Contextualizing barriers to long-acting reversible contraception in Delaware

Beyond knowledge: Introducing embodied aversion through the case of contraception

Family planning programs have largely operated at the individual level, seeking to enhance individuals' knowledge of, change attitudes towards, and improve consistent use of efficacious contraception. Social science research has added to these efforts by emphasizing the structural influences that shape individuals' contraceptive attitudes, beliefs, and behaviors. Such work highlights the importance of embodied knowledge which is informed by social contexts and provides individuals with a sense of assuredness in knowing which contraception works well for them (and within their bodies). However, through qualitative analysis of in-depth interviews with 59 self-identified women conducted from 2017 to 2018 across the state of Delaware in the United States, we argue that there is a powerful facet of contraceptive decision-making that lies beyond articulatable, conscious knowledge, which we name "embodied aversion." We draw on affect theory and stigma theory to introduce embodied aversion as an influential feeling and orientation away from implantable and insertable contraceptive methods that arises from internalized stigma around the reproductive body. Embodied aversion overpowers conscious understanding of contraceptive benefits like efficacy, ease of use, and longevity. Our research presents embodied aversion as a missing piece of contraceptive understanding that we argue is vital in more fully conceptualizing experiential dimensions of contraceptive use. Doing so enhances patient-centered care, shared decision-making, and reproductive autonomy.

Intersections between culture, contraception, knowledge and the body in the USA

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.

Integrating long-acting reversible contraceptives into primary care internal medicine practices: A clinical innovation to reduce wait time

BACKGROUND

Long-acting reversible contraception (LARC) has long been regarded as highly effective and safe. However, access is limited and lengthy when specialty referrals are required.

OBJECTIVES

To integrate LARC services into an urban internal medicine primary care practice to decrease wait time for LARC procedures.

DESIGN/METHODS

This pre-post with control group study took place at two large urban academic primary care practices (Practices A and B) and included patients ages 18 to 45 years assigned female sex at birth. Pre-implementation baseline data were collected retrospectively from 2019 to 2020 by identifying subjects who requested LARC insertion or removal via their primary care practice and were referred to Obstetrics and Gynecology (Ob/Gyn) for the procedure. Wait time was noted from time of initial request in the medical record to time of procedure. Practice A developed an integrated primary care LARC program in which one of their LARC-trained providers began offering these procedures within their own practice. All other providers within the practice were educated on how to counsel patients about the devices and procedures. Practice B did not have an in-house LARC provider and continued referring patients to Ob/Gyn. Post-implementation data were collected prospectively 2021-2022.

RESULTS

Ninety-one patients in Practice A experienced a significant decrease in wait time (87 vs 21 days, p < 0.001) over the observation period, with a majority undergoing procedures on their first visit with the in-house LARC provider. Wait time for the 54 patients in Practice B remained unchanged (57 vs 47 days, p = .59), often requiring multiple specialty visits.

CONCLUSION

Integrating LARC services into a primary care internal medicine practice can significantly reduce wait times for these procedures with the potential to contribute to increased reproductive and menstrual autonomy.