Contraception Planning Research Articles

Association of perinatal depression and postpartum contraception intent, choice, and actual use

ObjectivesDepression is common during pregnancy and the year following childbirth (the perinatal period). This study assessed the association of depressive symptoms and contraception decisions in perinatal individuals. Study designWe conducted a secondary analysis using data from the PRogram in Support of Moms (PRISM) study, a cluster randomized controlled trial of active interventions which aimed to address perinatal depression. This analysis included 191 individuals aged 18–45 who screened positive for depression on the Edinburgh Postnatal Depression Scale (EPDS, score ≥10) during pregnancy or up to 3 months postpartum. We assessed contraception intent and method choice at 1–3 months postpartum. At 5–7 months postpartum, we assessed contraceptive method used and EPDS depression scores. We used logistic regressions to examine the relationship between depression and contraceptive use/method. ResultsAt 1–3 months postpartum, the majority of participants (76.4%) expressed an intention to use contraception. Of those, over half (53.4%) indicated a preference for higher effectiveness contraception methods. Participants with persistent depression symptoms (positive EPDS) at 5–7 months were significantly less likely to report using higher effectiveness contraceptive methods (aOR = 0.28, 95% CI = 0.11–0.70) compared to those without. Among participants with persistent depressive symptoms, 21.1% reported using a contraception method of lower effectiveness than had originally intended. ConclusionPerinatal individuals with persistent depressive symptoms at 5–7 months postpartum reported greater use of less-effective contraception methods than originally planned. ImplicationsWe found associations between perinatal depression and use of less effective contraception use. Provider discussions regarding contraception planning is important, particularly in those with perinatal depression symptoms.

Factors Associated with the Uptake of Long-Acting Reversible Contraception and Contraceptive Use in Postpartum People with HIV at a Single Tertiary Care Center.

This study aimed to elucidate factors contributing to uptake of highly effective contraception, including permanent contraception, and no contraceptive plan among postpartum people with HIV (PWHIV). A retrospective cohort analysis was conducted to correlate postpartum birth control (PPBC) with sociodemographic and biomedical variables among postpartum PWHIV who received care at The Ruth M. Rothstein CORE Center and delivered at John H. Stroger, Jr. Hospital of Cook County in Chicago, from 2012 to 2020. Earlier gestational age (GA) at initiation of prenatal care, having insurance, and increased parity are associated with uptake of highly effective contraception. Meanwhile, later GA at presentation increased odds of having no PPBC plan. Early prenatal care, adequate insurance coverage, and thorough PPBC counseling are important for pregnant PWHIV. · Contraceptive use among PWHIV is poorly understood.. · Having insurance and increased parity are associated with long-acting reversible contraception use.. · Earlier GA at first prenatal care visit is associated with increased PPBC uptake..

Documentation of prenatal contraceptive counseling and fulfillment of permanent contraception: a retrospective cohort study

BackgroundBarriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling.MethodsThis is a planned secondary analysis of a multi-site cohort study of patients with documented desire for permanent contraception at the time of delivery at four hospitals located in Alabama, California, Illinois, and Ohio over a two-year study period. Our primary exposure was initial timing of documented plan for contraception (first, second, or third trimester, or during delivery hospitalization). We used univariate and multivariable logistic regression to analyze fulfillment of permanent contraception before hospital discharge, within 42 days of delivery, and within 365 days of delivery between patients with a documented plan for permanent contraception in the first or second trimester compared to the third trimester. Covariates included insurance status, age, parity, gestational age, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index.ResultsOf the 3103 patients with a documented expressed desire for permanent contraception at the time of delivery, 2083 (69.1%) had a documented plan for postpartum permanent contraception prenatally. After adjusting for covariates, patients with initial documented plan for permanent contraception in the first or second trimester had a higher odds of fulfillment by discharge (aOR 1.57, 95% C.I 1.24–2.00), 42 days (aOR 1.51, 95% C.I 1.20–1.91), and 365 days (aOR 1.40, 95% C.I 1.11–1.75), compared to patients who had their first documented plan in the third trimester.ConclusionsPatients who had a documented prenatal plan for permanent contraception in trimester one and two experienced higher likelihood of permanent contraception fulfillment compared to those with documentation in trimester three. Given the barriers to accessing permanent contraception, it is imperative that comprehensive, patient-centered counseling and documentation regarding future reproductive goals begin early prenatally.

