- Email: [email protected]
Comparing contraceptive choices among postabortion patients with and without free access to long-acting reversible contraceptive (LARC) methods
ABSTRACTS / Contraception 92 (2015) 359–414 have encountered accessing reproductive health care and satisfaction with their current method. Methods: We performed a statewide representative survey of women aged 18–49 using the GfK KnowledgePanel (n= 779, completion rate, 56%). We asked about having ever encountered specific types of barriers, current contraceptive method and preferred method if all were available at no out-of-pocket cost. Results: A majority (56%, CI, 51–61%) of sexually active women reported barriers to accessing reproductive health care, including inability to pay (70%, CI, 62–75%), language of providers (55%, CI, 49–62%) and difficulty getting time off from work or school (41%, CI, 34–47%). Half of women using less effective methods would prefer more effective methods (55%, CI, 41–68%). One fifth of hormonal method users (CI, 11–33%) would prefer a more effective method: 7% (CI, 2–21%) female sterilization, 6% (CI, 3–12%) vasectomy and 7% (CI, 2– 19%) a long-acting reversible contraceptive (LARC) method. The majority of women (61%, CI, 36–82%) who preferred a LARC method over their current method reported not using one because they could not afford it. Women relying on Medicaid or state and county programs were more likely to use a LARC method than women with private or no insurance (p=.04). Outcomes: Texas women face barriers to effective methods, and method use differs by insurance coverage. In situations where administrative data are delayed or inadequate, online panel surveys can provide timely information regarding access to and use of family planning services.
385
Lee J Kaiser Permanente, Oakland, CA, USA Postlethwaite D, Merchant M, Alton K, Gupta P, Raine-Bennett T
Women's awareness of their contraceptive benefits after the Affordable Care Act
Objectives: We hypothesized that women receiving abortions within Kaiser Permanente Northern California (KPNC) had higher initiation of long-acting reversible contraceptive (LARC) methods than women referred to contracted services and that LARC method initiation lowers risk for unintended pregnancy within 12 months. Methods: A retrospective cohort study was conducted of a randomized proportional sample of 12,671 women aged 15–44 receiving abortions (KPNC vs. contracted services) in 2011–2012 to determine LARC method initiation within 90 days. Demographic and clinical characteristics (age, race/ethnicity, gravidity, parity, method initiated, unintended pregnancy within 12 months) were collected from databases and medical records. Analysis included descriptive statistics, chi-square tests, t tests and logistic regression models to assess predictors of LARC method initiation and unintended pregnancy within 12 months. Results: On average, women who obtained an abortion within KPNC were older than those who received contracted services (29.8 vs. 26.6, pb.0001). The two groups differed significantly in age, race/ethnicity and gravidity. A LARC method was significantly less likely to be initiated within 90 days in the contracted service group compared with those receiving abortion within KPNC (12% vs. 19.1%, p=.012). Significant predictors of LARC method initiation within 90 days included KPNC abortion services (vs. contracted) (OR, 1.87, p=.007) and having had more than three pregnancies. The likelihood of unintended pregnancy was increased among women who were younger, Black or had had more than three pregnancies or no LARC method initiation. Outcomes: KPNC members who were referred to contracted providers for an abortion were less likely to initiate a LARC method, putting them at greater risk for future unintended pregnancy.
