Provision Of Contraception Research Articles

Effects of the COVID-19 pandemic on publicly supported clinics providing contraceptive services in four US states

ObjectivesThe COVID-19 pandemic has disrupted contraceptive service provision in the United States (US). We aimed to explore the impact of COVID-19 on the publicly supported family planning network at the provider level. This study adds to the literature documenting the challenges of the pandemic as well as how telehealth provision compares across timepoints. Study designWe conducted a survey among sexual and reproductive health (SRH) providers at 96 publicly supported clinics in four US states asking about two timepoints—one early in the pandemic and one later in the pandemic. We used descriptive statistics to summarize the data. ResultsWe found that almost one-third of sites reduced contraceptive services because of the pandemic, with a few temporarily stopping contraceptive services altogether. More sites stopped provision of long-acting reversible contraception (LARC), Pap tests, and Human papillomavirus (HPV) vaccinations than other methods or services. We also found that sites expanded some practices to make them more accessible to patients, such as extending existing contraceptive prescriptions without consultations for established patients and expanding telehealth visits for contraceptive counseling. In addition, sites reported high utilization of telehealth to provide contraceptive services. ConclusionsUnderstanding how service delivery changed due to the pandemic and how telehealth can be used to provide SRH services sheds light on how these networks can best support providers and patients in the face of unprecedented crises such as the COVID-19 pandemic. ImplicationsThis study demonstrates that providers increased provision of telehealth for sexual and reproductive health care during the COVID-19 pandemic; policymakers in the US should support continued reimbursement of telehealth care as well as resources to expand telehealth infrastructure. In addition, this study highlights the need for more research on telehealth quality.

Scoping review into models of interconception care delivered at well-child visits for the Australian context.

The interconception period provides an opportunity to address women's health risks and optimise birth spacing before the next pregnancy. This scoping review aimed to identify models of interconception care (ICC) delivered at well-child visits (WCVs) around the world, review the impacts of ICC delivered, and what the feasibility and applicability of these models were. The global review included clinical studies that that were identified using medical subject headings (MeSH) and keyword combinations. Studies were included if they met the criteria: were clinical studies; examined a model of ICC; were conducted by a registered health professional; and examined women who had given birth within the last 24-months. The following databases were searched: Medline (OVID); CINAHL (EBSCO); PubMed; and Embase (OVID). Relevant studies were screened in Covidence and the data was then extracted using a narrative analysis. Fifteen studies met the inclusion criteria. The benefits of ICC delivered at WCVs included screening for maternal health behaviours and conditions and increase women's uptake of interventions. The studies identified that implementing ICC at WCVs was acceptable to women. Identified challenges included lack of time for health providers, lack of education among women and health providers, and limited funding for WCVs. ICC interventions found in this review included family planning counselling and provision of long-acting contraception; health promotion of folic acid; and postpartum depression screening. The research concluded that ICC delivered at WCVs contributes to improving health behaviours for future pregnancies. Increased capacity for this care at WCVs could be achieved with targeted resources and time allocation.

Online platforms for prescription and supply of hormonal contraception in Australia: a mapping review.

Online platforms have emerged as a convenient way for individuals to access contraception. However, the extent to which such services exist in Australia and how they operate is currently unknown. We aimed to identify Australian online contraception platforms and evaluate the services they provide to determine the degree to which they may facilitate equitable access to contraception. We conducted an internet search to identify online contraception platforms operating in Australia. Data were extracted from each of the platforms relating to operating policies, services provided and associated payment processes, as well as prescribing and screening processes for assessing user suitability. As of July 2022, eight online contraception platforms operating within Australia were identified. All platforms offered oral contraception, with two also offering the vaginal ring, and one emergency oral contraception. None of the platforms provided access to long-acting reversible contraception. Significant variability existed in product and membership costs across platforms, with only one platform providing access to subsidised medicines. Five platforms restricted services to those already using oral contraception. Overall, online questionnaires were deemed to be adequately screening for important contraindications to using oral contraception. While online contraception platforms may be a valuable option for some individuals who face access barriers and are willing to pay out-of-pocket for to have their contraception sent straight to their home, they do not necessarily ensure that individuals can access their contraceptive method of choice or address recognised financial and structural barriers to contraceptive care.

