Provision Of Contraception Research Articles

Contraceptive Provision to Women With Intellectual and Developmental Disabilities Enrolled in Medicaid.

To compare contraceptive provision to women with and without intellectual and developmental disabilities enrolled in North Carolina Medicaid. Our retrospective cohort study used 2019 North Carolina Medicaid claims to identify women aged 15-44 years with and without intellectual and developmental disabilities at risk for pregnancy who were continuously enrolled during 2019 or had Family Planning Medicaid with at least one claim. We calculated the proportion in each cohort who received 1) most or moderately effective contraception, 2) long-acting reversible contraception, 3) short-acting contraception, and 4) individual methods. We classified contraceptive receipt by procedure type and disaggregated across sociodemographic characteristics. Adjusting for age, race, ethnicity, and urban or rural setting, we constructed logistic regression models to estimate most or moderately effective contraceptive provision odds by intellectual and developmental disability status and by level or type of intellectual and developmental disability. We performed subanalyses to estimate co-occurrence of provision and menstrual disorders. Among 9,508 women with intellectual and developmental disabilities and 299,978 without, a significantly smaller proportion with intellectual and developmental disabilities received most or moderately effective contraception (30.1% vs 36.3%, P <.001). With the exception of injectable contraception, this trend was consistent across all measures and remained statistically significant after controlling for race, ethnicity, age, and urban or rural status (adjusted odds ratio 0.75, 95% CI 0.72-0.79; P <.001). Among those who received most or moderately effective contraception, a significantly greater proportion of women with intellectual and developmental disabilities had co-occurring menstrual disorders (31.3% vs 24.3%, P <.001). These findings suggest disparities in contraceptive provision and potential differences in clinical indication by intellectual and developmental disability status. Future studies should investigate reasons for and barriers to contraceptive use among women with intellectual and developmental disabilities.

Building an implementation framework to address unmet contraceptive care needs in a carceral setting: a systematic review

BackgroundThe provision of contraceptive care for incarcerated individuals has been largely inconsistent and has contributed to, at best, inadequate care, and at worst reproductive abuses, violence, and coercion. While previous research has identified strategies to remedy known issues, to date, very few recommendations have been implemented across the carceral system. To address this, we conducted a systematic review of policy and practice recommendations to improve contraceptive care to reproductive-aged, incarcerated individuals in the United States.MethodsWe conducted this systematic review utilizing the Joanna Briggs Institute methodology and framed it within the National Implementation Research Network’s (NIRN) Exploration stage. We searched PubMed, PSYCInfo, SCOPUS, ProQuest, Web of Science, MedLine, Social Science Citation Index and reference sections of included materials. Basic study information, explicitly stated policy and practice recommendations, and discussions and conclusions that subtly provide recommendations were extracted in full text. We utilized a thematic analysis approach to analyze the extracted text.ResultsA total of 45 materials met the inclusion criteria. Seven overarching themes were identified: 1) policy changes needed to implement care; 2) need for contraceptive care in carceral systems; 3) justice agency barriers regarding contraceptive care provision; 4) policy barriers to contraceptive access; 5) funding strategies to improve care; 6) patient preferences for contraceptive care delivery; and 7) healthcare provider knowledge regarding contraceptive care. The seven themes identified shed light on the need for, gaps, barriers, and facilitators of current contraceptive care provision to incarcerated individuals.ConclusionThis systematic review accomplished two goals of NIRN’s Exploration stage. First, the compiled evidence identified a clear need for change regarding policies and practices pertaining to contraceptive care provision to incarcerated individuals in the United States. Second, our findings identified several evidence-based solutions supported both by research and professional healthcare organizations to address the identified need for change. This study provides an initial blueprint for correctional agencies to implement the necessary changes for improving contraceptive care provision to incarcerated populations. The correctional system is in a unique position to deliver much-needed care, which would result in many potential benefits to the individuals, correctional system, and community at large.

Factors affecting female sexual well-being: a 5-year follow-up of a randomised clinical trial on post-abortion contraception

IntroductionSexual well-being is associated with general well-being. Several factors, such as overweight, infertility, anxiety and sex hormones, also play a role, but the effects of hormonal contraception remain a point...

