Initiation Of Contraception Research Articles

Improving Access to Contraception Careat a Local Nonprofit Clinic: A Quality Improvement Project.

One Midwest, non-profit clinic aimed to increase access to contraceptive services by improving their care delivery process through the implementation of a population-specific, contraception education program. The program included patient education, timely follow-up appointments, and free contraception. In this quality improvement project, a total of twenty-two mostly Spanish-speaking women signed up for a group education session that lasted thirty minutes and was offered monthly. The session was led by a female, bilingual provider and focused on contraception benefits, side effects, and common myths. After the session, the clinic offered same-day initiation of contraception for oral contraceptives, Depo-Provera injections, and Nexplanon implants. In this clinic, offering the class in conjunction with immediate initiation of the chosen birth control method decreased the average time to care delivery, showing a positive impact on access to these essential services.

Planning postpartum contraception for women with substance use disorders: Utilisation of the birth admission.

Women with substance use disorders (SUD) use less contraception, and experience higher rates of unintended pregnancy, compared to women without SUD. Contraception is discussed at the six-week postnatal appointment, which many women with SUD do not attend. Therefore, it is important women have the opportunity to formulate contraception plans before discharge from the birth admission. To assess postpartum contraception plans, including initiation and method of interest, among women with SUD and compare these to women without SUD. All births from January 2011 to September 2019 from one New South Wales local health district were analysed. Data included maternal demographics, SUD, and contraception plans. Chi-squared statistics and multivariate multinomial regression analyses were used to compare outcomes for women with and without SUD. Of 59 195 mothers, 429 (0.7%) had a SUD. There were 50.1% of women with SUD and 56.2% without SUD (P = 0.03) who had no documented plan for contraception. There were 37.3% of women with SUD and 42.4% without SUD (P = 0.06) who had a prescription for contraception or a referral to discuss contraception. There were 12.5% of women with SUD and 1.4% without SUD (P < 0.001) who initiated contraception in hospital. Although postpartum contraception initiation was higher among women with SUD, half of all women (with or without SUD) were discharged without a plan for contraception initiation. Embedding provision of postpartum contraception into maternity care, or investigating other opportunities, may improve access for all women, including those with SUD.

Integration of a facilitated access pathway for contraception into alcohol and other drug treatment services: A cohort study comparing metropolitan and regional settings.

Women who attend alcohol and other drug (AOD) services experience higher rates of unintended pregnancy, and access less contraception, than the general population. This study aims to observe contraceptive initiation and use after contraception services were offered at metropolitan and regional AOD services. Clinical staff were provided contraception education. One hundred women aged 16-49 were recruited from two services between 2017 and 2021. Women completed a questionnaire on their obstetrics and gynaecological history, pregnancy plans and contraception use. Women were provided education on contraception options and offered referral to a contraception pathway. The primary outcome was initiation of highly reliable contraception; secondary outcomes were the types of contraception initiated, and contraception use and pregnancy at 12 months. We compared the initiation of contraception across the two study sites. At baseline, 91% of women were not planning a pregnancy within 12 months, with 21% of these using highly reliable contraception. Of all women not planning a pregnancy, 28% initiated highly reliable contraception via the pathway (2% metropolitan, 51% regional, p < 0.001), with intrauterine devices being the most frequent method initiated (15%). At 12 months, 44% were using highly reliable contraception and 15% had recorded pregnancies. Contraception pathways for women in AOD treatment can improve initiation of highly reliable methods of contraception, although pregnancy rates were still high and there were large differences between the study sites. Care navigation and clinical champions are some potential facilitators to contraception access, and understanding additional barriers to access may be useful.

Selection of long acting reversible contraception methods by emergency contraception clients: A prospective observational study

ObjectivesTo describe long acting reversible contraception (LARC) initiation in emergency contraception (EC) visits. Study designEC clients age 18–35 years at four Utah family planning clinics between February 2021 and April 2023 chose between oral EC and three LARC options. ResultsOf 2106 EC clients approached, 306 (14.5%) requested LARC and 293 initiated a device: 160 (55%) an etonogestrel implant+ oral levonorgestrel (LNG), 72 (25%) a copper intrauterine device (IUD), and 61 (21%) a 52 mg levonorgestrel IUD (p < 0.001). ConclusionsIn this observational study, one in seven EC clients initiated a LARC method and more frequently selected the etonogestrel implant with oral levonorgestrel over an IUD. Clinical Trial RegistrationClinicaltrials.gov NCT04678817; registered 12/16/20.