Chuang C Penn State College of Medicine, Hershey, PA, USA
http://dx.doi.org/10.1016/j.contraception.2015.06.126
Mitchell J, Velott D, Sciamanna C, Legro R, Lehman E, Confer L, Weisman C
P77
Objectives: The study objective was to determine whether privately insured women are aware of their contraceptive benefits under the Affordable Care Act (ACA), which mandates no out-of-pocket cost for contraception, including long-acting reversible contraceptive (LARC) methods. Methods: The MyNewOptions study is an ongoing randomized controlled trial of an online intervention to help adult women make informed contraceptive decisions. The sample includes 989 female Highmark Health members aged 18–40. After confirming eligibility (sexually active, not planning pregnancy in the next 12 months), participants completed a baseline survey, which included the question, “To the best of your knowledge, does your health insurance policy currently cover these birth control methods at no cost to you (no copay or deductible payment)?—tubal sterilization (‘tubes tied’), birth control pills, IUD.” Results: Less than 5% of women knew that their insurance covers tubal sterilization, and less than 12% knew that they have full IUD coverage. Most women (58%) were aware that they had full coverage for birth control pills. Nearly one in five women would change methods if they did not have to worry about cost, of whom 30% would switch to an IUD and 9% would switch to the implant. Outcomes: We report that privately insured women in the MyNewOptions study are largely unaware of their expanded contraceptive benefits under the ACA, including coverage for LARC methods. For the ACA contraceptive coverage mandate to increase use of effective methods, raising women's awareness of the expanded benefit is an essential first step.
Comparing contraceptive choices among postabortion patients with and without free access to long-acting reversible contraceptive (LARC) methods
http://dx.doi.org/10.1016/j.contraception.2015.06.124
P75
http://dx.doi.org/10.1016/j.contraception.2015.06.125
P76 Postabortion LARC method initiation by service providers and risk of subsequent unintended pregnancy
Goyal V University of Texas at Austin, Austin, TX, USA Aiken ARA, Dermish A, Potter JE Objectives: In 2014, a Medicaid 1115 waiver program offering free LARC methods to low-income uninsured Travis County residents was implemented at Planned Parenthood in Austin, Texas. We evaluated preabortion contraceptive desires and postabortion LARC method uptake among women who were and were not eligible for the program. Methods: We conducted a study of women aged 18–44 seeking abortion at Planned Parenthood. Participants completed a survey assessing program eligibility and contraceptive desires before the abortion. We then collected information on the methods women obtained at Planned Parenthood after their procedure. We compared method desires among women eligible and ineligible for the LARC program and used logistic regression to assess the impact of program eligibility on LARC method uptake. Results: Our sample of 446 women comprised 27% low-income, uninsured, Travis County residents eligible for the LARC program, 21% low-income, uninsured non-Travis County residents ineligible for the program and 50% insured or high-income women. Desire for LARC methods was high among all three groups: 65%, 55% and 55%, respectively (p=.18). Yet only 4% of low-income ineligible women received a LARC method postabortion compared with 67% of low-income eligible women and 22% of insured/high income women. When we adjusted for contraceptive desires and demographic characteristics, low-income uninsured women eligible for the program were far more likely than those ineligible to obtain a postabortion LARC method (OR, 71.9; 95% CI, 22.4–230.5).
386
ABSTRACTS / Contraception 92 (2015) 359–414
Outcomes: In states where abortion providers cannot receive state family planning funds, local programs offering low-income uninsured women free access to postabortion LARC methods can meet a critical demand for highly effective contraception. http://dx.doi.org/10.1016/j.contraception.2015.06.127
P78 Postpartum contraception: an assessment of lactation consultants' knowledge and attitudes Dunn K University of California, San Diego, San Diego, CA, USA
