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1.
Objective
To compare long-acting reversible contraceptive (LARC) uptake before and after the Affordable Care Act (ACA) contraceptive mandate among women undergoing a first trimester surgical abortion.Study Design
We conducted a retrospective chart review of 867 women undergoing a first trimester surgical abortion at an academic gynecology practice between December 2010 and December 2014 (excluding August to December 2012) to evaluate intrauterine device and contraceptive implant uptake before and after the ACA contraceptive mandate.Results
Before the ACA contraceptive mandate, 79% of privately insured women (213 of 271) had full LARC coverage (no out-of-pocket costs) compared with 92% (298 of 324) after the mandate (p < .001). We found no difference in postabortal LARC uptake before and after the ACA in women with private insurance, Medicaid, or overall. Among all women, 46% chose a postabortal LARC method before the mandate as compared with 48% after the mandate (p = .63). Among privately insured women, 45% used a postabortal LARC method before the mandate as compared with 50% after the mandate (p = .25). One-half of privately insured women (268 of 534) with full or partial LARC coverage used a postabortal LARC method compared with 32% of privately insured women (18 of 56) with no LARC coverage after implementation of the ACA contraceptive mandate (p = .01).Conclusions
Despite the significant increase in full coverage of LARC among privately insured women, there was no change in postabortal LARC use after the ACA. However, privately insured women with full or partial LARC coverage were more likely to use a postabortal LARC method compared with privately insured women with no LARC coverage after the implementation of the ACA contraceptive mandate. 相似文献2.
Leah N. Torres David K. Turok Erin A.S. Clark Jessica N. Sanders Emily M. Godfrey 《Women's health issues》2018,28(5):393-400
Objective
To assess the impact of contraceptive counseling on the uptake of long-acting reversible contraception (LARC), namely, intrauterine devices and the contraceptive implant, by 3 months postpartum among women with a recent preterm birth.Design
We enrolled patients in a single-blinded, one-to-one, randomized, controlled trial to assess the impact of enhanced family planning counseling immediately after a viable preterm birth in the inpatient setting. Participants received either structured counseling with an emphasis on LARC by a family planning specialist (intervention) or routine postpartum care (control). We followed participants to the primary outcome of LARC use 3 months postpartum.Results
We followed 121 participants for 3 months. Primary outcome data were available for 119 participants (61 intervention, 58 control). We found no demographic differences between the groups. Participants in the intervention group were significantly more likely to use LARC at 3 months postpartum compared with controls (51% vs. 31%; p < .05). For every six women who received the counseling intervention, one additional woman was using a LARC method at 3 months.Conclusions
After a preterm birth, brief LARC-focused, structured counseling before hospital discharge significantly increased LARC method use at 3 months postpartum. 相似文献3.
Veronica X. Vela Elizabeth W. Patton Darshak Sanghavi Susan F. Wood Peter Shin Sara Rosenbaum 《Women's health issues》2018,28(2):137-143
Context
Long-acting reversible contraception (LARC) is the most effective reversible method to prevent unplanned pregnancies. Variability in state-level policies and the high cost of LARC could create substantial inconsistencies in Medicaid coverage, despite federal guidance aimed at enhancing broad access. This study surveyed state Medicaid payment policies and outreach activities related to LARC to explore the scope of services covered.Methods
Using publicly available information, we performed a content analysis of state Medicaid family planning and LARC payment policies. Purposeful sampling led to a selection of nine states with diverse geographic locations, political climates, Medicaid expansion status, and the number of women covered by Medicaid.Results
All nine states' Medicaid programs covered some aspects of LARC. However, only a single state's payment structure incorporated all core aspects of high-quality LARC service delivery, including counseling, device, insertion, removal, and follow-up care. Most states did not explicitly address counseling, device removal, or follow-up care. Some states had strategies to enhance access, including policies to increase device reimbursement, stocking and delivery programs to remove cost barriers, and covering devices and insertion after an abortion.Conclusions
Although Medicaid policy encourages LARC methods, state payment policies frequently fail to address key aspects of care, including counseling, follow-up care, and removal, resulting in highly variable state-level practices. Although some states include payment policy innovations to support LARC access, significant opportunities remain. 相似文献4.