Obstacles and Challenges in Gaining Access to Family Planning Services in Covid Era: A Cross-Sectional Descriptive Study

Introduction: Although WHO recommended continuing sexual and reproductive health services duringCOVID-19 pandemic, the services were either stopped completely or limited. Hence our study aims to determinethe challenges in the accessibility to family planning services as well as the impact on contraception and safeabortion services during COVID-19 era.Methods: This is a cross-sectional descriptive study conducted in the department of Obstetrics & Gynaecology,SRM hospital, Chennai from September 2021 to November 2021. Random sampling method was used to enrollparticipants after considering the inclusion and exclusion criteria.Results: Almost half of the study population (49.24%) faced difficulty in following any form of contraceptivemeasure amid pandemic. Non-availability of contraceptive supply (14.72%) was the major hurdle during thepandemic. Among the respondents who had terminated the pregnancy, the majority had done by general medicalpractitioner (66.67%) while only thirty-three percent terminated under specialist care. While comparing thecomplications during pregnancy termination, general medical practitioner approach led to more complicationsthan specialist care.Conclusion: Non-availability of contraceptive supplies, FP services amid COVID-19 pandemic has exerteddetrimental impact on the women reproductive health. Continuing FP and safe abortion services are essentialduring pandemic to sustain the success of high-quality reproductive services.

Systemic Effects on Access to and Utilization of Quality Contraceptive Services by Women of Reproductive age During Covid-19 Pandemics in Oyo State, Nigeria

The indirect health impacts include diversion or depletion of resources to provide routine care and decreased access to routine care resulting from an inability to travel due to restriction, fear, or other factors. This paper presents the findings of a cross-sectional quantitative study exploring systemic effects on access to and utilization of quality contraceptive services by women of reproductive age during the Covid-19 pandemic in Oyo State, Nigeria. A purposive sampling technique was used to select 471 users of users of MNCH services (postnatal clinic and family planning services and immunization uptakes) that responded to 43 structured questionnaires that included socio-demographical characteristics, knowledge of contraceptive products and service availability, contraceptive supplies, access and utilization, health system opportunities and challenges amidst Covid-19 pandemics. Of the 471 respondents, the mean age of respondents was 29.63± 3.29years, with (34.2%) within 26-30 years age group. Majorly self-employed/business (74.9%), (91.1%) Yorubas ethnicity. Only 49.2% accessed contraceptive services during restrictions; due to overwhelming fear of Covid-19 by (31.7%), and disruption of services (31.1%). Others mentioned cost, restriction in movement, and difficulty in seeing caregivers. With 65.4% of the total respondents currently obtained a method with easy in restrictions. The Chi-square test, on the relationship between respondents’ access to and utilization of contraceptive services with systemic factors shows a significant relationship with p =0.004 during the pandemic. It becomes highly imperative that the family planning program be redesigned to improve the health system as part of the preparedness measures to address gaps due to the Covid-19 restrictions. Keywords: Access and Utilization, Contraceptives, Covid-19 Pandemic, Effects, Systemic.

Abortion and Contraception in Medical School Curricula: A Survey of North American Family Medicine Clinical Curriculum Directors

