Future directions in performance measures for contraceptive care: a proposed framework

Abstract

In the United States, almost half (45%) of the approximately 6 million pregnancies each year are unintended [ [1] Finer L.B. Zolna M.R. Declines in unintended pregnancy in the United States, 2008–2011. N Engl J Med. 2016; 374: 843-852 Crossref PubMed Scopus (1269) Google Scholar ]. These statistics indicate that many women experience barriers to achieving their desired reproductive outcomes, which has potential adverse consequences for women, children and society at large, such as higher rates of preterm birth, lower rates of breastfeeding and lower educational attainment [ 2 Conde-Agudelo A. Rosas-Bermudez A. Kafury-Goeta A.C. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA. 2006; 295: 1809-1823 Crossref PubMed Scopus (765) Google Scholar , 3 DeFranco E.A. Seske L.M. Greenberg J.M. Muglia L.J. Influence of interpregnancy interval on neonatal morbidity. Am J Obstet Gynecol. 2015; 212: 386.e381-386.e389 Abstract Full Text Full Text PDF Scopus (38) Google Scholar , 4 Gipson J.D. Koenig M.A. Hindin M.J. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plan. 2008; 39: 18-38 Crossref PubMed Scopus (601) Google Scholar , 5 Sawhill I. Karpilow Q. Venator J. Families CoCa The impact of unintended childbearing on future generations. Brookings Institution, Washington, DC2014 Google Scholar , 6 Tsui A.O. McDonald-Mosley R. Burke A.E. Family planning and the burden of unintended pregnancies. Epidemiol Rev. 2010; 32: 152-174 Crossref PubMed Scopus (240) Google Scholar ]. Contraceptive care is a highly effective clinical intervention that can substantially reduce those adverse outcomes, help individuals and couples achieve their desired number and spacing of children, and save money [ 7 Foster D.G. Biggs M.A. Malvin J. Bradsberry M. Darney P. Brindis C.D. Cost-savings from the provision of specific contraceptive methods in 2009. Womens Health Issues. 2013; 23: e265-e271 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar , 8 Frost J. Finer L. Tapales A. The impact of publicly funded family planning clinic services on unintended pregnancies and government cost savings. J Health Care Poor Underserved. 2008; 19: 778-796 Crossref PubMed Scopus (57) Google Scholar , 9 Frost J.J. Sonfield A. Zolna M.R. Finer L.B. Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program. Milbank Q. 2014; 92: 696-749 Crossref PubMed Scopus (61) Google Scholar , 10 Sonfield A. Kost K. Institute TG Public costs from unintended pregnancies and the role of public insurance programs in paying for pregnancy and infant care: estimates for 2010. The Guttmacher Institute, New York, NY2015 Google Scholar , 11 Trussell J. Contraceptive failure in the United States. Contraception. 2011; 83: 397-404 Abstract Full Text Full Text PDF PubMed Scopus (982) Google Scholar ]. However, many women at risk of unintended pregnancy do not use contraception or use it incorrectly or inconsistently [ 12 Daniels K. Daugherty J. Jones J. Mosher W. Current contraceptive use and variation by selected characteristics among women aged 15–44: United States, 2011–2013. US National Center for Health Statistics, Hyattsville, MD2015 Google Scholar , 13 Jones R. Tapales A. Lindberg L. Frost J. Using longitudinal data to understand changes in consistent contraceptive use. Perspect Sex Reprod Health. 2015; 47: 131-139 Crossref PubMed Scopus (36) Google Scholar ], and there are documented barriers in access to and quality of contraceptive care services available [ [14] Obstet Gynecol. 2015; 125: 250-255 Crossref PubMed Google Scholar ].