pregnancy than women with lower PAM scores (50% vs. 7%, p=.02). Higher PAM score remained a significant predictor for self-confidence after risk adjustment (OR, 3.13; 95% CI, 1.11–8.78, p=.031). Higher confidence in avoiding pregnancy was associated with use of a moderately or highly effective contraceptive method (43% vs. 14%, p=.047). Women with lower scores were less likely than their counterparts to receive contraceptive counseling during a healthcare visit in the prior month (0% vs. 57%, pb.01). Outcomes: Our findings suggest that patient activation is an important framework for understanding factors that influence women's contraceptive use, including self-confidence and receipt of contraceptive counseling in a primary care setting. http://dx.doi.org/10.1016/j.contraception.2015.06.129
P80
Mody S, Bayer L Objectives: Lactation consultants interact with patients during postpartum hospitalization but may not have comprehensive education on postpartum contraception and its impact on breastfeeding. We aimed to assess lactation consultants' knowledge and attitudes about postpartum contraception and whether they are interested in more education on postpartum contraception. Methods: A 30-question survey was sent to self-identified lactation consultants. Participants were recruited via email, social media and at the California Breastfeeding summit. Results were analyzed using SPSS. Results: A total of 195 lactation consultants were surveyed. Seventy-seven percent (137/177) said they offered advice about postpartum contraception and its impact on breastfeeding. The majority of lactation consultants felt that the theoretical or proven risk outweighed the benefits or there was unacceptable health risk if the contraceptive progestin injection [85%, (118/139)] or the contraceptive progestin implant [88% (122/139)] were used within 21 days of delivery. Sixty-nine percent (92/134) reported prior education on postpartum contraception, but 82% (110/134) reported they wanted more education on this topic, specifically in the form of a webinar [62%, (83/134)]. Only 29.8% (40/134) reported knowing that the Centers for Disease Control and Prevention has the United States Medical Eligibility Criteria (USMEC) for contraceptive use guidance for postpartum contraception. Outcomes: There is a disconnect between the USMEC guidance and lactation consultants' knowledge regarding the safety of immediate postpartum contraception. Increased efforts should be made to improve education regarding postpartum contraception for lactation consultants. http://dx.doi.org/10.1016/j.contraception.2015.06.128
P79 The role of patient activation in contraceptive use
Patterns of contraceptive prescription by family medicine providers for US women with cardiovascular disease Godfrey E University of Washington, Seattle, WA, USA Sutko A, Keppel G, West I, Baldwin L-M Objectives: We compared current contraceptive methods prescribed by family medicine providers for women with cardiovascular disease and women without chronic medical conditions. Methods: Electronic health record data were used to conduct a retrospective cohort study of female patients aged 15–49 who had at least one face-to-face clinical visit with a family medicine provider between July 1, 2011 and December 31, 2012 at a rural family medicine practice in the Pacific Northwest; postmenopausal women and women with a hysterectomy were excluded. Documented contraceptive methods were compared among women with cardiovascular disease and those without chronic medical conditions. Results: Among 123 women with cardiovascular disease and 477 women without chronic conditions, family medicine provider documentation of any contraceptive method was low (35% vs. 42%, p=.14). Among women with cardiovascular disease, combined hormonal contraceptive methods were the most prevalent (16%), followed by the injectable (11%). Use of a highly effective method, including sterilization, was similar among women with cardiovascular disease and women without chronic conditions (13% vs. 17%; p=.36). Outcomes: Women with cardiovascular disease who are considered at risk for pregnancy had low documented rates of method use by their family medicine providers. Findings suggest that many women with underlying cardiovascular disease may be inadequately protected from unintended pregnancy or are prescribed methods considered less safe for them than other highly effective methods, according to US national contraceptive guidelines.
