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Postabortion LARC method initiation by service providers and risk of subsequent unintended pregnancy
ABSTRACTS / Contraception 92 (2015) 359–414 have encountered accessing reproductive health care and satisfaction with their current method. Methods: We performed a statewide representative survey of women aged 18–49 using the GfK KnowledgePanel (n= 779, completion rate, 56%). We asked about having ever encountered specific types of barriers, current contraceptive method and preferred method if all were available at no out-of-pocket cost. Results: A majority (56%, CI, 51–61%) of sexually active women reported barriers to accessing reproductive health care, including inability to pay (70%, CI, 62–75%), language of providers (55%, CI, 49–62%) and difficulty getting time off from work or school (41%, CI, 34–47%). Half of women using less effective methods would prefer more effective methods (55%, CI, 41–68%). One fifth of hormonal method users (CI, 11–33%) would prefer a more effective method: 7% (CI, 2–21%) female sterilization, 6% (CI, 3–12%) vasectomy and 7% (CI, 2– 19%) a long-acting reversible contraceptive (LARC) method. The majority of women (61%, CI, 36–82%) who preferred a LARC method over their current method reported not using one because they could not afford it. Women relying on Medicaid or state and county programs were more likely to use a LARC method than women with private or no insurance (p=.04). Outcomes: Texas women face barriers to effective methods, and method use differs by insurance coverage. In situations where administrative data are delayed or inadequate, online panel surveys can provide timely information regarding access to and use of family planning services.
385
Lee J Kaiser Permanente, Oakland, CA, USA Postlethwaite D, Merchant M, Alton K, Gupta P, Raine-Bennett T
Women's awareness of their contraceptive benefits after the Affordable Care Act
Objectives: We hypothesized that women receiving abortions within Kaiser Permanente Northern California (KPNC) had higher initiation of long-acting reversible contraceptive (LARC) methods than women referred to contracted services and that LARC method initiation lowers risk for unintended pregnancy within 12 months. Methods: A retrospective cohort study was conducted of a randomized proportional sample of 12,671 women aged 15–44 receiving abortions (KPNC vs. contracted services) in 2011–2012 to determine LARC method initiation within 90 days. Demographic and clinical characteristics (age, race/ethnicity, gravidity, parity, method initiated, unintended pregnancy within 12 months) were collected from databases and medical records. Analysis included descriptive statistics, chi-square tests, t tests and logistic regression models to assess predictors of LARC method initiation and unintended pregnancy within 12 months. Results: On average, women who obtained an abortion within KPNC were older than those who received contracted services (29.8 vs. 26.6, pb.0001). The two groups differed significantly in age, race/ethnicity and gravidity. A LARC method was significantly less likely to be initiated within 90 days in the contracted service group compared with those receiving abortion within KPNC (12% vs. 19.1%, p=.012). Significant predictors of LARC method initiation within 90 days included KPNC abortion services (vs. contracted) (OR, 1.87, p=.007) and having had more than three pregnancies. The likelihood of unintended pregnancy was increased among women who were younger, Black or had had more than three pregnancies or no LARC method initiation. Outcomes: KPNC members who were referred to contracted providers for an abortion were less likely to initiate a LARC method, putting them at greater risk for future unintended pregnancy.
Chuang C Penn State College of Medicine, Hershey, PA, USA
http://dx.doi.org/10.1016/j.contraception.2015.06.126
Mitchell J, Velott D, Sciamanna C, Legro R, Lehman E, Confer L, Weisman C
P77
Objectives: The study objective was to determine whether privately insured women are aware of their contraceptive benefits under the Affordable Care Act (ACA), which mandates no out-of-pocket cost for contraception, including long-acting reversible contraceptive (LARC) methods. Methods: The MyNewOptions study is an ongoing randomized controlled trial of an online intervention to help adult women make informed contraceptive decisions. The sample includes 989 female Highmark Health members aged 18–40. After confirming eligibility (sexually active, not planning pregnancy in the next 12 months), participants completed a baseline survey, which included the question, “To the best of your knowledge, does your health insurance policy currently cover these birth control methods at no cost to you (no copay or deductible payment)?—tubal sterilization (‘tubes tied’), birth control pills, IUD.” Results: Less than 5% of women knew that their insurance covers tubal sterilization, and less than 12% knew that they have full IUD coverage. Most women (58%) were aware that they had full coverage for birth control pills. Nearly one in five women would change methods if they did not have to worry about cost, of whom 30% would switch to an IUD and 9% would switch to the implant. Outcomes: We report that privately insured women in the MyNewOptions study are largely unaware of their expanded contraceptive benefits under the ACA, including coverage for LARC methods. For the ACA contraceptive coverage mandate to increase use of effective methods, raising women's awareness of the expanded benefit is an essential first step.
Comparing contraceptive choices among postabortion patients with and without free access to long-acting reversible contraceptive (LARC) methods
http://dx.doi.org/10.1016/j.contraception.2015.06.124
P75
http://dx.doi.org/10.1016/j.contraception.2015.06.125
P76 Postabortion LARC method initiation by service providers and risk of subsequent unintended pregnancy
Goyal V University of Texas at Austin, Austin, TX, USA Aiken ARA, Dermish A, Potter JE Objectives: In 2014, a Medicaid 1115 waiver program offering free LARC methods to low-income uninsured Travis County residents was implemented at Planned Parenthood in Austin, Texas. We evaluated preabortion contraceptive desires and postabortion LARC method uptake among women who were and were not eligible for the program. Methods: We conducted a study of women aged 18–44 seeking abortion at Planned Parenthood. Participants completed a survey assessing program eligibility and contraceptive desires before the abortion. We then collected information on the methods women obtained at Planned Parenthood after their procedure. We compared method desires among women eligible and ineligible for the LARC program and used logistic regression to assess the impact of program eligibility on LARC method uptake. Results: Our sample of 446 women comprised 27% low-income, uninsured, Travis County residents eligible for the LARC program, 21% low-income, uninsured non-Travis County residents ineligible for the program and 50% insured or high-income women. Desire for LARC methods was high among all three groups: 65%, 55% and 55%, respectively (p=.18). Yet only 4% of low-income ineligible women received a LARC method postabortion compared with 67% of low-income eligible women and 22% of insured/high income women. When we adjusted for contraceptive desires and demographic characteristics, low-income uninsured women eligible for the program were far more likely than those ineligible to obtain a postabortion LARC method (OR, 71.9; 95% CI, 22.4–230.5).