Background
The use of long-acting reversible contraceptive (LARC) methods, such as intrauterine devices (IUDs) and implants has demonstrated high effectiveness in preventing pregnancy. While LARC use in Title X programs has increased over the past decade, little is know about the extent to which gains are occurring uniformly across states.Methods
We examined state-level changes in LARC use among Title X clients between 2012 and 2016 using a repeated cross-sectional study design. States were characterized by the proportion of reproductive age women in need of publicly funded contraception. Variation in LARC use by level of need was examined using GEE models.Results
Across all states, LARC use in Title X clinics increased from 9.1% to 16.2% during the study period. In 2012, LARC use in the states with the highest and lowest level of need differed by 2.3 percentage points (7.8% compared to 10.1%). By 2015 the gap in LARC use between high and low need states widened to reach 5.3 percentage points, more than double what was observed in 2012. However, by 2016 the margin of the gap narrowed.Conclusions
Observed increases in LARC use among states with the highest level of need for publically funded services are much lower than what is observed among states with the lowest level of need. However, we did find this gap is narrowing. This finding is important given states with greater need are those with higher proportions of low-income and younger women who are at greater risk for experiencing unintended pregnancies. 相似文献5.
Correlates of long-acting reversible contraception versus sterilization use in advanced maternal age
Shelby N. Apodaca Melissa D. Mendez Sheralyn S. Sanchez Zuber D. Mulla 《Annals of epidemiology》2018,28(7):447-451
Purpose
To identify correlates associated with choosing long-acting reversible contraception (LARC) over female sterilization (FS) from a subsample of women aged 35 to 44 years in a nationally representative survey.Methods
We analyzed data from women aged 35 to 44 years from the 2011–2013 National Survey of Family Growth Female Respondent File (n = 1532). Data were analyzed using SAS 9.3 software. All analyses accounted for the complex survey sample design. Multinomial logistic regression was used to identify factors associated with choosing LARC versus FS. A domain analysis was performed focusing on women aged 35 to 44 years.Results
Approximately 90% of the surveyed women had not received counseling or information about birth control in the past 12 months. Factors associated with using an LARC method versus FS were higher level of education, birth outside of the United States, and higher number of lifetime male sexual partners. Factors associated with using FS versus an LARC method were non-Hispanic black race and women who had not had a checkup related to using a birth control method in the last 12 months.Conclusions
The results of our study suggest that a large proportion of women of advanced maternal age in the United States have not received contraceptive counseling in the past 12 months. Providers should focus on providing comprehensive contraceptive and sterilization counseling to women aged 35 to 44 years, especially those using unreliable, reversible contraception. 相似文献6.
7.
8.
Objectives
The objective of this study was to determine the cost of unintended pregnancy (UP) in Sweden and savings generated by a switch of 5% of women from short-acting reversible contraception (SARC) and other methods to long-acting reversible contraceptives (LARCs).Study design
We constructed an economic model to estimate the number and costs of UPs and contraceptive use over a 1-year period. The population consisted of all women aged 15–44 years requiring reversible contraception and at risk of UP. UPs could result in birth, spontaneous abortion, induced abortion, and ectopic pregnancy. The model included costs incurred by the healthcare payer or out-of-pocket expenses by women, and indirect costs, i.e., foregone wages from time away from work.Results
We estimated 73,989 unintended pregnancies yearly, amounting to costs of almost €158 million. A 5% switch from non-LARCs to LARCs would generate more than 3500 fewer UPs yearly with savings of nearly €7.7 million. The majority of these savings would arise from reduced costs for UPs.Conclusions
UPs are costly for society and women. A small change in the proportion of women using the most effective methods generates substantial cost savings due to fewer UPs and thus fewer abortions. A switch in 5% of women using non-LARCs could prevent more than 3500 UPs yearly, generating savings of more than SEK 70 million (€7.7 million) or of 2.4% of costs for UPs. 相似文献9.