Bello Kottenstette J NorthShore University HealthSystem, Evanston, IL, USA
http://dx.doi.org/10.1016/j.contraception.2015.06.130
Poston L, Hirshfeld M, Lapin B
P81
Objectives: Many unintended pregnancies occur because of contraceptive misuse and nonuse, which is partly due to lack of knowledge about contraception and low self-efficacy. We conducted a cross-sectional study among low-income women to examine the relationship between knowledge, skills and confidence in managing one's health, measured using the patient activation measure (PAM) and factors that influence women's contraceptive use. Methods: A survey and chart review were conducted among 18– 45-year-old women recruited from a community health center network in Chicago, IL, to measure the relationship between activation, self-confidence in avoiding pregnancy, contraceptive method use and contraceptive counseling. The associations between PAM and outcomes were evaluated using chi-square test and adjusted logistic regression models. Results: Among 112 participants (61% Latina, 15% Black, 14% White), we found no differences in PAM score by age, race/ethnicity or parity. Women with higher scores were more likely to be confident that they could avoid
Demand for modern family planning among married women living with HIV in western Ethiopia Melka AS Wollega University, Oromia, Nekemte, Ethiopia Feyissa TR Objectives: This study assessed the demand for modern family planning among married women living with HIV in western Ethiopia. Methods: A facility-based cross-sectional survey was conducted among 401 married women living with HIV selected from Nekemte Referral Hospital and Health Center. Convenience sampling of every other eligible patient was used to recruit respondents. Data were collected using a pretested, structured questionnaire. Frequencies and percentages were used to describe unmet need, met need and total demand by each explanatory variable. We then
385
Lee J Kaiser Permanente, Oakland, CA, USA Postlethwaite D, Merchant M, Alton K, Gupta P, Raine-Bennett T
Women's awareness of their contraceptive benefits after the Affordable Care Act
Objectives: We hypothesized that women receiving abortions within Kaiser Permanente Northern California (KPNC) had higher initiation of long-acting reversible contraceptive (LARC) methods than women referred to contracted services and that LARC method initiation lowers risk for unintended pregnancy within 12 months. Methods: A retrospective cohort study was conducted of a randomized proportional sample of 12,671 women aged 15–44 receiving abortions (KPNC vs. contracted services) in 2011–2012 to determine LARC method initiation within 90 days. Demographic and clinical characteristics (age, race/ethnicity, gravidity, parity, method initiated, unintended pregnancy within 12 months) were collected from databases and medical records. Analysis included descriptive statistics, chi-square tests, t tests and logistic regression models to assess predictors of LARC method initiation and unintended pregnancy within 12 months. Results: On average, women who obtained an abortion within KPNC were older than those who received contracted services (29.8 vs. 26.6, pb.0001). The two groups differed significantly in age, race/ethnicity and gravidity. A LARC method was significantly less likely to be initiated within 90 days in the contracted service group compared with those receiving abortion within KPNC (12% vs. 19.1%, p=.012). Significant predictors of LARC method initiation within 90 days included KPNC abortion services (vs. contracted) (OR, 1.87, p=.007) and having had more than three pregnancies. The likelihood of unintended pregnancy was increased among women who were younger, Black or had had more than three pregnancies or no LARC method initiation. Outcomes: KPNC members who were referred to contracted providers for an abortion were less likely to initiate a LARC method, putting them at greater risk for future unintended pregnancy.
Chuang C Penn State College of Medicine, Hershey, PA, USA
http://dx.doi.org/10.1016/j.contraception.2015.06.126
Mitchell J, Velott D, Sciamanna C, Legro R, Lehman E, Confer L, Weisman C
P77
Objectives: The study objective was to determine whether privately insured women are aware of their contraceptive benefits under the Affordable Care Act (ACA), which mandates no out-of-pocket cost for contraception, including long-acting reversible contraceptive (LARC) methods. Methods: The MyNewOptions study is an ongoing randomized controlled trial of an online intervention to help adult women make informed contraceptive decisions. The sample includes 989 female Highmark Health members aged 18–40. After confirming eligibility (sexually active, not planning pregnancy in the next 12 months), participants completed a baseline survey, which included the question, “To the best of your knowledge, does your health insurance policy currently cover these birth control methods at no cost to you (no copay or deductible payment)?—tubal sterilization (‘tubes tied’), birth control pills, IUD.” Results: Less than 5% of women knew that their insurance covers tubal sterilization, and less than 12% knew that they have full IUD coverage. Most women (58%) were aware that they had full coverage for birth control pills. Nearly one in five women would change methods if they did not have to worry about cost, of whom 30% would switch to an IUD and 9% would switch to the implant. Outcomes: We report that privately insured women in the MyNewOptions study are largely unaware of their expanded contraceptive benefits under the ACA, including coverage for LARC methods. For the ACA contraceptive coverage mandate to increase use of effective methods, raising women's awareness of the expanded benefit is an essential first step.
