- and middle-income countries between 2011 and 2019. We estimate the prevalence of unwanted family planning, defined as the proportion of women who report wanting a child in the next nine months but who are using contraception. We find that 12.2 percent of women have an unmet need for family planning, while 2.1 percent have unwanted family planning, with estimated prevalence rates ranging from 0.4 percent in Gambia to 7.1 percent in Jordan. About half of unwanted family planning use can be attributed to condoms, withdrawal, and abstinence. Estimating the prevalence of unwanted family planning is difficult given current data collection efforts, which are not designed for this purpose. We recommend that future surveys probe the reasons for the use of family planning.
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Affiliation(s)
- David Canning
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Mahesh Karra
- Frederick S. Pardee School of Global Studies, Boston University, Boston, MA, 02215, USA
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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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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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Fay KE, Traore F, Amico JR. Intrauterine device self-removal practices during the COVID-19 pandemic among family planning clinics. Contraception 2023; 118:109889. [PMID: 36243126 PMCID: PMC9554323 DOI: 10.1016/j.contraception.2022.09.127] [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: 05/09/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To explore the prevalence of intrauterine device self-removal practices before and during the COVID-19 pandemic among family planning clinics. STUDY DESIGN This is a secondary analysis of data from a descriptive, longitudinal study using a clinic-based convenience sample from the Abortion Clinical Research Network assessing baseline and pandemic-adaptive family planning practices. RESULTS Of the 63 sites that provided contraception, 5 (7.9%) reported providing guidance on intrauterine device self-removal at baseline. Sixteen sites (25.4%) provided guidance on self-removal by the end of the study period. Self-removal counseling was associated with being an academic center and reporting a median lower number of monthly contraceptive encounters. CONCLUSIONS Endorsement of IUD self-removal increased to one-quarter of sites by the final timepoint. IMPLICATIONS Twenty-five percent of family planning clinics reported provision of intrauterine device self-removal guidance by eight months into the COVID-19 pandemic, a three-fold increase from baseline; these findings suggest clinician support for patient autonomy in contraceptive self-management and limited concern for safety issues with self-removal during a public health emergency.
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Affiliation(s)
- Kathryn E. Fay
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, United States,Corresponding author
| | - Fadila Traore
- The Cambridge School of Weston, Weston, MA, United States
| | - Jennifer R. Amico
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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44
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Auerbach SL, Coleman-Minahan K, Alspaugh A, Aztlan EA, Stern L, Simmonds K. Critiquing the Unintended Pregnancy Framework. J Midwifery Womens Health 2023; 68:170-178. [PMID: 36637112 DOI: 10.1111/jmwh.13457] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 01/14/2023]
Abstract
The unintended pregnancy framework, a central tenet of sexual and reproductive health care delivery and research, has been depicted as an adverse outcome that should be prevented. There is growing criticism of the inadequacies of this framework, although little modification in public health guidelines, measurement, or clinical practice has been seen. This article critically reviews the literature on unintended pregnancy to encourage reflection on how this framework has negatively influenced practice and to inspire the advancement of more patient-centered care approaches. We begin by outlining the historical origins of the unintended pregnancy framework and review how this framework mischaracterizes patients' lived experiences, fails to account for structural inequities, contributes to stigma, and is built upon weakly supported claims of a negative impact on health outcomes. We close with a discussion of the relationship between health care provision and unintended pregnancy care and the implications and recommendations for realigning clinical practice, research, and policy goals.