Phenomenon: Contraception and abortion care are commonly accessed health services, and physicians in training will encounter patients seeking this care. Curricula that teach contraception and abortion provision during medical school equip medical students with valuable skills and may influence their intention to provide these services during their careers. Family planning is nevertheless understood to be underrepresented in most medical curricula, including in North American medical schools where the laws on providing contraception and abortion have been consequentially changing. This study investigated the prevalence and predictors of contraception and abortion education in North American medical curricula in 2021. Approach: We asked family medicine clerkship directors from Canada and the United States (US) to report about contraception and abortion teaching in their clinical curricula and their school’s whole curriculum and to report on associated factors. Survey questions were included in the 2021 Council of Academic Family Medicine’s Educational Research Alliance (CERA) survey of Family Medicine Clerkship Directors at accredited North American medical schools. Surveys were distributed between April 29 and May 28, 2021, to the 160 clerkship directors listed in the CERA organization database. Findings: Seventy-eight directors responded to the survey (78/160, 48%). 47% of responding directors reported no contraception teaching in the family medicine clerkship. 81.7% of responding directors reported no abortion teaching in the clerkship, and 66% indicated abortion was not being taught in their school’s whole curriculum. Medical school region correlated with the presence of abortion curricula, and schools with high graduation rates into the family medicine specialty reported abortion teaching more frequently. Fewer than 40% of responding directors had received training on both contraception and abortion care themselves. Insights: Contraception and abortion are both underrepresented in North American medical curricula. Formal abortion education may be absent from most family medicine clerkships and whole program curricula. To enhance family planning teaching in North American medical schools, we recommend that national curriculum resources be revised to include specific contraception and abortion learning objectives and for increased development and support for clinical curricula directors to universally include family planning teaching in whole program and family medicine clerkship curricula.

Single-visit long-acting reversible contraception provision and pregnancy rates within 3 months.

To assess the occurrence of pregnancy in a cohort of women who received a copper intrauterine device (IUD), hormonal IUDs or an etonogestrel (ENG) contraceptive implant at a single-visit practice. Prospective study conducted at the University of Campinas, Campinas, São Paulo, Brazil. We obtained data from four ongoing studies including both the date of the device placement, the first day of the last menstrual period, and the occurrence of pregnancy up to 3months after device placement. We included 2479 device placements (413 TCu380A IUDs, 1476 hormonal IUD and 590 ENG implants). Almost half of the device placements (1113/2479; 44.9%) were performed within the first 5 days of the menstrual cycle. We observed three pregnancies: one in an ENG implant user who received the implant within days 1-5 of the menstrual cycle; one in a woman who received a hormonal IUD during days 6-10 of the menstrual cycle; and one in a copper IUD user with placement during days 21-25 of menstrual cycle. Single-visit long-acting reversible contraception placements are a good strategy with overall very low pregnancy rates. This strategy has a potential to reduce unintended pregnancies and to reduce costs and barriers to both women and the healthcare system.

Spatial and Structural Design of Anganwadi Center using ETABS and Sketch Up

Anganwadi is a type of rural mother and child care centre in India. It was started by the Indian government in 1985 as part of the integrated child development services program to combat child hunger and malnutrition. Anganwadi means "courtyard shelter" in Indian Languages. A typical Anganwadi centre provides basic health care. It is a part of the Indian public health care system. Basic health care activities include contraceptive counseling and supply, nutrition education and supplementation, as well as pre-school activities. Primary school is a school in which children receive primary or elementary education from the age of about five to twelve, coming after pre-school and before secondary school.Six services like Supplementary Nutrition, Immunization, Health check-up, Referral Services, Nutrition and Health Education and Pre-school Education are provided to children in age group of 06 Months to 06 years, pregnant women and lactating mothers.Despite decades of impressive growth, India has an acute shortage of doctors. The doctor population ratio in 2013 was 1:1800; the recommended level is 1:1000. Through the Anganwadi system, the country is trying to meet its goal of providing affordable and accessible healthcare to local populations. Anganwadi workers have the advantage over the physicians living in the same rural area, which gives them insight into the state of health in the locality and assists in identifying the cause of problems and in countering them. They also have better social skills and can therefore more easily interact with the local people. As locals, they know and are comfortable with the local language and ways, are acquainted with the people, and are trusted.

Knowledge, attitudes, and practices of young people regarding HIV and unwanted pregnancies in Kinshasa

Despite the efforts made on education about risks linked to sexuality and the implementation of contraception provision strategies in DRC, still too many young people do not use condoms, even though they are confronted with HIV and unwanted pregnancies. To explore knowledge and practices of young people (15-24 years) about sexuality and to identify factors associated with the use of condoms and contraception. Qualitative descriptive study, conducted among 36 young people in three health zones (Biyela, Kalamu 2 and Selembao) in Kinshasa. Data analysis was done with Atlas.ti, a software adapted to the content analysis method. 86% of young people know the risks of unprotected sex (unwanted pregnancies and STIs such as HIV-AIDS). However, 44% have incorrect information about HIV, condoms, and other contraceptives. Condom use by young people was favored by their level of knowledge about sexuality, their perception of HIV, knowledge of a distribution point, the cost and the skills of healthcare providers. Young people’s knowledge of sexuality is not enough to make them use condoms. Several strategies aimed at building the skills of young people, parents, healthcare providers, as well as making contraception available to young people should be combined.

