Long-acting Reversible Contraception Use Research Articles

Postpartum Medicaid Coverage and Contraceptive Use Before and After Ohio's Medicaid Expansion Under the Affordable Care Act.

Ensuring that women with Medicaid-covered births retain coverage beyond 60days postpartum can help women to receive care that will improve their health outcomes. Little is known about the extent to which the Affordable Care Act (ACA) Medicaid expansion has allowed for longer postpartum coverage as more women entering Medicaid under a pregnancy eligibility category could now become income eligible. This study investigates whether Ohio's Medicaid expansion increased continuous enrollment and use of covered services postpartum, including postpartum visit attendance, receipt of contraceptive counseling, and use of contraceptive methods. We used Ohio's linked Medicaid claims and vital records data to derive a study cohort whose prepregnancy and 6-month postpartum period occurred fully in either before (January 2011 to June 2013) or after (November 2014 to December 2015) the ACA Medicaid expansion implementation period (N=170,787 after exclusions). We categorized women in this cohort according to whether they were pregnancy eligible (the treatment group) or income eligible (the comparison group) as they entered Medicaid and used multivariate logistic regression to test for differences in the association of the ACA expansion with their postpartum enrollment in Medicaid and use of services. Women who entered Ohio Medicaid in the pregnancy eligible category had a 7.7 percentage point increase in the probability of remaining continuously enrolled 6months postpartum relative to those entering as income eligible. Income eligible women had approximately a 5.0 percentage point increased likelihood of both a postpartum visit and use of long-acting reversible contraceptives. Pregnancy-eligible women had a significant but smaller (approximately 2 percentage point) increase in the likelihood of long-acting reversible contraceptive use. Ohio's ACA Medicaid expansion was associated with a significant increase in the probability of women's continuous enrollment in Medicaid and use of long-acting reversible contraceptives through 6months postpartum. Together, these changes translate into decreased risks of unintended pregnancy and short interpregnancy intervals.

A Pilot Study of a Top-Tier Contraception Simulation Program to Improve Long-Acting Reversible Contraception Practices Among Health Care Trainees

Long-acting reversible contraception methods are effective tools in family planning. However, resident physicians and other health care trainees may experience knowledge gaps and low utilization because of limited opportunity for training. The purpose of this pilot study is to evaluate self-assessed knowledge, counseling, and long-acting reversible contraception (LARC) device placement skills among health care trainees who attended a 1-day simulation-based training. In addition, we describe a simulation-based training program we developed to facilitate the use of LARC among health professionals. We conducted a cross-sectional evaluation of health care trainees attending simulation-based training on 2 occasions in 2017 and one occasion in 2018 in Chicago, Illinois. Participants rated their experience, comfort providing counseling, and placement skills with all LARC methods. Knowledge was measured using a series of multiple-choice questions. Responses to the survey were summarized using frequencies and percentages. A total of 253 health care professionals attended the simulations, and 244 completed the presurvey (96.4% response rate). Of those, 172 respondents were health care trainees, of which a majority were resident physicians. More than half reported never using top-tier methods in practice. Most indicated moderate to low knowledge to counsel patients and low skills to place each of the devices before training; self-reported knowledge and skills increased after completing training. Presimulation knowledge scores ranged from 0 to 19, with a median score of 14 of 19 correct responses. After training, average scores increased by 3 points (P < 0.0001). One-day training events can provide didactic education and simulation-based skills training in device placement that may result in increased access among the patients served by these providers.

Impact of a pay-for-performance scheme for long-acting reversible contraceptive (LARC) advice on contraceptive uptake and abortion in British primary care: An interrupted time series study.