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Affiliation(s)
| | - Kate Coleman-Minahan
- College of Nursing, University of Colorado-Anschutz Medical Campus, Aurora, Colorado
| | - Amy Alspaugh
- College of Nursing, University of Tennessee, Knoxville, Tennessee
| | | | - Lisa Stern
- Coalition to Expand Contraceptive Access, San Francisco, California
| | - Katherine Simmonds
- Roux Institute, Bouvé College of Health Sciences, Northeastern University, Portland, Maine
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Sweeney HE, Bainvoll L, Mandelbaum RS, Sangara RN, Violette CJ, Klar M, Matsushima K, Paulson RJ, Cahoon SS, Nguyen BT, Bender NM, Ouzounian JG, Matsuo K. Uptake of postplacental intrauterine device placement at cesarean delivery. AJOG GLOBAL REPORTS 2023; 3:100157. [PMID: 36748028 PMCID: PMC9898742 DOI: 10.1016/j.xagr.2022.100157] [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] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Several studies have investigated the effectiveness of intrauterine device placement at cesarean delivery as a contraceptive method. However, national-level use and outcomes of a postplacental intrauterine device at cesarean delivery are currently understudied in the United States. OBJECTIVE This study aimed to examine the trends, characteristics, and outcomes of patients who received a postplacental intrauterine device at cesarean delivery. STUDY DESIGN This retrospective cohort study used the National Inpatient Sample. The study cohort included patients who underwent cesarean delivery from October 2015 to December 2018. The exclusion criteria included hemorrhage, chorioamnionitis, uterine anomaly, hysterectomy, and permanent surgical sterilization. Eligible cases were grouped on the basis of the use of a postplacental intrauterine device at cesarean delivery. The primary outcome measures were temporal trends and characteristics associated with the use of a postplacental intrauterine device at cesarean delivery, assessed using the generalized estimating equation model in multivariable analysis. The secondary outcome measure was perioperative morbidity (leukocytosis, endometritis, myometritis, and sepsis). Propensity score matching was used to balance the baseline characteristics. RESULTS Among 2,983,978 patients who met the inclusion criteria, 10,145 patients (0.3%) received a postplacental intrauterine device at cesarean delivery. The use of a postplacental intrauterine device increased from 0.1% in the fourth quarter of 2015 to 0.6% in the fourth quarter of 2018 (P<.001). In a multivariable analysis, the use of a postplacental intrauterine device increased by 14% every quarter-year (adjusted odds ratio, 1.14; 95% confidence interval, 1.13-1.15). In addition, (1) patient characteristics of young age, non-White race, obesity, tobacco use, lowest quartile median household income, and insured with Medicaid; (2) hospital characteristics of large bed capacity and urban teaching setting in Northeast region; and (3) pregnancy characteristics of early gestational age at cesarean delivery, hypertensive disease, previous cesarean delivery, multifetal pregnancy, grand multiparity, placenta previa, and nonelective cesarean delivery represented the independent characteristics associated with the use of a postplacental intrauterine device (all P<.05). A regression tree model identified 35 discrete patterns of the use of a postplacental intrauterine device based on 8 factors (time, race or ethnicity, primary expected payer, obesity, hospital bed capacity, hospital teaching status, hospital region, and previous cesarean delivery). There were 9 patterns, representing 8.8% of the study population, exhibiting a use rate of ≥1.0%, whereas there were 7 patterns, representing 16.0% of the study population, exhibiting no use of a postplacental intrauterine device (absolute rate difference from the highest group to the lowest group, 4.7%). In a propensity score-matched model, postplacental intrauterine device placement at cesarean delivery was not associated with increased risk of measured morbidity (any, 1.8% vs 1.7%; odds ratio, 1.06; 95% confidence interval, 0.66-1.69; P=.812), including postpartum endometritis (1.2% vs 1.0%; odds ratio, 1.19; 95% confidence interval, 0.67-2.14; P=.554). CONCLUSION The use of a postplacental intrauterine device at cesarean delivery increased significantly in recent years in the United States.
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Affiliation(s)
- Heather E. Sweeney
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Sweeney, Ms Bainvoll, and Drs Mandelbaum, Sangara, Violette, and Matsuo)
| | - Liat Bainvoll
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Sweeney, Ms Bainvoll, and Drs Mandelbaum, Sangara, Violette, and Matsuo),Keck School of Medicine, University of Southern California, Los Angeles, CA (Ms Bainvoll)
| | - Rachel S. Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Sweeney, Ms Bainvoll, and Drs Mandelbaum, Sangara, Violette, and Matsuo),Division of Reproductive Endocrinology and Infertility, University of Southern California, Los Angeles, CA (Drs Mandelbaum and Paulson)
| | - Rauvynne N. Sangara
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Sweeney, Ms Bainvoll, and Drs Mandelbaum, Sangara, Violette, and Matsuo)
| | - Caroline J. Violette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Sweeney, Ms Bainvoll, and Drs Mandelbaum, Sangara, Violette, and Matsuo)
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany (Dr Klar)
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA (Dr Matsushima)
| | - Richard J. Paulson
- Division of Reproductive Endocrinology and Infertility, University of Southern California, Los Angeles, CA (Drs Mandelbaum and Paulson)
| | - Sigita S. Cahoon
- Division of Obstetrics, Gynecology, and Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Cahoon)
| | - Brian T. Nguyen
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Nguyen and Bender)
| | - Nicole M. Bender
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Nguyen and Bender)
| | - Joseph G. Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Ouzounian)
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Sweeney, Ms Bainvoll, and Drs Mandelbaum, Sangara, Violette, and Matsuo),Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (Dr Matsuo),Corresponding author: Koji Matsuo, MD, PhD.