Evidence-based family planning services among publicly funded providers in Texas

Healthy Texas Women (HTW) is a fee-for-service family planning program that excludes affiliates of abortion providers. The HTW network includes providers who participate in Title X or the state Family Planning Program (FPP) and primary care providers without additional family planning funding (HTW-only). The objective of this study is to compare client volume and use of evidence-based practices among HTW providers. Client volume was determined from administrative data on unduplicated HTW clients served in fiscal year (FY) 2017. A sample of 114 HTW providers, stratified by region, completed a 2018 survey about contraceptive methods offered, adherence to evidence-based contraceptive provision, barriers to offering IUDs and implants, and counseling/referrals for pregnant patients. Differences by funding source were assessed using t-tests and chi-square tests. Although HTW-only providers served 58% of HTW clients, most (72%) saw < 50 clients in FY2017. Only 5% of HTW providers received Title X or FPP funding, but 46% served ≥ 500 HTW clients. HTW-only providers were less likely than Title X providers to offer hormonal IUDs (70% vs. 92%) and implants (66% vs 96%); offer same-day placement of IUDs (21% vs 79%) and implants (21% vs 83%); and allow patients to delay cervical cancer screening when initiating contraception (58% vs 83%; all p < 0.05). There were few provider-level differences in counseling/referrals for unplanned pregnancy (p > 0.05). HTW-only providers served fewer clients and were less likely to follow evidence-based practices. Program modifications that strengthen the provider network and quality of care are needed to support family planning services for low-income Texans.

Men's involvement in family planning programs and associated factors from the perspective of women in Afghanistan; a case study

ObjectivesFamily planning is a cornerstone to the achievement of Sustainable Development Goals. However, men's involvement in family planning has been a challenge in many countries. This study aimed to investigate the participation of men in the family planning programs and related factors from the perspective of women referring to family planning organizations in Herat, Afghanistan 2021. MethodsThe study had a cross-sectional design. The participants of the study consisted of 544 married women aged 15-49 years selected by simple random sampling. The data collection tool was a valid and reliable questionnaire to assess the participation of men in family planning programs. To analyze the data, descriptive statistics and analytical methods including Mann-Whitney and Pearson Chi-Square tests were applied in SPSS 21. The answers to the open-end questions were analyzed, coded and classified in two main categories. ResultsThe average age of study participants was 28(±10) years and a significant proportion of them were illiterate (48.5%). Most of the participants were housewives (83.6%) and their husbands were non-professional workers (39.9%). The husbands participated in family planning programs by choosing the type of contraception (29.2%), provision of contraceptives (29.6%) and supporting their wives using them (49.3%). There were statistically significant relationships between women's and their husband's education level, and husband's employment status with the type of participation in family planning. The main incentives for Afghan men to participate family planning were the increased attention of families to the education and needs of children and the health and welfare of the wives. However, cultural norms supporting larger families, the desire for having boy children, the fear of contraception's side effects and religious prohibitions discourage them in using family planning methods. ConclusionA large number of the respondents stated that their spouse participated in family planning programs. It shows the importance and success of family planning centers in promoting sexual and reproductive health and family planning. Study showed that various factors affected men's participation in family planning programs. Recognition of these factors can help policy makers in designing behavioral interventions based on social marketing, and enhancing the effectiveness of these programs.

Development of a Protocol Using the Delphi Method for the ad interim Supply of Hormonal Contraceptives in Swiss Pharmacies.

