Copper T Research Articles

The Impact of Rural or Urban Location on Clinical Availability of the Copper IUD: A Mystery Caller Study [14F

INTRODUCTION: The copper IUD is the only highly effective non-hormonal method of contraception. It is also the most effective form of emergency contraception (EC), when placed within 5 days of unprotected intercourse, and is the only method of EC that provides ongoing contraception. For these reasons, local availability of the copper IUD to women is essential. METHODS: A mystery caller model was employed with a single caller making inquiries to urban and rural clinics in Washington state over a two-month period regarding availability of copper IUDs using a standardized script. Clinic types included OB/GYN, primary care, family planning and multispecialty. Clinics were identified using the HRSA 340B database, with allocation as urban vs rural based on the Office of Management and Budget county designations. The primary outcome was the reported availability of the copper IUD. Secondary outcomes included ability to schedule an appointment for copper IUD placement within 5 days. RESULTS: A total of 97 urban and 97 rural clinics were included in the analysis. A greater proportion of urban clinics reported availability of copper IUDs than rural clinics (78 vs 50%; p <0.001). Only 19 urban clinics and 10 rural clinics were able to schedule an appointment for copper IUD placement within the 5 day window needed for EC use (19 vs 10%, p = 0.07). CONCLUSION: Rural clinics are less likely to have copper IUDs available, even when clinic type is taken into account. Efforts are needed to increase availability of this method, particularly in rural areas.

Changes in uptake and cost of long-acting reversible contraceptive devices following the introduction of a new low-cost levonorgestrel IUD in Utah's Title X clinics: a retrospective review

ObjectiveThe objective was to assess changes in long-acting reversible contraceptive (LARC) method uptake at Utah's Title X clinics before and after introduction of a new, low-cost levonorgestrel (LNG) 52mg IUD (Liletta®). Study designWe conducted a retrospective medical record review of LARC visits occurring at seven Title-X family planning clinics in Utah before the introduction of the low-cost LNG IUD (preintroduction period: 01/01/2014–04/30/2015) and after (postintroduction period: 05/01/2015–03/31/2016). We ran segmented, interrupted time series ordinary least squares regression models using Newey–West standard errors to assess both the change in numbers of women initiating any LARC method and the average payment amount per LARC method. We evaluated both the low-cost LNG IUD and all LARC methods. ResultsAt the outset of preintroduction period, there were 29.2 [95% confidence interval (CI): 20.1–38.4] monthly LNG IUD insertions. Immediately postintroduction, there was a significant level of increase of 14.4 LNG IUD insertions the first month (95% CI: 2.0–26.8) followed by a significant trend increase each month of 2.4 additional LNG IUD insertions (95% CI: 0.32–4.47). Postintroduction, there was a significant level of remitted-payment decrease from all sources of −$240.43 per LNG IUD (95% CI: −311.02 to 168.87) followed by a significant monthly trend decrease of −$23.01 per LNG IUD (95% CI: −32.02 to −13.98). There were minimal changes in uptake and payment of other LARC methods following the introduction of the low-cost LNG IUD. ConclusionsFollowing introduction of a low-cost LNG IUD at Title X clinics, LNG IUD initiation increased and average payment for the method decreased. ImplicationsReducing the cost of LARC methods, both to clinics and to patients, is essential to expanding access. Additional efforts to develop and provide access to low-cost copper IUDs and subdermal implants as well as novel LARC methods should be continued.