Emily M. Johnston Andrea E. Strahan Peter Joski Anne L. Dunlop E. Kathleen Adams 《Women's health issues》2018,28(2):122-129
Introduction
We use data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2012 to 2015 to estimate the effects of the Affordable Care Act's (ACA) Medicaid expansions on insurance coverage and access to care for low-income women of reproductive age (19–44).Methods
We use two-way fixed effects difference-in-differences models to estimate the effects of Medicaid expansions on low-income (<100% of the Federal Poverty Level) women of reproductive age. Additional models are stratified to estimate effects based on women's parental status, pre-ACA state Medicaid eligibility levels, and the presence of a state Medicaid family planning waiver.Results
ACA Medicaid expansions decreased uninsurance among low-income women of reproductive age by 13.2 percentage points. This decrease was driven by a decrease of 27.4 percentage points for women without dependent children, who also experienced a decrease in the likelihood of not having a personal doctor (13.3 percentage points). We find a 3.8-percentage point reduction in the likelihood of experiencing a cost barrier to care among all women, but no significant effects for other access measures or subgroups. When stratified by state policies, decreases in uninsurance were greater in states expanding from pre-ACA eligibility levels of less than 50% of Federal Poverty Level (19.4 percentage points) and in states without a Medicaid family planning waiver (17.6 percentage points).Conclusions
The ACA Medicaid expansion increased insurance coverage for low-income women of reproductive age, with the greatest effects for women without dependent children and women residing in states with relatively lower pre-ACA Medicaid eligibility levels or with no family planning waiver before the ACA. 相似文献10.
Tierney Wolgemuth Colleen Judge-Golden Lisa Callegari Xinhua Zhao Maria Mor Sonya Borrero 《Women's health issues》2018,28(6):480-487
Background
Although pregnancy intention is strongly associated with contraceptive use, little is known about the interaction between pregnancy intention and attitude, or how they jointly affect contraceptive use.Methods
Cross-sectional data from a national survey of women veterans who receive care within the Veterans Affairs Healthcare System were used to examine relationships among pregnancy intention (in next year, in >1 year, never, not sure), attitude toward hypothetical pregnancy (worst thing, neutral, best thing), and contraceptive use among women at risk for unintended pregnancy. Bivariate and multivariable analyses assessed associations between pregnancy intention and attitude, both separately and jointly, with contraceptive use. Multinomial regression assessed the relationship of intention and attitude with contraceptive method effectiveness.Results
Among 858 women at risk of unintended pregnancy, bivariate analysis demonstrated that pregnancy intention and attitude were associated, but not perfectly aligned. In logistic regression models including both variables, intention of never versus in next year (adjusted odds ratio [aOR], 2.78; 95% confidence interval [CI], 1.34–5.75) and attitude of worst thing versus best thing (aOR, 2.86; 95% CI, 1.42–5.74) were each positively associated with contraception use. Among women using contraception, intention of never (aOR, 3.17; 95% CI, 1.33–7.59) and attitude of worst thing (OR, 2.09; 95% CI, 1.05–4.17) were associated with use of highly effective (e.g., intrauterine devices and implants) versus least effective (e.g., barrier) methods.Conclusions
These findings support prior research suggesting that pregnancy intention alone does not fully explain contraceptive behaviors and imply that attitude toward pregnancy plays an important role in shaping contraceptive use independent of pregnancy intentions. 相似文献11.
12.
Jessica N. Sanders Jenny A. Higgins Daniel E. Adkins Greggory J. Stoddard Lori M. Gawron David K. Turok 《Women's health issues》2018,28(5):401-407
Introduction
Contraceptives improve women's lives and public health, but many women discontinue their contraceptive method owing to dissatisfaction. An underexamined aspect of contraceptive discontinuation is sexual acceptability, or how contraception affects sexual experiences. Investigators' aims were two-fold: 1) to document changes in multiple domains of women's sexual experiences with their intrauterine device (IUD) or contraceptive implant over time and 2) to examine whether these sexuality factors were associated with method continuation at 12 months.Methods
We enrolled 200 eligible family planning clients and collected data at baseline and at 1, 3, 6, and 12 months. Sexual acceptability measures included the Female Sexual Function Index-6, the New Sexual Satisfaction Scale, and participants’ perceptions of whether their contraceptive method had had a neutral, positive, or negative effect on their sex life. Survival analysis and Cox regression with time-varying covariates related sexuality measures to method continuation over time while controlling for other relevant factors.Results
Among 193 women who received an IUD or implant, 20% selected the copper IUD, 46% the levonorgestrel IUD, and 34% the etonogestrel implant. Ten percent discontinued their method during the year. Although changes in Female Sexual Function Index-6 and New Sexual Satisfaction Scale scores were not associated with discontinuation, individuals who perceived that their method detracted from their sexual experience had significantly higher removal rates than those who reported no sexual changes or positive sexual changes (adjusted hazard ratio, 8.04; 95% CI, 1.53–42.24), even when controlling for method type, bleeding changes, and a variety of covariates and controls.Conclusions
Although limited by the small sample of discontinuers, we found that women's perceptions of how their method affects their sex life were associated with contraceptive continuation over time. Sexual acceptability should receive more attention in both contraceptive research and counseling. 相似文献13.