(1) Background: Pharmacists are often challenged with situations where women are already on hormonal contraceptives (HC) but have no valid prescription. By Swiss law, pharmacists are allowed to supply prescription-only drugs in exceptional situations without a physician's prescription. Because eligibility for HC can change, women at risk for complications, such as serious side effects, need to be identified. We aimed to develop a protocol to assist pharmacists in clarifying and documenting eligibility for HC. (2) Methods: We conducted a survey using the Delphi method to identify relevant clarifications and develop a protocol for pharmacists. Proposed material was created based on the literature and existing toolkits/protocols aimed at verifying eligibility for HC. A multidisciplinary expert panel, consisting of gynecologists and pharmacists, reviewed the proposed material and provided anonymized feedback over two survey cycles. (3) Results: This Delphi survey revealed items essential to the clarification of eligibility for HC in pharmacies for women who are already using it. This resulted in a protocol that maps "best practices" regarding these ad interim supplies of HC given without a prescription in Switzerland. (4) Conclusions: This survey, made using the Delphi method, allowed us to create a protocol for pharmacists that aims to verify and document eligibility for HC in Switzerland, where HC is frequently supplied without a prescription.

An evaluation of remote algorithm-assisted consultations for the safe prescribing of progesterone-only pills in a digital setting

Abstract Introduction This study aimed assessed the prescribing quality of progesterone-only pills (POP) to determine whether online asynchronous algorithmic assisted consultations alone could help women or whether enhanced remote consultations still need to be performed. Our digital service follows Faculty of Sexual and Reproductive Healthcare FSRH clinical guidance, patients who have conditions that fall in category of UKMEC 3 and 4 would be signposted to other methods.1,2 The service works by patients completing an online consultation which is supported by algorithm-assisted consultations. The algorithm is written by doctors and pulls out the relevant information for the clinician to suggest whether it safe to prescribe. Asynchronized consultations using algorithms can identify patients for whom POP is not suitable to prescribe. As this is safe and scalable, it has the potential to improve access to contraception for women. For those women where technology identifies that POP is not suitable, there is still an important place for remote interaction to ensure that women are able to make an informed and safe contraceptive choice. Aim To review patients who met a Faculty of Sexual and Reproductive Healthcare (FSRH) exclusion for POP to determine adherence to FSRH clinical guidance on signposting these patients to in-person services where appropriate,1.2 and to review patients’ medical records, who were initially declined POP after completing an online consultation to identify the outcome and potential pathway improvement. Methods A retrospective case-note review of 362 patients, who met a FSRH exclusion criteria for POP, using a large digital sexual health service for POP (Cerelle, Cerazette, Norgeston, Noriday) between 1.3.21-25.5.22. Those patients who were not prescribed POP were then identified, to see how they were managed; how many were signposted to the clinic and how many were managed remotely and subsequently prescribed POP. The data underwent descriptive statistical analysis. Ethical approval was not required as this was a service evaluation. Results Of the 362 patients who met the FSRH exclusion criteria (100% female, aged 18-51), 288 (80%) patients were declined from POP treatment and signposted to in-persons services, 74 (20%) were prescribed POP after clinician review. Of the 288 who were initially declined POP, 110 (38%) patients sought further advice with a clinician remotely, resulting in 83 being prescribed POP and 27 being declined. Overall clinicians correctly followed guidance for 99% (284/288) of POP consultations who met the FSRH exclusion criteria.2 Of these 4 patients reported potential exclusion criteria for POP and were prescribed. Upon reflection, clinicians felt the potential exclusion criteria could have been explored further before prescribing. Discussion/Conclusion Asynchronous consultations bring lots of efficiencies, assists clinicians in triaging and managing the majority of patients. We’ve developed a pathway where patients can undertake a further discussion with a clinician remotely, which resulted in provision of remote contraception. This is convenient for patients and has the potential or may ease pressure off in-person services.

