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Concurrent use of multiple contraceptive methods in the United States
Abstracts / Contraception 96 (2017) 263–306
Conclusions: Baseline demographic and attitudinal factors have limited predictive value for early discontinuation. The majority of young LARC initiators continued their methods for at least 2.5 years. While more women discontinued the implant before 30 months, the IUD discontinuations happened sooner than implant discontinuations. http://dx.doi.org/10.1016/j.contraception.2017.07.086
P57 Unfulfilled postpartum sterilization intent before and after introduction of immediate postpartum long-acting reversible contraception RH Cohen University of Colorado, Aurora, CO, USA J Sheeder Objectives: Publicly insured women face many barriers to obtaining a desired postpartum sterilization prior to hospital discharge, including postpartum complications, staff availability, patient concerns or lack of required advance consent forms. LARC methods are an alternative to postpartum sterilization. We aimed to assess whether the proportion of women discharged with highly effective postpartum contraception (tubal ligation, IUD or implant) increased when postpartum LARC methods were offered prior to discharge. Methods: This retrospective chart review utilized data from the University of Colorado Hospital. We included women aged 21 or older with primary Medicaid coverage who desired sterilization at admission for delivery. The study compared groups before and after Medicaid coverage of inpatient postpartum LARC methods. We described barriers to intended sterilization, and using multivariable logistic regression, we described factors associated with highly effective contraceptive initiation. Results: Of 206 women who desired postpartum sterilization, 66.0% underwent the procedure before discharge (69.9% before postpartum LARC was offered, 62.1% afterward; p=.30). Few women in the cohort initiated implants (3.9%), and none initiated IUDs when these methods were offered prior to hospital discharge. The most common barrier among women who did not obtain a desired postpartum sterilization was lack of advance consent forms (37.1%). Cesarean delivery (aOR, 20.0; 95% CI, 7.0–57.3) had the strongest association with initiating highly effective contraception. Conclusions: Availability of inpatient postpartum LARC methods did not significantly increase rates of highly effective contraceptive initiation before hospital discharge among publicly insured women. Providers should ensure that advance consent forms are signed and individualize plans for alternate contraception prior to admission for delivery. http://dx.doi.org/10.1016/j.contraception.2017.07.087
P58 A comprehensive reproductive health needs assessment for syringe exchange program participants MS Tschann John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA J Elia, J Salcedo, R Soon, B Kaneshiro Objectives: We aimed to describe the reproductive health needs of female participants in Hawaii’s syringe-exchange program. Methods: We conducted a written survey among female syringe exchange program participants as part of a three-armed needs assessment, which also included a participant focus group and community stakeholder interviews. Our survey’s convenience sample consisted of female program participants recruited at the program site.
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Results: We received surveys from 50 program participants, after which point it was determined that all female participants had been approached. Most respondents were homeless or had temporary housing (74%, n=37), and 34 (68%) were of reproductive age. Participants ranked their overall health needs as (1) hygiene/cleanliness, (2) physical safety and (3) sexually transmitted infection (STI)/HIV testing. The majority of reproductive-aged respondents (62%, n=21/34) did not want to become pregnant in the next year, but 81% (n=17/21) reported using no current contraceptive method. Participants were interested in a contraceptive method that lasted months, rather than days or years. Because menstrual hygiene and personal security were challenges for program participants, bleeding pattern and method storage requirements were important considerations when choosing a method. Conclusions: While program participants did not include contraception as a primary health care concern, most endorsed unmet contraceptive need. These survey results will inform the other phases of the needs assessment. Collectively, the findings from the three arms of this assessment will be analyzed to identify interventions that could comprehensively address the reproductive, safety and general health care needs expressed by female program participants. http://dx.doi.org/10.1016/j.contraception.2017.07.088
P59 Concurrent use of multiple contraceptive methods in the United States ML Kavanaugh Guttmacher Institute, New York, NY, USA J Jerman Objectives: We aimed to identify the prevalence of, characteristics associated with, and combinations of use of more than one contraceptive method at last intercourse among U.S. women between 2008 and 2014. Methods: We conducted simple and multivariable logistic regression analyses using data on concurrent contraceptive use from two nationally representative samples of women aged 15–44 who had used some form of contraception at last intercourse in the past 3 months in the 2006–2010 (n=6624) and 2013– 2015 (n=3027) cycles of the National Survey of Family Growth. Results: Use of more than one contraceptive method at last sex increased from 14% in 2008 to 17% in 2014 (p=.01). This increase was driven primarily by women aged 25–29 (p=.009) and non-Hispanic white women (p=.002). In 2014, women who were not partnered (aOR, 4.1; pb.001) and women with higher education (aOR, 1.9; p=.002) had increased odds of multiple method use. The odds were decreased among women aged 30–39 (aOR, 0.5; p=.012), non-Hispanic black women (aOR, 0.7; p=.046) and Hispanic women (aOR, 0.4; p b.001). The most common method combinations were short-acting hormonal methods combined with condoms (35%) or withdrawal (16%); some 6% of women combined LARC with condoms. Conclusions: A sizable proportion of U.S. women use more than one contraceptive method during sex; current estimates of contraceptive use focused exclusively on single-method use may underestimate the extent to which women are protected from unintended pregnancy. http://dx.doi.org/10.1016/j.contraception.2017.07.089
P60 Associations between contraceptive counseling practices and patient satisfaction HR Simons Planned Parenthood Federation of America, New York, NY, USA J Leon-Atkins, H Spector, G Fager, L Kantor, JE Kohn Objectives: We aimed to assess associations between contraceptive counseling practices and patient-reported satisfaction with the counselor, counseling and
