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The impact of excluding planned parenthood from a state family planning program
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ABSTRACTS / Contraception 92 (2015) 359–414
were associated with an increased hazard of expulsion (HR, 1.57; 95% CI, 1.00–2.45 and HR, 2.30; 95% CI,1.15–4.33, respectively). Compared with vaginal delivery or abortion, cesarean delivery preceding IUD insertion was associated with a decreased hazard of expulsion (HR, 0.36; 95% CI, 0.18–0.73). Outcomes: Provider type is not associated with an increased hazard of IUD expulsion in this urban clinic. Menses and pain during insertion are associated with an increased hazard of expulsion, and immediate prior cesarean delivery is associated with a decreased hazard of expulsion. http://dx.doi.org/10.1016/j.contraception.2015.06.113
P64 The relationship between body mass index (BMI) and contraceptive method choice at last intercourse: results from the 2006–2010 and 2011–2013 National Survey of Family Growth (NSFG) Nguyen B University of Chicago, Chicago, IL, USA Gilliam M, Fabiyi C Objectives: Prior analysis of the 2002 NSFG revealed no association between BMI and contraceptive use. The objective of this study was to reexamine this relationship using updated NSFG data. Methods: Using 2006–2010 and 2011–2013 NSFG data, we examined the relationship between BMI status (normal weight, overweight, obese) and use of highly effective, effective, least effective or no method of contraception at last intercourse. Adjusted odds ratios (aORs) and confidence intervals were determined from a multinomial logistic regression adjusted for demographic, socioeconomic and reproductive covariates. Results: Of 10,331 women aged 20–44, who were neither pregnant nor trying to get pregnant, and who provided contraceptive data, 13.1% reported not using any method at last intercourse; among contraceptive users, 42% used the most effective methods (IUDs, implants, injectables). Excluding underweight women, 31.4% of respondents were obese. After multivariable adjustment, obesity (when compared with normal weight) was associated with no method use (aOR, 1.82; 95% CI, 1.02–3.25). Among those using a method, however, obese status was associated with use of a highly effective method (aOR,4.06; 95% CI, 1.5–10.8), which was also associated with education, private insurance, multiparity and recent contraceptive counseling after we controlled for BMI. Outcomes: While obesity is associated with not using a method at last intercourse, among women who use contraceptives, obesity is associated with using highly effective methods. Additional regression analyses using obesity-related comorbidities may help explain these findings.
continuation rates. Intent-to-treat principles were applied for comparing incidence of unintended pregnancy. Results: Of the 894 participants, 57% chose to be in the preference group and 43% in the randomization group. Loss to follow-up was less than 2%. The 12-month method continuation rates were 66% (62–70%) (preference-SARC), 55% (47–62%) (randomized-SARC) and 81% (75–87%) (randomized-LARC) (pb.001). The 12-month unintended pregnancy rates were 5.6% (3.8–8.2%) (preference-SARC), 8.8% (5.1–15.2%) (randomized-SARC) and 0.7% (0– 4.8%) (randomized-LARC) (p=.011). The 24-month unintended pregnancy rates were 14.5% (10.3–19.9%) (preference-SARC), 12.7% (7.2–22.2%) (randomizedSARC) and 3.8% (1.4–10.3%) (randomized-LARC) (p=.007). Outcomes: Even in a typical population of short-acting method users, LARC methods proved highly acceptable. Women randomized to receive a LARC method experienced superior protection from unintended pregnancy; this finding is attributable to the technology and not underlying factors that often bias observational studies. Benefits of increased voluntary uptake of LARC methods may extend to wider populations than previously thought. http://dx.doi.org/10.1016/j.contraception.2015.06.115
P66 The impact of excluding planned parenthood from a state family planning program Stevenson AJ University of Texas at Austin, Austin, TX, USA Potter JE, Flores-Vazquez IM, Allgeyer RL
Hubacher D FHI 360, Durham, NC, USA
Objectives: In January 2013, Texas' family planning Medicaid waiver program was terminated and replaced by a state-funded program excluding Planned Parenthood affiliates. We measured the impact of this exclusion in terms of changes in service volume by method in each of Texas' 254 counties and contraceptive continuation and subsequent pregnancy among injectable users. Methods: We analyzed complete annual billing records from Texas' fee-forservice family planning programs for the period 2011–2013 and used county-level clustered Poisson regression to compare volumes of IUDs, implants and injectables provided before and after the exclusion. By employing difference-in-differences, we compared the change in counties served by Planned Parenthood versus the change in those not served. We also linked to Medicaid deliveries among injectable users and used chi-square tests to compare continuation and subsequent pregnancy in this population before and after the exclusion took effect. Results: Our Poisson regression models demonstrated an overall decline in provision of IUDs (− 20%, p=.010), injectables (− 17%, p=.011) and implants (− 18%, p=.041) after the exclusion. But counties served by Planned Parenthood saw greater declines in provision of IUDs (− 58%, p= .027) and injectables (− 39%, p=.016). Among injectable users, continuation declined from 56% to 46% after the exclusion (pb.001), and the proportion of injectable users who became pregnant within 18 months of injection increased (3.68% vs. 4.24%, p=.030). Outcomes: Women who relied on the Texas fee-for-service family planning program had decreased access to IUDs, and injectables after Planned Parenthood was excluded. This decreased access also led to higher levels of pregnancy among injectable users after the exclusion.