BackgroundLong-acting reversible contraception (LARC) is among the most effective contraceptive methods, but uptake remains low even in high-income settings. In 2009/2010, a target-based pay-for-performance (P4P) scheme in Britain was introduced for primary care physicians (PCPs) to offer advice about LARC methods to a specified proportion of women attending for contraceptive care to improve contraceptive choice. We examined the impact and equity of this scheme on LARC uptake and abortions.Methods and findingsWe examined records of 3,281,667 women aged 13 to 54 years registered with a primary care clinic in Britain (England, Wales, and Scotland) using Clinical Practice Research Datalink (CPRD) from 2004/2005 to 2013/2014. We used interrupted time series (ITS) analysis to examine trends in annual LARC and non-LARC hormonal contraception (NLHC) uptake and abortion rates, stratified by age and deprivation groups, before and after the P4P was introduced in 2009/2010. Between 2004/2005 and 2013/2014, crude LARC uptake rates increased by 32.0% from 29.6 per 1,000 women to 39.0 per 1,000 women, compared with 18.0% decrease in NLHC uptake. LARC uptake among women of all ages increased immediately after the P4P with step change of 5.36 per 1,000 women (all values are per 1,000 women unless stated, 95% CI 5.26–5.45, p < 0.001). Women aged 20 to 24 years had the largest step change (8.40, 8.34–8.47, p < 0.001) and sustained trend increase (3.14, 3.08–3.19, p < 0.001) compared with other age groups. NLHC uptake fell in all women with a step change of −22.8 (−24.5 to −21.2, p < 0.001), largely due to fall in combined hormonal contraception (CHC; −15.0, −15.5 to −14.5, p < 0.001). Abortion rates in all women fell immediately after the P4P with a step change of −2.28 (−2.98 to −1.57, p = 0.002) and sustained decrease in trend of −0.88 (−1.12 to −0.63, p < 0.001). The largest falls occurred in women aged 13 to 19 years (step change −5.04, −7.56 to −2.51, p = 0.011), women aged 20 to 24 years (step change −4.52, −7.48 to −1.57, p = 0.030), and women from the most deprived group (step change −4.40, −6.89 to −1.91, p = 0.018). We estimate that by 2013/2014, the P4P scheme resulted in an additional 4.53 LARC prescriptions per 1,000 women (relative increase of 13.4%) more than would have been expected without the scheme. There was a concurrent absolute reduction of −5.31 abortions per 1,000 women, or −38.3% relative reduction. Despite universal coverage of healthcare, some women might have obtained contraception elsewhere or had abortion procedure that was not recorded on CPRD. Other policies aiming to increase LARC use or reduce unplanned pregnancies around the same time could also explain the findings.ConclusionsIn this study, we found that LARC uptake increased and abortions fell in the period after the P4P scheme in British primary care, with additional impact for young women aged 20–24 years and those from deprived backgrounds.

Cost sharing, postpartum contraceptive use, and short interpregnancy interval rates among commercially insured women