Implementing a clinical checklist for pregnant patients with opioid use disorder.

Opioid use disorder (OUD) has been increasing in pregnant patients over the past two decades. Best practice guidelines that are available for these patients, must now be implemented by health care teams. Clinical checklists have been used for other complex patient cohorts with good success and are a potentially viable tool for ensuring best practices with this patient population as well. Maine has seen a dramatic increase in the number of pregnant patients with OUD. Many of these patients seemed to "fall through the cracks" in the traditional prenatal care model. The obstetrical care team expressed feeling overwhelmed by the complex care needs of these patients and unsure of how to improve their care. To improve prenatal care delivery for patients with OUD, we implemented an evidence-based clinical checklist. This local, NP-led quality improvement project was done in partnership with a state-led initiative to improve perinatal care for patients with OUD. An evidence-based checklist provided by the state initiative was implemented for prenatal patients with diagnosed OUD. Use of a clinical checklist for patients with OUD increased the rate of several best practices during their prenatal care, including emergency naloxone prescription, tracking prescription monitoring reports, and contraceptive planning. Rates of completed prenatal screening for substance misuse, social determinants of health, and intimate partner violence also increased in our practice overall, as a result of this project. To further improve perinatal care coordination for patients with OUD, we recommend future evaluation of clinical checklists within various practice settings.

A CROSS-SECTIONAL OBSERVATIONAL STUDY REGARDING KNOWLEDGE, ATTITUDE, AND PRACTICE OF CONTRACEPTION AMONG ELIGIBLE COUPLES RESIDING IN THE FIELD PRACTICE AREA ASSOCIATED WITH TERTIARY CARE CENTER

Objectives: The objectives of the study were to observe the knowledge, attitude, and practice among the eligible couples in the area of study. Methods: A population-based cross-sectional study was done in the field practice area of Postpartum Unit, Department of Obstetrics and Gynaecology, Rajindra Hospital, Patiala. Institutional Ethical Committee approval was taken. A structured questionnaire was made and validated. The knowledge, attitude, and practice related to contraceptives were thoroughly asked by face-to-face interviews with the eligible couples (15–49 years) with the help of a pre-validated and pre-tested questionnaire. The sample size for frequency in a population is 350. Results: The majority of the population 181 (51.7%), belongs to the age group of 30–39 years, followed by 114 (32.6%) in the age group of 20– 29 years and 52 (14.8%) in 40–49 years. 298 (85.14%) couples had knowledge regarding contraception and family planning. The majority of the population in the area of study had opted for permanent sterilization methods that included tubectomy in 103 (29.4%) cases, followed by vasectomy in 81 (23.1%) cases. The majority of couples, 25 (29.4%), had a fear of the side effects of the contraceptive, followed by feeling ashamed to buy 19 (22.3%). Of 298 (85.14%) couples had knowledge regarding contraception and family planning, and among those were literate. While 52 (14.86%) cases did not have knowledge of contraception, in which 20 (42.6%) were illiterate. Conclusion: We can conclude that awareness about newer contraceptive methods is still lacking and needs to be increased at the community level as well as by the health-care workers by formulation of new policies by the government.

Abortion restrictions and medical residency applications

Residency selection is a challenging process for medical students, one further complicated in the USA by the recent Dobbs v Jackson Women’s Health Organization (Dobbs) decision over-ruling the federal right...

Factors Used by Mobile Applications to Predict Female Fertility Status and Their Reported Effectiveness: A Scoping Review.