Access to long-acting reversible contraception among US publicly funded health centers

ObjectivesAccess to a full range of contraceptive methods, including long-acting reversible contraception (LARC), is central to providing quality family planning services. We describe health center-related factors associated with LARC availability, including staff training in LARC insertion/removal and approaches to offering LARC, whether onsite or through referral. Study DesignWe analyzed nationally representative survey data collected during 2013–2014 from administrators of publicly funded U.S. health centers that offered family planning. The response rate was 49.3% (n=1615). In addition to descriptive statistics, we used multivariable logistic regression to identify health center characteristics associated with offering both IUDs and implants onsite. ResultsTwo-thirds (64%) of health centers had staff trained in all three LARC types (hormonal IUD, copper IUD, implant); 21% had no staff trained in any of those contraceptive methods. Half of health centers (52%) offered IUDs (any type) and implants onsite. After onsite provision, informal referral arrangements were the most common way LARC methods were offered. In adjusted analyses, Planned Parenthood (AOR=9.49) and hospital-based (AOR=2.35) health centers had increased odds of offering IUDs (any type) and implants onsite, compared to Health Departments, as did Title X-funded (AOR=1.55) compared to non-Title X-funded health centers and centers serving a larger volume of family planning clients. Centers serving mostly rural areas compared to those serving urbans areas had lower odds (AOR 0.60) of offering IUD (any type) and implants. ConclusionsVariation in LARC access remains among publicly funded health centers. In particular, Health Departments and rural health centers have relatively low LARC provision. ImplicationsFor more women to be offered a full range of contraceptive methods, additional efforts should be made to increase availability of LARC in publicly-funded health centers, such as addressing provider training gaps, improving referrals mechanisms, and other efforts to strengthen the health care system.

Enhancing inductance of spiral copper inductor with BaFe 12 O 19 /poly (phenylene oxide) composite as an embedded magnetic core

Abstract Methyltriethoxysilane-treated BaFe12O19 particles were added into poly (phenylene oxide) (PPO) to obtain a composite system in the condition of benzoyl peroxide as an initiator. Thermal stability, structure, mechanical behavior and dielectric and magnetic properties were characterized to investigate the effects of BaFe12O19 particles on the performance of PPO-based composites. BaFe12O19/PPO composites were employed as embedded magnetic core to enhance the inductance of spiral copper inductors. Inductance value and quality (Q)-factor of the spiral copper inductor increased to 1.58 μH and 40.2 at 30 MHz respectively when 50 wt% BaFe12O19 particles were added into PPO matrix for a composite system as an embedded magnetic core.

Classic versus uterine sound-sparing approach for insertion of copper T380A intrauterine device: A randomized clinical trial

Abstract Objective The current study compares the efficacy of the classic approach and the uterine sounding sparing approach (a new approach) for copper intrauterine device (Cu-IUD) insertion. Study design A randomized clinical trial. Setting Woman's Health Hospital, Assiut, Egypt. Materials and methods The current study was an open parallel randomized clinical study conducted in Assiut Woman’s Health Hospital, Egypt included women requesting Copper IUD insertion. Enrolled women were randomized into 2 groups; group I included women subjected to classic approach for Cu-IUD insertion and group II included women had Cu-IUD insertion using the uterine sound-sparing approach (USSA). This approach utilized transvaginal ultrasound (TV/US) for assessment of the uterine cavity length and position before IUD insertion without using uterine sounding. The primary outcome was the successful Cu-IUD insertion. Results 46 women were analyzed in group I and 46 in group II. The pain during IUD insertion and 5 min post-insertion was significantly lower in group II than group I (p Conclusions Cu-IUD can be inserted successfully without using uterine sound provided using TV/US prior to insertion. This method associated with less pain, greater women satisfaction during insertion with shorter duration.

What Are Women Told When Requesting Family Planning Services at Clinics Associated with Catholic Hospitals? A Mystery Caller Study.

