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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
OBJECTIVE 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 (DC) 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 DC. 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), 4770 Buford Highway NE, Atlanta, Georgia, USA.
| | - Shanna Cox
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Atlanta, Georgia, USA
| | - Lisa Romero
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Atlanta, Georgia, USA
| | - Donatus Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Atlanta, Georgia, USA
| | - Maura Whiteman
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Atlanta, Georgia, USA
| | - Charlan Kroelinger
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Atlanta, Georgia, USA
| | - Lijing Ouyang
- Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Atlanta, Georgia, USA
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Beatty K, Smith MG, de Jong J, Weber A, Adelli R, Khoury A. Impact of the Choose Well Initiative on Contraceptive Access at Federally Qualified Health Centers in South Carolina: A Midline Evaluation. Am J Public Health 2023; 113:1167-1172. [PMID: 37651659 PMCID: PMC10568501 DOI: 10.2105/ajph.2023.307384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Choose Well (CW) is a statewide contraceptive access initiative to reduce unintended pregnancy among patients utilizing federally funded family planning services. We examined CW's impact on contraceptive access at South Carolina federally qualified health centers from 2016 to 2019, which reported significantly higher increases in providing the full range of contraceptive methods and training onsite. CW prioritized ensuring change sustainability through obtaining funding and institutionalizing changes. (Am J Public Health. 2023;113(11):1167-1172. https://doi.org/10.2105/AJPH.2023.307384).
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Affiliation(s)
- Kate Beatty
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Michael G Smith
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Jordan de Jong
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Amy Weber
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Rakesh Adelli
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Amal Khoury
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
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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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Bullington BW, Arora KS. Fulfillment of Desired Postpartum Permanent Contraception: a Health Disparities Issue. Reprod Sci 2022; 29:2620-2624. [PMID: 35713848 PMCID: PMC10120182 DOI: 10.1007/s43032-022-00912-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
Women of color experience marked disparities in fulfillment of desired postpartum permanent contraception. While many attribute the disparity to the required Medicaid sterilization consent form and 30-day waiting period established in response to forced and coerced sterilizations, the policy does not entirely explain the disparity; racial and ethnic disparities persist even within strata of insurance type. We therefore propose framing postpartum permanent contraception as a health disparities issue that requires multi-level interventions to address. Based on the literature, we identify discrete levels of barriers to postpartum permanent contraception fulfillment at the patient, physician, hospital, and policy levels that interact and compound within and between individual levels, affecting each individual patient differently. At the patient level, sociodemographic characteristics such as age, race and ethnicity, and parity impact desire for and fulfillment of permanent contraception. At the physician level, implicit bias and paternalistic counseling contribute to barriers in permanent contraception fulfillment. At the hospital level, Medicaid reimbursement, operating room availability, and religious affiliation influence fulfillment of permanent contraception. Lastly, at the policy level, the Medicaid consent form and waiting period pose a known barrier to fulfillment of desired postpartum permanent contraception. Unpacking each of these discrete barriers and untangling their collective impact is necessary to eliminate racial and ethnic disparities in permanent contraception fulfillment.
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Affiliation(s)
- Brooke W Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 3031 Old Clinic Building, CB 7570, Chapel Hill, NC, 27599, USA.
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5
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Shelton D, Ramage M, Hughes P, Tak C. Factors associated with contraceptive use among postpartum women with substance use disorder. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100764. [PMID: 36057204 DOI: 10.1016/j.srhc.2022.100764] [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: 02/19/2022] [Revised: 07/19/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Rates of unintended pregnancy among women with substance use disorder (SUD) are much higher than the general reproductive-age population, suggesting lower rates of contraceptive use. This study aims to determine the prevalence of contraceptive use in postpartum women with SUD and identify factors associated with its use. METHODS This retrospective cohort study using electronic health record data from 2016 to 2019 included postpartum adult women with any SUD who received care at a high-risk pregnancy clinic (n = 353). The primary outcome was contraception utilization as identified using diagnosis and procedure codes. An adjusted multivariate logistic regression was used to evaluate the relationship between postpartum contraceptive use and sample characteristics. RESULTS Of the 353 postpartum women with SUD, contraceptive use was found in 128 (36.3%) women. Among the study population, the most commonly reported substance use disorders were nicotine use disorder (70.3%), opioid use disorder (51.3%), and cannabis use disorder (15.0%). Among those with opioid use disorder, 45.3% were found to be using medication for opioid use disorder (MOUD). Women who attended a postpartum visit had 2.23 times the odds of using contraception compared to women who did not (OR: 2.23, 95% CI: 1.20-4.15). Those using MOUD had 3.69 times the odds of using contraception compared to those who were not (OR: 3.69, 95% CI: 1.89-7.19). Overall, women who utilized contraception were more likely to be younger than 25, receiving MOUD, and participating in postpartum care. CONCLUSIONS Postpartum women with SUD are not using contraceptive methods and this is associated with a lack of appropriate healthcare interventions in the perinatal period, which can reduce the odds of receiving effective family planning services. Specialized whole-health interventions and policies to increase access to care for women with SUD should be developed.
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Affiliation(s)
- Danielle Shelton
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, 301 Pharmacy Ln, CB#7355, Chapel Hill, NC 27599-7355, United States.
| | - Melinda Ramage
- Mountain Area Health Education Center (MAHEC), 121 Hendersonville Rd, Asheville, NC 28803-6828, United States
| | - Phillip Hughes
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, 301 Pharmacy Ln, CB#7355, Chapel Hill, NC 27599-7355, United States; Department of Research, UNC Health Sciences at MAHEC, 121 Hendersonville Rd, Asheville, NC 28803-6828, United States
| | - Casey Tak
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, 301 Pharmacy Ln, CB#7355, Chapel Hill, NC 27599-7355, United States; Department of Pharmacotherapy, College of Pharmacy, University of Utah, 30 S 2000 E, Salt Lake City, UT 8411, United States
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6
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Yates L, Birken S, Thompson TA, Stuart GS, Greene S, Hassmiller Lich K, Weinberger M. A qualitative analysis of Medicaid beneficiaries perceptions of prenatal and immediate postpartum contraception counseling. WOMEN'S HEALTH 2022. [PMCID: PMC9486062 DOI: 10.1177/17455057221124079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: In the United States, about four out of every ten births are financed by
Medicaid, making it a program that is key in addressing racial disparities
in maternal health. Many women covered by Medicaid have access to prenatal
and immediate postpartum contraception counseling that can aid them in their
postpartum contraception decision-making. However, existing inequities
within Medicaid and a history of reproductive harms targeting Black women
and women with low incomes may contribute to women with Medicaid having
different experiences of contraception counseling. This qualitative study
explores how Black women and White women insured by Medicaid perceive
prenatal and immediate postpartum contraception counseling and identifies
additional factors that shape their contraception decision-making. Methods: We conducted semi-structured interviews with 15 Medicaid beneficiaries who
delivered at a public teaching hospital in North Carolina. Interviews
focused on women’s beliefs about planning for pregnancy, experiences with
prenatal and immediate postpartum contraception counseling, and perceived
need for postpartum contraception. We used a priori and emergent codes to
analyze interviews. Results: Seven Black women and eight White women completed interviews 14–60 days
postpartum. All women reported receiving prenatal and immediate postpartum
counseling. Several women described receiving prenatal counseling,
reflective of patient-centered contraception counseling, that helped in
their postpartum contraception decision-making; one woman described
receiving immediate postpartum counseling that helped in her
decision-making. Some Black women reported receiving unsupportive/coercive
contraception counseling. In addition to contraception counseling, past
reproductive health experiences and future pregnancy intentions were salient
to women’s contraception decision-making. Conclusions: Prenatal and immediate postpartum contraception counseling can help some
Medicaid beneficiaries with their postpartum contraception decision, but
past reproductive health experiences and future pregnancy intentions are
also relevant. Counseling that does not consider these experiences may be
harmful, particularly to Black women, further contributing to racial
disparities in maternal postpartum health outcomes.
