Intimate partner violence in women receiving gynecologic and abortion care

Abstracts / Contraception 78 (2008) 167–195 Methods: Between December 2007 and March 2008, we conducted 21 focus groups with African-American parents and their adolescents aged 15–17 in Pittsburgh, PA. Groups were stratified by gender and participant type, and were audio recorded, transcribed and analyzed using the grounded theory approach to content analysis. Atlas.Ti was used for coding and creating data matrices to compare themes across gender and participant type. Results: Parents and adolescents differed markedly in their recall of discussions about these topics. Adolescents generally reported that parents— particularly mothers — had communicated their values and expectations regarding the use of contraception and abortion. However, parents found these topics difficult and reported discussing them infrequently. Parents addressed these issues primarily when teachable moments arise, such as if a child's physician brought up these subjects, if a teen within the family's social network became pregnant, had an abortion or was discovered to be using contraception. Conclusions: Parents infrequently communicate directly with their children about contraception and abortion. However, children are clearly aware of their parent's values and expectations regarding these topics. These findings suggest that providers should continue providing family planning counseling to adolescents and should consider counseling assisting parents to develop skills for addressing these topics.

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Objectives: With the exact mechanisms of action of hormonal contraception still unknown and with evidence both for and against postfertilization effects, it is important to assess how influential postfertilization effects are to female adolescents' choice of contraception. Methods: We conducted 30-min face-to-face interviews with 196 female adolescents, aged 13 to 21 years, from an outpatient adolescent clinic to determine what they know about the mechanisms of action of various methods of contraception and what their attitudes are regarding different mechanisms of action. Results: Participants had a knowledge level of 8.49±3.68 (range 0–20) for the mechanism of actions of various methods. Although the majority of participants could not categorize accurately the 18 different contraceptive's mechanism of action, there was a correlation between the method's mechanism and the method participants intended to use. Over half (59.2%) said that their choice to stop or continue using a method depended on how often the method works after fertilization but before implantation with 39.3% saying they would “definitely not use something to prevent pregnancy that works after implantation.” Conclusions: Adolescents know less about how methods of contraception work than they realize and this inaccurate information appears to influence their contraceptive decision making. Fully educating adolescents about contraceptives' known and unknown mechanisms of action may assist them in making more informed decisions about contraception.

P29 PRIMARY CARE PROVIDER'S PERSPECTIVES ON THE CHALLENGES OF CONTRACEPTIVE COUNSELING Akers AA University of Pittsburgh, Pittsburgh, USA Santucci A, Nikolajski CE, Gold MA, Schwarz B Objectives: To examine primary care provider's perspectives about contraceptive counseling. Methods: Between November 2007 and January 2008, we conducted six focus groups with primary care providers (PCP) who work at four clinics in Pittsburgh, PA. The question guide explored whether, when and how providers provide contraception counseling. All groups were audio recorded, transcribed and coded by two independent coders using Atlas. Ti software. We used a grounded theory approach to content analysis. Results: Four contraceptive counseling styles were identified: (a) counseling as part of routine care, (b) counseling in response to a patient request, (c) counseling precipitated by the prescription of noncontraceptive medications and (d) counseling limited to referral to a family planning specialist. Health system barriers to contraceptive counseling included limited clinical time, competing medical priorities, the increasing number of contraceptive options, the age and gender diversity of primary care populations and the lack of communication between PCPs and gynecologists. Provider barriers included lack of knowledge and comfort regarding contraceptive counseling. Patient barriers included religious beliefs, infrequent sexual activity, familiarity with a limited number of methods and patient desire for fertility despite medical contraindications to pregnancy. Conclusions: Primary care providers vary widely in their knowledgebase, perceived competence and comfort providing contraceptive counseling. Efforts to improve integration of contraceptive counseling in primary care settings are needed. P30 FEMALE ADOLESCENTS' KNOWLEDGE OF AND ATTITUDES TOWARD THE MECHANISMS OF ACTION OF CONTRACEPTION Rossiter B University of Pittsburgh, Pittsburgh, PA, USA Gold M, Whetstone H

P31 INTIMATE PARTNER VIOLENCE IN WOMEN RECEIVING GYNECOLOGIC AND ABORTION CARE Chavkin D University of Pennsylvania, Philadelphia, PA, USA Gee RE Objectives: To examine the relationship between the number of abortions and intimate partner violence (IPV). Methods: A total of 1493 women at Planned Parenthood in Philadelphia were surveyed; 485 women presenting for routine gynecologic care and 1008 women presenting for abortion care. Institutional review board approval was received from the University of Pennsylvania. The selfadministered survey instrument contained 32 questions regarding patient demographics, contraception use and knowledge, reproductive health knowledge and an IPV screening tool. Results: We found that multiparity is associated with an increase in IPV. Additional factors associated with IPV included partner willingness to use contraception (pb.001), living situation (p=.001), employment status (p=.018) and being able to afford contraception (p=.001). Conclusion: Our results suggest that overall parity, not number of abortions, is associated with an increase in IPV. Further studies will be needed to confirm our findings and to confirm the positive risk factors identified. We hope to use these results to design and implement IPV prevention programs in this population. P32 INTRAUTERINE DEVICE KNOWLEDGE, ATTITUDES AND EXPERIENCE AMONG SENIOR OBSTETRICS AND GYNECOLOGY RESIDENTS Cabiya M University of Illinois at Chicago, Chicago, IL, USA Cowett A, Harwood B Objectives: To describe senior obstetrics and gynecology residents' knowledge, experience and attitudes regarding IUD provision and to assess