Knowledge and Comfort in Providing Contraception, Sexual, and Reproductive Healthcare Among Pediatric Nurses in California

To evaluate the awareness, comfort, and feeling of competence of California registered nurses (RNs) in the provision of contraception and sexual and reproductive healthcare (SRH) to adolescent patients following California Assembly Bill (AB) 2348 legislation that expanded RN scope of practice to include provision of self-administered and injectable hormonal contraception. A cross-sectional, descriptive survey was used to assess pediatric registered nurses’ awareness of AB2348, perceived level of competence and comfort in the provision of sexual and reproductive health care (N = 504). A sample of pediatric RNs in California were included in this analysis. Descriptive statistics were used to assess demographic characteristics and summarize participants responses, and Fisher's exact tests were used to identify difference between groups. Responses from 45 pediatric RNs are reported in this analysis. The majority (80.0%, n = 36) of nurses in this study had no knowledge of AB2348. Many expressed a lack of comfort dispensing contraception (34.6%, n = 16), discussing age-appropriate information on safer sex practices (62.2%, n = 28), and providing sexually transmitted infection education (49.9%, n = 22).While most of the pediatric RNs reported frequently providing care to pediatric patients of reproductive age the majority were not comfortable providing contraception, safer sex education, or sexually transmitted infection education, and were unaware that it is within their scope of practice to independently provide services using standardized procedures. Increased training the provision of SRH care is needed among pediatric RNs to increase their sense of competence and comfort in providing adolescent SRH care.

Moving policy to practice: role of advocacy in enabling provision of injectable contraceptives by pharmacists in Kenya.

Expanding access to contraceptive services by making them available in pharmacies and drug shops is a family planning high-impact practice. In 2018, Kenya's Ministry of Health amended its family planning guidelines to allow pharmacists and pharmaceutical technologists throughout the country to provide subcutaneous and intramuscular depot medroxyprogesterone acetate. Amending the policy did not necessarily mean that the policy would be implemented. The Advance Family Planning project launched an advocacy campaign to engage key stakeholders to work with the Ministry of Health to implement the policy. Consequently, a family planning training package for pharmacists and pharmaceutical technologists was developed and rolled out. The advocacy process also led to strengthening family planning reporting by the trained pharmacists and pharmaceutical technologists. To further enhance sustainability by ensuring a continuous pool of pharmacy professionals equipped with skills to provide family planning services, Advance Family Planning and its partners advocated with universities and the Pharmacy and Poisons Board to revise the pre-service training curriculum to include family planning as a competence area for pharmacists and pharmaceutical technologists. A key lesson learned is that policy formulation does not necessarily translate to policy implementation. Advocacy is often needed to move policy to practice, especially where resources are required. Policy implementation also requires incremental achievement of milestones and the need for advocacy for each step in the process. Implementation of the policy provision that allows pharmacists and pharmaceutical technologists to provide injectable contraceptives has implications beyond family planning programs. It provides a point of reference for allowing pharmacists to offer other primary health care services, such as immunization, injectable HIV prophylaxis, and other interventions that might not be provided for in policy.

Scoping review protocol: exploration of the barriers and facilitators to the uptake of early postnatal contraception

IntroductionIt is well documented that many women do not desire a short interpregnancy interval. Medical societies, government agencies and leaders in the field recommend that contraception should be part of...

Five years later: Can women in Los Angeles County, California, get adequate pill supplies?

ObjectivesThis study sought to determine if pharmacies in Los Angeles County had implemented 2017 legislation requiring insurance companies based in California to fully reimburse for 13 cycles of oral contraceptives dispensed at once. Study designWe conducted a secret shopper telephone survey of Los Angeles County pharmacies nearly 5 years after the legislation went into effect. We chose the categorical state family program (Family PACT) to represent all programs covered by the legislation. Representative numbers of pharmacies were randomly selected in each of Los Angeles County’s eight service planning areas in proportion to the number of women living in each area. We asked pharmacies if they would fill a prescription for a year’s supply of contraception all at once for a patient enrolled in Family PACT. ResultsWe contacted a total of 582 pharmacies and excluded the 150 unresponsive pharmacies. Of the 432 pharmacies contacted, only 3.2% said they would dispense a 1-year supply of pills at once to a patient enrolled in this representative program. Nearly 50% explicitly said they would not dispense 13 cycles at one time regardless of the prescription. ConclusionsOnly 3.2% of surveyed pharmacies in Los Angeles County said they would comply with current legislation, which requires dispensing 1-year supply of pills at once. ImplicationsCollaboration among physicians, pharmacies, and patients along with enhanced insurance company oversight will be needed to improve dispensing practices to achieve the lower unintended pregnancy rates associated with providing adequate contraceptive supplies.