Increasing access to effective birth control after childbirth may meet many women's preferences and reduce short interpregnancy interval rates. Eliminating out-of-pocket costs for contraception has been reported to increase the use of the most effective methods among women with employer-based insurance, but the prevalence and effects of patient cost sharing for contraception have not been studied during the postpartum period. This study aimed to examine the association between cost sharing for long-acting reversible contraception and postpartum contraception use patterns and pregnancies in the 12 months after delivery. We conducted a retrospective cohort analysis of commercially insured women undergoing childbirth from 2014 to 2018 using Optum's (Eden Prairie, MN) de-identified Clinformatics Data Mart database. This large national database includes nonretired employees and their dependents who are enrolled in health insurance plans sponsored by large- or medium-sized US-based employers. Women with 12 months of continuous enrollment postpartum were included. Childbirth, pregnancy, and contraceptive method (female sterilization, long-acting reversible contraceptives, other hormonal methods, and no prescription method observed) were identified using claims data. Contraceptive use patterns were observed at 3, 6, and 12 months postpartum and adjusted for individual and plan characteristics. Median out-of-pocket costs were $0 for sterilization and other hormonal methods but nonzero for long-acting reversible contraception. We therefore used simple and multivariable logistic regressions to examine the association between plan-level cost sharing (no cost sharing, $0; low cost sharing, >$0-<$200; and high cost sharing, ≥$200 out-of-pocket cost) for any long-acting reversible contraceptive insertion and contraceptive use patterns and short interpregnancy interval rates, controlling for age, household income, race and ethnicity, region, and insurance plan type. Among 25,298 plans with cost sharing data, we identified 172,941 women with continuous enrollment for 12 months postpartum, including 82,500 (47.7%) in no cost sharing, 22,595 (13.1%) in low cost sharing, and 67,846 (39.2%) in high cost sharing plans. The percentage of postpartum women in the study sample using any prescription contraceptive method was 39.5% by 3 months, 43.8% by 6 months, and 46.0% by 12 months. At all time points, postpartum women in no cost sharing plans had a higher predicted probability of long-acting reversible contraceptive use (eg, at 12 months: no cost sharing, 22.0%; low cost-sharing, 17.5%; high cost sharing, 18.3%; P<.001) and a lower predicted probability of no prescription method use (eg, at 12 months: no cost sharing, 51.8%; low cost sharing, 55.0%; high cost sharing, 54.9%; P<.001) than those in low or high cost sharing plans. Predicted probabilities of female sterilization and other hormonal method use did not differ substantively by plan cost sharing for long-acting reversible contraception at any time point. The proportion of women experiencing a short interpregnancy interval was low (1.9% by 3 months, 1.9% by 6 months, 2.0% by 12 months) and did not differ by plan cost sharing for long-acting reversible contraception at any time point. Out-of-pocket costs for long-acting reversible contraception influence the method of contraception used by postpartum women with employer-based insurance. Eliminating financial barriers to long-acting reversible contraception access after childbirth may help women initiate their preferred method and increase the use of long-acting reversible contraceptives among interested women who otherwise might utilize less effective methods.

Management of bothersome bleeding associated with progestin-based long-acting reversible contraception: a review.

To describe common bleeding patterns and treatment strategies to minimize bothersome bleeding in users of progestin-based long-acting reversible contraception (LARC). Most levonorgestrel intrauterine device users will establish a favorable bleeding pattern within a year; NSAIDs are the most effective bridge to help with bothersome bleeding during that time period. Early follicular phase insertion and fundal placement are associated with more favorable early bleeding profiles. Recent studies exploring tranexamic acid, mifepristone, and tamoxifen's adjunct role show modest or no benefit. The progestin implant is associated with more persistent unpredictable bleeding disproportionately affecting women with higher etonogestrel serum levels; recent studies indicate that oral contraceptives, ulipristal acetate, and tamoxifen may all provide temporary relief. Women's healthcare providers can offer patients adjunct medical therapies to minimize bothersome bleeding associated with progestin LARC use, which may result in increased satisfaction and continuation rates of these effective forms of contraception.

Contraceptive practices in women with chronic medical conditions

Contraception in women with severe medical conditions is a potential measure to reduce maternal mortality. We sought to determine the contraceptive use in women with medical conditions at the University Hospital of the West Indies (UHWI) in Jamaica to determine if there is room for improvement in contraceptive use. Participants were identified from the medical out-patient departments and questionnaires administered. Two hundred and sixty females between 18 and 44 years with varied chronic medical conditions were included. Those included were systemic lupus erythematosus (SLE), diabetes, hypertension (HTN), thyroid disease, cardiac and renal disease. The total current use of contraception was 58.4%, while 41.6% were not on contraceptives. The use of barrier methods and long-acting reversible contraceptives (LARCs) was 71% and 10%, respectively. The current use of contraception in patients with sickle cell disease (SCD) was 84% (p=.004) and in rheumatoid arthritis (RA), 14% (p=.028). Fifty-eight (58, 24.2%) of the women were using two or more methods of contraception. There is a role for improving contraceptive use among women with medical conditions as they are at increased risk of pregnancy complications. IMPACT STATEMENT What is already known on this subject? Women with medical comorbidities significantly contribute to both direct and indirect causes of maternal mortality. Contraception may play an integral role in reducing the risk of dying in chronically ill women; however, the use of contraception in this group is often suboptimal. What the results of this study add? This study adds to the literature that in this high-risk group, there is an underuse of long-acting reversible contraceptives, which is ideal for this population. What the implications are of these findings for clinical practice or further research? The results will provide evidence that this high-risk group of women should be targeted and counselled regarding their risk of morbidity and mortality in pregnancy as well as contraception use while their condition is optimised. From this evidence, services may be put in place in institutions, especially in low-resource settings.