P084The role of pediatric subspecialists in adolescent and young adult contraceptive care

<h3>Objectives</h3> To evaluate pediatric subspecialists' contraceptive attitudes and care practices for their adolescent and young adult (AYA) patients with chronic medical illnesses and/or medications that put them at risk for adverse pregnancy outcomes. <h3>Methods</h3> We used listservs to recruit pediatric subspecialists that care for AYAs (aged 12–24) at risk for pregnancy who have complex medical conditions that pose significant pregnancy health risk, as defined by the WHO (World Health Organization) or who use teratogenic medications. Participants completed an online survey about their contraceptive attitudes and care behaviors. <h3>Results</h3> 510 pediatric subspecialists completed the survey (24% renal, 18% pulmonology, 18% gastroenterology, 9% rheumatology and; the remaining 31% included endocrinology, hematology/oncology, and neurology). Most (73%) felt their role included discussing contraception with patients, but only 38% felt it was important to discuss with all their adolescent patients and only 5% felt "totally comfortable" doing so. Only 18% had a clinic policy or note template regarding contraception78% felt their role included making a referral for contraception: 60% referred to adolescent medicine and only 37% referred to gynecology specialists. 11% felt that their role included contraceptive provision. Most (78%) said having referral resources, and training on taking a sexual history and on local laws would make it easier for them to discuss sexual and reproductive health with their patients. <h3>Conclusions</h3> Our findings demonstrate a clear and important need for complex family planning specialists to develop collaborative training and referral relationships with pediatric subspecialists to improve access to reproductive healthcare for their patients.

P099Statewide changes in service trends at utah title x clinics around the domestic gag rule, 2017–2021

<h3>Objectives</h3> Utah is one of six states that lost all Title X funding with the passage of the Domestic Gag Rule in July 2019. We explored trends in service provision at Utah Title X clinics from 2017 to 2021 to evaluate the impact of the loss of this funding. <h3>Methods</h3> Using service delivery data from seven Title X clinics collected between January 2017 and August 2021, we identified most frequently used diagnostic and procedural codes and compared trends in service provision and service utilization using interrupted time series analyses (ITSA), risk ratios, and regression models. <h3>Results</h3> We saw decreases in average patient age and higher proportions of patients with public/private insurance compared to self-payers each year. Type of care provided changed significantly over time: odds decreased that a visit was related to contraception (OR, 0.86; 95% CI, 0.85–0.86) or cervical cancer screening (OR, 0.81; 95% CI, 0.80–0.82), and increased that a visit included sexually transmitted infection (STI) screening (OR, 1.10; 95% CI, 1.10–1.11). Despite these trends, our ITSA found the impact of the Gag Rule to be nonsignificant atop the already decreasing trend in monthly contraceptive visits (p=0.58). <h3>Conclusions</h3> Despite concerns that loss of Title X funding would decrease contraception provision, our analyses identified a shift in care provision away from contraception and preventive health, towards more acute services like STI testing and treatment. Trend analysis showed this shift beginning as early as 2017, with no significant level change after the Gag Rule was enacted. This suggests that other factors influenced service changes.

P069Adolescent patients’ comfort discussing contraception: Comparing physicians’ perceptions and adolescents’ self-reported preferences

<h3>Objectives</h3> Primary care physicians (PCPs) develop long-term relationships with adolescent patients and are trusted resources for reproductive health information. We compared physicians' perceptions of adolescent patients' comfort in asking about contraception with adolescents' self-reported comfort. <h3>Methods</h3> Patients aged 13–25 obtaining primary care at a large health system in Los Angeles County who were assigned female at birth completed a survey on their perceived barriers, facilitators, and preferences regarding contraceptive care. Physicians caring for this population completed electronic surveys on their perceived barriers to contraception provision. <h3>Results</h3> Family medicine (FM, n=36), Internal Medicine (IM, n=36), Medicine-Pediatrics (n=23), and Pediatrics (n=17) physicians completed our survey. Most physicians felt their patients aged 12-16 were somewhat or extremely comfortable asking about contraception (Pediatrics 64.7%, 95% CI: 38.3%-85.8%; Medicine-Pediatrics 57.1%, 34.0%-78.2%; FM 60.0%; 40.6%-77.3%). This perceived comfort was higher for ages 17-21 (88.0%, 80.3%- 90.4%) and ages 22-26 (85.3 %, 77.3%-91.4%) with similar breakdowns by specialty. Patients (n=80) reflected a similar trend, with older patients most likely to report feeling somewhat or extremely comfortable discussing contraception with their PCP (ages 13-16: 65.2%, 42.7%-83.6%; ages 17-21: 82.4%, 56.6%-96.2%; ages 22-25: 95.6%, 78.9%-99.9%). Patients additionally reported it was very or extremely important that their PCP initiate the discussion on contraception (ages 13-16: 59.1%, 36.4%-79.3%; ages 17-21: 62.5%, 35.4%-84.8%; ages 22-25: 71.4%, 47.8%-88.7%). <h3>Conclusions</h3> While physicians may correctly perceive adolescent patients' comfort discussing contraception, most adolescents prefer that their physician raise the topic. This data encourages physicians to initiate reproductive health discussions with their adolescent patients.