"Meeting Patients Where They're at": Clinician Perspectives on Integration of Family Planning Services into Office-Based Addiction Treatment.

To study clinician perspectives on the feasibility of incorporating family planning services within office-based addiction treatment (OBAT) clinics. We sought to understand the unique facilitators of and barriers to the integration of contraceptive services within the OBAT model with a goal to support the design and implementation of a program tailored to meet the reproductive health needs of patients with substance use disorder. After obtaining institutional review board approval, we conducted qualitative semistructured interviews with OBAT clinicians (registered nurses, advanced practice registered nurses, and physicians) at a tertiary-care safety-net hospital. Interview transcripts were analyzed using deductive codes utilizing key components of the Promoting Action on Research Implementation in Health Services and Ottawa Decision Support Frameworks. We analyzed 20 interviews. Our data noted 3 major themes: (1) evidence to support integration of family planning and OBAT, (2) inherent strengths and facilitative factors of the OBAT model, and (3) barriers and challenges of the OBAT model influencing successful integration. Strengths included the destigmatizing and trust-building OBAT approach to care, common use of patient-centered counseling, and providers' nuanced understanding of substance use disorder-specific impacts on reproductive health. Barriers included time constraints, balancing urgent patient recovery needs, the desire for additional contraception provision training, and concern for potential contraceptive coercion. Office-based addiction treatment clinics have inherent strengths that may make it a beneficial location for integrated family planning services. Future research should elicit patient perspectives to ensure the implementation of a family planning program in OBAT that supports patients' reproductive goals while avoiding stigma or reproductive coercion.

Contraception After Abortion.

After a spontaneous or induced abortion, people may desire to delay or prevent a future pregnancy and many desire to use contraceptive methods to do so. Contraception counseling and provision at the time of abortion care are important components to improve contraceptive access and convenience for people undergoing abortion care. The majority of hormonal and barrier contraceptive methods may be safely initiated at the time of medication or procedural abortion or shortly thereafter, although delayed initiation may be necessary in certain circumstances. A patient-centered approach to contraceptive counseling can identify patients' priorities and mitigate provider coercion or pressure.

The use and access to contraception in Sweden during the COVID-19 pandemic period

Purpose Explore perceived access to, the need for, use of, and satisfaction with telemedicine services for contraceptive counselling and prescription-renewal-only during the COVID-19 pandemic, and the impact of the COVID-19 pandemic period on the choice and use of contraceptives. Materials and methods Internet-based e-survey of Swedish women of fertile age, 16–49 years. Results In total, 1016 participants completed the survey. Most participants (69.7%) rated their access to contraceptive services ‘as usual’. Among the remaining participants, a higher proportion rated their access as deteriorated (73.4%) compared to improved (26.6%; p < 0.001). In total, 38.0% reported a need for contraceptive counselling, whereof 14.0% had used telemedicine for counselling and reported high satisfaction. Telemedicine for prescription-renewal-only was used by 15.1% of the total population. Two per cent reported use of another contraceptive than their intended, whereof long-acting reversible contraceptives were the most common intended method. The proportion of current contraceptive users was lower than in 2017 (62.4% vs 71.1%, p < 0.001), and current users of long-acting reversible contraception decreased from 30.6% to 19.3% (p < 0.001). Conclusions During the COVID-19 pandemic period, most women found their access to contraceptive services unaffected, but more women felt that it had deteriorated than improved. The use of telemedicine was low, and the use of contraception overall fell. Efforts are needed to raise awareness of available services, and TM-provided interventions for maintained quality of care and informed decision-making remain to be evaluated. SHORT CONDENSATION The COVID-19 period imposed a change in contraceptive service provision, and efforts are needed to raise awareness of available services, including telemedicine. Access to all contraceptives, including LARCs, is crucial and telemedicine-provided interventions need evaluation.

Postpartum Family Planning in Pediatrics: A Survey of Parental Contraceptive Needs and Health Services Preferences.

