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Patient perception of immediate postpartum long-acting reversible contraception (LARC)
288
Abstracts / Contraception 96 (2017) 263–306
help to inform new contraceptive development and contraceptive counseling to meet young women’s needs and preferences. This analysis addresses a gap in evidence by analyzing young women’s experiences of side effects among both method discontinuers and continuers to more accurately assess the real impact of method side effects on use. Methods: This analysis comprised 831 women aged 18–25 enrolled in a 12month longitudinal study who initiated a new contraceptive method at 1 of 40 Planned Parenthood study sites in 2011–2013. Data on contraception, side effects and discontinuation were collected on quarterly surveys. The impact of side effects on method discontinuation was modeled using stratified Cox proportional hazards regression. Results: Side effects were reported among both method discontinuers and continuers. For example, 79% of IUD discontinuers reported pain/cramping, while 74% of IUD continuers did, and 15% of pill discontinuers reported breast pain compared with 19% of pill continuers. Some side effects were associated with significantly higher discontinuation rates including increased bleeding between periods (HR, 1.49; 95% CI, 1.17–1.91), irregular periods (HR, 1.28; 95% CI, 1.01–1.62), depression (HR, 1.55, 95% CI, 1.26–2.20), nausea (HR, 1.35; 95% CI, 1.02–1.78) and acne (HR, 1.47; 95% CI, 1.12–1.94). Conclusions: Our findings confirm the importance of side effects in contraceptive discontinuation but also highlight that many women experiencing side effects continue their method. A detailed examination of the side effects that actually contribute to discontinuation can inform contraceptive care. http://dx.doi.org/10.1016/j.contraception.2017.07.097
P68 Pregnancy prevention on the fly: prevalence and correlates of contraceptive lapse among young women traveling internationally S Martins University of Minnesota School of Public Health, Minneapolis, MN, USA W Hellerstedt Objectives: Many aspects of international travel may influence women’s contraceptive use, but the contraceptive practices of traveling women have not been documented. We sought to estimate the prevalence and correlates of contraceptive lapse among young U.S. women during their recent international trip. Methods: We surveyed 340 female university students who had recently traveled internationally less than 3 months ago; were 18–29 years old; had a history of sex with men; considered the United States their home country; and were not married, engaged, pregnant or attempting pregnancy. Participants reported their contraceptive use during travel and several potential correlates at the individual, interpersonal and community levels. We defined contraceptive lapse as error or nonadherence on any method used during the trip (e.g., missed pill). We examined crude associations between lapse and correlates and, for variables significant at pb.20, estimated adjusted relative risk (aRR) of contraceptive lapse with multivariable regression. Results: Overall, 29% of travelers had a contraceptive lapse. Lapse was significantly (pb.05) associated with use of the pill (aRR, 7.8) or ring (aRR, 10.4) during travel vs. other or no method, trip duration of more than 30 days vs. 1–7 days (aRR, 2.0), having trouble communicating with a travel sex partner about contraception (aRR, 2.1) and perceiving abortion to be difficult to access in the travel destination (aRR, 1.8). We also observed a linear increase in lapse risk with increasing perceived severity of language barriers during travel (aRR range, 1.4–2.2). Conclusions: There are unique risk factors for contraceptive lapse associated with international travel, which providers may mitigate through pretravel counseling. http://dx.doi.org/10.1016/j.contraception.2017.07.098
P69 Patient perception of immediate postpartum long-acting reversible contraception (LARC) KK Sznajder Johns Hopkins University School of Medicine, Baltimore, MD, USA DN Carvajal, C Sufrin Objectives: Immediate postpartum LARC provision is increasing in practice. Expanding access to LARC for women who may otherwise have limited access to contraception is important. However, this effort must be tempered by the consideration that these same women may also be at risk for undue pressure to use LARC based on our knowledge of historical practices and provider bias related to race, ethnicity and socioeconomic status. Our objective was to explore the patient perception and experience of immediate postpartum LARC contraceptive counseling, decision making and placement with a focus on reproductive autonomy. Methods: This is a qualitative study using semistructured, in-depth interviews with 17 women who received an IUD or contraceptive subdermal implant immediately postpartum. We collected data based on saturation of themes and analyzed interviews using grounded theory. Results: Participants were very receptive to the option of immediate postpartum LARC. They expressed a desire for