Comparison of postpartum family planning uptake between primiparous and multiparous women in Webuye County Hospital, Kenya.

BackgroundPostpartum family planning (PPFP) is associated with health, social and economic benefits to a woman and her family. Its uptake, particularly of the more effective, long-acting reversible contraceptives (LARCs), is low. The role of parity in PPFP uptake is inconclusive. The aim of this study was to compare the uptake of PPFP and LARCs between primiparous and multiparous women accompanying their children for the first measles vaccine, which is at 9 months after delivery, in Webuye County Hospital, Kenya.MethodsThis was a cross-sectional study. Study participants were recruited using a systematic random sampling method and data were collected using a pretested, structured, interviewer-administered questionnaire. The collected data were analysed using an independent t-test to compare PPFP uptake between primiparous and multiparous women, whereas chi-square tests (for categorical data) and independent t-tests (for numerical data) were used to compare the various socio-demographic characteristics and occurrence of various predictors of PPFP uptake between the two groups of postpartum women. Factors that were significantly different between the two groups were controlled for using logistic regression.ResultsThere was a significant difference on PPFP uptake (22.0%; 95% CI: 11.8–32.3; p < 0.001), but none on LARC use (OR = 0.88; 95% CI: 0.46–1.66) between the two groups of women. The unadjusted and adjusted OR for the effect of parity on FP uptake was 3.48 (95% CI: 1.88–6.42) and 2.32 (95% CI: 1.15–4.67), respectively.ConclusionThere is a significant difference in the uptake of PPFP, but not LARCs, between primiparous women and multiparous women accompanying their children for the 9-month measles vaccine in Webuye County Hospital. Primiparous women are less likely to initiate the use of PPFP compared to their multiparous counterparts.

Long-acting reversible contraception utilization and associated factors among women in extended postpartum period in\xa0Hossana town, southern Ethiopia: cross sectional study

BackgroundIn low and middle-income countries, 95% of postpartum women want to avoid a pregnancy for 2 years, but 70% are not using contraception. Delay in use of contraception by couples during postpartum period can result in many unwanted pregnancies. Long-acting reversible contraception (LARC) is ideal for postpartum women. Therefore this study aimed at assessing the prevalence and factors associated with LARC use among postpartum women.MethodsFacility based cross sectional study was conducted from July 23-Aug 25, 2018. Systematic random sampling technique was employed to recruit a total of 381 women in extended postpartum period visiting Child Immunization service in hosanna health institutions. Pretested structured questionnaire was used for data collection. Data was analyzed by SPSS version 20. Binary and multiple logistic regression analysis was done. The presence and strength of association was determined using AOR with its 95% CI. Variables with P value less than 0.05 were considered as statistical significant.ResultsThe prevalence of LARC use was 36.5% (95%CI (33.05–39.95)). The main reason for not using LARC was fear of side effect and false information. Previous use of LARC (AOR = 3.3, 95%CI (1.7–6.5)) and have ever discussed with health providers on LARC (AOR = 2.5, 95%CI (1.1–5.74)) were found to be significantly associated with LARC use.ConclusionsThe utilization of LARC among postpartum women was found to be higher than other studies in Ethiopia. Provision of effective contraceptive counseling during Antenatal, delivery and postnatal care services with emphasis on LARC/Postpartum Intra-Uterine Device is important.

The effect of an educational video on long-acting reversible contraception (LARC) utilization at 6-8weeks postpartum period: a randomized controlled trial.