Family planning, whether for pregnancy prevention or conception, is of pivotal importance to women of reproductive age. As hormonally driven methods, such as oral contraceptive pills, are widely used but have numerous side effects, women often seek alternative non-hormonal, non-invasive options, including fertility-tracking mobile applications (apps). However, the effectiveness of these apps as a method of contraception and conception planning has not been extensively vetted. The goal of this scoping review is to identify the various factors used by apps marketed as a method of contraception and/or family planning to predict a woman's fertility status, as well as their documented effectiveness. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, a literature search was performed in CINAHL, MEDLINE, and Alt HealthWatch databases for articles published between October 1, 2017, and October 4, 2022. Quality assessment of eligible full-text articles was conducted using the Joanna Briggs Institute critical appraisal tools. A total of 629 articles were screened. Overall, 596 articles were excluded and the remaining 33 articles underwent full-text review. Seven articles were included in the final analysis, yielding data on the following five apps: Natural Cycles, Ava Fertility, Clearblue Connected, Ovia Fertility, and Dynamic Optimal Timing (DOT). Data supporting the effectiveness of these apps is limited. All apps provided predictions on fertility status throughout a woman's menstrual cycle using proprietary algorithms, biometric data, and self-reported menstrual cycle data. Further research, particularly independent research following a randomized controlled design, on the efficacy of these apps is needed to produce more robust results.

Neighbourhood socioeconomic position, prenatal care and fulfilment of postpartum permanent contraception: Findings from a multisite cohort study.

Research suggests neighbourhood socioeconomic vulnerability is negatively associated with women's likelihood of receiving adequate prenatal care and achieving desired postpartum permanent contraception. Receiving adequate prenatal care is linked to a greater likelihood of achieving desired permanent contraception, and access to such care may be critical for women with Medicaid insurance given that the federally mandated Medicaid sterilization consent form must be signed at least 30 days before the procedure. We examined whether adequacy of prenatal care mediates the relationship between neighbourhood socioeconomic position and postpartum permanent contraception fulfilment, and examined moderation of relationships by insurance type. This secondary analysis of a retrospective cohort study examined 3012 Medicaid or privately insured individuals whose contraceptive plan at postpartum discharge was permanent contraception. Path analysis estimated relationships between neighbourhood socioeconomic position (economic hardship and inequality, financial strength and educational attainment) and permanent contraception fulfilment by hospital discharge, directly and indirectly through adequacy of prenatal care. Multigroup testing examined moderation by insurance type. After adjusting for age, parity, weeks of gestation at delivery, mode of delivery, race, ethnicity, marital status and body mass index, having adequate prenatal care predicted achieving desired sterilization at discharge (β = 0.065, 95% confidence interval [CI]: 0.011, 0.117). Living in neighbourhoods with less economic hardship (indirect effect -0.007, 95% CI: -0.015, -0.001), less financial strength (indirect effect -0.016, 95% CI: -0.030, -0.002) and greater educational attainment (indirect effect 0.012, 95% CI: 0.002, 0.023) predicted adequate prenatal care, in turn predicting achievement of permanent contraception by discharge. Insurance status conditioned some of these relationships. Contact with the healthcare system via prenatal care may be a mechanism by which neighbourhood socioeconomic disadvantage affects permanent contraception fulfilment, particularly for patients with Medicaid. To promote reproductive autonomy and healthcare equity, future inquiry and policy might closely examine how neighbourhood social and economic characteristics interact with Medicaid mandates.

Contraceptive plans and purchase after an induced abortion: A nationwide register study from Finland