385
Lee J Kaiser Permanente, Oakland, CA, USA Postlethwaite D, Merchant M, Alton K, Gupta P, Raine-Bennett T
Women's awareness of their contraceptive benefits after the Affordable Care Act
Objectives: We hypothesized that women receiving abortions within Kaiser Permanente Northern California (KPNC) had higher initiation of long-acting reversible contraceptive (LARC) methods than women referred to contracted services and that LARC method initiation lowers risk for unintended pregnancy within 12 months. Methods: A retrospective cohort study was conducted of a randomized proportional sample of 12,671 women aged 15–44 receiving abortions (KPNC vs. contracted services) in 2011–2012 to determine LARC method initiation within 90 days. Demographic and clinical characteristics (age, race/ethnicity, gravidity, parity, method initiated, unintended pregnancy within 12 months) were collected from databases and medical records. Analysis included descriptive statistics, chi-square tests, t tests and logistic regression models to assess predictors of LARC method initiation and unintended pregnancy within 12 months. Results: On average, women who obtained an abortion within KPNC were older than those who received contracted services (29.8 vs. 26.6, pb.0001). The two groups differed significantly in age, race/ethnicity and gravidity. A LARC method was significantly less likely to be initiated within 90 days in the contracted service group compared with those receiving abortion within KPNC (12% vs. 19.1%, p=.012). Significant predictors of LARC method initiation within 90 days included KPNC abortion services (vs. contracted) (OR, 1.87, p=.007) and having had more than three pregnancies. The likelihood of unintended pregnancy was increased among women who were younger, Black or had had more than three pregnancies or no LARC method initiation. Outcomes: KPNC members who were referred to contracted providers for an abortion were less likely to initiate a LARC method, putting them at greater risk for future unintended pregnancy.
Chuang C Penn State College of Medicine, Hershey, PA, USA
http://dx.doi.org/10.1016/j.contraception.2015.06.126
Mitchell J, Velott D, Sciamanna C, Legro R, Lehman E, Confer L, Weisman C
P77
Objectives: The study objective was to determine whether privately insured women are aware of their contraceptive benefits under the Affordable Care Act (ACA), which mandates no out-of-pocket cost for contraception, including long-acting reversible contraceptive (LARC) methods. Methods: The MyNewOptions study is an ongoing randomized controlled trial of an online intervention to help adult women make informed contraceptive decisions. The sample includes 989 female Highmark Health members aged 18–40. After confirming eligibility (sexually active, not planning pregnancy in the next 12 months), participants completed a baseline survey, which included the question, “To the best of your knowledge, does your health insurance policy currently cover these birth control methods at no cost to you (no copay or deductible payment)?—tubal sterilization (‘tubes tied’), birth control pills, IUD.” Results: Less than 5% of women knew that their insurance covers tubal sterilization, and less than 12% knew that they have full IUD coverage. Most women (58%) were aware that they had full coverage for birth control pills. Nearly one in five women would change methods if they did not have to worry about cost, of whom 30% would switch to an IUD and 9% would switch to the implant. Outcomes: We report that privately insured women in the MyNewOptions study are largely unaware of their expanded contraceptive benefits under the ACA, including coverage for LARC methods. For the ACA contraceptive coverage mandate to increase use of effective methods, raising women's awareness of the expanded benefit is an essential first step.
Comparing contraceptive choices among postabortion patients with and without free access to long-acting reversible contraceptive (LARC) methods
http://dx.doi.org/10.1016/j.contraception.2015.06.124
P75
http://dx.doi.org/10.1016/j.contraception.2015.06.125
P76 Postabortion LARC method initiation by service providers and risk of subsequent unintended pregnancy
Goyal V University of Texas at Austin, Austin, TX, USA Aiken ARA, Dermish A, Potter JE Objectives: In 2014, a Medicaid 1115 waiver program offering free LARC methods to low-income uninsured Travis County residents was implemented at Planned Parenthood in Austin, Texas. We evaluated preabortion contraceptive desires and postabortion LARC method uptake among women who were and were not eligible for the program. Methods: We conducted a study of women aged 18–44 seeking abortion at Planned Parenthood. Participants completed a survey assessing program eligibility and contraceptive desires before the abortion. We then collected information on the methods women obtained at Planned Parenthood after their procedure. We compared method desires among women eligible and ineligible for the LARC program and used logistic regression to assess the impact of program eligibility on LARC method uptake. Results: Our sample of 446 women comprised 27% low-income, uninsured, Travis County residents eligible for the LARC program, 21% low-income, uninsured non-Travis County residents ineligible for the program and 50% insured or high-income women. Desire for LARC methods was high among all three groups: 65%, 55% and 55%, respectively (p=.18). Yet only 4% of low-income ineligible women received a LARC method postabortion compared with 67% of low-income eligible women and 22% of insured/high income women. When we adjusted for contraceptive desires and demographic characteristics, low-income uninsured women eligible for the program were far more likely than those ineligible to obtain a postabortion LARC method (OR, 71.9; 95% CI, 22.4–230.5).