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Chin E, Leung K, Moore Simas TA, Kumaraswami T. Changes in postpartum contraception utilization rates during the early stage of the COVID-19 pandemic. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231175311. [PMID: 37334467 DOI: 10.1177/17455057231175311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND The first wave of the COVID-19 pandemic was associated with restricted access to reproductive care including delayed abortion and female sterilization procedures, in addition to altered maternity care experiences. Given high rates of unintended and short-interval pregnancies in the United States in general and negative obstetric outcomes specifically associated with COVID-19, access to all effective pregnancy prevention methods during the pandemic was crucial. OBJECTIVES To investigate changes in contraception utilization rates prior to delivery discharge, at outpatient postpartum visits, and at 10 weeks' postpartum, at the largest healthcare system in Central Massachusetts, during the first wave of the COVID-19 pandemic (15 March to 15 May 2020), compared to the same period in 2019. DESIGN Retrospective cohort review. METHODS Compared perinatal individuals (n = 495) who received prenatal care and delivered at UMass Memorial Medical Center from mid-March to mid-May in both 2019 (non-pandemic) and 2020 (COVID-19 pandemic). Receipt of contraception prior to delivery discharge and at outpatient postpartum visit was estimated and compared between the two time periods using the Chi-square test for categorical variables (or Fisher's exact test when cell counts were < 5) and Student's t-test for continuous variables. Multivariable logistic regression was performed to adjust for confounders. RESULTS The proportion of individuals who used long-acting reversible contraception before delivery discharge was 4% in 2019 and 13% in 2020 (p = 0.01). Modes of outpatient postpartum visit contraception did not vary from 2019 to 2020, (p = 0.06). Overall, there were no differences in contraception utilization rates at 10 weeks' postpartum from 2019 to 2020, (p = 0.50). CONCLUSION Compared to a year prior, immediate postpartum long-acting reversible contraception use increased during the first wave of the COVID-19 pandemic, while overall contraception use at 10 weeks' postpartum remained unchanged. The evaluation of contraceptive use during the most restrictive time of COVID-19 pandemic can help identify opportunities to increase access to effective contraception, such as the immediate postpartum period prior to hospital discharge.
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Affiliation(s)
- Emily Chin
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Katherine Leung
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School/UMass Memorial Health, Worcester, MA, USA
| | - Tara Kumaraswami
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School/UMass Memorial Health, Worcester, MA, USA
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Goyal S, Monsour M, Ko JY, Curtis KM, Whiteman MK, Coy KC, Cox S, Romero L. Contraception claims by medication for opioid use disorder prescription status among insured women with opioid use disorder, United States, 2018. Contraception 2023; 117:67-72. [PMID: 36243128 PMCID: PMC9722562 DOI: 10.1016/j.contraception.2022.09.129] [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: 07/01/2022] [Revised: 09/14/2022] [Accepted: 09/23/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE(S) To understand how contraception method use differed between women prescribed and not prescribed medications for opioid use disorder (MOUD) among commercially-insured and Medicaid-insured women. STUDY DESIGN IBM Watson Health MarketScan Commercial Claims and Encounters database and the Multi-State Medicaid database were used to calculate the (1) crude prevalence, and (2) adjusted odds ratios (adjusted for demographic characteristics) of using long-acting reversible or short-acting hormonal contraception methods or female sterilization compared with none of these methods (no method) in 2018 by MOUD status among women with OUD, aged 20 to 49 years, with continuous health insurance coverage through commercial insurance or Medicaid for ≥6 years. Claims data was used to define contraception use. Fisher exact test or χ2 test with a P-value ≤ 0.0001, based on the Holm-Bonferroni method, and 95% confidence intervals were used to determine statistically significant differences for prevalence estimates and adjusted odds ratios, respectively. RESULTS Only 41% of commercially-insured and Medicaid-insured women with OUD were prescribed MOUD. Medicaid-insured women with OUD prescribed MOUD had a significantly lower crude prevalence of using no method (71.1% vs 79.0%) and higher odds of using female sterilization (aOR, 1.33; 95% CI: 1.06-1.67 vs no method) than those not prescribed MOUD. Among commercially-insured women there were no differences in contraceptive use by MOUD status and 66% used no method. CONCLUSIONS Among women with ≥ 6 years of continuous insurance coverage, contraceptive use differed by MOUD status and insurance. Prescribing MOUD for women with OUD can be improved to ensure quality care. IMPLICATIONS Only two in five women with OUD had evidence of being prescribed MOUD, and majority did not use prescription contraception or female sterilization. Our findings support opportunities to improve prescribing for MOUD and integrate contraception and MOUD services to improve clinical care among women with OUD.