Catholic Church directives restrict family planning service provision at Catholic health care institutions. It is unclear whether obstetrics and gynecology clinics that are owned by or have business affiliations with Catholic hospitals offer family planning appointments. Mystery callers phoned 144 clinics nationwide that were found on Catholic hospital websites between December 2014 and February 2016, and requested appointments for birth control generally, copper IUD services specifically, tubal ligation and abortion. Chi-square and Fisher's exact tests assessed potential correlates of appointment availability, and multivariable logistic regressions were computed if bivariate testing suggested multiple correlates. Although 95% of clinics would schedule birth control appointments, smaller proportions would schedule appointments for copper IUDs (68%) or tubal ligation (58%); only 2% would schedule an abortion. Smaller proportions of Catholic-owned than of Catholic-affiliated clinics would schedule appointments for birth control (84% vs. 100%), copper IUDs (4% vs. 97%) and tubal ligation (29% vs. 72%); for birth control and copper IUD services, no other clinic characteristics were related to appointment availability. Multivariable analysis confirmed that tubal ligation appointments were less likely to be offered at Catholic-owned than at Catholic-affiliated clinics (odds ratio. 0.1); location and association with one of the top 10 Catholic health care systems also were significant. Adherence to church directives is inconsistent at Catholic-associated clinics. Women visiting such clinics who want highly effective methods may need to rely on less effective methods or delay method uptake while seeking services elsewhere.

Familiarity with Long-acting Reversible Contraceptives among Obstetrics and Gynecology, Family Medicine, and Pediatrics Residents: Results of a 2015 National Survey and Implications for Contraceptive Provision for Adolescents

Study ObjectiveTo assess familiarity with long-acting reversible contraceptives (LARC) among current obstetrics and gynecology (OB/GYN), family medicine (FM), and pediatrics senior residents in the United States. Design, Setting, Participants, Interventions, and Main Outcome MeasuresWe selected 156 OB/GYN, FM, and pediatrics residency programs using the American Medical Association Freida database. Senior residents completed a survey addressing any training they had received on LARC, and rated their comfort level counseling about and inserting LARC. Residents rated their likelihood of recommending LARC to an adolescent, nulliparous patient, and indicated whether they would like additional training on LARC. Descriptive and analytic statistics were generated using R statistical software (The R Project for Statistical Computing; https://www.r-project.org). ResultsThe survey was completed by 326 of 1,583 residents (20.6% response rate); at least 1 resident completed the survey at 105 (67.3%) of the residency programs contacted. Most programs (84.8%) provided some training on LARC. Residents in OB/GYN programs were comfortable counseling about and inserting contraceptive implants (97%, 83%), copper intrauterine devices (IUDs; 100%, 86%), and levonorgestrel (LNG) IUDs (100%, 86%). In FM programs, fewer residents were comfortable counseling about and inserting contraceptive implants (71%, 47%), copper IUDs (68%, 21%), and LNG IUDs (79%, 18%). Residents in pediatrics programs had low comfort levels counseling about contraceptive implants (14%), copper IUDs (14%), and LNG IUDs (25%); no pediatrics residents were comfortable inserting LARC. OB/GYN residents were significantly more likely to recommend a LARC to an adolescent, nulliparous patient (P = .019). Most pediatric and FM residents desired additional training on LARC (82.7% and 60.7%, respectively). ConclusionThis study shows that knowledge gaps exist regarding LARC among FM and pediatrics residents.

2-Year contraceptive discontinuation rates among immediate postpartum implant and intrauterine device users at a rural district hospital in Malawi: a prospective cohort study

Objectives: We aimed to compare the 2-year discontinuation rates between postpartum Malawian women who received a contraceptive implant or copper IUD within 48 h of delivery.

For emergency contraception, political gaps are not scientific gaps.