Spector H, Monteith C, Chen P-L, Hart C
http://dx.doi.org/10.1016/j.contraception.2015.06.116
http://dx.doi.org/10.1016/j.contraception.2015.06.114
P65 Short-acting and long-acting reversible contraceptive methods: comparing effectiveness using a partially randomized patient preference trial
Objectives: We sought to generate unbiased estimates of contraceptive continuation rates, make valid comparisons and better understand the potential role that long-acting reversible contraceptive (LARC) methods can play in reducing unintended pregnancy. Methods: We recruited women aged 18–29 who were seeking a short-acting method (pills or injectable) from Planned Parenthood of Central North Carolina. Participants chose their preferred method or elected to be randomized to one of two method categories: short-acting reversible contraception (SARC) or LARC. Under randomization, participants received free methods and chose a product. Participants were followed prospectively. Kaplan–Meier techniques were used to estimate method
P67 Increasing engagement in contraceptive education with Milarc: a pilot, Web-based intervention to increase college women's acceptability and knowledge of LARC methods Caldwell A University of Michigan Medical School, Ann Arbor, MI, USA Ernst S, Steel M, Ela E, Zochowski MK, McAndrew L, Dalton VK, Stidham-Hall K
ABSTRACTS / Contraception 92 (2015) 359–414
were associated with an increased hazard of expulsion (HR, 1.57; 95% CI, 1.00–2.45 and HR, 2.30; 95% CI,1.15–4.33, respectively). Compared with vaginal delivery or abortion, cesarean delivery preceding IUD insertion was associated with a decreased hazard of expulsion (HR, 0.36; 95% CI, 0.18–0.73). Outcomes: Provider type is not associated with an increased hazard of IUD expulsion in this urban clinic. Menses and pain during insertion are associated with an increased hazard of expulsion, and immediate prior cesarean delivery is associated with a decreased hazard of expulsion. http://dx.doi.org/10.1016/j.contraception.2015.06.113
P64 The relationship between body mass index (BMI) and contraceptive method choice at last intercourse: results from the 2006–2010 and 2011–2013 National Survey of Family Growth (NSFG) Nguyen B University of Chicago, Chicago, IL, USA Gilliam M, Fabiyi C Objectives: Prior analysis of the 2002 NSFG revealed no association between BMI and contraceptive use. The objective of this study was to reexamine this relationship using updated NSFG data. Methods: Using 2006–2010 and 2011–2013 NSFG data, we examined the relationship between BMI status (normal weight, overweight, obese) and use of highly effective, effective, least effective or no method of contraception at last intercourse. Adjusted odds ratios (aORs) and confidence intervals were determined from a multinomial logistic regression adjusted for demographic, socioeconomic and reproductive covariates. Results: Of 10,331 women aged 20–44, who were neither pregnant nor trying to get pregnant, and who provided contraceptive data, 13.1% reported not using any method at last intercourse; among contraceptive users, 42% used the most effective methods (IUDs, implants, injectables). Excluding underweight women, 31.4% of respondents were obese. After multivariable adjustment, obesity (when compared with normal weight) was associated with no method use (aOR, 1.82; 95% CI, 1.02–3.25). Among those using a method, however, obese status was associated with use of a highly effective method (aOR,4.06; 95% CI, 1.5–10.8), which was also associated with education, private insurance, multiparity and recent contraceptive counseling after we controlled for BMI. Outcomes: While obesity is associated with not using a method at last intercourse, among women who use contraceptives, obesity is associated with using highly effective methods. Additional regression analyses using obesity-related comorbidities may help explain these findings.