Infant well-child visits are increasingly being explored as opportunities to address parental postpartum health needs, including those related to reproductive health. To inform potential pediatric clinic-based interventions, this study assessed postpartum contraceptive needs and health services preferences. We surveyed postpartum individuals attending 2 to 6-monthwell-child visits at three Northern California pediatric clinics (2019-20). We examined unmet contraceptive needs; the acceptability of contraceptive education, counseling, and provision at well-child visits; and sociodemographic and clinical correlates. We conducted univariate and multivariable regression modeling to assess associations between sociodemographic and clinical variables, the status of contraceptive needs, and acceptability measures. Study participants (n=263) were diverse in terms of race and ethnicity (13% Asian, 9% Black, 37% Latinx, 12% Multi-racial or Other, 29% White), and socioeconomic status. Overall, 25% had unmet contraceptive needs. Unmet need was more common among participants who had delivered more recently, were multiparous, or reported ≥1 barrier to obtaining contraception; postpartum visit attendance, education, race, and ethnicity were not associated with unmet need. Most participants deemed the following acceptable in the pediatric clinic: receiving contraceptive information (85%), discussing contraception (86%), and obtaining a contraceptive method (81%). Acceptability of these services was greater among participants with unmet contraceptive needs, better self-rated health, and private insurance (all P<.05). A quarter of participants had unmet contraceptive needs beyond the early postpartum period. Most considered the pediatric clinic an acceptable place to address contraception, suggesting the pediatric clinic may be a suitable setting for interventions aiming to prevent undesired pregnancies and their sequelae.

"I fear those things": non-uptake of contraceptives, and barriers to use among adolescent girls and young women at high risk of HIV infection in Kampala, Uganda.

Adolescent girls and young women involved in risky behaviors are vulnerable to multiple health problems, yet sexual and reproductive health services remain underutilized. We evaluated factors associated with non-uptake of contraceptives and barriers to use among adolescent girls and young women (14-24 years old) at high risk of HIV infection in an environment where contraceptives were provided at no cost. We conducted a mixed methods study, utilizing data from a baseline cross sectional survey and qualitative in-depth interviews. Survey participants tested negative for pregnancy and reported willingness to use contraception. Non-uptake of contraceptives was defined as not taking contraception at any study visit (baseline and throughout the study). Logistic regression model was used to assess factors associated with non-uptake of contraceptives. We purposively selected participants for interviews to discuss their knowledge and experiences with contraceptives and make suggestions to improve uptake. Qualitative data were analyzed thematically. All 285 participants were included in the analysis. Out of the 285 participants 127 were not using contraceptives and of the 127, 44 (34.6%) did not take up any method throughout the study while 43 of the 83 remaining participants (who took up a method) chose male condoms only. Non-uptake of contraceptives was less likely among older women (20-24 years) (aOR = 0.32, 95% CI 0.16-0.89) compared to younger women (less than 20 years). Qualitative data showed that concerns about future fertility, fear of associated side effects and influence from close relations contributed to non-uptake of contraception. Non-uptake of contraceptives was common despite the promotion and provision of contraceptives in the context of a research study mainly because adolescents lack autonomy while making contraceptive decisions. Identifying and addressing their concerns and continued counselling on contraceptive use alongside condom promotion may improve uptake and utilization of contraceptives.

Online survey of consumer awareness and perceptions of a Massachusetts law for 12-month supply of contraception

ObjectivesThis study aimed to characterize awareness of a 2017 Massachusetts (MA) law that ensures access to a 12-month supply of short-acting contraceptive methods (e.g., pill, patch, and vaginal ring) among short-acting contraceptive users in MA and to identify perceived benefits and concerns of a 12-month supply. Study designAn online survey was administered to a Qualtrics panel of MA women who were using short-acting contraceptive methods and were insured by an eligible health plan. The survey’s primary outcome was general awareness of the law; interest in, receipt of, and perceived benefits and risks of a 12-month supply were also elicited. Analysis included descriptive statistics and bivariate and multivariable analyses examining factors associated with awareness of the law. ResultsAmong the 207 survey respondents, 76% were aware of the law, and 93% expressed interest in receiving a 12-month supply of a short-acting method; however, only 9% received it. Respondents identified as White (66%), privately insured (59%), and pill users (44%). Concerns about a 12-month supply included privacy, product expiration, and change in personal medical status. Perceived benefits included avoiding multiple trips to pharmacy and increased compliance. Multivariable analyses showed general awareness of the law was only associated with employer-based insurance, with those respondents having 75% lower odds of being aware of the law than respondents with Medicaid coverage. ConclusionAlthough a high percentage of women surveyed were aware of the law and most were interested in receiving a 12-month supply of their short-acting method, the low percentage who have received a 12-month supply suggests barriers to policy uptake. ImplicationsThis study describes perceptions of the 12-month supply provision of the contraception Act Advancing Contraceptive Coverage and Economic Security in our State law. Addressing consumer concerns may be important to improve the implementation and dissemination of this state policy change.