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Affiliation(s)
- Lindsey Yates
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah Birken
- Department of Implementation Science, Bowman Gray Center for Medical Education, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Gretchen S Stuart
- Department of Obstetrics and Gynecology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sandra Greene
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Williams JN, Xu C, Costenbader KH, Bermas BL, Pace LE, Feldman CH. Racial Differences in Contraception Encounters and Dispensing Among Female Medicaid Beneficiaries With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2021; 73:1396-1404. [PMID: 32526084 PMCID: PMC7728620 DOI: 10.1002/acr.24346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/02/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE African American and Hispanic women with systemic lupus erythematosus (SLE) have the highest rates of potentially avoidable pregnancy complications, yet racial disparities in family planning among reproductive-age women with SLE have not been well-studied. Our objective was to examine whether there are racial differences in contraception encounters and dispensing among US Medicaid-insured women with SLE. METHODS Using Medicaid claims data from 2000-2010, we identified women ages 18-50 years with SLE. We examined contraception encounters and uptake over 24 months. We used multivariable logistic regression to estimate the odds ratio and 95% confidence interval by race/ethnicity of contraception encounters, any contraception dispensing, and highly effective contraception (HEC) use, adjusted for age, region, year, SLE severity, and contraindication to estrogen. We also compared contraception encounters and dispensing among women with SLE to the general population and women with diabetes mellitus. RESULTS We identified 24,693 reproductive-age women with SLE; 43% were African American, 35% White, 15% Hispanic, 4% Asian, 2% other race, and 1% American Indian/Alaska Native. Nine percent had a contraceptive visit, 10% received any contraception, and 2% received HEC. Compared to White women, African American and Asian women had lower odds of contraception dispensing, and African American women had lower odds of HEC use. Women with SLE were more likely to receive HEC than the general population and women with diabetes mellitus. CONCLUSION In this study of reproductive-age women with SLE, African American and Asian women had lower odds of contraception dispensing and African American women had lower odds of HEC use. Further study is needed to understand the factors driving these racial disparities among this population.
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Affiliation(s)
- Jessica N. Williams
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chang Xu
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karen H. Costenbader
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bonnie L. Bermas
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lydia E. Pace
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Candace H. Feldman
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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8
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Smith M, McCool-Myers M, Kottke MJ. Analysis of Postpartum Uptake of Long-Acting Reversible Contraceptives Before and After Implementation of Medicaid Reimbursement Policy. Matern Child Health J 2021; 25:1361-1368. [PMID: 34109490 DOI: 10.1007/s10995-021-03180-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The postpartum period is a time of high unmet contraception need. Providing long-acting reversible contraception (LARC), particularly in the immediate postpartum period, is one strategy to meet contraceptive needs. This practice may also prevent unintended and short interpregnancy interval pregnancies. In recent years, state Medicaid programs have implemented reimbursement policies for LARC use in the inpatient setting. The purpose of this study was to assess the uptake of inpatient postpartum LARCs at a large urban hospital with a sizable Medicaid population, before and after policy implementation. METHODS Using billing records from January 2015 and December 2017, we extracted data on patient demographics and LARC uptake before Medicaid policy change (2015) and after policy change (2016 and 2017). Implant and intrauterine device insertions were classified as inpatient postpartum (0-7 days after birth), outpatient postpartum (1-8 weeks after) or interval (9+ weeks after). RESULTS In the 3-year study period, 2091 LARC insertions occurred, of which 700 (33.5%) were inpatient postpartum, 429 (20.5%) outpatient postpartum, and 962 (46.0%) interval. After policy implementation, inpatient postpartum LARC insertions increased from 2.6 per 100 deliveries to 16.8 per 100 deliveries. Significant differences in uptake were seen in Black and Hispanic populations. The number of outpatient postpartum LARCs remained stable and tubal sterilizations decreased. CONCLUSIONS FOR PRACTICE Implementation of reimbursement policies contributed to a sharp uptake of inpatient postpartum LARCs. Improved access to effective, reversible contraception could reduce the number of unplanned and short interpregnancy interval pregnancies, ultimately lowering rates of maternal morbidity and mortality.
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Affiliation(s)
- Madeline Smith
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, USA
| | - Megan McCool-Myers
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University School of Medicine, 46 Armstrong Street SE, Atlanta, GA, 30303, USA.
| | - Melissa J Kottke
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University School of Medicine, 46 Armstrong Street SE, Atlanta, GA, 30303, USA
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Gifford K, McDuffie MJ, Rashid H, Knight EK, McColl R, Boudreaux M, Rendall MS. Postpartum contraception method type and risk of a short interpregnancy interval in a state Medicaid population. Contraception 2021; 104:284-288. [PMID: 34023380 DOI: 10.1016/j.contraception.2021.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the likelihood of a short interpregnancy interval (IPI) resulting in a birth among women covered by Medicaid, as a function of postpartum contraceptive method type. STUDY DESIGN We used Medicaid claims and eligibility data to identify women (aged 15-44) who had a Medicaid-financed birth in Delaware in the years 2012-2014 (n = 10,328). Claims were analyzed to determine postpartum contraceptive type within 60 days of the index birth, and linked birth certificates were used to determine the incidence and timing of a subsequent birth through 2018 (regardless of payer). We used logistic regression to analyze the likelihood of having a short IPI following the index birth as a function of postpartum contraceptive type, controlling for preterm births, parity, having a postpartum checkup, and maternal characteristics including age, race, education, and marital status. RESULTS Compared to patients receiving postpartum long-acting reversible contraceptive methods (LARC), patients with no contraceptive claims had nearly 5 times higher odds (odds ratio [OR] = 4.98, confidence interval [CI] = 3.05-8.13) and those with claims for moderately effective methods (injectable, pill, patch, or ring) had 3.5 times higher odds (OR = 3.51, CI = 2.13-5.77) of a subsequent birth following a short IPI. CONCLUSIONS In a state population of Medicaid-enrolled women, women with claims for postpartum LARC had substantially lower risk of a short IPI resulting in a birth. IMPLICATIONS Women who received LARC within 60 days postpartum are less likely to experience a short interpregnancy interval resulting in a birth. The evidence suggests that recent state policy changes that make postpartum LARC more accessible to those that desire it will be an effective strategy in helping patients obtain desired birth intervals.