Objective
The objective was to determine if young women initiating long-acting reversible contraceptives (LARCs) who report new sexual partner(s) would be less likely to report use of a condom than women using short-acting reversible contraceptive (SARC) methods.Study design
We enrolled a prospective cohort of 13–24-year-old women attending an adolescent-specific contraception clinic. Participants completed questionnaires at the contraceptive initiation visit and 6 months later. At follow-up, we asked if they had sexual intercourse with a new partner, if they had used condoms, if their condom use patterns had changed and why. We analyzed factors associated with condom use.Results
We enrolled 1048 women; 771 (73.6%) initiated LARC and 384 (36.6%) initiated SARC. At 6 months, 508 participants (48.5%) completed the follow-up survey: 380 LARC initiators and 128 SARC initiators. Approximately 23% of LARC initiators and 27% of SARC initiators reported a new partner. SARC initiators who had a new partner were more likely to report condom use at least one time than LARC initiators reporting a new partner [82.4% vs. 59.6%; odds ratio (OR): 3.17, 95% confidence interval (CI): 1.19–8.43]. Such condom use was 42% higher among LARC initiators who reported a new sexual partner than those without and 38% higher for SARC initiators. In multivariable logistic regression, new sexual partner [adjusted OR (aOR) 3.29, 95% CI 2.10–5.16], SARC initiation (aOR 2.08, 95% CI 1.35–3.22) and age <20 (aOR 1.68, 95% CI 1.14–2.49) were independent predictors of condom use.Conclusion
While young women are less likely to report condom use in the 6 months after initiating a LARC than after initiating a short-acting method, both groups increase their condom use similarly if they report a new sexual partner.Implications
The differential in condom use between LARC initiators and SARC initiators is likely related to their perceived need for pregnancy prevention, as both groups increase their condom use similarly if they had new sexual partners. 相似文献14.
Brian T. Nguyen Jennifer L. Elia Cathrine Y. Ha Bliss E. Kaneshiro 《Women's health issues》2018,28(1):51-58
Objective
Conflicting research findings on the association of obesity and pregnancy intention may be due to their collective definition of obesity at a body mass index of 30 kg/m2 or greater. However, obese women with a BMI of 40 kg/m2 or greater may be both behaviorally and clinically different from obese women with a lower BMI. This study reexamines this relationship, stratifying by class of obesity; the study also explores variations in contraceptive use by class of obesity given their potential contribution to the incidence of unintended or unwanted pregnancy.Methods
This study combined data from the 2006 through 2010 and 2011 through 2013 US National Survey of Family Growth. Pregnancy intention (intended, mistimed, unwanted) and current contraceptive use (no method, barrier, pill/patch/ring/injection, long-acting reversible contraceptive, sterilization) were compared across body mass index categories: normal (18.5–24.9 kg/m kg/m2), overweight (25.0–29.9), obese class 1 (30.0–34.9 kg/m2), class 2 (35.0–39.9 kg/m2), and class 3 (≥40 kg/m2, severe obesity). Weighted multinomial logistic regressions were refined to determine independent associations of body mass index class and pregnancy intention, as well as contraceptive method, controlling for demographic, socioeconomic, and reproductive factors.Results
Body mass index data were available for 9,848 nonpregnant, sexually active women who reported not wanting to become pregnant. Women with class 3 obesity had significantly greater odds of mistimed (adjusted odd ratio [aOR], 1.67; 95% confidence interval [CI], 1.02–2.75) or unwanted (aOR, 1.96; 95% CI, 1.15–3.32) pregnancy compared with normal weight women. Women with class 2 or 3 obesity were more likely to not be using contraception (aOR, 1.53–1.62; 95% CI, 1.04–2.29). Although women with class 2 obesity were more likely to be using long-acting reversible contraceptive methods and sterilization over short-acting hormonal methods (aOR, 1.67; 95% CI, 1.08–2.57; aOR, 2.05; 95% CI,1.44–2.91), this association was not observed among women with class 3 obesity.Conclusions
Women with class 3 obesity are at greater risk of unintended pregnancy and are less likely to be using contraception than normal weight women. Whether these findings are related to patient and/or provider barriers that are not as visible among women with class 1 and class 2 obesity warrants further investigation. 相似文献15.