Emergency contraception (EC) is the only opportunity for women to prevent an unwanted pregnancy after unprotected intercourse. Simple compassion for women who are in this situation combined with solid scientific data to support the safety of oral EC should be enough to promote strategies to expand access to these medications as well as the most effective method of EC, the copper IUD. A wide array of women's healthcare organisations promote increasing EC access to improve clinical care, a position clearly supported by the four foundations of biomedical ethics: autonomy, nonmaleficence, beneficence, and justice. Ironically, in the political sphere, conservative morals are the foundation for limiting access, despite the conflict with scientific evidence. In this issue, Drs. Cameron, Li, and Gemzell-Danielson present an opportunity for clinicians to review the data behind public and scientific oral EC controversies. These controversies can easily be divided into two groups. The first group contains issues that despite scientifically sound evidence remain controversial because of religious and political opposition. In essence, these issues are not scientifically controversial. Contention exists only because EC provides greater reproductive autonomy and thus clashes with conservative sexual values, which aim to shame women having sex for pleasure and not for procreation. Limiting effective methods of post coital contraception supports this position and limits women's sexual freedom. This scientifically uncontroversial group includes the oral EC mechanism of action, excellent safety, lack of population effect, and inability to serve as an abortifacient. The second group contains topics where scientific evidence is lacking or imperfect. This group includes the potential decrease in progestin containing contraception efficacy when initiated with ulipristal, methods to manage the potential negative effect of obesity on EC efficacy, and whether the oral EC mechanism of action is important to users. Ironically, despite sound evidence, it is this first group which forms the foundation for opposition to implementing EC best practices. As scientists and clinical researchers have done their work here, this realm is now the work of policy experts, advocates, and politicians. There are many examples of politics influencing good clinical care, which for oral EC means improving access and affordability. Inexpensive over the counter (OTC) availability of oral EC is the target for advocates and politicians on both sides. Whereas oral levonorgestrel and ulipristal EC products are available OTC in Europe, a long political battle has been waged on this issue in the USA, where OTC ulipristal is not even on the horizon. However, promoting regulatory approval is not enough. Politics can also support pharmacists who refuse women access to EC or prevent this behaviour. Sexual assault victims are a critical group in need of EC and several entities have passed legislation mandating offering EC when these women present for medical care. Finally, EC coverage can be mandated or restricted through private and government-sponsored medical coverage. In the USA, a Supreme Court decision enables private companies to forego EC insurance coverage for employees based on moral beliefs even though the court has acknowledged these are not scientifically valid. In areas of medical controversy, scientific evidence and biomedical ethics can lead both clinicians and policy makers in the right direction. In this case the road clearly leads to increasing EC access and affordability. Dr Turok reports grants and personal fees from Teva pharmaceuticals, outside the submitted work. Teva distributes the Paragard copper IUD, a method of emergency contraception. The ICMJE disclosure form is available as online supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Beyond Plan B: A Qualitative Study of Canadian Pharmacists' Emergency Contraception Counselling Practices.

Pharmacists are often the front-line health care providers for women seeking emergency contraception (EC). This study explored Ontario pharmacists' EC counselling practices and their perceived barriers to recommending the most effective EC method, the copper IUD (Cu-IUD). This qualitative study used one-on-one, semistructured interviews with 20 pharmacists working in pharmacies located within a 1-km radius of a large sexual health clinic that offered postcoital IUDs in downtown Toronto. All pharmacists provided counselling about levonorgestrel (LNG-EC), and all considered it important. Nevertheless, they rarely discussed the Cu-IUD, even in circumstances where LNG-EC could be less effective, such as delayed presentation or for women with BMI >25 kg/m2. Some pharmacists felt conflicted in their dual roles as health care and customer service provider when counselling about and selling EC, and many felt uncomfortable discussing body weight. Pharmacists were not well informed about the Cu-IUD. They identified many pharmacist-specific barriers to counselling about the Cu-IUD for EC, as well as health systems issues around Cu-IUD provision and insertion. Ontario pharmacists embraced their role in EC counselling, yet their discussions rarely included the most effective Cu-IUD option. Educating and training pharmacists about the Cu-IUD and establishing referral pathways for IUD insertion could expand their counselling about this EC option.

With smart strategies, immediate postpartum LARC is possible.