Long-acting reversible contraception is highly effective in preventing unintended pregnancy and unsafe abortion. An educational video administered during early postpartum period might be an effective tool to improve postpartum LARC use. The objectives were to evaluate whether a postpartum educational video about LARC could increase postpartum LARC utilization at 6-8weeks postpartum and to assess why postpartum women did not receive LARC. This randomized-controlled trial was conducted at the postpartum unit of a university Hospital between August 2016 and February 2017. Postpartum women who were aged > 20years and willing to participate were recruited. Participants allocated to the study group watched the 7-min educational video on LARC methods while the control group did not. To assess LARC utilization, data were collected at 6-8weeks postpartum using telephone calls and/or medical record review to determine postpartum contraception use and reasons for not using LARC. Two-hundred and seventy participants were enrolled, and the video (135) and non-video (135) groups had similar baseline characteristics. In the video group, 57.8% (95% CI 49.0-66.2) reported using a LARC method, compared to 25.9% (95% CI 18.8-34.2) in the non-video group (p < 0.05). The reasons for not using LARC in both groups were inconvenience of access (42.0-43.8%) and uncertainty about methods (17.0-24.6%). The educational video introduced at immediate postpartum period was efficacious in increasing the utilization of LARC at 6-8weeks postpartum. Inconvenience of access was the most common reason cited for not using LARC. Clinicaltrials.in.th TCTR20171225001 "retrospectively registered".

Use of Long-Acting Reversible Contraceptives Amongst Adolescents: An Integrative Review

Four of 5 pregnancies among adolescents aged 14 to 19 are unintended. Long-acting reversible contraceptives (LARCs) have been found to be the most effective form of birth control. Despite the strong endorsement for LARCs, their use among adolescents remains low. An integrative review was conducted to inform Canadian nurse practitioners about how to effectively implement the use of LARCs in their practice as a strategy to reduce unintended pregnancy amongst adolescents. Nurse practitioners can contribute to the use of LARCs by being proactive, providing accurate, evidence-based information, and reducing or eliminating barriers to contraceptive access.

Cost-effectiveness of integrated HIV prevention and family planning services for Zambian couples.

To present the incremental cost from the payer's perspective and effectiveness of couples' family planning counseling (CFPC) with long-acting reversible contraception (LARC) access integrated with couples' voluntary HIV counseling and testing (CVCT) in Zambia. This integrated program is evaluated incremental to existing individual HIV counseling and testing and family planning services. Implementation and modelling. Fifty-five government health facilities in Zambia. Patients in government health facilities. Community health workers and personnel promoted and delivered integrated CVCT+CFPC from March 2013 to September 2015. We report financial costs of actual expenditures during integrated program implementation and outcomes of CVCT+CFPC uptake and LARC uptake. We model primary outcomes of cost-per-: adult HIV infections averted by CVCT, unintended pregnancies averted by LARC, couple-years of protection against unintended pregnancy by LARC, and perinatal HIV infections averted by LARC. Costs and outcomes were discounted at 3% per year. Integrated program costs were $3 582 186 (2015 USD), 82 231 couples received CVCT+CFPC, and 56 409 women received LARC insertions. The program averted an estimated 7165 adult HIV infections at $384 per adult HIV infection averted over a 5-year time horizon. The program also averted 62 265 unintended pregnancies and was cost-saving for measures of cost-per-unintended pregnancy averted, cost-per-couple-year of protection against unintended pregnancy, and cost-per-perinatal HIV infection averted assuming 3 years of LARC use. Our intervention was cost-savings for CFPC outcomes and CVCT was effective and affordable in Zambia. Integrated couples-focused HIV and family planning was feasible, affordable, and leveraged HIV and unintended pregnancy prevention.