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Affiliation(s)
- Katie Gifford
- Biden School of Public Policy & Administration, University of Delaware, Newark, DE, United States.
| | - Mary Joan McDuffie
- Biden School of Public Policy & Administration, University of Delaware, Newark, DE, United States
| | - Hira Rashid
- Office of Health Affairs, West Virginia University
| | - Erin K Knight
- Biden School of Public Policy & Administration, University of Delaware, Newark, DE, United States
| | - Rebecca McColl
- Biden School of Public Policy & Administration, University of Delaware, Newark, DE, United States
| | - Michel Boudreaux
- University of Maryland School of Public Health, University of Maryland, College Park, MD, United States
| | - Michael S Rendall
- Maryland Population Research Center, University of Maryland, College Park, MD, United States
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10
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Burke KL, Thaxton L, Potter JE. Short-acting hormonal contraceptive continuation among low-income postpartum women in Texas. Contracept X 2020; 3:100052. [PMID: 33490950 PMCID: PMC7809391 DOI: 10.1016/j.conx.2020.100052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/18/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective was to assess continuation of the pill, patch, ring or injectable (i.e., short-acting hormonal contraception); characteristics associated with discontinuation; and subsequent method use among low-income postpartum women in Texas. STUDY DESIGN Using a 24-month cohort study of 1700 women who delivered in eight Texas hospitals and were uninsured or publicly insured at the time of delivery, we focused on 456 women who used short-acting hormonal contraception within 6 months after delivery. We classified this sample according to characteristics and method preference, and estimated rates of discontinuation and associated predictors using life tables and Cox models. We assessed reasons for discontinuation and subsequent contraceptive use among those who discontinued. RESULTS Roughly half used the pill and half used the injectable. One hundred seventy-eight (39%) expressed a baseline preference for the method they used, 162 (36%) preferred a long-acting reversible contraception method, and 41 (9%) preferred sterilization. After 1 year, 72% had discontinued [95% confidence interval (CI) 67.1-75.7]. Foreign-born Hispanic women were less likely to discontinue than U.S.-born Hispanics [adjusted hazard ratio (aHR), 0.65; 95% CI 0.50-0.84]. Those who wanted a more effective method (aHR, 1.44; 95% CI 1.12-1.85) and those who lost insurance coverage (aHR, 1.47; 95% CI 1.12-1.92) were more likely to discontinue. The most common reasons for discontinuation were side effects and access/cost. Of those who discontinued, 243 (68%) switched to a less effective or no method. Only 47 (13%) switched to their preferred method. CONCLUSIONS Short-acting hormonal contraceptive discontinuation is high in this population. Many switch to less effective methods after discontinuation despite preferring methods at least as effective as the pill, patch, ring or injectable. IMPLICATIONS Expanding contraceptive coverage in the 2 years after delivery should be a state and federal policy priority. In clinics, providers should discuss contraceptive preferences throughout pregnancy and the interpregnancy interval.
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Affiliation(s)
- Kristen Lagasse Burke
- Population Research Center, University of Texas at Austin, Austin, TX, USA
- Department of Sociology, University of Texas at Austin, Austin, TX, USA
| | - Lauren Thaxton
- Department of Sociology, University of Texas at Austin, Austin, TX, USA
- Dell Medical School, Department of Women's Health, University of Texas at Austin, Austin, TX, USA
| | - Joseph E. Potter
- Population Research Center, University of Texas at Austin, Austin, TX, USA
- Department of Sociology, University of Texas at Austin, Austin, TX, USA
- Dell Medical School, Department of Women's Health, University of Texas at Austin, Austin, TX, USA
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11
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Shreffler KM, Tiemeyer S, Price JR, Frye LT. The role of pregnancy intendedness and prenatal contraceptive counseling on postpartum contraceptive use. Contracept Reprod Med 2020; 5:28. [PMID: 33101704 PMCID: PMC7579982 DOI: 10.1186/s40834-020-00127-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 09/17/2020] [Indexed: 11/21/2022] Open
Abstract
Background The study was conducted to prospectively examine how pregnancy intendedness and prenatal provider counseling about postpartum contraceptive options are associated with lack of contraception use at 6 months post-birth (e.g., increased risk for a short interpregnancy interval). Methods Logistic regression models were used to examine risk for no postpartum contraception use among a sample of low-income and racially/ethnically diverse women recruited from two metropolitan perinatal clinics in Tulsa, OK. Results Women who reported that they were trying to get pregnant or “okay either way” about getting pregnant had significantly lower odds of using contraception at 6 months post childbirth than those who had unintended pregnancies. Having providers who discussed postpartum contraceptive options during pregnancy significantly increased the odds of contraceptive uptake among those who were planning or ambivalent about their pregnancies. Conclusions Intentions of a current pregnancy and provider contraceptive counseling matter for postpartum contraceptive use and the associated risk for a short interval subsequent pregnancy. Provider contraceptive counseling that accounts for the intendedness of a current pregnancy may offer a more targeted approach to prevent a short interval subsequent pregnancy.
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Affiliation(s)
| | - Stacy Tiemeyer
- Oklahoma State University, 700 N. Greenwood Ave, Tulsa, OK 74106 USA
| | - Jameca R Price
- University of Oklahoma Health Sciences Center, 4502 E. 41st St, Tulsa, OK 74135 USA
| | - Lance T Frye
- Oklahoma State University Center for Health Sciences, 1111 W. 17th St, Tulsa, OK 74107 USA
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Bruce K, Benno J, Kieltyka L. Variation in Postpartum Use of Most and Moderately Effective Contraceptive Methods Among Louisiana Women. Matern Child Health J 2020; 24:1151-1160. [PMID: 32613334 DOI: 10.1007/s10995-020-02971-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Women experiencing unintended and short-interval pregnancies are at increased risk for adverse outcomes. Nationally, researchers report disparities in women's use of effective contraceptive methods based on demographic, cultural, financial and system-level factors. Despite 58% of Louisiana births being unplanned, researchers have not reported on these relationships in Louisiana. METHODS We used Louisiana Pregnancy Risk Assessment Monitoring System data from 2015 to 2018. Among postpartum women who were not abstinent, pregnant, or trying to become pregnant, we estimated use of five categories of effective contraception versus no effective method. We used multivariable multinomial logistic regression to investigate the association between effective contraceptive use and race/ethnicity, postpartum insurance and education. RESULTS Among Louisiana postpartum women who were not abstinent, pregnant, or trying to become pregnant, 35.4% were not using effective contraception. Women with public insurance had greater odds of using long-acting reversible contraception than women with private insurance (adjusted odds ratio [AOR] 1.55; 95% confidence interval [CI] 1.11-2.16). Compared to women with a bachelor's or higher, women with less than high school (AOR 2.09; CI 1.22-3.56), high school (AOR 3.11; CI 2.01-4.82) or some college education (AOR 2.48; CI 1.64-3.75) had greater odds of using permanent contraception. Black (AOR 3.83; CI 2.66-5.54) and Hispanic (AOR 3.85; CI 2.09-7.11) women, women with less than high school (AOR 6.79; CI 2.72-16.94), high school (AOR 7.26; CI 3.06-17.21) and some college (AOR 7.22; CI 3.14-16.60), and women with public insurance (AOR 1.91; CI 1.28-2.87) had greater odds of using injectable contraception. DISCUSSION Results showed variation in effective contraceptive method use by race/ethnicity, insurance and education. These findings highlight the need for state-level research into the individual, provider, and policy-level factors that influence women's contraceptive choices.