continuation rates. Intent-to-treat principles were applied for comparing incidence of unintended pregnancy. Results: Of the 894 participants, 57% chose to be in the preference group and 43% in the randomization group. Loss to follow-up was less than 2%. The 12-month method continuation rates were 66% (62–70%) (preference-SARC), 55% (47–62%) (randomized-SARC) and 81% (75–87%) (randomized-LARC) (pb.001). The 12-month unintended pregnancy rates were 5.6% (3.8–8.2%) (preference-SARC), 8.8% (5.1–15.2%) (randomized-SARC) and 0.7% (0– 4.8%) (randomized-LARC) (p=.011). The 24-month unintended pregnancy rates were 14.5% (10.3–19.9%) (preference-SARC), 12.7% (7.2–22.2%) (randomizedSARC) and 3.8% (1.4–10.3%) (randomized-LARC) (p=.007). Outcomes: Even in a typical population of short-acting method users, LARC methods proved highly acceptable. Women randomized to receive a LARC method experienced superior protection from unintended pregnancy; this finding is attributable to the technology and not underlying factors that often bias observational studies. Benefits of increased voluntary uptake of LARC methods may extend to wider populations than previously thought. http://dx.doi.org/10.1016/j.contraception.2015.06.115
P66 The impact of excluding planned parenthood from a state family planning program Stevenson AJ University of Texas at Austin, Austin, TX, USA Potter JE, Flores-Vazquez IM, Allgeyer RL
Hubacher D FHI 360, Durham, NC, USA
Objectives: In January 2013, Texas' family planning Medicaid waiver program was terminated and replaced by a state-funded program excluding Planned Parenthood affiliates. We measured the impact of this exclusion in terms of changes in service volume by method in each of Texas' 254 counties and contraceptive continuation and subsequent pregnancy among injectable users. Methods: We analyzed complete annual billing records from Texas' fee-forservice family planning programs for the period 2011–2013 and used county-level clustered Poisson regression to compare volumes of IUDs, implants and injectables provided before and after the exclusion. By employing difference-in-differences, we compared the change in counties served by Planned Parenthood versus the change in those not served. We also linked to Medicaid deliveries among injectable users and used chi-square tests to compare continuation and subsequent pregnancy in this population before and after the exclusion took effect. Results: Our Poisson regression models demonstrated an overall decline in provision of IUDs (− 20%, p=.010), injectables (− 17%, p=.011) and implants (− 18%, p=.041) after the exclusion. But counties served by Planned Parenthood saw greater declines in provision of IUDs (− 58%, p= .027) and injectables (− 39%, p=.016). Among injectable users, continuation declined from 56% to 46% after the exclusion (pb.001), and the proportion of injectable users who became pregnant within 18 months of injection increased (3.68% vs. 4.24%, p=.030). Outcomes: Women who relied on the Texas fee-for-service family planning program had decreased access to IUDs, and injectables after Planned Parenthood was excluded. This decreased access also led to higher levels of pregnancy among injectable users after the exclusion.
Spector H, Monteith C, Chen P-L, Hart C
http://dx.doi.org/10.1016/j.contraception.2015.06.116
http://dx.doi.org/10.1016/j.contraception.2015.06.114
P65 Short-acting and long-acting reversible contraceptive methods: comparing effectiveness using a partially randomized patient preference trial
Objectives: We sought to generate unbiased estimates of contraceptive continuation rates, make valid comparisons and better understand the potential role that long-acting reversible contraceptive (LARC) methods can play in reducing unintended pregnancy. Methods: We recruited women aged 18–29 who were seeking a short-acting method (pills or injectable) from Planned Parenthood of Central North Carolina. Participants chose their preferred method or elected to be randomized to one of two method categories: short-acting reversible contraception (SARC) or LARC. Under randomization, participants received free methods and chose a product. Participants were followed prospectively. Kaplan–Meier techniques were used to estimate method
P67 Increasing engagement in contraceptive education with Milarc: a pilot, Web-based intervention to increase college women's acceptability and knowledge of LARC methods Caldwell A University of Michigan Medical School, Ann Arbor, MI, USA Ernst S, Steel M, Ela E, Zochowski MK, McAndrew L, Dalton VK, Stidham-Hall K