Contraception-related knowledge, attitude, belief contexts among US women experiencing homelessness: A scoping review.

Contraception provision may help reduce undesired pregnancies, but women experiencing homelessness may have low health literacy, specific attitudes, and certain beliefs that influence contraception uptake. This scoping review identifies what is known about pregnancy prevention and contraception knowledge, attitudes, and beliefs among US women experiencing homelessness. This review examined English articles that measured the context of knowledge, attitudes, and beliefs related to contraceptive use for avoiding pregnancy among US women experiencing homelessness. Using PRISMA-ScR guidelines, articles published before May 2022 were located via PubMed, EBSCOhost, and Embase. The initial search identified 1204 articles, and 10 met the inclusion criteria. There were five quantitative, four qualitative, and one mixed-methods study, published between 2000 and 2022, with samples of 15-764 women ranging from ages 15-51. Contraception knowledge, attitudes, and beliefs related to pregnancy prevention suggested several knowledge gaps (e.g., contraception efficacy), contraception preferences and past experiences, interpersonal relationship influences, and vulnerability to clinic and shelter-specific barriers. These findings may ultimately inform contraception interventions in partnership with the community of US women who experience homelessness and the health care and social service organizations who serve them.

Contraception.

Contraception counseling and provision are vital components of comprehensive health care. An unplanned pregnancy can be particularly challenging for patients with chronic illness. Internal medicine physicians are uniquely positioned to assess pregnancy readiness and provide contraception, as they often intersect with pregnancy-capable patients at the moment of a new diagnosis or when providing ongoing care for a chronic medical condition. A shared decision-making counseling approach engages patients, ensures patient-centered care, and supports their choice of a contraceptive method that aligns with their reproductive plans and medical needs.

Women’s Reproductive Health Rights in Poland. Between a Druggists’ Conscience Clause and Their Legal Duty to Provide Contraceptives

This article recommends the promotion of moral competence in the health and pharmacy professions to enable them to respect human and patient health rights with a focus on the provision of reproductive and sexual health care services. In certain cultures, health care and drug providers follow their conscientious objection (conscience clause) and decline to perform specific health services, including the provision of legal contraceptives in cases protected by legal and human rights. Such malpractices may violate patients’ and purchasers’ legitime rights. The article also presents findings obtained in Poland with N=121 women experimentally interviewed to examine their experiences as contraception purchasers, to assess their preference concerning facing human vs. robotic pharmacists, to manage the risk of refusal argued by the conscientious objection, and to score their moral competence with one of the dilemmas included in the MCT by G. Lind. This study demonstrated that purchasers with higher C-score (C for moral competence) would not just prefer a robotic pharmacist without a ‘conscience’ but, rather, a competent sales staff able to instruct the patient and advice her on any related queries. It further results that participants with higher moral competence are thus less likely to trust the medical expertise of artificial intelligence. We conclude that public institutions in pluralistic societies must manage normative reproductive health contexts more inclusively, and the election, education, and practice of health professionals in the public health care sector require the development of a normative mindset toward respecting the rights of all patients instead of respecting them selectively at the diktat of particularistic conscience.

