- Email: [email protected]
Correlates of long-acting reversible methods of contraception use among young women from 2002 to 2008
316
Abstracts / Contraception 84 (2011) 302–336
required to offer medication abortion. Providers interested in offering medication abortion appear to be primarily motivated by attitudes that it improves patient care. Our findings underscore the importance of improving medication abortion knowledge among adolescent medicine providers.
P28
CONSEQUENCES OF DELAYS FOR WOMEN SEEKING STATE-SUBSIDIZED INSURANCE FOR ABORTION CARE IN THE COMMONWEALTH OF MASSACHUSETTS Bessett D University of Cincinnati, Cincinnati, OH, USA Gorski K, Ostrow M, Jinadasa D, Peterson MJ Objectives: To learn about women's experiences applying for subsidized insurance and its use for abortion services under Massachusetts's health care reform. Methods: We interviewed low-income women presumed eligible for subsidized insurance about 1 month after contact with Massachusetts abortion funds. Results: Thirty-nine (43%) of 91 potential subjects agreed to be interviewed. More than half of those interviewed described delaying their abortions while trying to secure subsidized insurance; the average reported delay was about 17 days. Women reported stress while managing symptoms without disclosing the pregnancy and worried about affordability as time went on. Delays also increased travel time to alternate providers. Only 11 of the 32 who applied for subsidized insurance secured coverage of their abortion. One woman had a miscarriage before becoming insured. Nineteen paid out of pocket or in combination with a philanthropic abortion fund to pay for their care, usually because they were approaching a fee increase. Delays also limited women's ability to obtain medication abortion; one woman decided to continue her pregnancy once she was unable to obtain medication abortion. Another woman “timed out” of an in-state surgical abortion when she was unable to obtain insurance quickly and she also continued the pregnancy. Conclusions: Delays in enrollment for subsidized insurance led women to postpone abortion care and transferred the economic burden from the state to women and philanthropic abortion funds. Intangible costs included stress, prolonged pregnancy symptoms, increased travel time and limited access to medication abortion. Delays completely prevented two women from obtaining the abortions they sought. Enrollment procedures for subsidized insurance in Massachusetts need improvement.
almost exclusively in Vancouver and Victoria. Since 1995, BC has experienced an estimated decline in the number of abortion providers offering services at hospitals outside the clinic system of upwards of 60%, and a 65% decline in the number of abortions provided in such hospitals. Conclusions: BC abortion rates are not following Canadian declining trends and are increasingly available only in clinics located in large population centers. Accessibility for women in rural and remote locations has declined 65% from 1995 to 2005.
P30
NO IMPROVEMENT IN EMERGENCY CONTRACEPTION PROVISION AFTER SEXUAL ASSAULT: A NATIONAL SURVEY, 2004 AND 2009 Patel A John H. Stroger Jr., Hospital of Cook County, Chicago, IL, USA Tilmon S, Sheth A, Nguyen L, Chaparala S, Bhogireddy V, Chor J, Patel D, Keith L Objectives: To compare information obtained in surveys of US emergency departments in 2004 and 2009 about the provision of and counseling for emergency contraception to sexual assault victims. Methods: We conducted a cross-sectional prevalence survey on a representative sample of 20% of hospitals, stratified by state and territory, using a list provided by the American Hospital Association in 2004 and 2009. We administered our 13-question telephone survey to emergency department personnel in order to assess emergency department practices regarding provision and counseling of emergency contraception for sexual assault victims. Results: Survey response rates in 2004 and 2009 were 89% and 84%, respectively. The prevalence of counseling sexual assault victims about emergency contraception remained almost identical at 77% and 78% for 2004 and 2009, respectively (p=.73). Provision of emergency contraception to sexual assault victims also changed very little in this time period, from 63% in 2004 to 64% in 2009 (p=.28). Provision rates varied by number of victims treated, region of the country and status of state legislation. Conclusions: Emergency contraception provision for sexual assault victims in emergency departments has not increased over time and does not reflect regulatory changes in accessibility, such as the introduction of over-thecounter administration.
