Public Funding for Contraception, Provider Training, and Use of Highly Effective Contraceptives: A Cluster Randomized Trial

Thompson, K.; Rocca, Corinne H.; Kohn, Julia E.; Goodman, Suzan; Stern, Lisa; Blum, Maya; Speidel, J. Joseph; Darney, Philip D.; Harper, Cynthia C.

doi:10.2105/ajph.2015.303001

Cited by 40 publications

(37 citation statements)

References 15 publications

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“…Given prior analyses showing the importance of funding for LARC use, 13,17 we assessed participant health insurance (public [Medicaid, other state program], private, no insurance, do not know) as well as 3 site-level funding policy variables: whether the site was in a state with a family-planning Medicaid expansion program, Medicaid coverage of abortion, and mandated private insurance contraceptive coverage. 18 …”

Section: Methodsmentioning

confidence: 99%

Contraception after medication abortion in the United States: results from a cluster randomized trial

Rocca

Goodman

Grossman

et al. 2018

American Journal of Obstetrics and Gynecology

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BACKGROUND Understanding how contraceptive choices and access differ for women having medication abortions compared to aspiration procedures can help to identify priorities for improved patient-centered postabortion contraceptive care. OBJECTIVE The objective of this study was to investigate the differences in contraceptive counseling, method choices, and use between medication and aspiration abortion patients. STUDY DESIGN This subanalysis examines data from 643 abortion patients from 17 reproductive health centers in a cluster, randomized trial across the United States. We recruited participants aged 18–25 years who did not desire pregnancy and followed them for 1 year. We measured the effect of a full-staff contraceptive training and abortion type on contraceptive counseling, choice, and use with multivariable regression models, using generalized estimating equations for clustering. We used survival analysis with shared frailty to model actual intrauterine device and subdermal implant initiation over 1 year. RESULTS Overall, 26% of participants (n = 166) had a medication abortion and 74% (n = 477) had an aspiration abortion at the enrollment visit. Women obtaining medication abortions were as likely as those having aspiration abortions to receive counseling on intrauterine devices or the implant (55%) and on a short-acting hormonal method (79%). The proportions of women choosing to use these methods (29% intrauterine device or implant, 58% short-acting hormonal) were also similar by abortion type. The proportions of women who actually used short-acting hormonal methods (71% medication vs 57% aspiration) and condoms or no method (20% vs 22%) within 3 months were not significantly different by abortion type. However, intrauterine device initiation over a year was significantly lower after the medication than the aspiration abortion (11 per 100 person-years vs 20 per 100 person-years, adjusted hazard ratio, 0.50; 95% confidence interval, 0.28–0.89). Implant initiation rates were low and similar by abortion type (5 per 100 person-years vs 4 per 100 person-years, adjusted hazard ratio, 2.41; 95% confidence interval, 0.88–6.59). In contrast to women choosing short-acting methods, relatively few of those choosing a long-acting method at enrollment, 34% of medication abortion patients and 53% of aspiration abortion patients, had one placed within 3 months. Neither differences in health insurance nor pelvic examination preferences by abortion type accounted for lower intrauterine device use among medication abortion patients. CONCLUSION Despite similar contraceptive choices, fewer patients receiving medication abortion than aspiration abortion initiated intrauterine devices over 1 year of follow-up. Interventions to help patients receiving medication abortion to successfully return for intrauterine device placement are warranted. New protocols for same-day implant placement may also help patients receiving medication abortion and desiring a long-acting method to receive one.

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Section: Methodsmentioning

confidence: 99%

Contraception after medication abortion in the United States: results from a cluster randomized trial

Rocca

Goodman

Grossman

et al. 2018

American Journal of Obstetrics and Gynecology

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“…Although the challenges for current pediatricians to obtain IUD training are real, a cluster randomized trial of a 4-hour training for placement of LARC methods by family planning clinic providers showed substantial increases in LARC provision. 27 Medical educators should redouble efforts to provide trainees with opportunities to place IUDs and implants, and push for training in LARC procedures as standard for pediatric trainees.…”

Section: Discussionmentioning

confidence: 99%

Can Pediatricians Provide Long-Acting Reversible Contraception?