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Affiliation(s)
- Sonal Goyal
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Michael Monsour
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jean Y. Ko
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kathryn M. Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Maura K. Whiteman
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kelsey C. Coy
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States,Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Shanna Cox
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lisa Romero
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
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"It Just Depends on Their Stability": A Qualitative Examination of Patient Factors Influencing Providers' Contraceptive Counseling Approaches for Persons With Substance Use Disorders. J Addict Med 2023; 17:89-94. [PMID: 35916431 DOI: 10.1097/adm.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This qualitative study examined how patient-related factors influence providers' contraceptive counseling for persons with substance use disorders (SUDs). Specifically, we explored individual behavior and social factors that contribute to providers modifying their contraceptive counseling approaches and described how providers alter their counseling recommendations and communication strategies in the presence of such factors. METHODS In 2019, we purposively recruited a national sample of contraceptive providers (N = 24) and conducted semistructured phone interviews to inquire about their contraceptive counseling practices for women with SUDs. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis with inductive codes. RESULTS Participants included 10 medical doctors, 8 nurse practitioners, and 6 certified nurse-midwives. We found that providers modify their contraceptive counseling provision when their patients are actively using substances or have unstable living conditions, such as intimate partner violence or homelessness. With patients experiencing these instabilities, providers reported postponing contraceptive discussions until patients are stabilized in treatment, recommending long-active reversible contraceptive methods, and varying communication styles according to their own perceptions of patients' communication needs. Providers perceived that individuals in long-term recovery have increased stability and fewer barriers to contraceptive access and adherence and therefore reported increased willingness to provide greater autonomy during contraceptive decision making and shift the counseling focus to short-acting contraceptive methods. CONCLUSIONS This study highlights that substance use and social "stability" of patients contributes to how providers approach their contraceptive counseling and make methods recommendations for their patients with SUDs. More research is needed to understand strategies that individuals with SUDs use to overcome barriers to contraceptive access and adherence in the context of active substance use and social instability.
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Liddell JL. Birth control access experiences for members of an Indigenous tribe in the Gulf Coast. WOMENS STUDIES INTERNATIONAL FORUM 2023. [DOI: 10.1016/j.wsif.2022.102667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Simmons RG, Baayd J, Elliott S, Cohen SR, Turok DK. Improving access to highly effective emergency contraception: an assessment of barriers and facilitators to integrating the levonorgestrel IUD as emergency contraception using two applications of the Consolidated Framework for Implementation Research. Implement Sci Commun 2022; 3:129. [PMID: 36494859 PMCID: PMC9737706 DOI: 10.1186/s43058-022-00377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emergency contraception prevents unwanted pregnancy after sexual intercourse. New evidence has demonstrated that the levonorgestrel 52 mg IUD is a highly effective method of emergency contraception. However, translating this research finding into clinical practice faces existing barriers to IUD access, including costs and provider training, novel barriers of providing IUDs for emergency contraception at unscheduled appointments. The purpose of this study was to identify barriers and facilitators to the utilization of the levonorgestrel IUD as emergency contraception from client, provider, and health systems perspectives. METHODS We conducted English and Spanish-speaking focus groups (n=5) of both contraceptive users (n=22) and providers (n=13) to examine how the levonorgestrel IUD as EC was perceived and understood by these populations and to determine barriers and facilitators of utilization. We used findings from our focus groups to design a high-fidelity in-situ simulation scenario around EC that we pilot tested with clinical teams in three settings (a county health department, a community clinic, and a midwifery clinic), to further explore structural and health systems barriers to care. Simulation scenarios examined health system barriers to the provision of the levonorgestrel IUD as EC. We coded both focus groups and in-clinic simulations using the modified Consolidated Framework for Implementation Research (CFIR). We then applied our findings to the CFIR-Expert Recommendations for Implementing Change (ERIC) Barrier Busting Tool and mapped results to implement recommendations provided by participants. RESULTS Ultimately, 9 constructs from the CFIR were consistently identified across focus groups and simulations. Main barriers included suboptimal knowledge and acceptability of the intervention itself, appropriately addressing knowledge and education needs among both providers and contraceptive clients, and adequately accounting for structural barriers inherent in the health system. The CFIR-ERIC Barrier Busting Tool identified eight strategies to improve levonorgestrel IUD as EC access: identifying implementation champions, conducting educational meetings, preparing educational toolkits, involving patients and their partners in implementation, conducting a local needs assessment, distributing educational materials, and obtaining patient feedback. CONCLUSIONS To sustainably incorporate the levonorgestrel IUD as EC into clinical practice, education, health systems strengthening, and policy changes will be necessary.
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Affiliation(s)
- Rebecca G. Simmons
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jami Baayd
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Sarah Elliott
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Susanna R. Cohen
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - David K. Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
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