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Affiliation(s)
- Katharine Bruce
- Bureau of Family Health, Office of Public Health, Louisiana Department of Health, 1450 Poydras Street, New Orleans, LA, 70112, USA. .,Council of State and Territorial Epidemiologists, 2635 Century Parkway NE, Atlanta, GA, 30345, USA.
| | - Jia Benno
- Bureau of Family Health, Office of Public Health, Louisiana Department of Health, 1450 Poydras Street, New Orleans, LA, 70112, USA
| | - Lyn Kieltyka
- Bureau of Family Health, Office of Public Health, Louisiana Department of Health, 1450 Poydras Street, New Orleans, LA, 70112, USA
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Verbus E, Ascha M, Wilkinson B, Montague M, Morris J, Mercer BM, Arora KS. The Association of Public Insurance with Postpartum Contraception Preference and Provision. Open Access J Contracept 2019; 10:103-110. [PMID: 31908549 PMCID: PMC6927572 DOI: 10.2147/oajc.s231196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/07/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Prior studies have noted that public insurance status is associated with increased uptake of postpartum contraception whereas others have pointed to public insurance as a barrier to accessing highly effective forms of contraception. OBJECTIVE To assess differences in planned method and provision of postpartum contraception according to insurance type. STUDY DESIGN This is a secondary analysis of a retrospective cohort study examining postpartum women delivered at a single hospital in Cleveland, Ohio from 2012-2014. Contraceptive methods were analyzed according to Tier-based effectiveness as defined by the Centers for Disease Control and Prevention. The primary outcome was postpartum contraception method preference. Additional outcomes included method provision, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery. RESULTS Of the 8281 patients in the study cohort, 1372 (16.6%) were privately and 6990 (83.4%) were publicly insured. After adjusting for the potentially confounding clinical and demographic factors through propensity score analysis, public insurance was not associated with preference for a Tier 1 versus Tier 2 postpartum contraceptive method (matched adjusted odds ratio [maOR] 0.89, 95% CI 0.69-1.15), but was associated with a preference for Tier 1/2 vs Tier 3/None (maOR 1.41, 95% CI 1.17-1.69). There was no difference between women with private or public insurance in terms of method provision by 90 days after delivery (maOR 0.94, 95% CI 0.75-1.17). Public insurance status was also associated with decreased postpartum visit attendance (maOR 0.54, 95% CI 0.43-0.68) and increased rates of subsequent pregnancy within 365 days of delivery (maOR 1.29, 95% CI 1.05-1.59). CONCLUSION Public insurance status does not serve as a barrier to either the preference or provision of effective postpartum contraception. Women desiring highly- or moderately effective methods of contraception should have these methods provided prior to hospital discharge to minimize barriers to method provision.
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Affiliation(s)
- Emily Verbus
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mustafa Ascha
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Wilkinson
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mary Montague
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jane Morris
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Brian M Mercer
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
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Oduyebo T, Zapata LB, Boutot ME, Tepper NK, Curtis KM, D'Angelo DV, Marchbanks PA, Whiteman MK. Factors associated with postpartum use of long-acting reversible contraception. Am J Obstet Gynecol 2019; 221:43.e1-43.e11. [PMID: 30885772 DOI: 10.1016/j.ajog.2019.03.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/14/2019] [Accepted: 03/11/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Contraception use among postpartum women is important to prevent unintended pregnancies and optimize birth spacing. Long-acting reversible contraception, including intrauterine devices and implants, is highly effective, yet compared to less effective methods utilization rates are low. OBJECTIVES We sought to estimate prevalence of long-acting reversible contraception use among postpartum women and examine factors associated with long-acting reversible contraception use among those using any reversible contraception. STUDY DESIGN We analyzed 2012-2015 data from the Pregnancy Risk Assessment Monitoring System, a population-based survey among women with recent live births. We included data from 37 sites that achieved the minimum overall response rate threshold for data release. We estimated the prevalence of long-acting reversible contraception use in our sample (n = 143,335). We examined maternal factors associated with long-acting reversible contraception use among women using reversible contraception (n = 97,013) using multivariable logistic regression (long-acting reversible contraception vs other type of reversible contraception) and multinomial regression (long-acting reversible contraception vs other hormonal contraception and long-acting reversible contraception vs other nonhormonal contraception). RESULTS The prevalence of long-acting reversible contraception use overall was 15.3%. Among postpartum women using reversible contraception, 22.5% reported long-acting reversible contraception use, which varied by site, ranging from 11.2% in New Jersey to 37.6% in Alaska. Factors associated with postpartum long-acting reversible contraception use vs use of another reversible contraceptive method included age ≤24 years (adjusted odds ratio = 1.43; 95% confidence interval = 1.33-1.54) and ≥35 years (adjusted odds ratio = 0.87; 95% confidence interval = 0.80-0.96) vs 25-34 years; public insurance (adjusted odds ratio = 1.15; 95% confidence interval = 1.08-1.24) and no insurance (adjusted odds ratio = 0.73; 95% confidence interval = 0.55-0.96) vs private insurance at delivery; having a recent unintended pregnancy (adjusted odds ratio = 1.44; 95% confidence interval = 1.34-1.54) or being unsure about the recent pregnancy (adjusted odds ratio = 1.29; 95% confidence interval = 1.18-1.40) vs recent pregnancy intended; having ≥1 previous live birth (adjusted odds ratio = 1.40; 95% confidence interval = 1.31-1.48); and having a postpartum check-up after recent live birth (adjusted odds ratio = 2.70; 95% confidence interval = 2.35-3.11). Hispanic and non-Hispanic black postpartum women had a higher rate of long-acting reversible contraception use (26.6% and 23.4%, respectively) compared to non-Hispanic white women (21.5%), and there was significant race/ethnicity interaction with educational level. CONCLUSION Nearly 1 in 6 (15.3%) postpartum women with a recent live birth and nearly 1 in 4 (22.5%) postpartum women using reversible contraception reported long-acting reversible contraception use. Our analysis suggests that factors such as age, race/ethnicity, education, insurance, parity, intendedness of recent pregnancy, and postpartum visit attendance may be associated with postpartum long-acting reversible contraception use. Ensuring all postpartum women have access to the full range of contraceptive methods, including long-acting reversible contraception, is important to prevent unintended pregnancy and optimize birth spacing. Contraceptive access may be improved by public health efforts and programs that address barriers in the postpartum period, including increasing awareness of the availability, effectiveness, and safety of long-acting reversible contraception (and other methods), as well as providing full reimbursement for contraceptive services and removal of administrative and logistical barriers.
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Affiliation(s)
- Titilope Oduyebo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA.