The need to provide immediate postpartum access to intrauterine contraceptives and contraceptive implants for those who desire them is now widely acknowledged among leading healthcare organizations. The most recently updated versions of the UK, US, and World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use (MEC) all support placement of the progestin implant, Copper IUD, and levonorgestrel IUS following delivery of the placenta and before hospital discharge. Postpartum placement has been recognized as safe, effective, and acceptable by the Royal College of Obstetricians and Gynaecologists (RCOG) and the American College of Obstetricians and Gynecologists (ACOG). This article is protected by copyright. All rights reserved.

P037 Why do women discontinue long acting reversible methods of contraception? – findings from an integrated sexual health clinic

IntroductionLong acting methods of contraception, namely the progestogen only implant and the intra-uterine devices are reliable methods of contraception, favoured by commissioners of integrated sexual health. However in practice, a...

Evaluation of Novel Integrated Dielectric Barrier Discharge Plasma as Ozone Generator

This paper presents a characterization of an integrated ozone generator constructed by seven of reactors of Dielectric Barrier Discharge Plasma (DBDP). DBDP a has spiral-cylindrical configuration. Silence plasma produced ozone inside the DBDP reactor was generated by AC-HV with voltage up to 25 kV and maximum frequency of 23 kHz. As a source of ozone, dry air was pumped into the generator and controlled by valves system and a flowmeter. We found ozone concentration increased with the applied voltage, but in contrary, the concentration decreased with the flow rate of dry air. It was also found that a maximum concentration was 20 mg/L and ozone capacity of 48 g/h with an input power of 1.4 kW. Moreover, in this generator, IP efficiency of 8.13 g/kWh was obtained at input power 0.45 kW and air flow rate of 9 L/min. Therefore, be the higher ozone capacity can be produced with higher input power; however, it provided lower IP efficiency. The effect of dry air flow rate and applied voltage on ozone concentrations have been studied. At last, spiral wire copper was very corrosive done to the interaction with ozone, and it is necessary to do a research for finding the best metals as an active electrode inside of the quartz dielectric.

A Suspended Six-Port Transformer-Based Power Divider for 2.4 GHz Applications

This paper presents a transformer-based power divider with six-port suspending structure for 2.4 GHz wireless applications. The proposed power divider, which is featured with chip size (2.9 mm × 2.8 mm × 21 μm), was constructed by an 8-μm-thick Cu bottom electrode, a 5 μm-height supporting copper post, and an 8-μm-thick suspended spiral copper conducting layer with a 13 μm air gap. The main structure included two transformers and six input/output matching capacitors for simultaneously achieving two single-to-differential paths so that the chip size of the complex multiple-ports transceiver could be reduced. According to the results, the proposed divider has characteristics of the radio frequency (RF), and its input return losses are around −10 dB, output return losses are beneath −10 dB, and minimum amplitude imbalance is below 1.5 dB and less than 1° phase imbalance at 2.4 GHz operating frequency.

The Comparative Effect of Capsella bursa-pastoris and Mefenamic Acid on Sexual Function of Copper IUD Users

The Comparative Effect of Capsella bursa-pastoris and Mefenamic Acid on Sexual Function of Copper IUD Users

Immediate postpartum intrauterine device and implant program outcomes: a prospective analysis

