Patient interest in and availability of a 12-month supply of contraception: A cross-sectional analysis.

Nineteen states have passed legislation requiring insurers to cover the dispensation of a 12-month supply of short-acting, hormonal contraception. To determine whether 12-month contraceptive supply policies were associated with an increase in the receipt of 12-month or longer supply of contraception. This retrospective cohort study included data from all female Medicaid enrollees aged 18 to 44 years who used short-acting hormonal contraception (ie, pill, patch, or ring) from 2016 to 2020. Eleven treatment states where legislation required insurers to cover a 12-month supply of contraception to continuing users and 25 comparison states without such legislation prior to December 2020. Proportion of contraception months received via a single 12-month or longer fill. This study included 48 255 512 months of dispensed oral pill, patch, and ring contraception prescription supply among 4 778 264 female Medicaid enrollees. The majority of months of supplied contraception were for the contraceptive pill rather than the patch or ring. In a staggered difference-in-differences model, the 12-month supply policy was associated with an estimated 4.39-percentage point (pp) increase (95% CI, 4.38 pp-4.40 pp) in the proportion of contraception dispensed as part of a 12-month or longer supply, from a mean of 0.11% in treatment states during the first quarter of the study period. Investigating the heterogeneity in policy association across states, California stood out with a 7.17-pp increase (95% CI, 7.15 pp-7.19 pp) in the proportion of contraception dispensed as a 12-month or longer supply; in the other 10 treatment states, the policy association was less than 1 pp. In this cohort study of Medicaid recipients using short-acting hormonal contraception, the passage of a 12-month contraceptive supply policy was associated with a minimal increase in the proportion of contraception dispensed through a 12-month or longer supply.

Eighteen states, including Oregon, have passed legislation requiring insurers to cover dispensation of a 12-month supply of short-acting, hormonal contraception. To determine whether Oregon's 2016 12-month supply law was associated with an increase in contraceptive supply received. This retrospective cohort study of hormonal contraceptive users using Oregon's All Payer All Claims database examined the quantity of contraceptive supply dispensed 3 years before and 3 years after the 2016 policy change. We also assessed changes among patients attributed to Title X clinics. Legislation requiring insurers in Oregon to cover a 12-month supply of contraception to continuing users. Receipt of a 12-month supply of hormonal contraception. This cohort study of insured users (mean [SD] age, 27.4 [2.1] years) of short-acting hormonal contraception included 639 053 contraceptive prescriptions. Results indicated that more than 80% of prescriptions for contraceptives cover 3 months or fewer. Most women in the study population used the oral contraceptive pill, lived in a metropolitan area, and were privately insured. We did not observe a significant association between the passage of the 12-month supply policy and receipt of a 12-month supply (aOR, 1.01; 95% CI, 0.74-1.38). Receipt of a 12-month supply was more common for Medicaid recipients than the privately insured (aOR, 9.40; 95% CI, 6.62-13.34). We did find a shift from 1 month to 2 to 3 months supply being dispensed. The policy change was associated with a small, overall increase in quantity dispensed (0.27 months supply; 95% CI, 0.15 to -0.38). Title X clinics prescribed 3 months more of contraceptive supply than non-Title X clinics (3.03 months supply; 95% CI, 2.64-3.41). However, the policy change was not associated with increased contraceptive supply dispensed at Title X clinics. In this cohort study of insured users of short-acting hormonal contraception, the passage of a 12-month contraceptive supply policy was not associated with an increase in contraceptive supply dispensed.

ObjectiveThis study sought to determine if there was a difference in the months of oral contraception prescribed by resident physicians living in U.S. states with a 12-month supply policy compared to resident physicians in states without a policy.MethodsWe conducted an exploratory descriptive study using a convenience sample of Obstetrics and Gynecology resident physicians (n = 275) in the United States. Standard bivariate analyses were used to compare the difference between groups.ResultsFew resident physicians in both groups (3.8% with a policy and 1.4% without a policy) routinely prescribed a 12-month supply of contraception. The mean coverage prescribed by providers in states with and without a policy was 2.81 and 2.07 months (p < 0.05).ConclusionsThe majority of resident physicians were unaware of 12-month contraceptive supply policies and unable to correctly write a prescription for 12-months of contraception, regardless of whether they lived in a state with a 12-month contraceptive supply policy. Physician education may be needed to effectively implement 12-month contraceptive supply policies.

Real world outcomes related to providing an annual supply of short-acting hormonal contraceptives

Twelve-month prescribing of contraceptive pill, patch, and ring before and after a standardized electronic medical record order change

Online survey of consumer awareness and perceptions of a Massachusetts law for 12-month supply of contraception

Objectives: To determine patterns of consultation in general practice and provision of contraception before teenage pregnancy.Design: Case-control study, with retrospective analysis of case notes.Setting: 14 general practices in Trent region.Subjects:...