ObjectivesTo examine the types of hormonal contraceptive methods chosen at the time of the abortion, and how they correspond to post-abortion hormonal contraceptive purchase. Study designThis was a prospective register-based study. We identified the present cohort of 8428 women undergoing induced abortion between July 1, 2017 and December 31, 2018, using the Prescription Centre, Social Insurance Institution database and the Finnish National Register of Induced Abortions. From the Register of Induced Abortions, we gathered information on planned post-abortion contraception. The redeemed prescriptions of hormonal contraception were identified from the Prescription Centre until December 31, 2019. We analyzed the hormonal contraceptive methods planned at the time of the abortion, and how they corresponded to hormonal contraceptive purchase during the 1-year follow-up. We also assessed factors (age, socioeconomic status, education, civil status, and reproductive history) affecting post-abortion contraceptive purchase by using Poisson regression models. ResultsAt the time of the abortion, 83% (n = 7023) of the women were planning to start using hormonal contraception. Planning any hormonal contraception at the time of the abortion was associated with a higher probability to purchase hormonal contraception after the abortion (incidence rate ratio [IRR] 2.30, 95% confidence intervals [CI] 2.07–2.55), especially in cases of the vaginal ring (IRR 42.66, 95% CI 33.89–53.71) and contraceptive patch (IRR 156.33, 95% CI 111.31–219.55). The following variables were associated with lower incidence rates for purchasing hormonal contraception after the abortion: educational level of bachelor at the highest or missing information on education, civil status as married or divorced, and history of delivery or induced abortion. ConclusionsThe majority of women undergoing abortion plan to use hormonal contraceptive method for post-abortion contraception. Planning any hormonal contraceptive method at the time of an induced abortion is an important predictor of purchasing the method within the year after the abortion. ImplicationsHormonal contraceptive purchase after an abortion is associated with pre-abortion contraceptive planning. Many background factors for not purchasing hormonal contraception can be identified, which may guide counseling dedicated to these groups.

Reproductive health of refugees: barriers to accessing healthcare systems in host countries

Refugees around the world face numerous challenges when it comes to accessing healthcare services, particularly in the area of reproductive health. This narrative review aims to explore the barriers that refugees encounter when trying to access healthcare systems in their host countries. These barriers include language and cultural differences, lack of knowledge about the healthcare system, limited access to transportation, financial constraints, and stigma. Comprehensive healthcare services, including healthcare access, nutrition, and mental health support, are crucial to prevent and manage chronic diseases and improve health outcomes for refugees, particularly those with diabetes who may face restricted availability of medications and monitoring devices. It is essential to ensure refugees diagnosed with diabetes have sufficient access to insulin supplies and equipment to administer it securely. We also highlight the impact of these barriers on the reproductive health of refugees, including inadequate prenatal care, lack of access to contraception and family planning services, and increased risk of sexually transmitted infections. The findings of this review underscore the urgent need for policymakers and healthcare providers to address the unique challenges that refugees face when accessing reproductive healthcare. Efforts must be made to improve access to information, increase cultural competency among healthcare providers, and address financial and transportation barriers. By addressing these challenges, we can ensure that refugees have the necessary support and resources to maintain their reproductive health and well-being. No conflict of interests was declared by the authors.

Association Among Race, Ethnicity, Insurance Type, and Postpartum Permanent Contraception Fulfillment.

To evaluate the association among race, ethnicity, insurance type, and fulfillment of permanent contraception requests. This is a secondary analysis of a retrospective cohort of patients who delivered at 20 or more gestational weeks in a 2-year time period at four hospitals across the United States: University of California San Francisco, Northwestern Memorial Hospital, MetroHealth Medical Center in Cleveland, and University of Alabama at Birmingham. All patients included had permanent contraception documented as their postpartum contraceptive plan. We used modified Poisson models to estimate the associations among race and ethnicity, insurance type, and fulfillment of permanent contraception before hospital discharge, within 6 weeks of delivery, and within 1 year of delivery, adjusting for age, parity, gestational age, delivery type, marital status, body mass index, insurance type, adequacy of prenatal care, and hospital site. Of 2,945 people in our cohort, 1,243 (42.2%) were non-Hispanic Black, and 820 (27.8%) were Hispanic, and 882 (30.0%) were non-Hispanic White. Overall, 1,731 of 2,945 patients (58.2%) who desired postpartum permanent contraception received it before hospital discharge, 1,746 of 2,945 (59.3%) received it within 6 weeks of delivery, and 1,927 of 2,945 (65.4%) received it within 1 year of delivery. Across all racial and ethnic groups, patients with Medicaid insurance were less likely to have their desired postpartum permanent contraception procedure fulfilled compared with patients with private insurance. In unadjusted models, non-Hispanic Black patients were less likely to have their desired postpartum permanent contraception procedure fulfilled. In an examination of interaction with insurance type, non-Hispanic Black patients with private insurance were less likely to have permanent contraception fulfilled compared with non-Hispanic White patients with private insurance before adjustment. After adjustment, there were no significant associations between race and postpartum permanent contraception fulfillment among those with Medicaid or private insurance. In unadjusted models, we find marked racial disparities in fulfillment of permanent contraception. Controlling for individual- and facility-level factors eliminated associations among race, ethnicity, insurance type, and fulfillment, likely because covariates are mediators on the pathway between racism and fulfillment.