comprehensive, objective information early and often during antepartum contraceptive counseling, and several valued counseling from multiple providers. Participants also expressed a desire for autonomy in their contraceptive decision making and described making internally motivated decisions. Some women reported feeling pushed by providers during counseling and were critical of their experiences. Conclusions: Overall, women spoke positively about immediate postpartum LARC. Our data suggest that providers should start contraceptive counseling early in prenatal care and address it at multiple visits. Patients may benefit from speaking with multiple providers. Providers should be aware of historical reproductive injustices and should strive to deliver comprehensive, objective information about all contraceptive methods. http://dx.doi.org/10.1016/j.contraception.2017.07.099
P70 What do young women need to engage in effective contraception conversations with their providers? BA Levandowski SUNY Upstate Medical University, Syracuse, NY, USA N Richards, P Youngs-Maher, E Crockett, T Stewart, CP Morley Objectives: This community-based participatory research identified communication elements young women need to effectively engage in contraceptive conversations with their providers. Methods: Seven focus groups were conducted with Hispanic and African American women aged 15–19 (n=2); Hispanic, African American and white women aged 20– 24 (n=3); and reproductive health providers (n=2). Focus groups were audio-recorded and transcribed. Data were analyzed using inductive coding and thematic analyses in NVivo (v.11). Findings were reviewed with the Community Advisory Board. Results: Young women felt that “being heard” and providers felt that “empowering” young women were critical elements for successful contraceptive conversations. Women asked family, friends and providers for information, or chose the internet and social media due to anonymity, yet rarely raised questions on information source reliability or validity. Young women need to know how to be an effective health consumer or “how to be a patient.” At provider offices, intervention opportunities could occur at intake, with providers and within shared decision making. Providers need to “be patient with their patients.” Family values, parental figures, and school or community-based sexual education resources have a substantial impact on young women’s health knowledge, empowerment and contraceptive choices. Conclusions: Intervention suggestions need clarification, including how future programming can address the tension between urban myths and facts related to
Abstracts / Contraception 96 (2017) 263–306
help to inform new contraceptive development and contraceptive counseling to meet young women’s needs and preferences. This analysis addresses a gap in evidence by analyzing young women’s experiences of side effects among both method discontinuers and continuers to more accurately assess the real impact of method side effects on use. Methods: This analysis comprised 831 women aged 18–25 enrolled in a 12month longitudinal study who initiated a new contraceptive method at 1 of 40 Planned Parenthood study sites in 2011–2013. Data on contraception, side effects and discontinuation were collected on quarterly surveys. The impact of side effects on method discontinuation was modeled using stratified Cox proportional hazards regression. Results: Side effects were reported among both method discontinuers and continuers. For example, 79% of IUD discontinuers reported pain/cramping, while 74% of IUD continuers did, and 15% of pill discontinuers reported breast pain compared with 19% of pill continuers. Some side effects were associated with significantly higher discontinuation rates including increased bleeding between periods (HR, 1.49; 95% CI, 1.17–1.91), irregular periods (HR, 1.28; 95% CI, 1.01–1.62), depression (HR, 1.55, 95% CI, 1.26–2.20), nausea (HR, 1.35; 95% CI, 1.02–1.78) and acne (HR, 1.47; 95% CI, 1.12–1.94). Conclusions: Our findings confirm the importance of side effects in contraceptive discontinuation but also highlight that many women experiencing side effects continue their method. A detailed examination of the side effects that actually contribute to discontinuation can inform contraceptive care. http://dx.doi.org/10.1016/j.contraception.2017.07.097