Provision of contraceptives by Brazilian general gynaecologists: a nationwide online survey

Objective To assess the provision of contraceptives by Brazilian obstetricians and gynaecologists (Obst/Gyns) during medical consultation and associated factors. Methods An anonymous online survey was conducted with Obst/Gyns regarding age, gender, training, method counselling about and provision of long-acting reversible contraception (LARC). Results Of 16,000 Obst/Gyns, 610 (3.8%) answered the survey. After multiple regression analysis, female Obst/Gyns (reference) (OR male was 0.53 [95%CI 0.28–0.98], p = 0.044) and Obst/Gyns aged between 20 and 39 were more likely to provide an IUD. For hormonal-IUDs, Obst/Gyns who had had theoretical training in hormonal-IUD insertion (reference no training) (OR = 2.13 [95%CI 1.14–3.99], p = 0.018), those who work in a private facility or public hospital, and those that allowed more time during consultations (reference) (OR short time = 0.33 [95%CI 0.17–0.63], p < 0.001) were more likely to provide them. Obst/Gyns who were hands-on trained were more likely to provide subdermal implant (OR = 2.04 [95%CI 1.45–2.87], p < 0.001). Conclusions There is a gap between theoretical and practical training received by this cohort of Obst/Gyns regarding LARCs, mainly contraceptive implants and hormonal-IUDs. The identification of barriers to offering contraceptives is essential to providing client-centred contraceptive care.

Contextual factors influencing the roles of patent medicine vendors in the provision of injectable contraception services in Nigeria

BackgroundPatent medicine vendors (PMVs) play vital roles in the delivery of family planning services in Nigeria and other developing countries. There is a growing recognition of the need to integrate them into the formal health care system as a strategy to increase the contraceptive prevalence rate and achieve universal health coverage. Though promising, the success of this proposition is largely dependent on a critical analysis of the factors which influence their operations. This study was designed to identify the contextual factors influencing the provision of injectable contraceptive services by PMVs and the broader effects of their activities on the health system to inform similar interventions in Nigeria.MethodsThis was a qualitative study guided by the UK Medical Research Council’s Framework for Complex Interventions. Twenty-seven in-depth interviews were conducted among officials of the association of PMVs, health workers, government regulatory officers and programme implementers who participated in a phased 3-year (2015–2018) intervention designed to enhance the capacity of PMVs to deliver injectable contraceptive services. The data were transcribed and analyzed thematically using NVIVO software.ResultsThe contextual factors which had implications on the roles of PMVs were socio-cultural and religious, the failing Nigerian health system coupled with government regulatory policies. Other factors were interprofessional tensions and rivalry between the PMVs and some categories of health care workers and increasing donors’ interest in exploring the potentials of PMVs for expanded healthcare service provision. According to the respondents, the PMVs bridged the Nigerian health system service delivery gaps serving as the first point of contact for injectable contraceptive services and this increased contraceptive uptake in the study sites. A negative effect of their operation is the tendency to exceed their service provision limits, which has spurred a planned tiered PMV accreditation system.ConclusionsThis study has highlighted the contextual factors which define the roles and scope of practice of PMVs involved in injectable contraceptive service provision. Strategies and interventions aimed at expanding the healthcare delivery roles of PMVs must be encompassing to address the broader contextual factors which underpin their capacities and functions.

Interconception care in Australian general practice: a qualitative study.

GPs provide care for women across the lifespan. This care currently includes preconception and postpartum phases of a woman's life. Interconception care (ICC) addresses women's health issues between pregnancies that then have impact on maternal and infant outcomes, such as lifestyle and biomedical risks, interpregnancy intervals, and contraception provision. However, ICC in general practice is not well established. To explore GP perspectives about ICC. Qualitative interviews were undertaken with GPs between May and July 2018. Eighteen GPs were purposively recruited from South-Eastern Australia. Audiorecorded semi- structured interviews were transcribed verbatim and analysed thematically using the Framework Method. Most participants were unfamiliar with the concept of ICC. Delivery was mainly opportunistic, depending on the woman's presenting need. Rather than a distinct and required intervention, participants conceptualised components of ICC as forming part of routine practice. GPs described many challenges including lack of clarity about recommended ICC content and timing, lack of engagement and perceived value from mothers, and time constraints during consultations. Facilitators included care continuity and the availability of patient education material. Findings indicate that ICC is not a familiar concept for GPs, who feel that they have limited capacity to deliver such care. Further research to evaluate patient perspectives and potential models of care is required before ICC improvements can be developed, trialled, and evaluated. These models could include the colocation of multidisciplinary services and services in combination with well-child visits.

A Focus on Contraception in the Wake of Dobbs.

A Focus on Contraception in the Wake of Dobbs.