The Family Planning 2020 initiative aims to reach 120 million new family planning users by 2020. Drug shops and pharmacies are important private-sector sources of contraception in many contexts but are less well understood than public-sector sources, especially in urban environments. This article explores the role that drug shops and pharmacies play in the provision of contraceptive methods in selected urban areas of Nigeria and Kenya as well as factors associated with women's choice of where to obtain these methods. Using data collected in 2010/2011 from representative samples of women in selected urban areas of Nigeria and Kenya as well as a census of pharmacies and drug shops audited in 2011, we examine the role of drug shops and pharmacies in the provision of short-acting contraceptive methods and factors associated with a women's choice of family planning source. In urban Nigeria and Kenya, drug shops and pharmacies were the major source for the family planning methods of oral contraceptive pills, emergency contraceptives, and condoms. The majority of injectable users obtained their method from public facilities in both countries, but 14% of women in Nigeria and 6% in Kenya obtained injectables from drug shops or pharmacies. Harder-to-reach populations were the most likely to choose these outlets to obtain their short-acting methods. For example, among users of these methods in Nigeria, younger women (<25 years old) were significantly more likely to obtain their method from a drug shop or pharmacy than another type of facility. In both countries, family planning users who had never been married were significantly more likely than married users to obtain these methods from a drug shop or a pharmacy than from a public-sector health facility. Low levels of family planning-related training (57% of providers in Kenya and 41% in Nigeria had received training) and lack of family planning promotional activities in pharmacies and drug shops in both countries indicate the need for additional support from family planning programs to leverage this important access point. Drug shops and pharmacies offer an important and under-leveraged mechanism for expanding family planning access to women in urban Nigeria and Kenya, and potentially elsewhere. Vulnerable and harder-to-reach groups such as younger, unmarried women and women who do not yet have children are the most likely to benefit from increased access to family planning at drug shops and pharmacies.

<h3>Background:</h3> The Family Planning 2020 initiative aims to reach 120 million new family planning users by 2020. Drug shops and pharmacies are important private-sector sources of contraception in many contexts but are less well understood than public-sector sources, especially in urban environments. This article explores the role that drug shops and pharmacies play in the provision of contraceptive methods in selected urban areas of Nigeria and Kenya as well as factors associated with women’s choice of where to obtain these methods. <h3>Methods:</h3> Using data collected in 2010/2011 from representative samples of women in selected urban areas of Nigeria and Kenya as well as a census of pharmacies and drug shops audited in 2011, we examine the role of drug shops and pharmacies in the provision of short-acting contraceptive methods and factors associated with a women’s choice of family planning source. <h3>Results:</h3> In urban Nigeria and Kenya, drug shops and pharmacies were the major source for the family planning methods of oral contraceptive pills, emergency contraceptives, and condoms. The majority of injectable users obtained their method from public facilities in both countries, but 14% of women in Nigeria and 6% in Kenya obtained injectables from drug shops or pharmacies. Harder-to-reach populations were the most likely to choose these outlets to obtain their short-acting methods. For example, among users of these methods in Nigeria, younger women (&lt;25 years old) were significantly more likely to obtain their method from a drug shop or pharmacy than another type of facility. In both countries, family planning users who had never been married were significantly more likely than married users to obtain these methods from a drug shop or a pharmacy than from a public-sector health facility. Low levels of family planning-related training (57% of providers in Kenya and 41% in Nigeria had received training) and lack of family planning promotional activities in pharmacies and drug shops in both countries indicate the need for additional support from family planning programs to leverage this important access point. <h3>Conclusions:</h3> Drug shops and pharmacies offer an important and under-leveraged mechanism for expanding family planning access to women in urban Nigeria and Kenya, and potentially elsewhere. Vulnerable and harder-to-reach groups such as younger, unmarried women and women who do not yet have children are the most likely to benefit from increased access to family planning at drug shops and pharmacies.

Effective contraception is central to reproductive health and unintended pregnancies have a major negative impact on both maternal and child health. It is recognized that there is a global unmet need for effective contraception and often the unplanned pregnancy is terminated, sometimes by unsafe practices. There is recognition of the importance of accessible, effective fertility regulation both in the Millennium Development Goal 5b and now in Sustainable Development Goal 3. It is hoped that contraceptive provision will be expanded and made accessible to many women who previously were not able to address their fertility needs. The World Health Organization offers input and excellent clinical advice through the Medical Eligibility Criteria for contraceptive use which are regularly updated. It is recommended that these should be adapted for local use where appropriate. An understanding of the success of contraceptive methods with typical rather than perfect use is central to advising women and their partners on their contraceptive options. Attention to women with special needs such as those with medical disorders, young women, and women living with HIV must be central to any contraceptive service. Counselling should include discussing the risks and benefits of appropriate methods, the availability of emergency contraception, and the ongoing access to contraceptive counselling and reproductive health services. The aim of contraceptive service provision is to avoid unintended pregnancies and ensure that women feel empowered in the choices they make. Services providers are encouraged to provide a spectrum of contraceptive options which are accessible and acceptable to all clients.