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Maegan E Boutot
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Kathryn M Curtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Denise V D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Polly A Marchbanks
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
| | - Maura K Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA
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Thompson EL, Vamos CA, Logan RG, Bronson EA, Detman LA, Piepenbrink R, Daley EM, Sappenfield WM. Patients and providers’ knowledge, attitudes, and beliefs regarding immediate postpartum long-acting reversible contraception: a systematic review. Women Health 2019; 60:179-196. [DOI: 10.1080/03630242.2019.1616042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Erika L. Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, USA
- The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
| | - Cheryl A. Vamos
- The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
| | - Rachel G. Logan
- The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
| | - Emily A. Bronson
- Florida Perinatal Quality Collaborative & The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
| | - Linda A. Detman
- Florida Perinatal Quality Collaborative & The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
| | - Rumour Piepenbrink
- The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
| | - Ellen M. Daley
- The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
| | - William M. Sappenfield
- Florida Perinatal Quality Collaborative & The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
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Wilkinson B, Ascha M, Verbus E, Montague M, Morris J, Mercer B, Arora KS. Medicaid and receipt of interval postpartum long-acting reversible contraception. Contraception 2019; 99:32-35. [PMID: 30194927 PMCID: PMC6289711 DOI: 10.1016/j.contraception.2018.08.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/20/2018] [Accepted: 08/29/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We sought to evaluate the impact of insurance type on receipt of an interval postpartum LARC, controlling for demographic and clinical factors. STUDY DESIGN This is a retrospective cohort study of 1072 women with a documented plan of LARC for contraception at time of postpartum discharge. This is a secondary analysis of 8654 women who delivered at 20 weeks or beyond from January 1, 2012, through December 31, 2014, at an urban teaching hospital in Ohio. LARC receipt within 90 days of delivery, time to receipt, and rate of subsequent pregnancy after non-receipt were compared between women with Medicaid and women with private insurance. Postplacental LARC was not available at the time of study completion. RESULTS One hundred eighty-seven of 822 Medicaid-insured and 43 of 131 privately insured women received a LARC postpartum (22.7% vs 32.8%, P=.02). In multivariable analysis, private insurance status was not significantly associated with LARC receipt (OR 1.29, 95% C.I. 0.83-1.99) though adequate prenatal care was (OR 2.33, 95% C.I. 1.42-4.00). Of women who wanted but did not receive a LARC, 208 of 635 (32.8%) Medicaid patients and 19 of 88 (21.6%) privately insured patients became pregnant within 1 year (P=.02). CONCLUSION Differences in receipt of interval postpartum LARC were not significant between women with Medicaid insurance versus private insurance after adjusting for clinical and demographic factors. Adequate prenatal care was associated with LARC receipt. Medicaid patients who did not receive a LARC were more likely to become pregnant within one year of delivery than those with private insurance. IMPLICATIONS While insurance-related barriers have been reduced given recent policy changes, access to care remains an important determinant of postpartum LARC provision and subsequent unintended pregnancy.
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Affiliation(s)
- Barbara Wilkinson
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA
| | - Mustafa Ascha
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
| | - Emily Verbus
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Mary Montague
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Jane Morris
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Brian Mercer
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
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17
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Guzzo KB, Eickmeyer K, Hayford SR. Does Postpartum Contraceptive Use Vary By Birth Intendedness? PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2018; 50:129-138. [PMID: 30040189 PMCID: PMC6135704 DOI: 10.1363/psrh.12074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/20/2018] [Accepted: 03/23/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Women with an unintended birth have an elevated risk of subsequent unintended pregnancy, and multiple unintended pregnancies could exacerbate any negative consequences of such births. It is therefore important to understand whether postpartum contraceptive use differs by birth intendedness. METHODS Data on 2,769 births reported in the 2011-2015 cycles of the National Survey of Family Growth were used to examine postpartum contraceptive use. Life-table estimates were employed to assess differences by birth intendedness in timing of postpartum contraceptive use, and multinomial logistic event history methods were used to model initial contraceptive uptake and efficacy by birth intendedness. RESULTS Compared with postpartum women whose births were on time or too late, those with seriously mistimed and those with unwanted births were more likely to first adopt a highly effective method (e.g., implant or IUD), rather than no method (relative risk ratios, 1.9 and 1.7, respectively); mothers with unwanted births were also more likely to first use least effective methods (e.g., condoms or withdrawal) instead of no method (1.5). Mothers with seriously mistimed births had a reduced likelihood of using either effective methods (e.g., the pill or injectable) or least effective methods, rather than highly effective ones (0.5 for each). CONCLUSION The elevated risk of repeat unintended fertility does not seem to be due to mothers' initial postpartum contraceptive behavior. Whether mothers with unintended births use contraceptives less consistently, discontinue use sooner or switch methods more often than those with intended births remains to be seen.
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Affiliation(s)
- Karen Benjamin Guzzo
- Associate Professor, Department of Sociology, Bowling Green State University, Bowling Green, OH
| | - Kasey Eickmeyer
- Ph.D. Candidate, Department of Sociology, Bowling Green State University, Bowling Green, OH
| | - Sarah R Hayford
- Associate Professor, Department of Sociology, Ohio State University, Columbus
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18
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Bellows BK, Tak CR, Sanders JN, Turok DK, Schwarz EB. Cost-effectiveness of emergency contraception options over 1 year. Am J Obstet Gynecol 2018; 218:508.e1-508.e9. [PMID: 29409847 DOI: 10.1016/j.ajog.2018.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/28/2017] [Accepted: 01/22/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The copper intrauterine device is the most effective form of emergency contraception and can also provide long-term contraception. The levonorgestrel intrauterine device has also been studied in combination with oral levonorgestrel for women seeking emergency contraception. However, intrauterine devices have higher up-front costs than oral methods, such as ulipristal acetate and levonorgestrel. Health care payers and decision makers (eg, health care insurers, government programs) with financial constraints must determine if the increased effectiveness of intrauterine device emergency contraception methods are worth the additional costs. OBJECTIVE We sought to compare the cost-effectiveness of 4 emergency contraception strategies-ulipristal acetate, oral levonorgestrel, copper intrauterine device, and oral levonorgestrel plus same-day levonorgestrel intrauterine device-over 1 year from a US payer perspective. STUDY DESIGN Costs (2017 US dollars) and pregnancies were estimated over 1 year using a Markov model of 1000 women seeking emergency contraception. Every 28-day cycle, the model estimated the predicted number of pregnancy outcomes (ie, live birth, ectopic pregnancy, spontaneous abortion, or induced abortion) resulting from emergency contraception failure and subsequent contraception use. Model inputs were derived from published literature and national sources. An emergency contraception strategy was considered cost-effective if the incremental cost-effectiveness ratio (ie, the cost to prevent 1 additional pregnancy) was less than the weighted average cost of pregnancy outcomes in the United States ($5167). The incremental cost-effectiveness ratios and probability of being the most cost-effective emergency contraception strategy were calculated from 1000 probabilistic model iterations. One-way sensitivity analyses were used to examine uncertainty in the cost of emergency contraception, subsequent contraception, and pregnancy outcomes as well as the model probabilities. RESULTS In 1000 women seeking emergency contraception, the model estimated direct medical costs of $1,228,000 and 137 unintended pregnancies with ulipristal acetate, compared to $1,279,000 and 150 unintended pregnancies with oral levonorgestrel, $1,376,000 and 61 unintended pregnancies with copper intrauterine devices, and $1,558,000 and 63 unintended pregnancies with oral levonorgestrel plus same-day levonorgestrel intrauterine device. The copper intrauterine device was the most cost-effective emergency contraception strategy in the majority (63.9%) of model iterations and, compared to ulipristal acetate, cost $1957 per additional pregnancy prevented. Model estimates were most sensitive to changes in the cost of the copper intrauterine device (with higher copper intrauterine device costs, oral levonorgestrel plus same-day levonorgestrel intrauterine device became the most cost-effective option) and the cost of a live birth (with lower-cost births, ulipristal acetate became the most cost-effective option). When the proportion of obese women in the population increased, the copper intrauterine device became even more most cost-effective. CONCLUSION Over 1 year, the copper intrauterine device is currently the most cost-effective emergency contraception option. Policy makers and health care insurance companies should consider the potential for long-term savings when women seeking emergency contraception can promptly obtain whatever contraceptive best meets their personal preferences and needs; this will require removing barriers and promoting access to intrauterine devices at emergency contraception visits.