The role of advocacy in sustaining male contraceptive research and development.

Novel male contraceptives have been in development for well over half a century, and despite a robust predicted global market for new methods, funding for research and development has been extremely limited. While the pharmaceutical industry previously supported male contraceptive research and development, industry partners are only spectators in the current space, awaiting a product that has been de-risked by the public sector before re-entering the field. Current male contraceptive development efforts are thus primarily funded by nonprofit, non-governmental, and government agencies who also act as the primary advocates for the field. Specific organizations include the International Consortium on Male Contraception, the Population Council, the Male Contraceptive Initiative, the World Health Organization, and the US National Institutes of Health. The funding provided by these public agencies, alongside their social and policy-based advocacy efforts such as market research, public education, and calls to action have kept the male contraceptive product development space afloat, resulting in a pipeline of potential products advancing towards market approval. However, as these products mature into more expensive clinical stages of development, they continue to face significant funding challenges, which many programs may not overcome. To fully realize the benefits of novel male contraceptive options, it is incumbent on philanthropic entities, impact investors, venture capital, and/or the pharmaceutical sector to provide significant and timely support for male contraceptive research and development.

Contraception Initiation after Early Abortion in a Family Medicine Setting: A Retrospective Chart Review.

Early abortion increasingly is provided in the primary care setting, allowing improved access, continuity of care, and contraception, if desired. We aimed in this retrospective chart review to describe postabortion contraception provision in a family medicine office. Participants were those patients who obtained an induced abortion during an 11-year period at a family medicine office. We documented contraception provision within 30 days of abortion and used simple proportions, Fisher exact tests, and χ2 tests to describe differences in contraceptive provision by type of abortion and continuity status. Most of the patients who underwent abortions (254/353, 72%) had documentation of a contraceptive method within 30 days of abortion, which was similar for patients who had either a medication (124/166, 75%) or an aspiration abortion (130/187, 70%, P = 0.71). The most common contraceptives were contraceptive pills (104/353, 29%) or intrauterine devices (68/353, 19%). Patients who chose a tier 1 method were more likely to have a procedure abortion (50/87, 57%), whereas patients who chose a tier 2 method were likely to have a medication abortion (83/160, 52%). Fewer than half (45%, 158/353, P = 0.0002) were continuity patients and established patients in the primary care office. Most tier 1 contraceptive users were continuity patients (49/87, 60%), whereas most patients without a contraceptive method were noncontinuity patients (72/99, 73%). The primary care setting is uniquely equipped for providing early abortion and postabortion contraception. Although the providers offered all contraceptive options to eligible patients, continuity patients were more likely to receive more effective contraception in their primary care office.

Contraceptive uptake in postpartum people with and without opioid use disorder and opioid use with co-occurring substance use

BackgroundUsing contraception to delay pregnancy allows people with opioid use disorder (OUD) to choose when they are ready to continue their families. Yet, postpartum contraceptive uptake among people with OUD has not been well characterized. MethodsAnalyses used 73,811 pregnancy episodes among 61,221 people (2016–2021) from the St. Louis University-SSM Virtual Data Warehouse. OUD was defined from the year prior and through pregnancy. Contraceptive uptake was defined within 90-days after delivery. We used Generalized Estimating Equations-type multinomial logit models to assess association of OUD +/- co-occurring substance use disorders (SUDs) with any contraception (yes/no) and type of contraception (effective – pills, patch, ring, injection; or highly effective – long-acting reversible, LARC methods [intrauterine device, implant] and sterilization). ResultsThe sample was 66.0 % white and average age was 27.7 years (±5.6). 32.5 % of pregnancies were followed by contraception initiation, 2.3 % had an OUD diagnosis, and 1.3 % OUD with co-occurring SUD. There was no association between OUD and postpartum contraception receipt, but OUD was associated with decreased highly effective compared to effective method initiation (aOR=0.76; 95 % CI: [0.64–0.91]). OUD plus co-occurring SUD was associated with decreased uptake across all contraception types (aOR=0.81[0.70–0.93]), specifically, highly-effective methods (aOR=0.48[0.38–0.61]). ConclusionsOverall postpartum contraception uptake among people with OUD is comparable to uptake in the non-OUD population. People with OUD plus co-occurring SUDs are particularly unlikely to receive contraception. The reasons people choose contraceptive methods are complex and may differ by SUD severity. More information is needed to understand factors that impact postpartum contraception initiation.