Introduction
Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states' Medicaid programs and the private health insurance plans in their service areas to provide high-quality contraceptive care to the millions of women relying on services at these sites annually.Methods
We collected survey data from a nationally representative sample of 535 clinics providing family planning services that received Title X funding and conducted semistructured interviews with 23 administrators at a subsample of surveyed clinics to explore provider-reported experiences working with health plans and to identify barriers to, and practices that lead to, adequate reimbursement for services provided.Results
Providers report that knowledgeable staff are crucial to securing contracts with both public and private insurance plan issuers, and that the contracts they secure often include coverage restrictions on methods or services clinics offer their clients. Good staff relationships with issuers are key to obtaining adequate and consistent reimbursement for all covered services.Conclusions
Providers are trying to understand how insurance programs in their area knit together. Regardless of how U.S. health policies and delivery systems may change in the coming years, it is imperative that publicly funded family planning centers continue to work with health plans and maximize their third-party revenue to provide services to those in need. 相似文献16.
Background
Previous research shows that sexual minority women have higher rates of unintended pregnancy than heterosexual women, but has not considered the wide range of contraceptive method effectiveness when exploring this disparity. We examine contraceptive use effectiveness and desire for pregnancy prevention information among college women across sexual orientation identity as a risk factor for unintended pregnancy.Methods
Using the National College Health Assessment Fall 2015 dataset, restricted to women who reported engaging in vaginal sex and not wanting to be pregnant (N = 6,486), logistic regression models estimated the odds of contraceptive method effectiveness and desire for pregnancy prevention information by sexual orientation.Results
Most women (57%) reported using a moderately effective contraceptive method (e.g., pill, patch, ring, shot) at last vaginal sex. Compared with heterosexual women, bisexual (adjusted odds ratio [aOR], 0.48; 95% confidence interval [CI], 0.37–0.62), lesbian (aOR, 0.03; 95% CI, 0.02–0.06), pansexual/queer (aOR, 0.38; 95% CI, 0.25-.56), and other (aOR, 0.50; 95% CI, 0.30–0.81) women were significantly less likely to have used a moderately effective method compared with no method. Only 9% of the sample used a highly effective method; asexual (aOR, 0.58; 95% CI, 0.37–0.92) and lesbian (aOR, 0.07; 95% CI, 0.03–0.20) women were significantly less likely than heterosexual women to have used these methods. Pansexual/queer and bisexual women were more likely than heterosexual women to desire pregnancy prevention information.Conclusions
Several groups of sexual minority women were less likely than heterosexual women to use highly or moderately effective contraceptive methods, putting them at increased risk for unintended pregnancy, but desired pregnancy prevention information. These findings bring attention to the importance of patient-centered sexual and reproductive care to reduce unintended pregnancy. 相似文献17.
18.
Objective
The objective was to examine levels of, correlates of and changes in the use of individual and grouped methods of contraception among US females aged 15–44 from 2008 to 2014.Study design
Using three rounds of the National Survey of Family Growth, we analyzed samples of 12,279 (2008), 5601 (2012) and 5699 (2014) females. We conducted simple and multivariable logistic regression analyses to identify associations between demographic characteristics and contraceptive use, as well as between characteristics and changes in use patterns.Results
In terms of overall trends in contraceptive use between 2008 and 2014, there was no significant change in the proportion of women who used a method among either all women (60%) or those at risk of unintended pregnancy (90%). Significant changes in use occurred among six methods. The largest increase in use was among users of long-acting reversible contraceptive (LARC) methods, including the intrauterine device and implant — from 6% to 14% — across almost all population groups of female contraceptive users, while the largest decrease occurred among users of sterilization — from 37% to 28% — with lower-income women driving the decline in female sterilization and higher-income women driving the decline in a partner's sterilization as a primary method. Moderate increases were seen in the use of withdrawal and natural family planning.Conclusion
Most shifts in recent contraceptive use have occurred among the most effective methods — sterilization and LARCs. Differences in method-specific user characteristics underscore the importance of ensuring full access to the broad range of methods available.Implications
The lack of change in the overall use of contraceptives among women at risk for unintended pregnancy may have implications for the extent to which further declines in national rates of unintended pregnancy can be expected. 相似文献19.
20.
Kimberly B. Werner Renee M. Cunningham-Williams Whitney Sewell Arpana Agrawal Vivia V. McCutcheon Mary Waldron Andrew C. Heath Kathleen K. Bucholz 《Women's health issues》2018,28(5):421-429