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Affiliation(s)
- Brandon K Bellows
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT; SelectHealth, Murray, UT.
| | - Casey R Tak
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
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Sundstrom B, Szabo C, Dempsey A. "My Body. My Choice": A Qualitative Study of the Influence of Trust and Locus of Control on Postpartum Contraceptive Choice. JOURNAL OF HEALTH COMMUNICATION 2018; 23:162-169. [PMID: 29297766 DOI: 10.1080/10810730.2017.1421728] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Postpartum contraception helps reduce unintended pregnancy and space births to improve maternal and child health. This study explored women's perceptions of contraceptive choice during the postpartum period in the context of locus of control and trust in healthcare providers. Researchers conducted six focus groups with 47 women, ages 18-39, receiving postpartum care at an outpatient clinic. Techniques from grounded theory methodology provided an inductive approach to analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated a constant-comparative coding process to identify emergent themes. Participants expressed a preference for relationship-centered care, in which healthcare providers listened, individualized their approach to care through rapport-building, and engaged women in shared decision-making about contraceptive use through open communication, reciprocity, and mutual influence. Conflicting health messages served as barriers to uptake of effective contraception. While participants trusted their healthcare provider's advice, many women prioritized personal experience and autonomy in decisions about contraception. Providers can promote trust and relationship-centered care to optimize contraceptive uptake by listening, exploring patient beliefs and preferences about contraception and birth spacing, and tailoring their advice to individuals. Results suggest that antenatal contraceptive counseling should incorporate information about effectiveness, dispel misconceptions, and engage patients in shared decision-making.
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Affiliation(s)
- Beth Sundstrom
- a College of Charleston, Department of Communication , Charleston , SC , USA
| | - Caitlin Szabo
- b Emory University School of Medicine, Department of Gynecology and Obstetrics , Atlanta , GA , USA
| | - Angela Dempsey
- c Medical University of South Carolina, Department of Obstetrics and Gynecology , Charleston , SC , USA
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Borges ALV, Dos Santos OA, Fujimori E. Concordance between intention to use and current use of contraceptives among six-month postpartum women in Brazil: The role of unplanned pregnancy. Midwifery 2017; 56:94-101. [PMID: 29096285 DOI: 10.1016/j.midw.2017.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 09/19/2017] [Accepted: 10/17/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE to examine the effect of pregnancy planning status in the concordance between intention to use and current use of contraceptives among postpartum women. DESIGN AND SETTING a prospective study was conducted in 12 primary health care facilities in São Paulo, Brazil, from November 2013 to September 2014. PARTICIPANTS A total of 264 woman aged 15-44 years old completed a face-to-face interview when they were pregnant (baseline), and were interviewed by phone at 6 months postpartum. MEASUREMENTS At baseline, participants were questioned about the contraceptive method they would prefer to be using at 6 months postpartum. At 6 months postpartum, they answered about the contraceptive method they were currently using. Pregnancy planning status was measured using the Brazilian Portuguese London Measure of Unplanned Pregnancy. We conducted logistic regression, considering contraceptive preference-use concordance as the dependent variable and the main covariate as pregnancy planning status. FINDINGS Only 28.9% of postpartum women were using the method they preferred to use when they were pregnant. The agreement between preference and contraceptive use was higher for injectables (60.9%) and lowest for IUD, as nobody who preferred it was actually using it. Women who were not sure about what method they intended to use after childbirth more frequently reported no use at six months postpartum. Multivariate logistic regression showed that postpartum women whose pregnancy was unplanned were less likely to use the contraceptive methods that they intended to use when they were pregnant [aOR=0.36; 95%CI=0.14-0.97]. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Brazilian women were able to access contraceptives in the postpartum period. However, there is a considerable discordance between their contraceptive intention to use and use at the sixth postpartum month. A higher unmet demand for IUD and sterilization should be highlighted. The pregnancy planning status is associated to postpartum contraceptive preference-use concordance, so interventions before pregnancy may affect postpartum contraceptive use. Women with unintended pregnancies present an important opportunity to offer additional family planning counseling.
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Affiliation(s)
- Ana Luiza Vilela Borges
- Public Health Nursing Department, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, Cep 050403-000 São Paulo, SP, Brazil.
| | - Osmara Alves Dos Santos
- Public Health Nursing Department, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, Cep 050403-000 São Paulo, SP, Brazil.
| | - Elizabeth Fujimori
- Public Health Nursing Department, School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, Cep 050403-000 São Paulo, SP, Brazil.
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Contraception After Delivery Among Publicly Insured Women in Texas: Use Compared With Preference. Obstet Gynecol 2017; 130:393-402. [PMID: 28697112 DOI: 10.1097/aog.0000000000002136] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess women's preferences for contraception after delivery and to compare use with preferences. METHODS In a prospective cohort study of women aged 18-44 years who wanted to delay childbearing for at least 2 years, we interviewed 1,700 participants from eight hospitals in Texas immediately postpartum and at 3 and 6 months after delivery. At 3 months, we assessed contraceptive preferences by asking what method women would like to be using at 6 months. We modeled preference for highly effective contraception and use given preference according to childbearing intentions using mixed-effects logistic regression testing for variability across hospitals and differences between those with and without immediate postpartum long-acting reversible contraception (LARC) provision. RESULTS Approximately 80% completed both the 3- and 6-month interviews (1,367/1,700). Overall, preferences exceeded use for both-LARC: 40.8% (n=547) compared with 21.9% (n=293) and sterilization: 36.1% (n=484) compared with 17.5% (n=235). In the mixed-effects logistic regression models, several demographic variables were associated with a preference for LARC among women who wanted more children, but there was no significant variability across hospitals. For women who wanted more children and had a LARC preference, use of LARC was higher in the hospital that offered immediate postpartum provision (P<.035) as it was for U.S.-born women (odds ratio [OR] 2.08, 95% CI 1.17-3.69) and women with public prenatal care providers (OR 2.04, 95% CI 1.13-3.69). In the models for those who wanted no more children, there was no significant variability in preferences for long-acting or permanent methods across hospitals. However, use given preference varied across hospitals (P<.001) and was lower for black women (OR 0.26, 95% CI 0.12-0.55) and higher for U.S.-born women (OR 2.32, 95% CI 1.36-3.96), those 30 years of age and older (OR 1.82, 95% CI 1.07-3.09), and those with public prenatal care providers (OR 2.04, 95% CI 1.18-3.51). CONCLUSION Limited use of long-acting and permanent contraceptive methods after delivery is associated with indicators of health care provider and system-level barriers. Expansion of immediate postpartum LARC provision as well as contraceptive coverage for undocumented women could reduce the gap between preference and use.