Comparing contraceptive choices among postabortion patients with and without free access to long-acting reversible contraceptive (LARC) methods
http://dx.doi.org/10.1016/j.contraception.2015.06.124
P75
http://dx.doi.org/10.1016/j.contraception.2015.06.125
P76 Postabortion LARC method initiation by service providers and risk of subsequent unintended pregnancy
Goyal V University of Texas at Austin, Austin, TX, USA Aiken ARA, Dermish A, Potter JE Objectives: In 2014, a Medicaid 1115 waiver program offering free LARC methods to low-income uninsured Travis County residents was implemented at Planned Parenthood in Austin, Texas. We evaluated preabortion contraceptive desires and postabortion LARC method uptake among women who were and were not eligible for the program. Methods: We conducted a study of women aged 18–44 seeking abortion at Planned Parenthood. Participants completed a survey assessing program eligibility and contraceptive desires before the abortion. We then collected information on the methods women obtained at Planned Parenthood after their procedure. We compared method desires among women eligible and ineligible for the LARC program and used logistic regression to assess the impact of program eligibility on LARC method uptake. Results: Our sample of 446 women comprised 27% low-income, uninsured, Travis County residents eligible for the LARC program, 21% low-income, uninsured non-Travis County residents ineligible for the program and 50% insured or high-income women. Desire for LARC methods was high among all three groups: 65%, 55% and 55%, respectively (p=.18). Yet only 4% of low-income ineligible women received a LARC method postabortion compared with 67% of low-income eligible women and 22% of insured/high income women. When we adjusted for contraceptive desires and demographic characteristics, low-income uninsured women eligible for the program were far more likely than those ineligible to obtain a postabortion LARC method (OR, 71.9; 95% CI, 22.4–230.5).
386
ABSTRACTS / Contraception 92 (2015) 359–414
Outcomes: In states where abortion providers cannot receive state family planning funds, local programs offering low-income uninsured women free access to postabortion LARC methods can meet a critical demand for highly effective contraception. http://dx.doi.org/10.1016/j.contraception.2015.06.127
P78 Postpartum contraception: an assessment of lactation consultants' knowledge and attitudes Dunn K University of California, San Diego, San Diego, CA, USA
pregnancy than women with lower PAM scores (50% vs. 7%, p=.02). Higher PAM score remained a significant predictor for self-confidence after risk adjustment (OR, 3.13; 95% CI, 1.11–8.78, p=.031). Higher confidence in avoiding pregnancy was associated with use of a moderately or highly effective contraceptive method (43% vs. 14%, p=.047). Women with lower scores were less likely than their counterparts to receive contraceptive counseling during a healthcare visit in the prior month (0% vs. 57%, pb.01). Outcomes: Our findings suggest that patient activation is an important framework for understanding factors that influence women's contraceptive use, including self-confidence and receipt of contraceptive counseling in a primary care setting. http://dx.doi.org/10.1016/j.contraception.2015.06.129
P80
Mody S, Bayer L Objectives: Lactation consultants interact with patients during postpartum hospitalization but may not have comprehensive education on postpartum contraception and its impact on breastfeeding. We aimed to assess lactation consultants' knowledge and attitudes about postpartum contraception and whether they are interested in more education on postpartum contraception. Methods: A 30-question survey was sent to self-identified lactation consultants. Participants were recruited via email, social media and at the California Breastfeeding summit. Results were analyzed using SPSS. Results: A total of 195 lactation consultants were surveyed. Seventy-seven percent (137/177) said they offered advice about postpartum contraception and its impact on breastfeeding. The majority of lactation consultants felt that the theoretical or proven risk outweighed the benefits or there was unacceptable health risk if the contraceptive progestin injection [85%, (118/139)] or the contraceptive progestin implant [88% (122/139)] were used within 21 days of delivery. Sixty-nine percent (92/134) reported prior education on postpartum contraception, but 82% (110/134) reported they wanted more education on this topic, specifically in the form of a webinar [62%, (83/134)]. Only 29.8% (40/134) reported knowing that the Centers for Disease Control and Prevention has the United States Medical Eligibility Criteria (USMEC) for contraceptive use guidance for postpartum contraception. Outcomes: There is a disconnect between the USMEC guidance and lactation consultants' knowledge regarding the safety of immediate postpartum contraception. Increased efforts should be made to improve education regarding postpartum contraception for lactation consultants. http://dx.doi.org/10.1016/j.contraception.2015.06.128