Feasibility of adolescent contraceptive care in the pediatric emergency department: A pilot randomized controlled trial.

This study assessed feasibility constructs of adolescent contraceptive care in the pediatric emergency department (PED), including contraception initiation. We conducted a randomized trial in two PEDs with pregnancy-capable adolescents aged 15-18 years who were assigned to enhanced usual care (usual) or same-day initiation (same day). All received counseling and clinic referral, but same-day participants could also receive contraception in the PED. We trained PED clinicians in counseling and prescribing. Adolescents and clinicians rated feasibility using five Likert-type items (1 = strongly disagree to 5 = strongly agree) after the session. We assessed PED medication initiation and appropriateness via medical record review and contraception use and side effects at 30 days via adolescent survey. To further explore feasibility, we conducted clinician interviews at study completion; these were audio-recorded, transcribed, and analyzed. We hypothesized contraceptive care would be feasible (defined as average score ≥ 4 across five survey items). We enrolled 37 adolescents (12 in usual and 25 in same-day), mean age was 16.6 years, 73% were Black, and 19% were Hispanic. We trained 27 clinicians. Average feasibility scores were 4.6 ± 0.4 (adolescents) and 4.1 ± 0.8 (clinicians). Eleven (44%) same-day participants initiated contraception in the PED. One adolescent with migraines initially received estrogen-containing pills; this was corrected after discharge. At 30 days, same-day participants were more likely to report contraception use (78% vs. 13%; p = 0.007). One adolescent reported bloating as a side effect. Clinicians enjoyed delivering contraceptive care, found study resource materials useful, and identified staffing shortages as a barrier to care delivery. We are among the first to report on PED-based adolescent contraception initiation to prevent unintended pregnancy. Adolescents and clinicians reported that contraceptive care was feasible. Initiation was common and medications were largely appropriate and tolerated. Future efforts should explore integrating contraceptive care into routine PED care.

Does reversible postpartum contraception reduce the risk of pregnancy condition recurrence? A longitudinal claims-based study from Maine

PurposeTo estimate the effect of reversible postpartum contraception use on the risk of recurrent pregnancy condition in the subsequent pregnancy and if this effect was mediated through lengthening the interpregnancy interval (IPI). MethodsWe used data from the Maine Health Data Organization's Maine All Payer Claims dataset. Our study population was Maine women with a livebirth index pregnancy between 2007 and 2019 that was followed by a subsequent pregnancy starting within 60 months of index pregnancy delivery. We examined recurrence of three pregnancy conditions, separately, in groups that were not mutually exclusive: prenatal depression, hypertensive disorders of pregnancy (HDP), and gestational diabetes (GDM). Effective reversible postpartum contraception use was defined as any intrauterine device, implant, or moderately effective method (pills, patch, ring, injectable) initiated within 60 days of delivery. Short IPI was defined as ≤ 12 months. We used log-binomial regression models to estimate risk ratios and 95 % confidence intervals, adjusting for potential confounders. ResultsApproximately 41 % (11,448/28,056) of women initiated reversible contraception within 60 days of delivery, the prevalence of short IPI was 26 %, and the risk of pregnancy condition recurrence ranged from 38 % for HDP to 55 % for prenatal depression. Reversible contraception initiation within 60 days of delivery was not associated with recurrence of the pregnancy condition in the subsequent pregnancy (aRR ranged from 0.97 to 1.00); however, it was associated with lower risk of short IPI (aRR ranged from 0.67 to 0.74). Conclusion(s)Although initiation of postpartum reversible contraception within 60 days of delivery lengthens the IPI, our findings suggest that it does not reduce the risk of prenatal depression, HDP, or GDM recurrence. This indicates a missed opportunity for providing evidence-based healthcare and health interventions in the intrapartum period to reduce the risk of recurrence.