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Thiel de Bocanegra H, Braughton M, Bradsberry M, Howell M, Logan J, Schwarz EB. Racial and ethnic disparities in postpartum care and contraception in California's Medicaid program. Am J Obstet Gynecol 2017; 217:47.e1-47.e7. [PMID: 28263752 DOI: 10.1016/j.ajog.2017.02.040] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 01/07/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Considerable racial and ethnic disparities have been identified in maternal and infant health in the United States, and access to postpartum care likely contributes to these disparities. Contraception is an important component of postpartum care that helps women and their families achieve optimal interpregnancy intervals and avoid rapid repeat pregnancies and preterm births. National quality measurements to assess postpartum contraception are being developed and piloted. OBJECTIVE To assess racial/ethnic variation in receipt of postpartum care and contraception among low-income women in California. STUDY DESIGN We conducted a prospective cohort study of 199,860 Californian women aged 15-44 with a Medicaid-funded delivery in 2012. We examined racial/ethnic variation of postpartum care and contraception using multivariable logistic regression to control for maternal age, language, cesarean delivery, Medicaid program, and residence in a primary care shortage area (PCSA). RESULTS Only one-half of mothers attended a postpartum visit (49.4%) or received contraception (47.5%). Compared with white women, black women attended postpartum visits less often (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], 0.71-0.76), were less likely to receive any contraception (aOR, 0.83; 95% CI, 0.78-0.89) and were less likely to receive highly effective contraception (aOR, 0.64; 95% CI, 0.58-0.71). Women with Spanish as their primary language were more likely to get any contraception (aOR, 1.15; 95% CI, 1.11-1.19) but had significantly lower odds of receiving a highly effective method (aOR, 0.94; 95% CI, 0.90-0.99) compared with women with English as their primary language. Similarly, women in PCSAs had a greater odds of getting any contraception (aOR, 1.06; 95% CI, 1.03-1.09), but 24% lower odds of getting highly effective contraception than women not living in PCSAs (aOR, 0.76; 95% CI, 0.73-0.79). CONCLUSION Significant racial/ethnic disparities exist among low-income Californian mothers' likelihood of attending postpartum visits and receiving postpartum contraception as well as receiving highly effective contraception.
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Taub RL, Jensen JT. Advances in contraception: new options for postpartum women. Expert Opin Pharmacother 2017; 18:677-688. [DOI: 10.1080/14656566.2017.1316370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
OBJECTIVE To assess pregnancies that could have been averted through improved access to contraceptive methods in the 2 years after delivery. METHODS In this cohort study, we interviewed 403 postpartum women in a hospital in Austin, Texas, who wanted to delay childbearing for at least 2 years. Follow-up interviews were completed at 3, 6, 9, 12, 18, and 24 months after delivery; retention at 24 months was 83%. At each interview, participants reported their pregnancy status and contraceptive method. At the 3- and 6-month interviews, participants were also asked about their preferred contraceptive method 3 months in the future. We identified types of barriers among women unable to access their preferred method and used Cox models to analyze the risk of pregnancy from 6 to 24 months after delivery. RESULTS Among women interviewed 6 months postpartum (n=377), two thirds had experienced a barrier to accessing their preferred method of contraception. By 24 months postpartum, 89 women had reported a pregnancy; 71 were unintended. Between 6 and 24 months postpartum, 77 of 377 women became pregnant (20.4%), with 56 (14.9%) lost to follow-up. Women who encountered a barrier to obtaining their preferred method were more likely to become pregnant less than 24 months after delivery. They had a cumulative risk of pregnancy of 34% (95% confidence interval [CI] 0.25-0.43) as compared with 12% (95% CI 0.05-0.18) for women with no barrier. All but three of the women reporting an unintended pregnancy had earlier expressed interest in using long-acting reversible contraception or a permanent method. CONCLUSION In this study, most unintended pregnancies less than 24 months after delivery could have been prevented or postponed had women been able to access their desired long-acting and permanent methods.
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Robbins CL, Farr SL, Zapata LB, D'Angelo DV, Callaghan WM. Postpartum contraceptive use among women with a recent preterm birth. Am J Obstet Gynecol 2015; 213:508.e1-9. [PMID: 26003062 PMCID: PMC5379122 DOI: 10.1016/j.ajog.2015.05.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/20/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the associations between postpartum contraception and having a recent preterm birth. STUDY DESIGN Population-based data from the Pregnancy Risk Assessment Monitoring System in 9 states were used to estimate the postpartum use of highly or moderately effective contraception (sterilization, intrauterine device, implants, shots, pills, patch, and ring) and user-independent contraception (sterilization, implants, and intrauterine device) among women with recent live births (2009-2011). We assessed the differences in contraception by gestational age (≤27, 28-33, or 34-36 weeks vs term [≥37 weeks]) and modeled the associations using multivariable logistic regression with weighted data. RESULTS A higher percentage of women with recent extreme preterm birth (≤27 weeks) reported using no postpartum method (31%) compared with all other women (15-16%). Women delivering extreme preterm infants had a decreased odds of using highly or moderately effective methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4-0.6) and user-independent methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4-0.7) compared with women having term births. Wanting to get pregnant was more frequently reported as a reason for contraceptive nonuse by women with an extreme preterm birth overall (45%) compared with all other women (15-18%, P < .0001). Infant death occurred in 41% of extreme preterm births and more than half of these mothers (54%) reported wanting to become pregnant as the reason for contraceptive nonuse. CONCLUSION During contraceptive counseling with women who had recent preterm births, providers should address an optimal pregnancy interval and consider that women with recent extreme preterm birth, particularly those whose infants died, may not use contraception because they want to get pregnant.
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Affiliation(s)
- Cheryl L Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Sherry L Farr
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Denise V D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - William M Callaghan
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Kroelinger CD, Waddell LF, Goodman DA, Pliska E, Rudolph C, Ahmed E, Addison D. Working with State Health Departments on Emerging Issues in Maternal and Child Health: Immediate Postpartum Long-Acting Reversible Contraceptives. J Womens Health (Larchmt) 2015; 24:693-701. [PMID: 26390378 PMCID: PMC4872698 DOI: 10.1089/jwh.2015.5401] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Immediate postpartum long-acting reversible contraceptives (LARC) are highly effective in preventing unintended pregnancy. State health departments are in the process of implementing a systems change approach to better apply policies supporting the use of immediate postpartum LARC. METHODS Beginning in 2014, a group of national organizations, federal agencies, and six states have convened a LARC Learning Community to share strategies and best practices in immediate postpartum LARC policy development and implementation. Community activities consist of in-person meetings and a webinar series as forums to discuss systems change. RESULTS The Learning Community identified eight domains for discussion and development of resources: training, pay streams, stocking and supply, consent, outreach, stakeholder partnerships, service location, and data and surveillance. The community is currently developing resource materials and guidance for use by other state health departments. CONCLUSIONS To effectively implement policies on immediate postpartum LARC, states must engage a number of stakeholders in the process, raise awareness of the challenges to implementation, and communicate strategies across agencies during policy development.