P31 P29
ABORTION IN BRITISH COLUMBIA: TRENDS OVER 10 YEARS COMPARED TO CANADA Norman WV University of British Columbia, Vancouver, British Columbia, Canada Objectives: To determine trends and distribution in Canadian and British Columbia (BC) abortion services from 1995 to 2005. Methods: We performed a secondary analysis of published data and data available through the BC Pregnancy Options Services database. We measured age-specific population trends and trends for abortion rates and service location in Canada and BC, and trends for the number of BC physicians performing abortions. Results: While Canadian abortion rates declined 12% from 1995 to 2005, BC rates have remained largely unchanged (0.6% decline overall, 9% in highest risk group). Age-specific population shifts do not explain the trends nor the difference between Canada and BC. In both jurisdictions, a trend towards abortion provision in purpose-specific clinics prevails. In BC, 81% of abortions are now provided within clinics located in large urban centers,
CORRELATES OF LONG-ACTING REVERSIBLE METHODS OF CONTRACEPTION USE AMONG YOUNG WOMEN FROM 2002 TO 2008 Sisco K Section of Family Planning and Contraceptive Research, University of Chicago, Chicago, IL, USA Dude A, Martins S, Whitaker A Objectives: Factors associated with use of long-acting reversible methods of contraception among adolescent and young adult women likely vary over time, especially as more young women choose these options. We sought to study changes from 2002 to 2008. Methods: We conducted an analysis of the 2006–2008 National Survey of Family Growth (NSFG) and compared it to our analysis of the 2002 NSFG. Our sample included sexually active women aged 15 to 24 years. We used multivariable logistic regression to identify correlates of ever-use of depot medroxyprogesterone acetate (DMPA) and the intrauterine device (IUD). Results: The percentage of young women who had ever used the IUD rose from 1.7% to 4.4% (pb.01), while ever-use of DMPA remained constant at
Abstracts / Contraception 84 (2011) 302–336 25%. Multivariable analyses showed changes over the two NSFG cycles. Hispanic race and marital status were no longer significantly associated with ever-use of the IUD, and black race and parity were no longer significantly associated with ever-use of DMPA. Increasing parity remained significantly associated with ever-use of the IUD in 2006–2008 (OR 52.8, 95% CI 8.85– 315.0 for one child; OR 119.9, 95% CI 16.7–859.2 for two or more children). As in the 2002 NSFG, history of teen pregnancy was associated with ever-use of DMPA (OR 1.79, 95% CI 1.02–3.15) but not of the IUD. Conclusions: While some factors such as marital status and race are no longer significantly associated with use of long-acting reversible contraceptive methods in young women, some important correlates such as parity remain associated with ever-use of the IUD.
P32
PREDICTORS OF LONG-ACTING REVERSIBLE CONTRACEPTION USE AMONG UNMARRIED YOUNG ADULTS Dempsey A Medical University of South Carolina, Charleston, SC, USA
317
2008. We conducted simple logistic regression and multinomial logistic regression analyses with adjustments for the sampling design to identify demographic and reproductive health characteristics predictive of LARC use. Results: LARC use among contracepting US women increased from 2.4% in 2002 to 5.6% in 2006–2008. The largest increases in LARC use occurred among the youngest and oldest age groups, non-Hispanic white and nonHispanic black women, US-born women and those in the highest income group. High prevalence of LARC use in 2006–2008 was seen among women who had given birth once or twice (10%), foreign-born women (8.8%) and Hispanic women (8.4%). After adjusting for key demographic and reproductive health characteristics, in comparisons to users of other contraceptive methods and to noncontraceptors at risk of unintended pregnancy, foreign-born women and women who experienced coitarche before age 18 were about twice as likely to be LARC users compared to women without those characteristics. Conclusions: A more diverse population of women used LARC methods in 2006–2008, as compared to 2002. However, there is likely more potential for increased voluntary uptake, especially among populations historically not considered to be candidates for LARC methods.