The prevalence of contraceptive use among postpartum women and its associated factors during the early phase of COVID-19 outbreak: a time series study

BackgroundUnintended pregnancies can adversely affect maternal health, preventable through timely postpartum contraception. During the COVID-19 pandemic, family planning services were constrained by policies that curtailed outpatient visits. We investigated the prevalence of postpartum contraceptive initiation at King Chulalongkorn Memorial Hospital (KCMH) during January to June 2020, comparing with the same period in 2019, and identified factors associated with such initiation.MethodsWe reviewed the medical records of 4506 postpartum women who delivered at KCMH during the study period. Logistic regression was conducted to test the association between early COVID-19 phase deliveries and post-partum long acting reversible contraception (LARC) initiation including copper intrauterine devices, levonorgestrel intrauterine systems, contraceptive implants, and progestogen-only injectable contraceptives.ResultsA total of 3765 women (83.6%), of whom 1821 delivered during the pandemic and 1944 during the historical cohort period, were included in this study. The proportion of women who initiated non-permanent modern contraceptives at six weeks postpartum was comparable between the COVID-19 (73.4%) and historical cohort (75.3%) (p = 0.27) periods. The proportion of women who initiated LARC at six weeks postpartumwas comparable between the historical cohort period (22.5%) and the COVID-19 (19.7%) (p = 0.05) period. Accessing a six-week postpartum check-up was independently associated with LARC initiation, of which the adjusted odds ratio (OR) (95% confidence interval) was 3.01 (2.26 to 4.02).ConclusionsOur findings demonstrated that accessing postpartum care significantly associate with the use of LARC. The data suggest the strong influence of postpartum check-ups in facilitating the adoption of effective contraception, emphasizing the need for accessible postpartum care to sustain maternal health during health crises.

YouTube and the implementation and discontinuation of the oral contraceptive pill: A mixed-method content analysis.

Women living in high-quality healthcare systems are more likely to use oral contraceptives at some point in their lives. Research findings have sparked controversial discussions about contraception in the scientific community and the media, potentially leading to higher rates of method discontinuation. Understanding the underlying motives for method discontinuation is crucial for reproductive health equity and future programming interventions. To address this question, this study aims to explore women's experiences of oral contraceptive use and discontinuation on YouTube. A concurrent explanatory mixed-methods design was used to conduct content analysis of German YouTube videos. The information from 175 videos of 158 individuals was extracted through quantitative descriptive content analysis. Twenty-one individuals were included in the qualitative content analysis. The body was a recurring theme in the pill biographies. Women described, for example, bodily sensations as reasons for taking and stopping the pill. They also described positive and negative side effects while taking the pill and after stopping. The most common side effects of taking the pill mentioned by YouTubers were mood swings (76/158), weight gain (45/158), headaches (33/158), and depressed mood (45/158). The symptoms after discontinuation reported most were facial skin impurities (108/158), decreased mood swings (47/158), hair loss (42/158), and weight loss (36/158). Overall, women overwhelmingly rated their discontinuation experience as positive (87/91). The study identified key symptoms of oral contraceptive initiation and discontinuation by portraying the experiences of female YouTubers, adding valuable insights to the understanding of method initiation and discontinuation. Further research is needed to explore women's personal experiences with method discontinuation beyond the YouTube platform.

Preference-aligned fertility management among married adolescent girls in Northern Nigeria: assessing a new measure of contraceptive autonomy

IntroductionUniversal access to sexual and reproductive healthcare—including family planning (FP)—is a global priority, yet there is no standard outcome measure to evaluate rights-based FP programme performance at the regional, national...

Choice and factors associated to the use of contraceptive methods among postpartum women: A prospective cohort study

ObjectivesTo assess women’s contraceptive preferences in the immediate postpartum period and identify factors associated with use of their desired contraceptive method six months later. Material and methodsThis prospective cohort study included women ≤48 h after delivery at a single public Brazilian hospital. The women’s interview took place in two different momentsbefore hospital discharge (in-person interview) and six months after delivery (by telephone contact). For data collection and management, we used the REDCap electronic tool. Univariate and multivariate analyses (unadjusted and adjusted Odds Ratio and 95 % confidence intervals) were used to identify factors associated with higher use of their desired contraceptive method six months after delivery. ResultsA total of 294 women (166 adolescents) were included. Initial contraceptive preferences were especially intrauterine devices (IUDs) (39.1 %), implants (33.0 %) and injectable hormonal contraceptives (17.0 %). Six months later, 42.5 % (n = 125) were using their desired contraceptive method. Younger age, white race and contraceptive initiation prior to hospital discharge were associated with use of their desired contraceptive at six months. ConclusionLong-acting reversible contraception (LARC) methods were the most desired contraceptives among women after delivery. Providing and initiating free contraception prior to discharge from a birthing unit is important with regard to use of their desired method.

Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative

Evaluating the impact of statewide contraceptive access initiatives is necessary for informing health policy and practice. To examine changes in contraceptive method use among a cohort of women of reproductive age in South Carolina during the Choose Well contraceptive access initiative. In this cohort study, baseline data from the initial Statewide Survey of Women administered from October 1, 2017, to April 30, 2018, to a probability-based sample of women of reproductive age in South Carolina and a peer state (Alabama) were linked with 3 follow-up surveys given in 2019, 2020, and 2021. Responses about contraception use from the initial survey were compared with responses across follow-up surveys using the regression-based differences-in-differences method. Data analysis was performed from October 2023 to February 2024. The South Carolina Choose Well contraceptive access initiative seeks to fill contraceptive access gaps and increase provision of a full range of contraceptive methods through engagement with a wide range of health care organizations across the state. Changes in contraceptive method use, including long-acting reversible contraception (LARC), intrauterine devices (IUDs), implants, short-acting hormonal injection, and barrier or other methods between the baseline survey (2017-2018) and 3 subsequent surveys (2019-2021). A total of 1344 female participants (mean [SD] age, 34 [7] years) completed the first survey (667 in Alabama and 677 in South Carolina). Use of LARC significantly increased in South Carolina (119 [17.6%] to 138 [21.1%]) compared with Alabama (120 [18.0%] to 116 [18.1%]; P = .004). Use of IUDs increased in South Carolina (95 [14.0%] to 114 [17.4%]) compared with Alabama (92 [13.8%] to 102 [15.9%]; P = .003). These associations persisted in the adjusted analysis, with a significant increase in the odds of LARC (adjusted odds ratio, 1.24; 95% CI, 1.06-1.44) and IUD (adjusted odds ratio, 1.19; 95% CI, 1.06-1.32) use at follow-up in South Carolina compared with Alabama. In this cohort study of 1344 participants, increases in the use of IUDs in South Carolina were noted after the implementation of the South Carolina Choose Well initiative that were not observed in a peer state with no intervention. Our findings may provide support in favor of statewide contraceptive access initiatives and their role in promoting access to reproductive health services.

Contraceptive uptake among gender-expansive individuals in the HER Salt Lake Contraceptive Initiative

ObjectivesWe examined differences in contraceptive uptake and discontinuation between gender-expansive individuals and cis-women in the HER Salt Lake Contraceptive Initiative. Study designWe used self-reported survey data to assess associations between gender identity, contraceptive uptake, and discontinuation. ResultsOf participants (n = 4289), 178/4289 (4%) identified as gender-expansive with 157/178 (88%) reporting recent sexual activity with men. Selection of IUD or Implant was most common, with 109/178 (61%) of gender-expansive individuals choosing these options. We observed similar methods selected (p = 0.2) and discontinuation rates at three years between participants (OR: 0.93, p = 0.8). ConclusionGender-expansive individuals had similar method selection and discontinuation rates as cis-women. ImplicationsOur finding of no difference in the uptake of contraception between cis-women and gender-expansive individuals should empower providers to openly discuss contraception with patients regardless of gender identity.

Change in Contraceptive Use Within South Carolina Medicaid Following the Choose Well Contraceptive Access Initiative: Did COVID-19 Alter the Trends?

COVID-19 hit at the midpoint of Choose Well, a statewide contraceptive access initiative commenced in South Carolina (SC) in 2017. This study assessed whether the pandemic altered the trends in contraceptive use among SC Medicaid during the first half of Choose Well. Contraception use among 333,253 women was analyzed from 2017 to 2022, divided into prepandemic (January 2017-February 2020) and pandemic (March 2020-December 2022) periods. Bivariate differences in contraceptive use were examined using Pearson's Chi square test across these periods, including the first, first two, and first three quarters of the pandemic. Interrupted time-series analysis assessed changes in trends for intrauterine devices (IUDs) and implants during pandemic compared with prepandemic levels. IUD and implant use dropped during the first two quarters of the pandemic. While IUD use matched the prepandemic levels by the end of the first three quarters, implant use slightly lagged. The use of injections and pills decreased from 16.6% and 26.2% during the prepandemic period to 13.6% and 21.7% during the pandemic period, respectively (p < 0.001). The trends in IUD and implant use in the pandemic period were higher by 0.01 (95% confidence interval [CI]: 0.01, 0.02) and 0.04 (95% CI: 0.03, 0.05) percentage points per month relative to the prepandemic trends, respectively. The pandemic's initial impact quickly stabilized, and overall, the gains in contraceptive use among Medicaid beneficiaries associated with Choose Well remained largely unaffected, with some methods showing increased trends.