Factors associated with long-acting and short-acting reversible contraceptive use in Ethiopia: an analysis of the 2016 Demographic and Health Survey

Purpose This study sought to examine different factors associated with use of contraceptive types among Ethiopian women, as well as to update the literature on general contraceptive use. These analyses can be used to tailor and improve family planning policy and long-acting contraceptive use. Methods The Ethiopia Demographic and Health Survey 2016 conducted in-person interviews with 15,683 women aged 15–49. Participants were asked about contraceptive use, family planning attitudes, personal and household characteristics, and lifestyle. We used bivariate and multivariate logistic regression to analyse factors associated with general contraceptive use and long-acting contraceptive use. Results Our study confirms many previously documented determinants of general contraceptive use including marital status, age, religion, decision-making ability, and occupation. Factors associated with long- versus short-term reversible contraceptive use were religion, region, age group, highest level of education, and discussing family planning at a health facility. Conclusion This study outlines crucial differences between long- and short-acting contraceptive users. Further family planning policy efforts taking into account regional, religious and other personal and socio-economic factors would effectively augment ongoing efforts. Additionally, the role played by discussion with health professionals in supporting long-term contraceptive use reflects the success of the ongoing effort to drive use in Ethiopia. KEY MESSAGE Global and national health actors are focused on improving access to long-acting contraceptives, however there is little evidence on factors that facilitate their uptake compared to the traditionally popular, short-acting contraceptives. Our study found significant religious and regional differences in long-acting contraceptive use which policy makers can use to guide their efforts.. Community health extension workers play a key role in long-term contraceptive access through tailored person-person education, consultation, and provision.

The age of LARC: making sexual citizens on the frontiers of technoscientific healthism

ABSTRACT Routinely positioned as the ‘first-line option’ for contraceptive choice-making, long-acting reversible contraception (LARC) promotion efforts have come under critical scrutiny by reproductive justice advocates for the extent to which public health actors’ preference for LARC devices may override potential users’ ability to freely (not) choose to use contraception among an array of options. We identify LARC promotion discourse as constituting ‘The Age of LARC’: multifarious strategies for producing responsible sexual citizens whose health behaviours are empowered via a LARC-only approach to contraceptive use. We suggest that immediate postpartum LARC insertion policies, which have proliferated in the U.S. since 2012, exemplify the new era of LARC hegemony, in which urgency, efficiency, cost-effectiveness, and outcomes dominate both health policy and clinical practice around these contraceptive technologies. By following these efforts to facilitate access to and use of immediate postpartum LARC, we find a discourse on sexual citizenship that paradoxically constructs sexual health freedom through the use of a single class of contraceptive technologies.

Impacts of a Home Visiting Program Enhanced with Content on Healthy Birth Spacing

ObjectivesThis study sought to determine the impact of Healthy Families Healthy Futures (HFHF) enhanced with Steps to Success (STS). HFHF is a structured home visiting program for teen parents in Houston that focuses on improving parenting skills and preventing child abuse. HFHF enhanced with STS includes content and activities aimed to reduce repeat pregnancies within 24 months after the first child’s birth.MethodsThe study team recruited 248 young mothers for the study, primarily through local health clinics and schools, and then randomly assigned them to either a treatment group that was eligible to participate in HFHF enhanced with STS or to a control group. The control group was not offered any other program through the study. Outcomes were measured by a survey administered 12 months after program intake, in five domains aligned with the program’s logic model: (1) exposure to information related to program content, (2) contraception knowledge, (3) contraception use, (4) enhanced family functioning, and (5) child health and development. To estimate program impacts, we used ordinary least squares regression, controlling for demographics and baseline measures of the outcome variables, if available. We use both frequentist approaches (calculations of statistical significance) and Bayesian posterior probabilities to interpret the findings.ResultsHFHF enhanced with STS significantly (p < .05) impacted exposure to information on parenting and birth control, with effects of 20.8 and 15.4 percentage points, respectively. Using Bayesian posterior probabilities, there is an 85% chance that the program had a favorable effect on these outcomes. We also calculate a probability of 77% that the program had a favorable impact on long-acting reversible contraceptive (LARC) use, but a probability of 89% that the program reduced knowledge of birth control pills; these two results were not statistically significant (p = .17 and .10, respectively).Conclusions for PracticeThese findings are primarily favorable and consistent with the program content and goals. Smaller than anticipated sample sizes due to recruitment challenges increased the chances for random error to affect the ability to detect statistically significant differences on many of our other outcomes; Bayesian posterior probabilities can therefore aid in interpreting the impact estimates. More research of this promising model is warranted.