P34
Savage A, Billingsley C, Korte J Objectives: This analysis identifies predictors of long-acting reversible contraception (LARC) use and knowledge of intrauterine contraception (IUC) among unmarried young adults at risk of unintended pregnancy. Methods: This is a secondary analysis of a national survey of fertility and contraceptive knowledge conducted by the Guttmacher Institute. Data were collected via phone interviews with a nationally representative probabilitybased sample of unmarried women and men ages 18 to 29. Our analysis includes women and men at risk for unintended pregnancy. Data were analyzed using a chi-square test for categorical variables and logistic regression to construct multivariable models. Results: Among the population at risk for unintended pregnancy (n=1222), 4% were currently using a LARC method (IUC=52, implant=4). Current LARC use was associated with older age, high IUC knowledge and earlier onset of sexual activity. Respondents with high IUC knowledge were six times more likely to be current LARC users (OR 6.3, 95% CI 1.4–28.8). Gender, insurance status, primary language, education level and use of public assistance did not predict current LARC use. Low knowledge of IUC was more likely among males, non-English speakers, those with high school education or less, and those with an external locus of control. Conclusions: Knowledge of IUC is an important modifiable characteristic that may improve LARC use among young, unmarried adults. Interventions to improve knowledge about IUC should target males, non-English speakers, those with lower educational attainment and those with an external locus of control.
P33
WHO USES LONG-ACTING REVERSIBLE CONTRACEPTIVE METHODS IN THE UNITED STATES? Kavanaugh M Guttmacher Institute, New York, NY, USA
COMPARISON OF UNINTENDED PREGNANCY RATES IN USERS OF 84/7, 21/7 AND 24/4 ORAL CONTRACEPTIVE REGIMENS USING THE I3 INVISION™ DATABASE Howard B Teva Branded Pharmaceutical Products R&D, Inc., Horsham, PA, USA Brewster C, Lage M Objectives: To compare unintended pregnancy rates between oral contraceptive (OC) users of three regimens: 84 days levonorgestrel/ethinyl estradiol (EE) 0.15 mg/0.03 mg tablets plus EE 0.01 mg for 7 days in place of placebo; 21 days combined EE/progestin plus 7 days placebo; and 24 days EE/progestin plus 4 days placebo over the course of 1 year. Methods: Data for this study were obtained from the i3 Invision™ Data Mart for the period from January 1, 2006, through March 31, 2010. Only women 15 to 40 years were included in the analysis. Two distinct analyses were performed, one comparing the 84/7 to 21/7 medications and the other comparing the 84/7 to 24/4 medications. The outcome of interest was pregnancy (diagnosis code of V22.xx or V23.xx) over the 1-year post index date. The 84/7 cohort was matched to the cohort of interest based upon age, sex, region, business type of insurance, insurance product and year of index date. Results: The proportions of women in the 15-to-40 age range for the 84/7, 21/ 7 and 24/4 medications were 5821 of 7236, 650,816 of 780,131 and 111,540 of 127,913, respectively. Pregnancy rate for users of the 84/7 regimen were 3.04% compared to 5.12% for users of the 21/7 regimen (pb.0001). Pregnancy rate for users of the 84/7 regimen were 3.03% compared to 5.28% for users of the 24/4 regimens (pb.0001). Conclusions: In this study, unintended pregnancy rates were significantly lower in women using an 84/7 OC regimen compared to 21/7 and 24/4 regimens.
P35
WHO USES ANAL SEX FOR BIRTH CONTROL? Jerman J, Hubacher D, Kost K, Finer L Objectives: To examine characteristics of US women associated with use of long-acting reversible contraception (LARC) and changes in these characteristics between 2002 and 2006–2008. Methods: We analyzed data on current contraceptive use from two nationally representative samples of women ages 15 to 44 in the National Survey of Family Growth, including 7643 women in 2002 and 7356 women in 2006–
Wiebe E University of BC, Vancouver, BC, Canada Objectives: To determine the rate, characteristics and experience of women who said they had used anal sex as a method of contraception. Methods: This was a questionnaire survey of women presenting for abortion. Demographic data including ethnicity, country of origin and length of residence in Canada were collected.