Postpartum long-acting reversible contraceptive adoption after a statewide initiative.

To examine the effects of a comprehensive, multiyear (2015-2020) statewide contraceptive access intervention in Delaware on the contraceptive initiation of postpartum Medicaid patients. The program aimed to increase access to all contraceptives, including long-acting reversible contraceptives (LARC). The program included interventions specifically targeting postpartum patients (Medicaid payment reform and hospital-based immediate postpartum (IPP) LARC training) and interventions in outpatient settings (provider training and operational supports). We used Medicaid claims data between 2012 and 2019, from Delaware and Maryland (a comparison state), to identify births and postpartum contraceptive methods up to 60 days postpartum among patients aged 15-44 years who were covered in a full-benefit eligibility category. Using difference-in-differences, we assessed changes in LARC, tubal ligation, and short-acting methods (oral contraceptive, injectable, patch/ring). LARC rates were assessed at 60 days after delivery and on an immediate postpartum basis. Other methods were only assessed at 60 days. Analyses were conducted separately for an early-adopting high-capacity hospital (that delivers approximately half of all Medicaid financed births) and for all other later-adopting hospitals in the state. Data were extracted from administrative claims. The program increased postpartum LARC insertions by 60 days after delivery by 11.7 percentage points (95% CI: 10.7, 12.8) in the early-adopting hospital and 6.9 percentage points (95% CI: 4.8, 5.9) in later-adopting hospitals. Increases in IPP versus outpatient LARC drove the change, but we did not find evidence that IPP crowded-out outpatient LARC services. We observed decreases in short-acting methods, suggesting substitution between methods, but the share of patients with any method increased at the early-adopting hospital (5.2 percentage points; 95% CI: 3.5, 6.9) and was not statistically significantly different at the later-adopting hospitals. Direct reimbursement for IPP LARC, in combination with provider training, had a meaningful impact on the share of Medicaid-enrolled postpartum women with LARC claims.

The Effect of Stigma on Family Planning and HIV Pre-exposure Prophylaxis Decisions of Young Women Accessing Post-Abortion Care in Kenya

Adolescent girls and young women (AGYW) in Eastern and Southern Africa face parallel epidemics of unintended pregnancy and HIV. Their sexual health decisions are often dominated by intersecting stigmas. In an implementation science project integrating delivery of daily, oral pre-exposure prophylaxis (PrEP) for HIV prevention into 14 post-abortion care (PAC) clinics in Kenya, we enrolled a subset of PrEP initiating AGYW (aged 15 to 30 years) into a research cohort. Utilizing log binomial models, we estimated the effect of PrEP stigma on PrEP continuation (measured via self-report and urine assay for tenofovir) and abortion stigma on contraceptive initiation. Between April 2022 and February 2023, 401 AGYW were enrolled after initiating PrEP through their PAC provider, of which 120 (29.9%) initiated highly-effective contraception. Overall, abortion and PrEP stigmas were high in this cohort. Abortion stigma was more prevalent among those that were adolescents, unmarried, and reported social harm. Among 114 AGYW returning for the month 1 follow-up visit, 83.5% reported continuing PrEP and 52.5% had tenofovir detected. In this subset, higher levels of PrEP stigma were significantly associated with greater likelihood of PrEP adherence, but not PrEP continuation. For abortion stigma, greater scores in the subdomain of isolation were significantly associated with greater likelihood of initiating a highly-effective contraception, while greater scores in the subdomain of community condemnation were significantly associated with reduced likelihood of initiating a highly-effective contraception. Given the burden of stigma documented by our work, PAC settings are a pivotal space to integrate stigma-informed counseling and to empower young women to optimize contraceptive and PrEP decisions.