Contraceptive use among young women in northern Ghana: a community-based study

Objective The aim of the study was to assess factors influencing contraceptive uptake among young women aged 15–24 years in Bolgatanga Municipal District, northern Ghana. Methods An analytical cross-sectional community-based study was conducted between December 2015 and April 2016. Participants (N = 580) were selected through multistage sampling and interviewed using a pretested structured questionnaire. Results The mean age of the participants was 20.5 years (standard deviation 2.8 years). About a third were less than 20 years old. Contraceptive knowledge was nearly universal (99.7%). About 67% of sexually experienced young women had used contraceptives, but less than a quarter had used long-acting reversible contraception (LARC). Age was the only independent predictor of contraceptive use: women in their 20s were more than twice as likely as adolescents to use contraceptives (adjusted relative risk 2.75; 95% confidence interval 2.04, 3.71; p < 0.001). Conclusion Strategies to improve contraceptive uptake among young people in the municipality should encourage the use of LARC.

Improving a long-acting reversible contraception usage by understanding client perspectives

BACKGROUND Despite the limited use of long-acting reversible contraception (LARC) in Indonesia, they have proven to be cost-effective in family planning programs. This study was aimed to identify the elements of ideas and views that people hold and their association with the use of LARC (intrauterine devices and implants) as a means of improving its utilization in Nusa Tenggara Barat (NTB) Province, Indonesia.&#x0D; METHODS Data were derived from the Improving Contraceptive Mix Methods survey of 6,384 respondents in Bima District, Central Lombok, and North Lombok, NTB Province, in 2015. Confirmatory factor analysis was used to identify suitable elements of 19 variables and generate three ideation elements on attitude, knowledge, and interpersonal communication. Subsequently, the association of three ideation elements with LARC use in NTB was examined.&#x0D; RESULTS Multivariate analysis revealed that LARC use was higher among women with a positive attitude toward LARC and high frequency of interpersonal communication. Women with positive attitudes had 7 times greater odds of using LARC than women with negative attitudes (adjusted odds ratio [aOR] = 7.18; 95% confidence interval [CI] = 6.09–8.55). Women with a high frequency of interpersonal communication were 2.4 times more likely to use LARC than women with low communication frequency (aOR = 2.40; 95% CI = 1.94–2.99).&#x0D; CONCLUSIONS To increase the use of LARC in NTB, family planning programs should not only focus on improving women’s knowledge but also prioritizing the promotion of positive attitudes toward LARC and facilitating interpersonal communication.

Intrauterine Devices in the Context of Gonococcal Infection, Chlamydial Infection, and Pelvic Inflammatory Disease: Not Mutually Exclusive.

The use of long-acting reversible contraception, namely, intrauterine device (IUDs) and the subdermal implant, has been recommended to address the high rate of the unintended pregnancy in the United States. IUDs are a safe, highly effective contraceptive method, suitable for most women. The underutilization of IUDs arises in part from the lack of translation of best practices in the clinical setting as well as fears and misperceptions about this contraceptive method held by health care providers and women. This article reviews screening and management of Neisseria gonorrhoeae and Chlamydia trachomatis infection and pelvic inflammatory disease (PID) in women who are using or want to use an IUD. An IUD may be inserted without prior screening for N gonorrhoeae or C trachomatis in women who are at low risk for sexually transmitted infections and asymptomatic. An in situ IUD may remain in the uterus during and after treatment for gonococcal infection, chlamydial infection, or PID. The risk of PID with an IUD in situ is less than 1%. Following IUD best practices, including their use in the context of sexually transmitted infections, can increase the availability of this method for suitable candidates and decrease the unintended pregnancy rate.

Changes to Contraceptive Method Use at Title X Clinics Following Delaware Contraceptive Access Now, 2008-2017.