P79 The role of patient activation in contraceptive use
Patterns of contraceptive prescription by family medicine providers for US women with cardiovascular disease Godfrey E University of Washington, Seattle, WA, USA Sutko A, Keppel G, West I, Baldwin L-M Objectives: We compared current contraceptive methods prescribed by family medicine providers for women with cardiovascular disease and women without chronic medical conditions. Methods: Electronic health record data were used to conduct a retrospective cohort study of female patients aged 15–49 who had at least one face-to-face clinical visit with a family medicine provider between July 1, 2011 and December 31, 2012 at a rural family medicine practice in the Pacific Northwest; postmenopausal women and women with a hysterectomy were excluded. Documented contraceptive methods were compared among women with cardiovascular disease and those without chronic medical conditions. Results: Among 123 women with cardiovascular disease and 477 women without chronic conditions, family medicine provider documentation of any contraceptive method was low (35% vs. 42%, p=.14). Among women with cardiovascular disease, combined hormonal contraceptive methods were the most prevalent (16%), followed by the injectable (11%). Use of a highly effective method, including sterilization, was similar among women with cardiovascular disease and women without chronic conditions (13% vs. 17%; p=.36). Outcomes: Women with cardiovascular disease who are considered at risk for pregnancy had low documented rates of method use by their family medicine providers. Findings suggest that many women with underlying cardiovascular disease may be inadequately protected from unintended pregnancy or are prescribed methods considered less safe for them than other highly effective methods, according to US national contraceptive guidelines.
Bello Kottenstette J NorthShore University HealthSystem, Evanston, IL, USA
http://dx.doi.org/10.1016/j.contraception.2015.06.130
Poston L, Hirshfeld M, Lapin B
P81
Objectives: Many unintended pregnancies occur because of contraceptive misuse and nonuse, which is partly due to lack of knowledge about contraception and low self-efficacy. We conducted a cross-sectional study among low-income women to examine the relationship between knowledge, skills and confidence in managing one's health, measured using the patient activation measure (PAM) and factors that influence women's contraceptive use. Methods: A survey and chart review were conducted among 18– 45-year-old women recruited from a community health center network in Chicago, IL, to measure the relationship between activation, self-confidence in avoiding pregnancy, contraceptive method use and contraceptive counseling. The associations between PAM and outcomes were evaluated using chi-square test and adjusted logistic regression models. Results: Among 112 participants (61% Latina, 15% Black, 14% White), we found no differences in PAM score by age, race/ethnicity or parity. Women with higher scores were more likely to be confident that they could avoid
Demand for modern family planning among married women living with HIV in western Ethiopia Melka AS Wollega University, Oromia, Nekemte, Ethiopia Feyissa TR Objectives: This study assessed the demand for modern family planning among married women living with HIV in western Ethiopia. Methods: A facility-based cross-sectional survey was conducted among 401 married women living with HIV selected from Nekemte Referral Hospital and Health Center. Convenience sampling of every other eligible patient was used to recruit respondents. Data were collected using a pretested, structured questionnaire. Frequencies and percentages were used to describe unmet need, met need and total demand by each explanatory variable. We then