P68 Pregnancy prevention on the fly: prevalence and correlates of contraceptive lapse among young women traveling internationally S Martins University of Minnesota School of Public Health, Minneapolis, MN, USA W Hellerstedt Objectives: Many aspects of international travel may influence women’s contraceptive use, but the contraceptive practices of traveling women have not been documented. We sought to estimate the prevalence and correlates of contraceptive lapse among young U.S. women during their recent international trip. Methods: We surveyed 340 female university students who had recently traveled internationally less than 3 months ago; were 18–29 years old; had a history of sex with men; considered the United States their home country; and were not married, engaged, pregnant or attempting pregnancy. Participants reported their contraceptive use during travel and several potential correlates at the individual, interpersonal and community levels. We defined contraceptive lapse as error or nonadherence on any method used during the trip (e.g., missed pill). We examined crude associations between lapse and correlates and, for variables significant at pb.20, estimated adjusted relative risk (aRR) of contraceptive lapse with multivariable regression. Results: Overall, 29% of travelers had a contraceptive lapse. Lapse was significantly (pb.05) associated with use of the pill (aRR, 7.8) or ring (aRR, 10.4) during travel vs. other or no method, trip duration of more than 30 days vs. 1–7 days (aRR, 2.0), having trouble communicating with a travel sex partner about contraception (aRR, 2.1) and perceiving abortion to be difficult to access in the travel destination (aRR, 1.8). We also observed a linear increase in lapse risk with increasing perceived severity of language barriers during travel (aRR range, 1.4–2.2). Conclusions: There are unique risk factors for contraceptive lapse associated with international travel, which providers may mitigate through pretravel counseling. http://dx.doi.org/10.1016/j.contraception.2017.07.098
P69 Patient perception of immediate postpartum long-acting reversible contraception (LARC) KK Sznajder Johns Hopkins University School of Medicine, Baltimore, MD, USA DN Carvajal, C Sufrin Objectives: Immediate postpartum LARC provision is increasing in practice. Expanding access to LARC for women who may otherwise have limited access to contraception is important. However, this effort must be tempered by the consideration that these same women may also be at risk for undue pressure to use LARC based on our knowledge of historical practices and provider bias related to race, ethnicity and socioeconomic status. Our objective was to explore the patient perception and experience of immediate postpartum LARC contraceptive counseling, decision making and placement with a focus on reproductive autonomy. Methods: This is a qualitative study using semistructured, in-depth interviews with 17 women who received an IUD or contraceptive subdermal implant immediately postpartum. We collected data based on saturation of themes and analyzed interviews using grounded theory. Results: Participants were very receptive to the option of immediate postpartum LARC. They expressed a desire for comprehensive, objective information early and often during antepartum contraceptive counseling, and several valued counseling from multiple providers. Participants also expressed a desire for autonomy in their contraceptive decision making and described making internally motivated decisions. Some women reported feeling pushed by providers during counseling and were critical of their experiences. Conclusions: Overall, women spoke positively about immediate postpartum LARC. Our data suggest that providers should start contraceptive counseling early in prenatal care and address it at multiple visits. Patients may benefit from speaking with multiple providers. Providers should be aware of historical reproductive injustices and should strive to deliver comprehensive, objective information about all contraceptive methods. http://dx.doi.org/10.1016/j.contraception.2017.07.099
P70 What do young women need to engage in effective contraception conversations with their providers? BA Levandowski SUNY Upstate Medical University, Syracuse, NY, USA N Richards, P Youngs-Maher, E Crockett, T Stewart, CP Morley Objectives: This community-based participatory research identified communication elements young women need to effectively engage in contraceptive conversations with their providers. Methods: Seven focus groups were conducted with Hispanic and African American women aged 15–19 (n=2); Hispanic, African American and white women aged 20– 24 (n=3); and reproductive health providers (n=2). Focus groups were audio-recorded and transcribed. Data were analyzed using inductive coding and thematic analyses in NVivo (v.11). Findings were reviewed with the Community Advisory Board. Results: Young women felt that “being heard” and providers felt that “empowering” young women were critical elements for successful contraceptive conversations. Women asked family, friends and providers for information, or chose the internet and social media due to anonymity, yet rarely raised questions on information source reliability or validity. Young women need to know how to be an effective health consumer or “how to be a patient.” At provider offices, intervention opportunities could occur at intake, with providers and within shared decision making. Providers need to “be patient with their patients.” Family values, parental figures, and school or community-based sexual education resources have a substantial impact on young women’s health knowledge, empowerment and contraceptive choices. Conclusions: Intervention suggestions need clarification, including how future programming can address the tension between urban myths and facts related to