In-hospital placement of intrauterine devices and contraceptive implants following vaginal and cesarean delivery is increasingly popular and responds to maternal motivation for highly effective postpartum contraception. Immediate postpartum intrauterine device insertion is associated with higher expulsion than interval placement, but emerging evidence suggests that the levonorgestrel intrauterine device may have a higher expulsion rate than the copper intrauterine device. This study evaluated in-hospital provision, expulsion, and 6-month continuation of immediate postpartum copper T380 intrauterine devices, levonorgestrel intrauterine devices, and contraceptive implants. We offered enrollment in this prospective observational trial to women presenting to the University of Utah labor and delivery unit from October 2013 through February 2016 who requested an intrauterine device or implant for postpartum contraception during prenatal care or hospitalization at the time of delivery. Following informed consent, participants completed questionnaires prior to hospital discharge and at 3 and 6 months postpartum. Data on expulsions at 6 months were validated by chart abstraction. During the study period, 639 patients requested a postpartum intrauterine device or implant and 350 patients enrolled in prospective follow-up prior to discharge from the hospital. Among enrollees, 325 (93%) received their preferred contraceptive device prior to hospital discharge: 88 (27%) copper intrauterine device users, 123 (38%) levonorgestrel intrauterine device users, and 114 (35%) implant users. Participants predominantly were Hispanic (90%), were multiparous (87%), reported a household income <$24,000 per year (87%), and underwent a vaginal delivery (77%). At 6 months postpartum, 289 of 325 device recipients (89%) completed follow-up. Among levonorgestrel intrauterine device users 17% reported expulsions relative to 4% of copper intrauterine device users. The adjusted hazard ratio for expulsion was 5.8 (confidence interval, 1.3-26.4). There was no statistically significant difference in expulsions by delivery type or continuation by device type. Among the 21 women who experienced intrauterine device expulsions, 14 (67%) requested a replacement long-acting reversible contraception device for contraception. The 6-month device continuation was ≥80% for all device types. An immediate postpartum long-acting reversible contraception program effectively provides women who desire highly effective reversible contraceptive devices with their method of choice prior to hospital discharge. Immediate postplacental levonorgestrel intrauterine device users have higher expulsion rates than copper intrauterine device users, but >8 of 10 women initiating an intrauterine device or implant continue use at 6 months postpartum.

A prospective study on contraceptives used by reproductive-aged patients with breast cancer and the assessment of information.

173 Background: For reproductive-aged breast cancer (BC) patients, contraception is needed during and after treatment. Few data are available concerning the methods used in the real life and the comprehension of patients. The main objective of our study was to describe the contraceptive practice and to identify the need of information for these patients. Methods: We conducted a survey in young BC patients treated at the National Institute of Oncology Rabat–Morocco. We analyzed the contraceptive methods used. Then, we assessed the level of information and counseling about contraception for this population. The SPSS 10.0 software was used for statistical analysis. Results: 72 patients respond to the survey. The mean age was 41.4 ± 6.3 years. 79.2% had localized disease. 97.2 % were under treatment. The sexual activity was maintained in 69.4%. The contraceptive methods used before the diagnosis and after the announcement are summarized in the Table. 52 pts were informed that the hormonal contraception were not recommended. 86.5% had this information from doctors. 67.3% were informed at the moment of announcement of diagnosis, 17.6% at the consultation of surgery, 29.4% before starting chemotherapy, 35.3% during chemotherapy and 17.6% at the end of treatment. After information about the contraceptive methods, 50 % used a masculine condom, 15.7% had a copper IUD, 18.6% used external ejaculation, 14.3% on patient had a tubal ligation and 14.3% didn’t use a contraception method. 66% patients of patients had not asked about contraceptive methods. The reasons: abstinence: 31.3%, the disease is more important than the contraception: 14.6%. Conclusions: Our study found that there is a lack of information concerning contraception for young BC patients. A contraceptive counseling is highly needed to decrease the risk of pregnancy during treatment. [Table: see text]

