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Addressing reproductive coercion in family medicine residency programs
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Abstracts / Contraception 94 (2016) 387–434
service utilization between women enrolled in commercial plans with and without costsharing for IUD placement. Methods: We included women aged 15–45 with continuous enrollment throughout 2014 and any contraception-related service claim or method fill in the Optum™ Clinformatics™ Data Mart. Using a patient-level analysis, we compared demographic characteristics and health service utilization (health maintenance examination, any family planning visit or IUD-related visit) between women in plans with and without costsharing for IUD placement. Results: Among eligible women (n=537,923), some 226,025 (42%) were enrolled in plans with cost-sharing for IUD placement. Compared with women in plans without cost-sharing, women in plans that did were significantly less likely to be White (65.0% vs. 69.7%, pb.001) and to report low income (18.8% vs. 20.8% household income bUS$50,000/year; p=.004). Similar proportions of women had had a health maintenance examination (55.1% vs. 55.2%, p=.96) and a family planning visit (16.3% vs. 16.9%, p=.25), but significantly fewer women in plans with cost-sharing had had any IUD-related visit (7.3% vs. 9.4%, pb.001) in 2014. Conclusions: Many women continue to be enrolled in plans with cost-sharing for IUD placement. These women are less likely to be White and to be from low-income households. Women enrolled in health plans with cost-sharing for IUD placement have fewer IUD-related office visits. http://dx.doi.org/10.1016/j.contraception.2016.07.184
144 OPERATIONALIZING PREGNANCY SUPPORTABILITY IN YOUNG COUPLES' PREGNANCY INTENTIONS Arcara J University of California, Berkeley, Berkeley, CA, USA Arteaga S, Freihart B, Villaseñor E, Gomez A Objectives: The construct of pregnancy supportability conceptualizes that personal, emotional, cognitive and physiological capacities for pregnancy are enabled or constrained by micro-level (e.g., relationships) and macro-level (e.g., societal norms) interactions. Supportability recognizes the myriad influences that empower or restrict realization of childbearing goals, distinct from dominant frameworks that narrowly define intended and unintended pregnancies with a solely individual lens. We employ this framework to assess aspects of supportability among young couples. Methods: Interview data from 50 young (aged 18–24) women and their male partners (n=100) were used to understand couple-level perspectives on the supportability of pregnancy. Results: Interviews illuminated the complexity of couples' considerations of pregnancy planning. Couples described personal and microlevel factors that would make pregnancy supportable or unsupportable, such as educational goals, relationship strength and family (dis)approval. Macro-level factors raised included cultural expectations for timing of parenthood and financial and housing (in)stability. Whether factors were considered supportive or nonsupportive varied by relationship status, socioeconomic status and experience of structural inequities. Conclusions: Couples considered the possibility of pregnancy from multiple levels, and some pregnancy decisions were influenced by or made in spite of perceptions of supportability or unsupportability. A more nuanced understanding of the multilevel and structural forces that affect young people's experiences, pregnancy intentions and health outcomes is needed to improve family planning research and care. http://dx.doi.org/10.1016/j.contraception.2016.07.185
145 THE ASSOCIATION BETWEEN INTIMATE PARTNER VIOLENCE AND CONDOM USE IN 36 LOW-AND MIDDLE-INCOME COUNTRIES Maxwell L McGill University, Montreal, QC, Canada Brahmbhatt H, Devries K, Benedetti A, Wagman J, Moreno CG, Nandi A
Objectives: The causal relationship between intimate partner violence (IPV) and HIV is poorly understood. We used the most recent Demographic and Health Surveys from all countries that applied the Reproductive Health Calendar and that measured women's exposure to physical, sexual or emotional IPV to estimate the association between women's past-year experience of IPV and current condom use. Methods: We applied propensity score matching within each country and iteratively selected the matching algorithm and caliper that resulted in the highest reduction in mean bias. Because confounders are not measured consistently across countries, we used two-stage random effects meta-analysis to produce country-level and pooled estimates for the matched and the unmatched samples. We explored whether the relationship between IPV and condom use was modified by male controlling behaviors and by the frequency of abuse in the subset of countries that collected that information. We used meta-regression to assess whether the relationship between IPV and condom use was modified by country-level HIV prevalence. Results: Country-level estimates from the matched sample differed significantly from full-sample estimates. The association between IPV and condom use varied across countries, with estimates on either side of the null value. In pooled analysis, IPV was not significantly associated with condom use (N=265,311; OR, 0.93; 95% CI, 0.83–1.05). HIV prevalence did not explain cross-country variation (OR, 0.99; 95% CI, 0.95–1.02). Conclusions: Cross-national studies of the association between IPV and condom use mask intercountry heterogeneity. Future research should explore sources of heterogeneity in cross-country estimates of the association between IPV and condom use. http://dx.doi.org/10.1016/j.contraception.2016.07.186