Conclusions: Baseline demographic and attitudinal factors have limited predictive value for early discontinuation. The majority of young LARC initiators continued their methods for at least 2.5 years. While more women discontinued the implant before 30 months, the IUD discontinuations happened sooner than implant discontinuations. http://dx.doi.org/10.1016/j.contraception.2017.07.086
P57 Unfulfilled postpartum sterilization intent before and after introduction of immediate postpartum long-acting reversible contraception RH Cohen University of Colorado, Aurora, CO, USA J Sheeder Objectives: Publicly insured women face many barriers to obtaining a desired postpartum sterilization prior to hospital discharge, including postpartum complications, staff availability, patient concerns or lack of required advance consent forms. LARC methods are an alternative to postpartum sterilization. We aimed to assess whether the proportion of women discharged with highly effective postpartum contraception (tubal ligation, IUD or implant) increased when postpartum LARC methods were offered prior to discharge. Methods: This retrospective chart review utilized data from the University of Colorado Hospital. We included women aged 21 or older with primary Medicaid coverage who desired sterilization at admission for delivery. The study compared groups before and after Medicaid coverage of inpatient postpartum LARC methods. We described barriers to intended sterilization, and using multivariable logistic regression, we described factors associated with highly effective contraceptive initiation. Results: Of 206 women who desired postpartum sterilization, 66.0% underwent the procedure before discharge (69.9% before postpartum LARC was offered, 62.1% afterward; p=.30). Few women in the cohort initiated implants (3.9%), and none initiated IUDs when these methods were offered prior to hospital discharge. The most common barrier among women who did not obtain a desired postpartum sterilization was lack of advance consent forms (37.1%). Cesarean delivery (aOR, 20.0; 95% CI, 7.0–57.3) had the strongest association with initiating highly effective contraception. Conclusions: Availability of inpatient postpartum LARC methods did not significantly increase rates of highly effective contraceptive initiation before hospital discharge among publicly insured women. Providers should ensure that advance consent forms are signed and individualize plans for alternate contraception prior to admission for delivery. http://dx.doi.org/10.1016/j.contraception.2017.07.087
P58 A comprehensive reproductive health needs assessment for syringe exchange program participants MS Tschann John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA J Elia, J Salcedo, R Soon, B Kaneshiro Objectives: We aimed to describe the reproductive health needs of female participants in Hawaii’s syringe-exchange program. Methods: We conducted a written survey among female syringe exchange program participants as part of a three-armed needs assessment, which also included a participant focus group and community stakeholder interviews. Our survey’s convenience sample consisted of female program participants recruited at the program site.
285
Results: We received surveys from 50 program participants, after which point it was determined that all female participants had been approached. Most respondents were homeless or had temporary housing (74%, n=37), and 34 (68%) were of reproductive age. Participants ranked their overall health needs as (1) hygiene/cleanliness, (2) physical safety and (3) sexually transmitted infection (STI)/HIV testing. The majority of reproductive-aged respondents (62%, n=21/34) did not want to become pregnant in the next year, but 81% (n=17/21) reported using no current contraceptive method. Participants were interested in a contraceptive method that lasted months, rather than days or years. Because menstrual hygiene and personal security were challenges for program participants, bleeding pattern and method storage requirements were important considerations when choosing a method. Conclusions: While program participants did not include contraception as a primary health care concern, most endorsed unmet contraceptive need. These survey results will inform the other phases of the needs assessment. Collectively, the findings from the three arms of this assessment will be analyzed to identify interventions that could comprehensively address the reproductive, safety and general health care needs expressed by female program participants. http://dx.doi.org/10.1016/j.contraception.2017.07.088
P59 Concurrent use of multiple contraceptive methods in the United States ML Kavanaugh Guttmacher Institute, New York, NY, USA J Jerman Objectives: We aimed to identify the prevalence of, characteristics associated with, and combinations of use of more than one contraceptive method at last intercourse among U.S. women between 2008 and 2014. Methods: We conducted simple and multivariable logistic regression analyses using data on concurrent contraceptive use from two nationally representative samples of women aged 15–44 who had used some form of contraception at last intercourse in the past 3 months in the 2006–2010 (n=6624) and 2013– 2015 (n=3027) cycles of the National Survey of Family Growth. Results: Use of more than one contraceptive method at last sex increased from 14% in 2008 to 17% in 2014 (p=.01). This increase was driven primarily by women aged 25–29 (p=.009) and non-Hispanic white women (p=.002). In 2014, women who were not partnered (aOR, 4.1; pb.001) and women with higher education (aOR, 1.9; p=.002) had increased odds of multiple method use. The odds were decreased among women aged 30–39 (aOR, 0.5; p=.012), non-Hispanic black women (aOR, 0.7; p=.046) and Hispanic women (aOR, 0.4; p b.001). The most common method combinations were short-acting hormonal methods combined with condoms (35%) or withdrawal (16%); some 6% of women combined LARC with condoms. Conclusions: A sizable proportion of U.S. women use more than one contraceptive method during sex; current estimates of contraceptive use focused exclusively on single-method use may underestimate the extent to which women are protected from unintended pregnancy. http://dx.doi.org/10.1016/j.contraception.2017.07.089
P60 Associations between contraceptive counseling practices and patient satisfaction HR Simons Planned Parenthood Federation of America, New York, NY, USA J Leon-Atkins, H Spector, G Fager, L Kantor, JE Kohn Objectives: We aimed to assess associations between contraceptive counseling practices and patient-reported satisfaction with the counselor, counseling and