Who is responsible for postpartum contraception advice and provision? The perspective of hospital-based maternity clinicians in New South Wales, Australia.

Access to postpartum contraception is critical for the health of the mother and subsequent pregnancies. However, the differential roles and responsibilities of maternity care providers in contraception discussions and provision are often unclear. Our study, part of a larger study on midwifery provision of contraceptive implants, presents the perspectives of hospital-based maternity clinicians. Participants suggested that contraception discussions and provision are a shared responsibility of maternity care providers but identified inconsistencies and issues with current approaches. Access to contraception could be improved through more routine discussions antenatally and postnatally and greater collaboration between maternity care providers in hospital, community and primary care settings.

Use of path analysis to predict changes to community pharmacy and GP emergency hormonal contraception (EHC) provision in England

ObjectivesIn 2014/2015, 46% of community pharmacies were commissioned by local authorities to provide emergency hormonal contraception (EHC) free without prescription in England. Commissioning EHC services influences EHC prescribing from General...

Improving Access to and Quality of Postpartum Contraception Provision.

Sexual activity and fertility can resume shortly after childbirth, but there are barriers to contraceptive access in the postpartum period. Unintended pregnancy and short interpregnancy intervals (of less than one year) can increase the risk of obstetric and neonatal complications. The antenatal period presents an opportunity to discuss contraceptive options, many of which can be safely initiated immediately after childbirth. Successful delivery of a postpartum contraception program requires an adequate number of maternity staff trained to provide the full range of methods.

Contraception free of charge for young women in Tuscany: an interrupted time series analysis

Abstract The Regional Health Authority of Tuscany, ITALY, launched in November 2018 a public program providing all contraceptive methods free of charge to all young residing women after medical evaluation at free family counselling centres. We aimed to explore the effect of the regional program on five outcomes - abortions, contraception provision, access to family counselling centres, conception, and outpatient service utilization for six sexually transmitted diseases (STDs). These outcomes were retrospectively computed from January 2016 to December 2020 using regional administrative databases, and then expressed as both annual rates per 1,000 and monthly rates per 100,000 women aged 14 to 25 years and residing in Tuscany. We ran interrupted time series (ITS) models to analyze how the trends in monthly rates changed over time after the intervention (set in November 2018). The decline in annual abortion rates per 1,000 women doubled from 2016-2018 (-9%, from 7.0 to 6.4) to 2018-2020 (-17%, from 6.4 to 5.3). ITS models revealed a significant post-intervention decrease in monthly abortion rates (-0.61, -1.11 to -0.12) and a significant increase in both access rates to counselling centres (87.60, 77.77 to 97.43) and contraception provision rates (16.75, 0.31 to 33.19). Conception rates fell significantly just in under-18 women (-0.84, -1.39 to -0.28). A significant reduction in outpatient service utilization rates for STDs emerged for N. gonorrhoeae, HSV, and HPV. As a prime example of similar initiatives in Italy, the free contraception program of Tuscany promoted access to counselling and contraception services among young under-25 women, empowering the entire care pathway. As a result, abortion rates declined significantly in this group. The wider access to counselling centres to obtain free contraception and overall enhancement of the pathway might have fostered sexual education and reproductive health, leading to a reduction in teenage conception and STD spread. Key messages • This study proves the effectiveness of the free contraception campaign of Tuscany in reducing abortions and empowering the entire care pathway, providing further evidence for policy accountability. • Therefore, this study supports the maintenance of this program and suggests the potential benefits of implementing and promoting similar initiatives in other Regions.