Websites Selling Direct-to-Consumer Anti-Mullerian Hormone Tests

The recent provision of direct-to-consumer (DTC) Anti-Mullerian Hormone (AMH) testing in several countries has been contentious, particularly due to concerns about judicious testing and informed consent. To describe and analyze information on websites that sell DTC AMH tests. Qualitative study including content analysis of text information from websites in multiple countries that sell AMH tests DTC. The top 50 search results from 4 different internet search strings were captured and reviewed for eligibility. Data were extracted in March 2022 and analyzed from April 2022 to July 2023. Themes and categories were derived from the website content using a conventional inductive approach, with a particular focus on information content, quality and accuracy, as well as the tone and language used. Twenty-seven websites across 7 different countries formed the sample for analysis. Information varied considerably across websites and was organized into 6 overarching categories: (1) whether a test description was included (25 websites [93%]); (2) statements about what the test can do, which included indicating ovarian reserve (26 websites [96%]) and indicating likelihood of conceiving (20 websites [74%]); (3) statements about the usefulness of the test result, which included enabling women to adjust their reproductive timeline (11 websites [41%]) and determining whether egg freezing was a viable option (8 websites [30%]); (4) blood collection method (ie, through a laboratory or an at-home sample); (5) promotion tactics, such as stating the convenience of testing (24 websites [89%]) and using language promoting empowerment and control (7 websites [26%]); and (6) statements about limitations of the test, which included polycystic ovary syndrome falsely inflating AMH levels (13 websites [48%]) and that it cannot accurately predict chances of conceiving (9 websites [33%]). In this qualitative study including content analysis, most websites selling DTC AMH tests included false and misleading claims which might lead consumers to purchase an AMH test in the belief that it can reliably predict fertility potential and age of menopause. Depending on the test result, this may in turn lead to misplaced anxiety or reassurance about one's fertility and modifications to subsequent conception or contraceptive plans and behavior.

Exploring the prevalence of abortion and its characteristics in Perú

ObjectivesOur paper presents the analysis of a nationwide survey that explored induced abortion among women using a ballot-box technique. Our objective was to determine the prevalence of abortion and the main characteristics of the procedure. Study designWe conducted surveys in households with 2400 women aged 18–49 from urban areas nationwide, between October 15 and 29, 2018. Data collection was overseen by the Instituto de Opinión Pública de la Universidad Católica del Perú. We performed a probabilistic, multistage, and socioeconomic level-stratified sampling. Our study used the “ballot-box technique” to ensure anonymity and reduce the risk of social desirability. ResultsWe visited 15,433 houses nationwide. Among those households where surveys could not be conducted, it was due to abandoned or inaccessible property, unwilling to participate, absent members, out of quota, or inconclusive survey. On average, 19.0% of Peruvian women at all socioeconomic levels reported having had at least one abortion in their lifetime. Induced abortion is reported at all socioeconomic levels and reported age of the abortion is concentrated between 19 and 29 years old. In 57.7% of cases, women sought healthcare personnel for their last induced abortion. Among them, procedure abortion (45.3%) stands out over medical abortions (34.0%). Thirty-three percent of women who reported having had at least one induced abortion in their lifetime were admitted to a hospital after their last abortion. ConclusionsThe illegality of abortion has not prevented its occurrence in Peru. Our results suggest that, in Peru, legal restrictions on induced abortion create an unfavorable context for women's health, exposing them to services whose safety is not guaranteed. Efforts should be made to increase awareness and education about contraception and family planning methods to prevent unwanted pregnancies and reduce the need for abortion. ImplicationsThese findings should be considered in public policy discussions regarding abortion, since they might have a great impact for better decision making. They demonstrate that legal restrictions have not prevented the occurrence of abortion but has only created unsafe conditions around it.