146 ADDRESSING REPRODUCTIVE COERCION IN FAMILY MEDICINE RESIDENCY PROGRAMS Rosenstein H Albert Einstein College of Medicine, Bronx, NY, USA Bennett A, Gold M Objectives: Reproductive coercion includes attempts to impregnate a partner against her will, control outcomes of a pregnancy, coerce a partner to have unprotected sex and interfere with contraception. There are limited data about how health care providers are addressing reproductive coercion. This study assessed the extent of teaching about reproductive coercion in US family medicine residency programs and also assessed knowledge, attitudes and practices about reproductive coercion among family medicine residents. Methods: This was a cross-sectional survey of residents affiliated with Reproductive Health EDucation In Family Medicine and getLARC programs, which receive support and funding for training about family planning. Links to a 26-item online survey were emailed to 832 residents at 27 programs. Results: Some 498 residents completed the survey (59.9%). Less than half of respondents (48%) had ever heard of reproductive coercion. Almost all residents (97%) agreed that it is their job to ask about reproductive coercion, but most (85%) had not received any training about it. Barriers to addressing reproductive coercion included a lack of knowledge (65%), lack of resources/referrals for patients dealing with reproductive coercion (50%) and a lack of time (40%). Residents had limited experience addressing this topic with patients — about one third (38%) of respondents had brought up the topic with a patient. Almost all respondents (98%) agreed that residents at their program would benefit from training about reproductive coercion. Conclusions: Family medicine residents do not have didactic or clinical experience with reproductive coercion. However, they are interested in further training. Training to increase knowledge of and comfort with talking to patients about reproductive coercion could enhance patient-centered discussions about contraception and pregnancy options. http://dx.doi.org/10.1016/j.contraception.2016.07.187
Abstracts / Contraception 94 (2016) 387–434
service utilization between women enrolled in commercial plans with and without costsharing for IUD placement. Methods: We included women aged 15–45 with continuous enrollment throughout 2014 and any contraception-related service claim or method fill in the Optum™ Clinformatics™ Data Mart. Using a patient-level analysis, we compared demographic characteristics and health service utilization (health maintenance examination, any family planning visit or IUD-related visit) between women in plans with and without costsharing for IUD placement. Results: Among eligible women (n=537,923), some 226,025 (42%) were enrolled in plans with cost-sharing for IUD placement. Compared with women in plans without cost-sharing, women in plans that did were significantly less likely to be White (65.0% vs. 69.7%, pb.001) and to report low income (18.8% vs. 20.8% household income bUS$50,000/year; p=.004). Similar proportions of women had had a health maintenance examination (55.1% vs. 55.2%, p=.96) and a family planning visit (16.3% vs. 16.9%, p=.25), but significantly fewer women in plans with cost-sharing had had any IUD-related visit (7.3% vs. 9.4%, pb.001) in 2014. Conclusions: Many women continue to be enrolled in plans with cost-sharing for IUD placement. These women are less likely to be White and to be from low-income households. Women enrolled in health plans with cost-sharing for IUD placement have fewer IUD-related office visits. http://dx.doi.org/10.1016/j.contraception.2016.07.184
144 OPERATIONALIZING PREGNANCY SUPPORTABILITY IN YOUNG COUPLES' PREGNANCY INTENTIONS Arcara J University of California, Berkeley, Berkeley, CA, USA Arteaga S, Freihart B, Villaseñor E, Gomez A Objectives: The construct of pregnancy supportability conceptualizes that personal, emotional, cognitive and physiological capacities for pregnancy are enabled or constrained by micro-level (e.g., relationships) and macro-level (e.g., societal norms) interactions. Supportability recognizes the myriad influences that empower or restrict realization of childbearing goals, distinct from dominant frameworks that narrowly define intended and unintended pregnancies with a solely individual lens. We employ this framework to assess aspects of supportability among young couples. Methods: Interview data from 50 young (aged 18–24) women and their male partners (n=100) were used to understand couple-level perspectives on the supportability of pregnancy. Results: Interviews illuminated the complexity of couples' considerations of pregnancy planning. Couples described personal and microlevel factors that would make pregnancy supportable or unsupportable, such as educational goals, relationship strength and family (dis)approval. Macro-level factors raised included cultural expectations for timing of parenthood and financial and housing (in)stability. Whether factors were considered supportive or nonsupportive varied by relationship status, socioeconomic status and experience of structural inequities. Conclusions: Couples considered the possibility of pregnancy from multiple levels, and some pregnancy decisions were influenced by or made in spite of perceptions of supportability or unsupportability. A more nuanced understanding of the multilevel and structural forces that affect young people's experiences, pregnancy intentions and health outcomes is needed to improve family planning research and care. http://dx.doi.org/10.1016/j.contraception.2016.07.185
145 THE ASSOCIATION BETWEEN INTIMATE PARTNER VIOLENCE AND CONDOM USE IN 36 LOW-AND MIDDLE-INCOME COUNTRIES Maxwell L McGill University, Montreal, QC, Canada Brahmbhatt H, Devries K, Benedetti A, Wagman J, Moreno CG, Nandi A
Objectives: The causal relationship between intimate partner violence (IPV) and HIV is poorly understood. We used the most recent Demographic and Health Surveys from all countries that applied the Reproductive Health Calendar and that measured women's exposure to physical, sexual or emotional IPV to estimate the association between women's past-year experience of IPV and current condom use. Methods: We applied propensity score matching within each country and iteratively selected the matching algorithm and caliper that resulted in the highest reduction in mean bias. Because confounders are not measured consistently across countries, we used two-stage random effects meta-analysis to produce country-level and pooled estimates for the matched and the unmatched samples. We explored whether the relationship between IPV and condom use was modified by male controlling behaviors and by the frequency of abuse in the subset of countries that collected that information. We used meta-regression to assess whether the relationship between IPV and condom use was modified by country-level HIV prevalence. Results: Country-level estimates from the matched sample differed significantly from full-sample estimates. The association between IPV and condom use varied across countries, with estimates on either side of the null value. In pooled analysis, IPV was not significantly associated with condom use (N=265,311; OR, 0.93; 95% CI, 0.83–1.05). HIV prevalence did not explain cross-country variation (OR, 0.99; 95% CI, 0.95–1.02). Conclusions: Cross-national studies of the association between IPV and condom use mask intercountry heterogeneity. Future research should explore sources of heterogeneity in cross-country estimates of the association between IPV and condom use. http://dx.doi.org/10.1016/j.contraception.2016.07.186
146 ADDRESSING REPRODUCTIVE COERCION IN FAMILY MEDICINE RESIDENCY PROGRAMS Rosenstein H Albert Einstein College of Medicine, Bronx, NY, USA Bennett A, Gold M Objectives: Reproductive coercion includes attempts to impregnate a partner against her will, control outcomes of a pregnancy, coerce a partner to have unprotected sex and interfere with contraception. There are limited data about how health care providers are addressing reproductive coercion. This study assessed the extent of teaching about reproductive coercion in US family medicine residency programs and also assessed knowledge, attitudes and practices about reproductive coercion among family medicine residents. Methods: This was a cross-sectional survey of residents affiliated with Reproductive Health EDucation In Family Medicine and getLARC programs, which receive support and funding for training about family planning. Links to a 26-item online survey were emailed to 832 residents at 27 programs. Results: Some 498 residents completed the survey (59.9%). Less than half of respondents (48%) had ever heard of reproductive coercion. Almost all residents (97%) agreed that it is their job to ask about reproductive coercion, but most (85%) had not received any training about it. Barriers to addressing reproductive coercion included a lack of knowledge (65%), lack of resources/referrals for patients dealing with reproductive coercion (50%) and a lack of time (40%). Residents had limited experience addressing this topic with patients — about one third (38%) of respondents had brought up the topic with a patient. Almost all respondents (98%) agreed that residents at their program would benefit from training about reproductive coercion. Conclusions: Family medicine residents do not have didactic or clinical experience with reproductive coercion. However, they are interested in further training. Training to increase knowledge of and comfort with talking to patients about reproductive coercion could enhance patient-centered discussions about contraception and pregnancy options. http://dx.doi.org/10.1016/j.contraception.2016.07.187