Contraception

OBJECTIVE: Nearly one-third of low-income women of reproductive age in the U.S. receive care in federally qualified community health centers, but comprehensive reproductive care is not consistently provided. Illinois Contraceptive Access Now (ICAN!) is an initiative addressing the access gap to high-quality contraceptive care with a focus on normalizing reproductive health screening for patients in federally qualified community health centers (FQHCs). STUDY DESIGN: This multi-method program evaluation used the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, with retrospective and prospective data collection from three Illinois FQHCs who participated as Quality Hubs, and from a Community Advisory Board...

OBJECTIVE: This study aimed to estimate and compare continuation rates of hormonal intrauterine devices (IUDs) when placed for contraceptive or menstrual management indications in adolescents and young adults. STUDY DESIGN: We conducted a secondary analysis of a prospectively collected database of all hormonal IUD insertions from January 1, 2017 through December 31, 2020, with at least one-year follow-up, across four Adolescent Medicine practices. IUD insertions without known indication were excluded...

OBJECTIVE(S): Low income can lead to limited choice of and access to contraception. We examine whether an unconditional cash transfer (UCT) impacts contraceptive use, including increased satisfaction with and reduced barriers to preferred methods, for individuals with low income. STUDY DESIGN: Baby's First Years (BFY) is a randomized control study of a monthly UCT to families with low incomes. The study enrolled 1,000 mothers at the time of childbirth across four US sites in 2018-2019; 400 were randomized to receive a UCT of $333/month and 600 were randomized to receive $20/month for the first years of their child's life...

OBJECTIVE: To examine the types of hormonal contraceptive methods chosen at the time of the abortion, and how they correspond to post-abortion hormonal contraceptive purchase. STUDY DESIGN: This was a prospective register-based study. We identified the present cohort of 8428 women undergoing induced abortion between July 1st 2017 and December 31st 2018, using the Prescription Centre, Social Insurance Institution database and the Finnish national Register of Induced Abortions...

OBJECTIVES: To assess the prevalence of and factors correlated with accepting a pelvic exam under anesthesia (EUA) by learners at the time of surgical abortion. STUDY DESIGN: Retrospective chart review assessing prevalence of and comparing factors associated with accepting EUA by learners at time of abortion. RESULTS: Most (88%) of the 274 patients accepted EUA by learners. Declining was associated with prior intimate partner violence. CONCLUSIONS: Most patients accept EUA by learners at time of abortion...

OBJECTIVE: To evaluate if inter-individual variability in serum etonogestrel (ENG) concentrations accounts for variability in mood-related side effects among ENG implant users. STUDY DESIGN: Participants underwent a single-time blood draw for measurement of serum ENG concentrations using a liquid-chromatography mass-spectrometry assay, and completed a questionnaire at enrollment that retrospectively assessed mood-related side effects during the period of implant use...

OBJECTIVES: LARC initiation been well-studied and intervened upon. Because LARC requires provider intervention for initiation and removal, it is critical to measure informed choice at the time of desired discontinuation as well. We examined perceptions of access to LARC discontinuation among women at two sites in Burkina Faso, where LARC is the dominant method in the contraceptive mix. STUDY DESIGN: We analyzed data from a 2017-2018 population-based, cross-sectional survey of n=281 implant users and n=55 IUD users at two sites in Burkina Faso...

OBJECTIVE: To explore the contraception content topics on the highly popular social media platform TikTok to understand this influential information source patients may bring into birth control counseling visits. STUDY DESIGN: Utilizing a snapshot method, we collected the 100 most popular TikTok English-language videos for each of eight contraception-specific search terms. We abstracted video content topics addressed and creator attributes. Two independent abstractors coded each video with high agreement, with a third coder adjudicating discrepancies...

The objective of this Clinical Recommendation is to review relevant literature and provide evidence-based recommendations for medication abortion between 14 0/7 and 27 6/7 weeks of gestation, with a focus on mifepristone-misoprostol and misoprostol-only regimens. We systematically reviewed PubMed articles published between 2008 and 2022 and reviewed reference lists of included articles to identify additional publications. See Search Strategy for more details. Several randomized trials of medication abortion between 14 0/7 and 27 6/7 weeks of gestation demonstrate that mifepristone 200 mg orally before misoprostol increases effectiveness (complete abortion at 24 or 48 hours) compared to misoprostol only...