The value of an extended postnatal program for contraceptive use during the first year postpartum

AbstractObjectiveTo investigate if earlier and repeated postpartum care visits (PPCVs) (3 and 7 weeks) compared to a standard visit (7 weeks) would increase early initiation of contraception and contraceptive use at 1‐year postpartum.DesignComparative clinical trial.SettingSix maternity clinics in Gothenburg, Sweden.PopulationThere were 447 women in the intervention group and 511 in the standard group.MethodsComparing standard postpartum care with an intervention model of care.Main Outcome MeasuresInitiation of contraception and method used.ResultsFrom January 2019 to June 2020, 1159, participants were enrolled. Analyses included 958 subjects where the intervention group had higher use of contraception (55.5%) compared to the standard group (48.5%), (95% confidence interval [CI]: 0.4–13.5), p = 0.037. Long‐acting reversible contraceptives were higher among users in the intervention group (56.9%) compared to the standard group (48%), (95% CI: −0.3 to 18.0), p = 0.059. Condom use was higher in the standard group (19%) compared to the intervention group (12.1%), (95% CI: 0.1–13.6), p = 0.047. Contraceptive use 1‐year postpartum was higher in the intervention group (55.7%) compared to the standard group (47.2%), (95% CI: 1.2–15.9), p = 0.023 and more pregnancies were reported in the standard group (7.8%) compared to the intervention group (4.1%), (95% CI: 0.5–7.0), p = 0.040.ConclusionThese results indicate the importance of earlier and additional PPCVs to increase early start‐up of contraception and to obtain a higher frequency of contraceptive use 1‐year postpartum to reduce pregnancies close to delivery.

Frequency of same-day contraceptive initiation, recent unprotected intercourse, and pregnancy risk: a prospective cohort study of multiple contraceptive methods

BackgroundSame-day start removes barriers to contraceptive initiation and may reduce the risk of unintended pregnancy. Same-day start may be appropriate for all contraceptive methods, but we lack data comparing methods. ObjectivesTo assess the frequency of same-day initiation among six contraceptive methods selected for “same-day start” among new contraceptive users and describe the efficacy of same-day start first cycle pregnancy risk by all contraceptive methods and by each method. Study DesignUsing prospective data from the HER Salt Lake Contraceptive Initiative, we identified and assessed outcomes for participants initiating a new method of contraception beyond the first seven days of their menstrual cycle (same-day start). Enrolled participants at four family planning clinics in Salt Lake County, Utah between September 2015-March 2017 received their method of choice regardless of their cycle day or recent unprotected intercourse. All participants self-reported last menstrual period data and unprotected intercourse events in the previous 2 weeks. We excluded participants that received care immediately after or within two weeks of abortion care. Clinical electronic health records provided information on contraceptive method initiation and use of oral emergency contraception. Participants reported pregnancy outcomes in 1-, 3-, and 6-month follow-up surveys with clinic verification to identify any pregnancy resulting from same-day initiation. The primary outcomes report the frequency of same-day start use and first cycle pregnancy risk among same-day start users of all contraceptive methods. The secondary outcomes include frequency of and pregnancy risk in the first cycle of use among same-day start contraception users by method. We also report frequency of unprotected intercourse within 5 days and 6-14 days of contraception initiation, frequency of concomitant receipt of oral emergency contraception with initiation of ongoing contraception, and pregnancy risk with these exposures. We analyzed pregnancy risk by contraceptive method initiated same-day and assessed for simultaneous use of oral emergency contraception. ResultsOf the 3,568 individuals enrolled, we identified the majority as same-day start users (n=2,575/3,568, 72.2%), with one in eight of those reporting unprotected intercourse in the previous 5 days (n=322/2,575, 12.5%) and one in ten reporting unprotected intercourse 6-14 days prior to contraceptive method initiation (n=254/2,575, 9.9%). We identified 11 pregnancies among same-day start users (0.4%, 95% CI 0.2%-0.7%) compared to 1 (0.1%. 95% CI 0.002%-0.6%) among those who initiated contraception within seven days from the last menstral period. Users of oral hormonal contraception and vaginal hormonal methods reported the highest 1st cycle pregnancy rates (1.0 – 1.2%). Among same-day start users, 174 (6.8%) received oral emergency contraception at enrollment in conjunction with another method. Of the same-day user who received emergency contraception at initiation, 4 (2.3%) pregnancies were reported. Conclusion(s)Same-day start is common and associated with a low pregnancy risk. Using the “any method, any-time” approach better meets contraceptive clients’ needs and maintains a low risk of pregnancy.