Changes in body composition in women using long-acting reversible contraception

ObjectiveUsers of hormonal long-acting reversible contraception (LARC) report weight gain as a side effect, but few studies have assessed body composition change among LARC users. We evaluated weight and body composition of healthy women using the levonorgestrel intrauterine system (LNG-IUS), copper intrauterine device (copper IUD) or etonogestrel implant (ENG implant). We hypothesized that weight gain and body composition over 12 months would not differ between copper IUD, LNG-IUS and ENG implant users. Study designWe performed a prospective cohort study of a subgroup of women enrolled in the Contraceptive CHOICE Project who initiated the LNG-IUS, copper IUD or ENG implant. Inclusion criteria included lack of metabolic and eating disorders or change in body weight of more than 5% in the 6 months before enrollment. We measured changes in weight and body composition (body fat percentage, total body fat mass, total lean mass and total body mass) in women who continued their method for 12 months. ResultsWe analyzed data from 149 participants: 85 LNG-IUS users, 31 copper IUD users and 33 ENG implant users. The mean age was 25.9 years, 56.4% were White, 82.5% had some college education and 67.6% were nulliparous. Although lean body mass increased over 12 months in LNG-IUS and copper IUD users but not in ENG implant users, changes in body weight and body composition did not differ between the groups. In the adjusted model, Black race was associated with change in total body mass (p<.05). ConclusionsAmong those who continued the method for 12 months, changes in body weight and composition did not differ between copper IUD, LNG-IUS and ENG implant users. Implications statementChanges in body weight and composition over 12 months did not differ between copper IUD users and LNG-IUS and ENG implant users among those with 12 months of continuous use.

Changes in IUD uptake with the availability of a low-cost levonorgestrel IUD — a retrospective review of Title X clinics

Objectives: US demand for long-acting reversible contraceptive (LARC) methods is increasing despite persistent cost barriers to obtaining these devices. In February 2015, the FDA approved a low-cost 52-mg levonorgestrel (LNG) IUD. This study assesses the difference in copper IUD, LNG-IUD and overall IUD uptake in Utah’s Title X clinics before and after introduction of the low-cost LNG-IUD. Methods: We conducted a retrospective review of IUD uptake via the electronic medical records at Utah’s Title X clinics (n=8) for the 11 months before and after introduction (Period 1 and Period 2, respectively). We assessed IUD uptake stratified by IUD type for these two periods. Results: There were a total of 1221 IUD insertions in Period 1 and 1758 insertions in Period 2. After the introduction of the low-cost LNG-IUD, we observed increases from baseline for copper IUD, LNG-IUD and all IUDs: 30%, 55% and 44%, respectively. Of women who received IUDs, the proportion who selected the LNG-IUD in Period 1 was 56% and 61% in Period 2 (p<.001). Fee type differed between the two periods as well (68% full fee vs. 32% reduced fee in Period 1 and 60% full fee vs. 40% reduced fee in Period 2). Conclusions: IUD use at these clinics increased overall after the introduction of the low-cost LNG-IUD. The increase observed in LNG-IUD use was significantly greater than the increase in copper IUD use. Fee types for the insertions during these two periods were also different.

Women's access to family planning services is highly variable at obstetrics and gynecology clinics affiliated with catholic hospitals

Objectives: We aimed to understand women's experiences calling to arrange access to family planning services at obstetrics and gynecology (ob-gyn) clinics that are affiliated with Catholic hospitals. Methods: In this national survey, we determined the number of ob-gyn clinics to call in each state based on population densities and used multiple online search strategies to confirm Catholic hospital affiliations. Using a mystery caller approach, we requested appointments for birth control, including the copper IUD, tubal ligation and abortion. We documented responses and whether referrals were given. Results: We completed calls between December 2014 and February 2016. Of the 144 clinics included, 31.2% of patient care coordinators reported that their clinic was Catholic owned. In response to appointment requests, 95% offered birth control, 68.1% offered copper IUD, 58.3% offered tubal ligation and 2.1% offered abortion. Catholic-owned clinics were less likely than Catholic-affiliated clinics to offer appointments for birth control (84.4% vs. 100%, p<.001), copper IUD (4.4% vs. 97%, p<.001) and tubal ligation (28.9% vs. 71.7%, p<.001). When services were denied, 52.2% did not offer a birth control/IUD referral, 41.7% did not offer a tubal ligation referral and 41.8% did not offer an abortion referral. Conclusions: Women's access to family planning services is highly variable within and throughout ob-gyn clinics in the US that are affiliated with Catholic hospitals. Access mostly depends on the specific service and whether the clinic is Catholic owned or Catholic affiliated. This highly variable access to needed care makes it difficult for women to act as informed health care consumers.