1052-P: Reproductive Health Counseling in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)

Background: Preconception planning can reduce complications in pregnancy with type 1 diabetes. However, high periconception HbA1C is not uncommon and increases maternal and fetal risks. Due to limited data regarding preconception counseling, questions about education and contraception use were added to the 2022 T1DX-QI survey. Methods: The annual T1DX-QI survey was conducted August-September 2022 with a site response rate of 94% of 50 sites: 33 pediatric (66%), 17 adult (34%). Respondents answered questions relating to clinic resources and practices. Response data was cleaned and summarized. Results: Most sites report discussing contraception (74%) and pregnancy planning (72%) once a year or more. Of pediatric sites, 42% report always asking about menstruation history compared to 6% of adult sites. Only 12% of adult and 6% of pediatric sites have a formal preconception counseling protocol. Only 12% of adult and 9% of pediatric sites estimated that >80% of their patients of childbearing potential were using contraception, and all sites estimated that <60% had a HbA1C under 7%. Conclusions: Though most sites report discussing contraception and pregnancy planning, estimated rates of formal counseling programs, contraception use and attaining goal HbA1C remain low. QI efforts are needed to determine rates of preconception counseling and implement best practices to improve pregnancy outcomes. Disclosure G.O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. M.Basina: None. R.Fallurin: None. C.J.Levy: Advisory Panel; Dexcom, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., T1D Exchange. T1dx-qi collaborative: n/a. S.J.Ogyaadu: None. C.Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Abbott Diabetes. N.Rioles: None. H.Hardison: None. A.J.Roberts: None. S.Accacha: None. I.Guttmann-bauman: None. F.Vendrame: Consultant; Eli Lilly and Company. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Decline in contraceptive use- is the health care provider to blame, too?

Objective: To assess what impact does primary physician counseling have on contraceptive uptake. Study Design: Cross-sectional Comparative study. Setting: Study was done in three semi – government hospitals in three different cities. Period: April 2022 to May 2022. Material & Methods: Patients in outpatient clinics of the hospitals were given a questionnaire by simple random sampling. It was to assess women for their current use of contraception based on the source of their information about contraception. These groups were compared with each other for their contraception uptake. Associations between education, parity, working status and contraception use was also sought. The sample size was 175 women. Results: Out of 175 participants, 74 (42.3%) were practicing contraception at the time and 53 (30.3%) did not know about contraception. Reasons for not using contraception included side effects 71 (40.6%), Doctor never told them 56 (32%) and husband not willing 50 (28.6%). More women were of parity 4 or less (58 vs 34) and more working women used contraception (16 vs 6). The difference was not statistically significant. Illiterate women used contraceptives less. With education, there was significantly more use (38 vs 10) p < 0.001. Most Women knew about contraception from neighbor/ relatives 57 (32.5%) and 41 (23.4%) did not practice any method. A doctor/health professional was the source in 37 (21.2%), only 12 (6.9%) did not adopt contraception with p = 0.003. There was a strong statistical significance. Conclusion: There was a strong association between the physician counseling and contraceptive use. There is a strong need of regular, persistent contraceptive advice during each antenatal visit to individualize a contraception plan to suit a couple.

The Effect Of Family Planning With ABPK Counseling On Decision Making Family Planning In Wus (Women Of Reproductive Age)

ABPK is a standard guideline for family planning counseling services which not only contains the latest information about contraception or family planning but also contains standard family planning counseling processes and steps that are based on the rights of family planning clients and informed choices. The purpose of this study was to find out whether there was any effect of counseling on family planning using contraceptive collection tools, the sample in this study was total sampling, namely all women of childbearing age in the Grogol area, Kediri district, the method used was providing family planning counseling with assistive devices decision-making. This research is an experimental study, one group pre-test post-test design, conducted in January 2023. The results of the Wilcoxon test, the results of this study are p-value <0.05, from the results of the study it can be stated that there is an effect of family counseling planning with decision-making tools for family planning decision making.