Abstracts / Contraception 84 (2011) 302–336
required to offer medication abortion. Providers interested in offering medication abortion appear to be primarily motivated by attitudes that it improves patient care. Our findings underscore the importance of improving medication abortion knowledge among adolescent medicine providers.
P28
CONSEQUENCES OF DELAYS FOR WOMEN SEEKING STATE-SUBSIDIZED INSURANCE FOR ABORTION CARE IN THE COMMONWEALTH OF MASSACHUSETTS Bessett D University of Cincinnati, Cincinnati, OH, USA Gorski K, Ostrow M, Jinadasa D, Peterson MJ Objectives: To learn about women's experiences applying for subsidized insurance and its use for abortion services under Massachusetts's health care reform. Methods: We interviewed low-income women presumed eligible for subsidized insurance about 1 month after contact with Massachusetts abortion funds. Results: Thirty-nine (43%) of 91 potential subjects agreed to be interviewed. More than half of those interviewed described delaying their abortions while trying to secure subsidized insurance; the average reported delay was about 17 days. Women reported stress while managing symptoms without disclosing the pregnancy and worried about affordability as time went on. Delays also increased travel time to alternate providers. Only 11 of the 32 who applied for subsidized insurance secured coverage of their abortion. One woman had a miscarriage before becoming insured. Nineteen paid out of pocket or in combination with a philanthropic abortion fund to pay for their care, usually because they were approaching a fee increase. Delays also limited women's ability to obtain medication abortion; one woman decided to continue her pregnancy once she was unable to obtain medication abortion. Another woman “timed out” of an in-state surgical abortion when she was unable to obtain insurance quickly and she also continued the pregnancy. Conclusions: Delays in enrollment for subsidized insurance led women to postpone abortion care and transferred the economic burden from the state to women and philanthropic abortion funds. Intangible costs included stress, prolonged pregnancy symptoms, increased travel time and limited access to medication abortion. Delays completely prevented two women from obtaining the abortions they sought. Enrollment procedures for subsidized insurance in Massachusetts need improvement.
almost exclusively in Vancouver and Victoria. Since 1995, BC has experienced an estimated decline in the number of abortion providers offering services at hospitals outside the clinic system of upwards of 60%, and a 65% decline in the number of abortions provided in such hospitals. Conclusions: BC abortion rates are not following Canadian declining trends and are increasingly available only in clinics located in large population centers. Accessibility for women in rural and remote locations has declined 65% from 1995 to 2005.
P30
NO IMPROVEMENT IN EMERGENCY CONTRACEPTION PROVISION AFTER SEXUAL ASSAULT: A NATIONAL SURVEY, 2004 AND 2009 Patel A John H. Stroger Jr., Hospital of Cook County, Chicago, IL, USA Tilmon S, Sheth A, Nguyen L, Chaparala S, Bhogireddy V, Chor J, Patel D, Keith L Objectives: To compare information obtained in surveys of US emergency departments in 2004 and 2009 about the provision of and counseling for emergency contraception to sexual assault victims. Methods: We conducted a cross-sectional prevalence survey on a representative sample of 20% of hospitals, stratified by state and territory, using a list provided by the American Hospital Association in 2004 and 2009. We administered our 13-question telephone survey to emergency department personnel in order to assess emergency department practices regarding provision and counseling of emergency contraception for sexual assault victims. Results: Survey response rates in 2004 and 2009 were 89% and 84%, respectively. The prevalence of counseling sexual assault victims about emergency contraception remained almost identical at 77% and 78% for 2004 and 2009, respectively (p=.73). Provision of emergency contraception to sexual assault victims also changed very little in this time period, from 63% in 2004 to 64% in 2009 (p=.28). Provision rates varied by number of victims treated, region of the country and status of state legislation. Conclusions: Emergency contraception provision for sexual assault victims in emergency departments has not increased over time and does not reflect regulatory changes in accessibility, such as the introduction of over-thecounter administration.
