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Houvèssou GM, Farías-Antúnez S, Bertoldi AD, da Silveira MF. Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort. Rev Saude Publica 2024; 58:02. [PMID: 38381892 PMCID: PMC10878683 DOI: 10.11606/s1518-8787.2024058005585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/04/2023] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria. METHODS The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI). RESULTS The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4-27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3-54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25-30 kg/m2 body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women's education, the lower the prevalence of inappropriate use of modern contraceptives. CONCLUSION In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women's reproductive health should be strengthened.
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Affiliation(s)
- Gbènankpon Mathias Houvèssou
- Universidade Federal de PelotasFaculdade de MedicinaPrograma de Pós-graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Simone Farías-Antúnez
- Universidade Federal de Santa CatarinaFaculdade de MedicinaDepartamento de Ciências da SaúdeFlorianópolisSCBrasilUniversidade Federal de Santa Catarina. Faculdade de Medicina. Departamento de Ciências da Saúde. Florianópolis, SC, Brasil
| | - Andréa D. Bertoldi
- Universidade Federal de PelotasFaculdade de MedicinaPrograma de Pós-graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Mariângela Freitas da Silveira
- Universidade Federal de PelotasFaculdade de MedicinaPrograma de Pós-graduação em EpidemiologiaPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-graduação em Epidemiologia. Pelotas, RS, Brasil
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Rodriguez MI, Skye M, Schrote K, Linz R, Pedhiwala N, Liberty A, Fuerst M, Edelman AB. Contraceptive services in Oregon's state-funded network during the COVID-19 pandemic. Contraception 2023; 123:110054. [PMID: 37088123 PMCID: PMC10122546 DOI: 10.1016/j.contraception.2023.110054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES To understand how changes to in-person health care during the COVID pandemic impacted contraceptive use in Oregon's state-funded network. STUDY DESIGN A retrospective cohort of 245,600 visits (virtual and in-person) among 70,295 women presenting to publicly funded family planning clinics in Oregon between January 2019 and June 2021. Data were abstracted from clinic records and restricted to visits of patients identifying as female, 12-51 years old, not using sterilization as a method. Contraception was grouped by effectiveness Tier (Tier 1: intrauterine device, implants; Tier 2: progestin injectable, pill/patch/ring). Multivariable logistic regression predicted the use of contraception by stage of the COVID pandemic which corresponded to service availability (prepandemic, acute: nonemergency services halted, subacute: restricted services), patient demographics, including insurance type, and clinic and geospatial characteristics. RESULTS Overall during the acute stage, people with visits were more likely to leave with a method of contraception odds ratios (OR) 1.39 (95% confidence interval [CI] 1.24-1.57); however, it was significantly less likely to be a Tier 1 method (OR 0.82, 95% CI 0.74-0.91) as compared to prepandemic. This finding was particularly marked in rural areas (OR 0.69 [96% CI 0.58-0.83]) and among the publicly insured (OR 0.87 [95% CI 0.80-0.94]). CONCLUSIONS Demand for contraception increased during the acute phase of the COVID pandemic, and shifts in method mix from Tier 1 to Tier 2 methods occurred. Disparities in contraceptive access persisted for those in rural locations or with public insurance. IMPLICATIONS Lessons learned from the COVID-19 pandemic are critical to informing our future emergency response. The need for family planning services increased during the public health emergency.
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Affiliation(s)
- Maria I Rodriguez
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA; Center for Reproductive Health Equity, Portland, OR, USA.
| | - Megan Skye
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Kaitlin Schrote
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Rachel Linz
- Reproductive Health Program, Oregon Health Authority, Portland, OR, USA
| | - Nisreen Pedhiwala
- Reproductive Health Program, Oregon Health Authority, Portland, OR, USA
| | - Abigail Liberty
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Megan Fuerst
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Alison B Edelman
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA; Center for Reproductive Health Equity, Portland, OR, USA
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Gomez AM, Rafie S, Garner-Ford E, Arcara J, Arteaga S, Britter M, De La Cruz M, Gleaton SK, Gomez-Vidal C, Luna B, Ortiz C, Rivera MC, Schuman L, Watanabe M, Logan R. Community perspectives on pharmacist-prescribed hormonal contraception in rural California. Contraception 2022; 114:10-17. [PMID: 35671841 DOI: 10.1016/j.contraception.2022.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES In the United States, numerous states have enabled pharmacists to prescribe hormonal contraception. Little research focuses on the perspectives of potential users of this service in rural communities. This study sought to describe awareness of, interest in, acceptability of, and support for pharmacist-prescribed contraception in a rural California county. STUDY DESIGN We conducted a community-based survey in 2019-20 in Tulare County, California. Researchers partnered with community members to design, implement, and analyze the survey. We recruited respondents who were ages 15 to 44 and assigned female sex at birth, using passive community-based approaches, social media advertisements, and social networks. Analyses focused on 177 respondents with a potential future need for contraception. RESULTS Thirty-one percent of respondents were aware that pharmacists could prescribe hormonal contraception in California, with more accurate knowledge among older respondents (p = 0.015). After receiving brief educational information about pharmacist-prescribed contraception, respondents expressed high levels of support and acceptability: they perceived pharmacist-prescribed contraception to be safe, time saving, and more convenient. Respondents were more comfortable talking about contraception with traditional contraceptive care providers compared to asking pharmacists questions about contraception. Fifty-seven percent were somewhat or very interested in obtaining contraception from a pharmacist, with higher levels of interest among those who preferred to use a different method. CONCLUSION Awareness of pharmacist-prescribed contraception in a rural California community was low, though people are supportive of and interested in utilizing this service. This research suggests that increased availability of pharmacist-prescribed contraception could support individuals' reproductive self-determination and address gaps in access.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, United State.
| | - Sally Rafie
- Department of Pharmacy, University of California, San Diego Health, San Diego, CA, United State; Birth Control Pharmacist, San Diego, CA, United State
| | | | - Jennet Arcara
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, United State
| | - Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, United State
| | - Morgan Britter
- Central Valley Voices for Access, Visalia, CA, United State
| | - Monica De La Cruz
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, United State
| | | | - Cristina Gomez-Vidal
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, United State
| | - Brianna Luna
- Central Valley Voices for Access, Visalia, CA, United State
| | | | | | - Logan Schuman
- Central Valley Voices for Access, Visalia, CA, United State
| | - Mia Watanabe
- Central Valley Voices for Access, Visalia, CA, United State
| | - Rachel Logan
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, United State
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