To explore clinicians' perspectives regarding the Massachusetts 2017 law, 'An Act Relative to Advancing Contraceptive Coverage and Economic Security in Our State' (ACCESS), including awareness of the law, perceived barriers and facilitators to successful implementation, and recommendations to improve uptake. ACCESS requires all insurers, except self-insured businesses, to cover short-acting reversible contraceptives (SARCs) at no cost to patients and for a 12-month supply to be prescribed/dispensed if desired after the completion of a three-month trial. We collected primary data from clinicians in Massachusetts from February 1 to July 31, 2021. Semi-structured interviews of a purposeful sample of Massachusetts clinicians who provide primary and/or women's health care were conducted via Zoom. Interview guide and codebook were created using the Theoretical Domains Framework. Interviews were analyzed using framework analysis, including deductive and inductive approaches. Major themes and subthemes were organized by a four-level model of the health care system: patient, care team (clinician), organization, and environment. Most (58.1%) of the 31 participants were not aware of the law. Perceived advantages of this law included decreasing burden on patients, unnecessary clinical visits, and administrative burden on staff for refill requests. Perceived disadvantages focused on concerns that patients would lose their medications or devices (patient-level) and decreased clinician contact with patients (provider-level). Perceived organization- and environmental-level barriers to implementation included lack of electronic medical record (EMR) prescription defaults and insurance coverage issues. Many felt EMR modifications and more training for clinicians and pharmacists could lead to a change in practice. Our study identifies potentially modifiable barriers to the implementation of the ACCESS law. Massachusetts clinicians' lack of awareness of the law demonstrates the need for statewide education, which may allow more eligible patients to obtain a 12-month SARC supply.

To compare the rates of recall of contraceptive discussion and provision of chosen contraceptive method before discharge among patients who recently birthed in two tertiary maternity units in Auckland, New Zealand. A cross-sectional survey of recently postpartum patients at tertiary and associated primary birthing units aligned with Auckland and Counties Manukau maternity services was undertaken in 2019 and 2020. Five hundred and seventy-one patients took part in the survey. Overall recall around contraceptive discussions was low, as was the number of patients leaving hospital with their preferred method of contraception. Compared to Counties Manukau, almost twice as many patients at Auckland were unable to recall either an antenatal or postpartum discussion with a health professional about contraception (77% vs 39%, p<0.001). Those birthing at Counties Manukau were also more likely to recall seeing a hospital contraceptive brochure than those at Auckland (42% vs 20%, p<0.001). Twice as many patients at Counties Manukau left hospital with their chosen method compared to those at Auckland (31% vs 14%, p<0.001). In addition, long-acting reversible contraceptives (LARCs) were more often chosen for contraception at Counties Manukau (31% vs 22%, p=0.01) and more patients left hospital with their LARC compared to Auckland (13% vs 7%, p=0.03). These differences between two large tertiary maternity services suggests an opportunity for quality improvement around contraception provision.

Background: Use of contraceptives improves individual and national health outcomes and indices as it prevents maternal mortality and morbidity, child mortality, incidence of sexually transmitted infections and retains adolescents and young girls in school with improvement in the economic earning power. Contraceptive Logistics is the supply of contraceptives in the right quantity and quality at the right place at the right time for the right cost to the right people. The Contraceptive Logistics Management System in Nigeria stipulates that to ensure uninterrupted product availability and minimal stock out, Family Planning Service Delivery Points (SDPs) are to be re-supplied on a bi-monthly basis to bring their stock level to a maximum of 4 months of stock at any given time. Method: A retrospective analysis of the impacts of the three logistic models operational in six southern states in Nigeria under the auspice of UNFPA funded family planning logistics supply chain. Three outcomes of interest used to assess the impacts were stock out rates, gaps in supply and proportion of new users of contraceptives. The three models of family planning logistics reviewed were direct government last mile distribution with external funding, direct government last mile distribution without external funding and a third party private logistic company last mile distribution Result: The stock out rates for the direct government logistics with external funding was 6-20%, the direct government logistics last mile distribution (LMD) without external funding had a stock out rate of 20-58% and the private logistic company last mile distribution had a stock out rate of 10-30%. In terms of the gap in supply, the supply gap with the direct government LMD with external funding model was 48%, while the direct government LMD with no external funding model had a supply gap of 73% and the private company LMD logistics model had a low supply gap of 28%. The proportion of FP users who were new users was 19% in the direct government LMD with external funding, 8% in direct government LMD without external funding, and 16% in private logistic company LMD. Discussion: Direct government last mile distribution (LMD) with external funding reached the highest number of new FP users followed by private logistic company LMD and therefore contributed the greatest to the reduction of unmet need in family planning and increasing the contraceptive prevalence rates. The highest stock out rate of contraceptives was associated with direct government LMD without external funding and the least stock out rate was associated with same direct government LMD but with external funding. The greatest gap in supply of contraceptives was seen with direct government LMD without external funding followed by direct government LMD with external funding. Private company LMD had the least supply gap in contraceptives.