P31 P29
ABORTION IN BRITISH COLUMBIA: TRENDS OVER 10 YEARS COMPARED TO CANADA Norman WV University of British Columbia, Vancouver, British Columbia, Canada Objectives: To determine trends and distribution in Canadian and British Columbia (BC) abortion services from 1995 to 2005. Methods: We performed a secondary analysis of published data and data available through the BC Pregnancy Options Services database. We measured age-specific population trends and trends for abortion rates and service location in Canada and BC, and trends for the number of BC physicians performing abortions. Results: While Canadian abortion rates declined 12% from 1995 to 2005, BC rates have remained largely unchanged (0.6% decline overall, 9% in highest risk group). Age-specific population shifts do not explain the trends nor the difference between Canada and BC. In both jurisdictions, a trend towards abortion provision in purpose-specific clinics prevails. In BC, 81% of abortions are now provided within clinics located in large urban centers,
CORRELATES OF LONG-ACTING REVERSIBLE METHODS OF CONTRACEPTION USE AMONG YOUNG WOMEN FROM 2002 TO 2008 Sisco K Section of Family Planning and Contraceptive Research, University of Chicago, Chicago, IL, USA Dude A, Martins S, Whitaker A Objectives: Factors associated with use of long-acting reversible methods of contraception among adolescent and young adult women likely vary over time, especially as more young women choose these options. We sought to study changes from 2002 to 2008. Methods: We conducted an analysis of the 2006–2008 National Survey of Family Growth (NSFG) and compared it to our analysis of the 2002 NSFG. Our sample included sexually active women aged 15 to 24 years. We used multivariable logistic regression to identify correlates of ever-use of depot medroxyprogesterone acetate (DMPA) and the intrauterine device (IUD). Results: The percentage of young women who had ever used the IUD rose from 1.7% to 4.4% (pb.01), while ever-use of DMPA remained constant at
Abstracts / Contraception 84 (2011) 302–336 25%. Multivariable analyses showed changes over the two NSFG cycles. Hispanic race and marital status were no longer significantly associated with ever-use of the IUD, and black race and parity were no longer significantly associated with ever-use of DMPA. Increasing parity remained significantly associated with ever-use of the IUD in 2006–2008 (OR 52.8, 95% CI 8.85– 315.0 for one child; OR 119.9, 95% CI 16.7–859.2 for two or more children). As in the 2002 NSFG, history of teen pregnancy was associated with ever-use of DMPA (OR 1.79, 95% CI 1.02–3.15) but not of the IUD. Conclusions: While some factors such as marital status and race are no longer significantly associated with use of long-acting reversible contraceptive methods in young women, some important correlates such as parity remain associated with ever-use of the IUD.
P32
PREDICTORS OF LONG-ACTING REVERSIBLE CONTRACEPTION USE AMONG UNMARRIED YOUNG ADULTS Dempsey A Medical University of South Carolina, Charleston, SC, USA
317
2008. We conducted simple logistic regression and multinomial logistic regression analyses with adjustments for the sampling design to identify demographic and reproductive health characteristics predictive of LARC use. Results: LARC use among contracepting US women increased from 2.4% in 2002 to 5.6% in 2006–2008. The largest increases in LARC use occurred among the youngest and oldest age groups, non-Hispanic white and nonHispanic black women, US-born women and those in the highest income group. High prevalence of LARC use in 2006–2008 was seen among women who had given birth once or twice (10%), foreign-born women (8.8%) and Hispanic women (8.4%). After adjusting for key demographic and reproductive health characteristics, in comparisons to users of other contraceptive methods and to noncontraceptors at risk of unintended pregnancy, foreign-born women and women who experienced coitarche before age 18 were about twice as likely to be LARC users compared to women without those characteristics. Conclusions: A more diverse population of women used LARC methods in 2006–2008, as compared to 2002. However, there is likely more potential for increased voluntary uptake, especially among populations historically not considered to be candidates for LARC methods.