No abstract text is available yet for this article.

OBJECTIVE: The availability of family planning and abortion training in residency is a concern for applicants, particularly following the overturning of Roe v Wade. We aimed to characterize public information on abortion training in obstetrics and gynecology residency programs in states with and without abortion bans. STUDY DESIGN: We abstracted residency program data using a publicly available database of obstetrics and gynecology residency programs. We performed a systematic internet search of each program's website to identify information on abortion training...

OBJECTIVE: To determine if pharmacies in Los Angeles County had implemented legislation that had been in effect since 2017 requiring insurance companies based in California to fully reimburse for 13 cycles of oral contraceptives dispensed at once. STUDY DESIGN: We conducted a secret shopper telephone survey of Los Angeles County pharmacies nearly five years after the legislation went into effect. We chose the categorial state family program (Family PACT) to represent all programs covered by the legislation...

Hemorrhage after abortion is rare, occurring in fewer than 1% of abortions, but associated morbidity may be significant. Although medication abortion is associated with more bleeding than procedural abortion, overall bleeding for the two methods is minimal and not clinically different. Hemorrhage can be caused by atony, coagulopathy and abnormal placentation, as well as by such procedure complications as perforation, cervical laceration and retained tissue. Evidence on which to make recommendations regarding risk factors and treatment for postabortion hemorrhage is extremely limited...

OBJECTIVE: Determine if replacement of patient-initiated, individual contraceptive education with mandatory group contraceptive education, during US Navy basic training, was associated with decreased LARC continuation. METHODS: Secondary analysis of administrative billing data from female military recruits who began basic training between September 2012 and February 2020. RESULTS: Servicewomen who started a LARC method during rather than after basic training had higher continuation rates...

OBJECTIVES: The ACGME requires all obstetrics and gynecology residents have access to "opt-out" abortion training. The impact of Dobbs v Jackson on training remains unknown. We aimed to describe residency programs affected by abortion bans and those lacking abortion training despite permissive state abortion policies. We considered demographic data to understand the impacts on residents underrepresented in medicine. STUDY DESIGN: We used publicly available databases and program websites to abstract data...

OBJECTIVES: The last nationwide evaluation of abortion education in undergraduate medical schools was conducted by Espey et. al. more than 15 years ago. To better understand what medical schools are teaching medical students about abortion care, we conducted a brief assessment of abortion education and training at U.S. medical schools. STUDY DESIGN: In April 2019, the study team emailed a three-item survey to the Obstetrics & Gynecology clerkship directors at AAMC-accredited U...

OBJECTIVES: The ExPAND Mifepristone learning collaborative (ExPAND) aims to support community-based primary care providers in overcoming logistical barriers to mifepristone provision. This qualitative study describes clinician and staff perspectives on the impact of ExPAND in two federally qualified health center networks (FQHCs). STUDY DESIGN: Researchers interviewed a purposive sample of clinicians, staff members, and clinic leaders from two participating Illinois FQHCs using an interview guide grounded in the Consolidated Framework for Implementation Research...

OBJECTIVES: To assess access to abortion pills offered by clinics providing state-funded family planning services in California. METHODS: We attempted to make two scripted calls to a 20% random sample of family planning clinics in California, stratified by county, as "secret shoppers" in 2020 and 2021. RESULTS: Clinic staff responded to 407 calls. Only 50 respondents (12%) reported their clinic offered abortion pills and 23 respondents (6%) accurately indicated to callers that abortion pills were available free to low-income individuals in California...

OBJECTIVE: The objective of this Clinical Recommendation is to review relevant literature and provide evidence-based recommendations for medication abortion between 14 0/7-27 6/7 weeks of gestation, with focus on mifepristone-misoprostol and misoprostol-only regimens. METHODS: We systematically reviewed PubMed articles published between 2008 and 2022 and reviewed reference lists of included articles to identify additional publications. See Search Strategy for more details...

OBJECTIVE: To estimate the annual number of incarcerated pregnant people in state and federal prisons needing an abortion. STUDY DESIGN: We used 2021 Bureau of Justice Statistics data and prior studies' findings to estimate the number of pregnant incarcerated people, then calculated state-specific abortion ratios to determine the number potentially needing an abortion. RESULTS: Out of 638 pregnant people incarcerated in prisons annually, 110 would be expected to need an abortion, including 55 in states where abortion is currently banned or restricted...