(480) Whose Responsibility Is It: Examining Internet Trends to Assess Vasectomy Interest Following the Texas Heartbeat Abortion Ban

Abstract Introduction There have been record-high numbers of anti-abortion laws being pushed in the United States, and Texas has been one of the few states not to have such laws struck down. In May 2021, Texas passed the “heartbeat abortion ban” law making abortions after detection of a fetal heartbeat illegal and liable to be sued in court. The bill was enacted on September 1st of the same year. Many have investigated its effect on women, abortion clinic services, and abortion providers, yet very few have examined its impact on men. Objective To examine the impact of Texas’s 6-week “Heartbeat Abortion Ban” on people’s interest in vasectomies through internet searches. Methods Relative search volumes (RSVs) of male family planning terms – “vasectomy”, “vasectomy cost”, “vasectomy near me”, “urologist near me”, and “how to get a vasectomy”-- in Texas and the United States between 2020 and 2021 were pulled from Google Trends Analytics. The scores were populated into Excel and t-tests were run between parallel dates in 2020 and in 2021. The terms “vasectomy” and “vasectomy cost” were coded as showing general interest, and the terms “vasectomy near me”, “urologist near me”, and “how to get a vasectomy” were coded as indicative of planning and a higher degree of motivation to carry out a vasectomy. Results The weekly RSV average score for the term “vasectomy” and “vasectomy cost” significantly increased from 2020 to 2021 in the United States and specifically in Texas (p<0.01). In 2021, the peak weekly relative search interest for “vasectomy” was from Sept 5th to 11th, almost one week after the bill was enacted. Additionally, average relative search term scores for terms indicative of carrying out a vasectomy such as “vasectomy near me”, “urologist near me”, and “how to get a vasectomy” were almost all significantly higher in 2021 than in 2020, except for “urologist near me” in Texas (p = 0.42) and “how to get a vasectomy” in the United States (p=0.13). However, none of the search terms related to carrying out a vasectomy significantly peaked within 2021 nor peaked specifically around the passing or enacting of the Texas “Heartbeat Abortion Ban” in Texas. Conclusions While general search trends about male family planning increased between 2020 and 2021, there was no increase in searches indicative of carrying out vasectomies surrounding the Texas abortion ban in Texas. These results paint a general stagnation and possible decline of people interested in following through with a vasectomy after Texas’s restrictive abortion law was passed and enacted. This could allude to the notion that society views contraception and family planning as a woman’s responsibility. Future studies looking at trends in vasectomy rates in regions with limitations on abortions can also be useful in understanding male involvement in family planning. Similar studies have not been conducted in the past. Disclosure No

Association of quality of prenatal care with contraceptive planning in a United States population: a retrospective cohort study

BackgroundUnderstanding how prenatal care influences planned postpartum contraception can help guide shared decision-making. This study looks to examine the association of the quality of prenatal care with planned postpartum contraception.MethodsThis is a retrospective cohort study conducted in a single tertiary, academic urban institution in the southwest United States. The institutional review board (IRB) for human research at Valleywise Health Medical Center approved this study. Using a validated measure of prenatal care, the Kessner index, prenatal care was classified as adequate, intermediate, or inadequate. The World Health Organization (WHO) protocol for contraceptive effectiveness was used to classify contraceptives as very effective, effective, and less effective. The planned contraceptive choice was determined at the time of hospital discharge after delivery by discharge summary. Chi-squared testing and logistic regression were used to measure associations between the adequacy of prenatal care and contraceptive planning.ResultsThis study included 450 deliveries, 404 (90%) patients with adequate prenatal care, and 46 (10%) patients without adequate (intermediate or inadequate) prenatal care. There was not a statistically significant difference in planning for very effective or effective methods of contraception at hospital discharge between adequate (74%) and non-adequate (61%) prenatal care groups (p = 0.06). There was no association between the adequacy of prenatal care and the effectiveness of contraceptive planning after controlling for age and parity (aOR = 1.7, 95% CI 0.89–3.22).ConclusionsMany women chose very effective and effective methods of postpartum contraception; however, there was no statistically significant association between the quality of prenatal care and planned contraception at hospital discharge.