Norris

Pritt

Berlan

2019

Journal of Pediatric and Adolescent Gynecology

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Study Objective: In the United States, 40% of high-school students have sex; few use highly effective and safe long-acting reversible contraceptives (LARCs): intrauterine devices and implants. Pediatricians are key health providers for many adolescents, yet few provide LARCs. Our objective was to understand the pragmatics of provision of LARCs (rather than beliefs or attitudes) and identify barriers to and opportunities for LARC provision by community-practicing pediatricians. Design: We conducted a qualitative descriptive study using semistructured interviews. Qualitative methods are valuable for generating conceptual models of complex phenomena. Setting: Set in a midsized Midwestern city, our study was community-based. Participants, Interventions, and Main Outcome Measures: We interviewed 23 pediatricians to understand their views about providing contraception (including LARCs) to adolescents. For analysis, we developed a coding schema and applied it using a priori and open coding. Results: Several interrelated themes regarding challenges to provision of LARC emerged: limited motivation for on-site LARC provision or referral streams, low pediatric patient interest in LARC, lack of pediatrician training about LARC provision, and inadequate structural elements for on-site placement of LARCs in pediatric offices. Each challenge could be remedied, because pediatricians were motivated to provide adolescent patients with high-quality care. Improvements in these interrelated conditions could facilitate pediatrician provision of LARC. Conclusion: Pediatricians and their patients want to prevent pregnancy, but current practice norms limit LARC provision by pediatricians. To increase LARC access in pediatrician offices, we suggest training in LARC provision and patient education for medical students, residents, and pediatricians; communicating about LARC methods with adolescents to increase patient demand; and systemic changes to improve referral processes and/or allow on-site LARC placements.

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“…However, disparities remain, especially for marginalized groups [25]. In the United States (US), the implementation of Affordable Care Act (ACA) indicated a significant result in increasing of use of overall contraceptive, in the use of Long-Acting Reversible Contraceptives (LARCs), in decreasing of the births, in reducing of the proportion of births from unwanted pregnancies, and in reducing an inequality among insured women [6,[26][27][28][29][30][31][32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

“…The JKN policy could increase LACs use, especially in the group who has subsidized health insurance and the Nusa-Maluku-Papua region, but an inequity has remained between urban and rural areas. Most studies indicated that health insurance had made a significant contribution to increasing of LACs use [6,[26][27][28][29][30][32][33][34][35][41][42][43][44][45][46]. The contribution of LACs use in the success of the family planning program is very crucial, but until 2016, LACs use coverage in Indonesia was only 18.72%.…”

Section: Discussionmentioning

confidence: 99%

Changes in Determinants and Equity of Family Planning Utilization after the Implementation of a National Health Insurance Policy in Indonesia: A Secondary Analysis of The 2012-2016 National Socio-Economic Survey of Indonesia

Nasution

Mahendradhata

Trisnantoro

2019

Preprint

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Background: The Indonesian government has been implementing the National Health Insurance Policy (Jaminan Kesehatan Nasional-JKN) since 2014. The utilization of family planning service is one of the programs to increase maternal and child health status that is included in the benefit package in JKN.This study aimed to describe determinants and to evaluate JKN based on equity indicators, especially in family planning services. Methods: Data were obtained from the 2012-2016 National Socio-Economic Survey (SUSENAS) of Indonesia. Contraceptive Prevalence Rate (CPR) and Long-acting contraceptives (LACs) use were used as indicators to evaluate family planning utilization. Chi-square and logistic regression tests were used to analyze the data. Respondents were married women between 15 and 49 years of age. Results: There was no progress in CPR after the implementation of JKN. At the national level, CPR decreased within five years (2012)(2013)(2014)(2015)(2016). Decreasing in urban areas and in the group that does not have health insurance were more than in rural areas and in the group that has health insurance. Utilization of non-LACs, especially injection (56%-57%) and pill (21%-24%), were still high within 2012-2016. At the national level, LACs use increased 3.18% between 2012-2016 (15.54%-18.72%). Increasing in urban areas and in the group that has subsidized health insurance were more than in rural areas and in the group that does not have subsidized. In 2016, the geography factor (rural-urban) and household economic status associated negatively with the use of overall contraceptive method (p<0.05). Conversely, all the determinants were positively associated with LACs use (p<0.05). Conclusions: Up to 2016, the JKN program did not increase CPR. Conversely, the JKN program obtained only small increases in LACs use. LACs use in rural areas is less than in urban areas. JKN program can increase LACs use in the group that has subsidized health insurance. CPR and LACs coverage could increase through health system improvement, and the societal norms approach.Health system improvement is operationalized through improving supply-side and regulations, increasing coordination among multiple agencies in the family planning program.

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Public Funding for Contraception, Provider Training, and Use of Highly Effective Contraceptives: A Cluster Randomized Trial

Abstract: Public funding and provider training substantially improve LARC access.

Cited by 40 publications

References 15 publications

Contraception after medication abortion in the United States: results from a cluster randomized trial

Contraception after medication abortion in the United States: results from a cluster randomized trial

Can Pediatricians Provide Long-Acting Reversible Contraception?

Changes in Determinants and Equity of Family Planning Utilization after the Implementation of a National Health Insurance Policy in Indonesia: A Secondary Analysis of The 2012-2016 National Socio-Economic Survey of Indonesia

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