Objectives. To measure changes in the contraceptive methods used by Title X clients after implementation of Delaware Contraceptive Access Now, a public-private initiative that aims to increase access to contraceptives, particularly long-acting reversible contraceptives (LARCs).Methods. Using administrative data from the 2008-2017 Family Planning Annual Reports and a difference-in-differences design, we compared changes in contraceptive method use among adult female Title X family planning clients in Delaware with changes in a set of comparison states. We considered permanent methods, LARCs, moderately effective methods, less effective methods, and no method use.Results. Results suggest a 3.2-percentage-point increase in LARC use relative to changes in other states (a 40% increase from baseline). We were unable to make definitive conclusions about other contraceptive method types.Conclusions. Delaware Contraceptive Access Now increased LARC use among Title X clients. Our results have implications for states considering comprehensive family planning initiatives.

Trends and factors associated with long-acting reversible contraception in Kenya

Background: Kenya has 12 million female adolescents and youths aged 10-34 years whose reproductive behavior will determine the growth and size of its population for the next decade. The anticipated momentum of births can be slowed by the use of long-acting reversible contraception (LARC) methods as they are more effective, need no user adherence, and hence have no risk of incorrect or inconsistent use. However, in spite of the many health and social benefits, LARC is underutilized because of myths and misconceptions. Kenya is in the ultimate decade towards Vision 2030 and investing in LARC can save costs of health care and accelerate the achievement of the development goal. The objective of this study was to establish factors associated with LARC use, with a view of establishing the potential for increasing demand. Methods: The study was national and used secondary data from the three waves of the Kenya Demographic Health Survey from 2003, 2008/09 and 2014 in a sample of all women of reproductive age who reported currently using modern contraceptive methods at the time of interview. Descriptive and logistic regression analysis was employed to profile and examine LARC users. Results: LARC use was low but picking up rapidly, especially among contraceptive users of higher social economic status in a major shift between 2008/09 and 2014. Consistent factors that influenced its use were age, wealth, and number of living children, while education and residence were of influence some of the time. Conclusions: There is huge unexploited potential for more LARC uptake based on the identified predictors of its use. Scaling up of LARC uptake is critical to deal with issues of poor user adherence, incorrect and inconsistent use, and method failure that characterize short-acting contraception, resulting in increased unintended pregnancies, incidences of unsafe abortions and maternal and infant mortality.

Adolescent Self-Reported Use of Highly Effective Contraception: Does Provider Counseling Matter?

To examine associations between provider counseling about specific contraceptive methods and method choices reported by adolescents. A cross-sectional, secondary analysis of the local 2015 Youth Risk Behavior Survey, to which we added 2 new/modified questions about long-acting reversible contraception (LARC). Rochester, New York. Female students in 9th-12th grade in the Rochester City School District. An anonymous, standardized survey was administered to collect data. We studied associations between students' reported contraceptive use and counseling (LARC, short-acting contraception [SAC], neither), health care factors, and potential risk/protective factors. Data were analyzed using bivariate and multivariate methods. Among 730 sexually active female respondents, 353/730 (49%) were African American and 182/730 (25%) were Other/Mixed race. 416/730 (57%) used no hormonal method at last sex, and 95/730 (13%) used LARC. 210/730 (29%) of participants recalled any LARC-specific counseling, and 265/730 (36%) any counseling on SAC. Recall of LARC and SAC counseling and use were significantly associated with speaking privately with a provider, but were not related to personal risk/protective factors. Multivariate analyses showed that recollection of LARC counseling was significantly associated with higher odds of using either LARC (adjusted odds ratio, 14.3; P<.001) or SAC (adjusted odds ratio, 2.1; P=.007). Recollection of either LARC or SAC counseling was associated with significantly lower odds of using no contraception. Adolescents' use of LARC was only 13%, but those who recalled contraceptive counseling had higher odds of using some hormonal method. Efforts are needed to improve provider counseling, maintain confidentiality, and identify effective methods to engage adolescents in meaningful, memorable discussions of LARC.