An assessment of postpartum contraception rates with evolving care during the COVID-19 pandemic

ObjectiveThe COVID-19 pandemic presented new care delivery obstacles in the form of scheduling procedures and safe presentation to in-person visits. Contraception provision is an indispensable component of postpartum care that was not immune to these challenges. Given the barriers to care during the initial months of the pandemic, we sought to examine how postpartum contraception, sterilization, and visit attendance were affected during this period.Study Design.We performed a retrospective chart review to examine contraception initiation, sterilization, and postpartum virtual and in-person visit attendance rates during the first six months (March 15 to September 7, 2020) of the COVID-19 pandemic compared to the rates in the same period in the year prior at a single tertiary academic care center. We abstracted data from the first prenatal visit through twelve weeks postpartum. ResultsWith the initiation of virtual appointments, postpartum visit attendance significantly increased (94.6 % vs 88.4 %, p < 0.001) during the pandemic with no difference in overall contraception uptake (51 % vs 54.1 %, p = 0.2) or sterilization (11.0 % vs 11.5 %, p = 0.88). During the pandemic, contraception prescribed differed significantly with a trend towards patient-administered methods including pills, patches, and rings (21 % vs 16 %, p = 0.02). In both periods, there was a significantly younger mean age (p < 0.001), higher proportion of non-White and non-Asian race (p < 0.001), public insurance (p = 0.003, 0.004), and an established contraceptive plan prenatally (p < 0.001) in the group that received contraception. ConclusionAs virtual postpartum visits were instituted, contraception initiation and sterilization were maintained at pre-pandemic rates and visit attendance rose despite the obstacles to care presented by the COVID-19 pandemic. Provision of virtual postpartum visits may be a driver to maintain contraception and sterilization rates at a time, such as early in the COVID-19 pandemic, when patient care is at risk to be disrupted by social distancing, isolation, and avoidance of medical campuses.

Medicaid and Fulfillment of Postpartum Permanent Contraception Requests.

To evaluate the association between Medicaid insurance and fulfillment of postpartum permanent contraception requests. We conducted a retrospective cohort study of 43,915 patients across four study sites in four states, of whom 3,013 (7.1%) had a documented contraceptive plan of permanent contraception at the time of postpartum discharge and either Medicaid insurance or private insurance. Our primary outcome was permanent contraception fulfillment before hospital discharge; we compared individuals with private insurance with individuals with Medicaid insurance. Secondary outcomes were permanent contraception fulfillment within 42 and 365 days of delivery, as well as the rate of subsequent pregnancy after nonfulfillment. Bivariable and multivariable logistic regression analyses were used. Patients with Medicaid insurance (1,096/2,076, 52.8%), compared with those with private insurance (663/937, 70.8%), were less likely to receive desired permanent contraception before hospital discharge (P≤.001). After adjustment for age, parity, weeks of gestation, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index, private insurance status was associated with higher odds of fulfillment at discharge (adjusted odds ratio [aOR] 1.48, 95% CI 1.17-1.87) and 42 days (aOR 1.43, 95% CI 1.13-1.80) and 365 days (aOR 1.36, 95% CI 1.08-1.71) postpartum. Of the 980 patients with Medicaid insurance who did not receive postpartum permanent contraception, 42.2% had valid Medicaid sterilization consent forms at the time of delivery. Differences in fulfillment rates of postpartum permanent contraception are observable between patients with Medicaid insurance and patients with private insurance after adjustment for clinical and demographic factors. The disparities associated with the federally mandated Medicaid sterilization consent form and waiting period necessitate policy reassessment to promote reproductive autonomy and to ensure equity.