P34
Savage A, Billingsley C, Korte J Objectives: This analysis identifies predictors of long-acting reversible contraception (LARC) use and knowledge of intrauterine contraception (IUC) among unmarried young adults at risk of unintended pregnancy. Methods: This is a secondary analysis of a national survey of fertility and contraceptive knowledge conducted by the Guttmacher Institute. Data were collected via phone interviews with a nationally representative probabilitybased sample of unmarried women and men ages 18 to 29. Our analysis includes women and men at risk for unintended pregnancy. Data were analyzed using a chi-square test for categorical variables and logistic regression to construct multivariable models. Results: Among the population at risk for unintended pregnancy (n=1222), 4% were currently using a LARC method (IUC=52, implant=4). Current LARC use was associated with older age, high IUC knowledge and earlier onset of sexual activity. Respondents with high IUC knowledge were six times more likely to be current LARC users (OR 6.3, 95% CI 1.4–28.8). Gender, insurance status, primary language, education level and use of public assistance did not predict current LARC use. Low knowledge of IUC was more likely among males, non-English speakers, those with high school education or less, and those with an external locus of control. Conclusions: Knowledge of IUC is an important modifiable characteristic that may improve LARC use among young, unmarried adults. Interventions to improve knowledge about IUC should target males, non-English speakers, those with lower educational attainment and those with an external locus of control.
P33
WHO USES LONG-ACTING REVERSIBLE CONTRACEPTIVE METHODS IN THE UNITED STATES? Kavanaugh M Guttmacher Institute, New York, NY, USA
COMPARISON OF UNINTENDED PREGNANCY RATES IN USERS OF 84/7, 21/7 AND 24/4 ORAL CONTRACEPTIVE REGIMENS USING THE I3 INVISION™ DATABASE Howard B Teva Branded Pharmaceutical Products R&D, Inc., Horsham, PA, USA Brewster C, Lage M Objectives: To compare unintended pregnancy rates between oral contraceptive (OC) users of three regimens: 84 days levonorgestrel/ethinyl estradiol (EE) 0.15 mg/0.03 mg tablets plus EE 0.01 mg for 7 days in place of placebo; 21 days combined EE/progestin plus 7 days placebo; and 24 days EE/progestin plus 4 days placebo over the course of 1 year. Methods: Data for this study were obtained from the i3 Invision™ Data Mart for the period from January 1, 2006, through March 31, 2010. Only women 15 to 40 years were included in the analysis. Two distinct analyses were performed, one comparing the 84/7 to 21/7 medications and the other comparing the 84/7 to 24/4 medications. The outcome of interest was pregnancy (diagnosis code of V22.xx or V23.xx) over the 1-year post index date. The 84/7 cohort was matched to the cohort of interest based upon age, sex, region, business type of insurance, insurance product and year of index date. Results: The proportions of women in the 15-to-40 age range for the 84/7, 21/ 7 and 24/4 medications were 5821 of 7236, 650,816 of 780,131 and 111,540 of 127,913, respectively. Pregnancy rate for users of the 84/7 regimen were 3.04% compared to 5.12% for users of the 21/7 regimen (pb.0001). Pregnancy rate for users of the 84/7 regimen were 3.03% compared to 5.28% for users of the 24/4 regimens (pb.0001). Conclusions: In this study, unintended pregnancy rates were significantly lower in women using an 84/7 OC regimen compared to 21/7 and 24/4 regimens.
P35
WHO USES ANAL SEX FOR BIRTH CONTROL? Jerman J, Hubacher D, Kost K, Finer L Objectives: To examine characteristics of US women associated with use of long-acting reversible contraception (LARC) and changes in these characteristics between 2002 and 2006–2008. Methods: We analyzed data on current contraceptive use from two nationally representative samples of women ages 15 to 44 in the National Survey of Family Growth, including 7643 women in 2002 and 7356 women in 2006–
Wiebe E University of BC, Vancouver, BC, Canada Objectives: To determine the rate, characteristics and experience of women who said they had used anal sex as a method of contraception. Methods: This was a questionnaire survey of women presenting for abortion. Demographic data including ethnicity, country of origin and length of residence in Canada were collected.