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Affiliation(s)
- Charlan D. Kroelinger
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa F. Waddell
- Association of State and Territorial Health Officials, Arlington, Virginia
| | - David A. Goodman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ellen Pliska
- Association of State and Territorial Health Officials, Arlington, Virginia
| | - Claire Rudolph
- Association of State and Territorial Health Officials, Arlington, Virginia
| | - Einas Ahmed
- Association of State and Territorial Health Officials, Arlington, Virginia
| | - Donna Addison
- 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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Contraception after delivery and short interpregnancy intervals among women in the United States. Obstet Gynecol 2015; 125:1471-1477. [PMID: 26000519 DOI: 10.1097/aog.0000000000000841] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate women's patterns of contraceptive use after delivery and the association between method use and risk of pregnancy within 18 months. METHODS We used the 2006-2010 National Survey of Family Growth to examine women's contraceptive use after delivery and at 3, 6, 12, and 18 months after giving birth. The sample included 3,005 births that occurred within 3 years of the survey date and for which information on contraceptive use was available. We estimated multivariable-adjusted Cox regression models to assess the association between women's method use and risk of pregnancy within 18 months after delivery. We also examined the percentage of pregnancies occurring 18 months or less after the index birth that were unintended. RESULTS Between delivery and 3 months postpartum, contraceptive use increased from 21% to 72%. At 3 months, 13% of women used permanent contraception, 6% used long-acting reversible contraceptives, 28% used other hormonal methods, and 25% relied on less-effective methods; the distribution of method use was similar in subsequent months. Among women using hormonal methods, 12.6% became pregnant within 18 months of delivery or less compared with 0.5% using permanent and long-acting contraception (adjusted hazard ratio [HR] 21.2, 95% confidence interval [CI] 6.17-72.8). Additionally, 17.8% of women using less-effective methods (HR 34.8, 95% CI 9.26-131) and 23% using no method (HR 43.2, 95% CI 12.3-152) became pregnant 18 months or less. At least 70% of pregnancies within 1 year after delivery were unintended. CONCLUSION Few women use long-acting reversible contraceptives after delivery, and those using less-effective methods have an increased risk of unintended pregnancy. LEVEL OF EVIDENCE II.
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White K, Potter JE, Zite N. Geographic Variation in Characteristics of Postpartum Women Using Female Sterilization. Womens Health Issues 2015; 25:628-33. [PMID: 26232310 DOI: 10.1016/j.whi.2015.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 06/15/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Southern states have higher rates of female sterilization compared with other areas of the United States, and the reasons for this are not well understood. We examined whether low-income and racial/ethnic minority women, who were previous targets of coercive practices, disproportionately report using sterilization in the South. METHODS We used data from 12 states participating in the Pregnancy Risk Assessment Monitoring System that collected information on women's contraceptive method use between 2006 and 2009. We categorized states according to geographic region: South, Midwest/West, and Northeast. Within each region, we computed the percentage of women using sterilization according to their demographic and obstetric characteristics and estimated multivariable-adjusted prevalence ratios to evaluate whether the same characteristics were associated with sterilization use. FINDINGS The percentage of postpartum women using sterilization ranged from 5.0% to 9.9% in the Northeast, 8.9% to 10.6% in the Midwest/West, and 11.6% to 22.4% in the South. Women in nearly all subgroups in Southern states were more likely to use sterilization than women in the Northeast. After multivariable adjustment, there were no differences in the prevalence of sterilization for Blacks compared with Whites in the Northeast (0.76; 95% CI, 0.55-1.06), Midwest/West (0.91; 95% CI, 0.80-1.04), and South (0.96; 95% CI, 0.85-1.07). Women with Medicaid-paid deliveries (vs. private insurance) had a higher prevalence of sterilization in all regions (p < .05). CONCLUSIONS These findings do not indicate that low-income and racial/ethnic minority women in the South use sterilization at disproportionately higher rates compared with other regions, and suggest that other differences, such as social norms and family planning policies, may contribute to this geographic variation.
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Affiliation(s)
- Kari White
- Department of Health Care Organization & Policy, University of Alabama at Birmingham, Health Care Organization & Policy, Birmingham, Alabama.
| | - Joseph E Potter
- University of Texas at Austin, Population Research Center, Austin, Texas
| | - Nikki Zite
- Department of Obstetrics and Gynecology, University of Tennessee, Graduate School of Medicine, Knoxville, Tennessee
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White K, Hopkins K, Aiken ARA, Stevenson A, Hubert C, Grossman D, Potter JE. The impact of reproductive health legislation on family planning clinic services in Texas. Am J Public Health 2015; 105:851-8. [PMID: 25790404 DOI: 10.2105/ajph.2014.302515] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We examined the impact of legislation in Texas that dramatically cut and restricted participation in the state's family planning program in 2011 using surveys and interviews with leaders at organizations that received family planning funding. Overall, 25% of family planning clinics in Texas closed. In 2011, 71% of organizations widely offered long-acting reversible contraception; in 2012-2013, only 46% did so. Organizations served 54% fewer clients than they had in the previous period. Specialized family planning providers, which were the targets of the legislation, experienced the largest reductions in services, but other agencies were also adversely affected. The Texas experience provides valuable insight into the potential effects that legislation proposed in other states may have on low-income women's access to family planning services.
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Affiliation(s)
- Kari White
- Kari White is with the Department of Health Care Organization & Policy, University of Alabama, Birmingham. At the time of the study, Kristine Hopkins, Abigail R. A. Aiken, Amanda Stevenson, Celia Hubert, and Joseph E. Potter were with the Population Research Center, University of Texas, Austin. Daniel Grossman is with Ibis Reproductive Health, Oakland, CA
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Whaley N, Burke A. Contraception in the postpartum period: immediate options for long-acting success. WOMEN'S HEALTH (LONDON, ENGLAND) 2015; 11:97-9. [PMID: 25776281 DOI: 10.2217/whe.14.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Natalie Whaley
- Department of Gynecology & Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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Contraceptive counseling and postpartum contraceptive use. Am J Obstet Gynecol 2015; 212:171.e1-8. [PMID: 25093946 DOI: 10.1016/j.ajog.2014.07.059] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/23/2014] [Accepted: 07/30/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of the study was to examine the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use. STUDY DESIGN The Pregnancy Risk Assessment Monitoring System 2004-2008 data were analyzed from Missouri, New York state, and New York City (n = 9536). We used multivariable logistic regression to assess the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use, defined as any method and more effective methods (sterilization, intrauterine device, or hormonal methods). RESULTS The majority of women received prenatal (78%) and postpartum (86%) contraceptive counseling; 72% received both. Compared with those who received no counseling, those counseled during 1 time period (adjusted odds ratio [AOR], 2.10; 95% confidence interval [CI], 1.65-2.67) and both time periods (AOR, 2.33; 95% CI, 1.87-2.89) had significantly increased odds of postpartum use of a more effective contraceptive method (32% vs 49% and 56%, respectively; P for trend < .0001). Results for counseling during both time periods differed by type of health insurance before pregnancy, with greater odds of postpartum use of a more effective method observed for women with no insurance (AOR, 3.51; 95% CI, 2.18-5.66) and Medicaid insurance (AOR, 3.74; 95% CI, 1.98-7.06) than for those with private insurance (AOR, 1.87; 95% CI, 1.44-2.43) before pregnancy. Findings were similar for postpartum use of any contraceptive method, except that no differences by insurance status were detected. CONCLUSION The prevalence of postpartum contraceptive use, including the use of more effective methods, was highest when contraceptive counseling was provided during both prenatal and postpartum time periods. Women with Medicaid or no health insurance before pregnancy benefited the most.
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Nelson AL. Postpartum contraception: a new frontier (again). J Womens Health (Larchmt) 2014; 23:193-4. [PMID: 24559240 DOI: 10.1089/jwh.2014.4735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anita L Nelson
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center , Manhattan Beach, California
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