BackgroundWorldwide, the importance of contraception to control fertility has been recognized. A useful indicator of the gap between reproductive preferences and the provision of contraception is “unmet need for contraception”. The aims of this paper are to estimate the levels of unmet need for contraception among married and single women, and to explore factors associated with unmet need for contraception for spacing and limiting births in Mexico.MethodsWe used the Mexican National Survey of Demographic Dynamics 2014, using a sub-sample of 56,797 sexually active women aged 15–49 years who were either currently in union or who had never been in union to estimate the prevalence of unmet need for spacing and limiting births. We applied multivariable binary logistic regressions to examine the relationship between unmet need for spacing and limiting considering associated factors.ResultsUnmet need for contraception was estimated at 11.5% among women in union (6.4% limiting; 5.1% spacing), and 28.9% for women never in union (8% limiting; 20.9% spacing). In the logistic regression for unmet need for spacing, the likelihood was statistically significant associated with younger women (OR = 6.8; CI = 2.95–15.48); women never in union (OR = 1.6; CI = 1.40–1.79); low levels of education (OR = 1.4; CI = 1.26–1.56); and residing in poor regions (OR = 1.9; CI = 1.52–2.49). Those with full access to public services were significantly less likely to have unmet need for spacing (OR = 0.8; CI = 0.66–0.88).In the logistic regression for unmet need for limiting, being younger (OR = 6.3; CI = 4.73–8.27), never in union and sexually active (OR = 3.0; CI = 2.47–3.54); with less schooling (OR 1.13; CI: 1.02–1.26); rural residence (OR = 1.2; CI = 1.07–1.32); and residing in poor regions (OR = 1.5; CI = 1.23–1.93) were factors positively associated with this unmet need. Women with private health services were the least likely to have unmet need for limiting (OR = 0.5; CI = 0.37–0.77).ConclusionsYounger women currently in union and never in union had the highest unmet needs of contraception for spacing and limiting. The results from this study suggest that in Mexico family planning services must prioritize the contraception needs of all young women, both in union and not in union, with appropriate and suitable services to cover their needs.

BackgroundUnmet need for contraception results in several health challenges such as unintended pregnancies, unwanted births and unsafe abortions. Most interventions have been unable to successfully address this unmet need due to various community and health system level factors. Identifying these inhibiting and enabling factors prior to implementation of interventions forms the basis for planning efforts to increase met needs. This qualitative study was part of the formative phase of a larger research project that aimed to develop an intervention to increase met needs for contraception through community and health system participation. The specific study component reported here explores barriers and enablers to family planning and contraceptive services provision and utilisation at community and health systems levels.MethodsTwelve focus group discussions were conducted with community members (n = 114) and two with healthcare providers (n = 19). Ten in-depth interviews were held with key stakeholders. The study was conducted in Kabwe district, Zambia. Interviews/discussions were translated and transcribed verbatim. Data were coded and organised using NVivo 10 (QSR international), and were analysed using thematic analysis.ResultsHealth systems barriers include long distances to healthcare facilities, stock-outs of preferred methods, lack of policies facilitating contraceptive provision in schools, and undesirable provider attitudes. Community level barriers comprise women’s experience with contraceptive side effects, myths, rumours and misconceptions, societal stigma, and negative traditional and religious beliefs. On the other hand, health systems enablers consist of political will from government to expand contraceptive services access, integration of contraceptive services, provision of couples counselling, and availability of personnel to offer basic methods mix. Functional community health system structures, community desire to delay pregnancy, and knowledge of contraceptive services are enablers at a community level.ConclusionsThese study findings highlight key community and health systems factors that should be considered by policy, program planners and implementers in the design and implementation of family planning and contraceptive services programmes, to ensure sustained uptake and increased met needs for contraceptive methods and services.