Removing Unnecessary Medical Barriers to Contraception: Celebrating a Decade of the U.S. Medical Eligibility Criteria for Contraceptive Use

Curtis, Kathryn M.; Zapata, Lauren B.; Pagano, H. Pamela; Nguyen, Antoinette; Reeves, Jennifer A.; Whiteman, Maura K.

doi:10.1089/jwh.2020.8910

Cited by 5 publications

(3 citation statements)

References 34 publications

(39 reference statements)

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“…Contraceptive methods are known to confer important non-contraceptive benefits to users [12,13], and available guidelines state that HC can be safely used by most women, even perimenopausal or with a family history of breast cancer [47][48][49]. Modern methods are offered in a variety of combinations and forms of administration (oral, injectable, transdermal, subdermal, intrauterine, and intravaginal), aimed to improve the safety profile of contraceptives in terms of side effects and ease of use.…”

Section: Discussionmentioning

confidence: 99%

Hormonal Contraception and the Risk of Breast Cancer in Women of Reproductive Age: A Meta-Analysis

Torres-de la Roche,

Acevedo-Mesa,

Lizarazo

et al. 2023

Cancers

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This study aims to summarize evidence from observational studies about the lifetime use of HC and the risk of BC in women of reproductive age. The PubMed, Cochrane, and EMBASE databases were searched for observational studies published from 2015 to February 2022. Meta-analyses were performed using adjusted odds ratios and relative risks with a random-effects model using the I2 statistic to quantify the heterogeneity among studies. Of the 724 studies identified, 650 were screened for title/abstract selection, 60 were selected for full-text revision, and 22 were included in the meta-analysis. Of these, 19 were case-control studies and 3 were cohort studies. The results of the meta-analysis indicate a significantly higher risk of developing BC in ever users of HC (pooled OR = 1.33; 95% CI = 1.19 to 1.49). This effect is larger in the subgroups of case-control studies (pooled OR = 1.44, 95% CI = 1.21 to 1.70) and in the subgroup of studies that strictly define menopausal status (pooled OR = 1.48; 95% CI, 1.10 to 2.00). Although our meta-analysis of observational studies (cohort and case-control) suggests a significantly increased overall risk of BC in users or ever-users of modern hormonal contraceptives, the high heterogeneity among studies (>70%) related to differences in study design, measurement of variables, confounders, among other factors, as well as publication biases should be considered when interpreting our results.

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Section: Discussionmentioning

confidence: 99%

Hormonal Contraception and the Risk of Breast Cancer in Women of Reproductive Age: A Meta-Analysis

Torres-de la Roche,

Acevedo-Mesa,

Lizarazo

et al. 2023

Cancers

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“…The Centers for Disease Control and Prevention Medical Eligibility Criteria for Contraceptive Use (MEC) uses four categories to classify medical conditions affecting eligibility for the use of various contraceptive methods: Category 1 is defined as medical conditions that have no restriction for the contraceptive method and category 2 includes medical conditions for which the advantages of using the method generally outweigh the risks, category 3 and 4 are typically considered contraindicated as the risks outweigh the benefits [21]. The goal of these recommendations is to remove unnecessary medical barriers to accessing and using contraception by providing clinicians reassurance that most contraceptive methods can be safely used by most people, even those with complex medical conditions [22].…”

Section: Contraceptive Counseling For the Medically Complex Individualmentioning

confidence: 99%

Optimizing postpartum contraception for high-risk obstetric patients

Miller

Darmawan²,

Henkel

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewThis review will focus on those who are at greatest risk of maternal and neonatal morbidity from a subsequent unplanned or short interval pregnancy and the interventions to increase contraceptive uptake in the postpartum period. Recent findingsPopulations at highest risk of maternal or neonatal morbidity --those with a history of preterm birth or those with complex medical conditions --are also those at the highest risk for unintended pregnancies attributed to low-efficacy contraceptive failure/ noncontraceptive use, and many are discharged from birth hospitalization without understanding the importance of birth spacing related to their high-risk pregnancies. Current innovative strategies to improve postpartum contraception access and uptake among high-risk populations include utilizing the antenatal period to initiate contraception counseling, developing multidisciplinary teams, and incorporating multimedia-based educational tools. However, ongoing challenges that continue to pose barriers to contraception access include racial and economic disparities and the restructuring of obstetric care during the COVID-19 pandemic.

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“…The US Medical Eligibility for Contraceptive Use (MEC), a national contraceptive guideline for health care providers, includes over 1800 recommendations for more than 60 conditions and characteristics, as well as information on certain drug interactions [ 9 ]. The US MEC provides recommendations for CF, but the current body of evidence is limited due to design flaws, few outcomes, and small sample sizes [ 8 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Web-Based Survey Piloting Process as a Model for Developing and Testing Past Contraceptive Use and Pregnancy History: Cystic Fibrosis Case Study

et al. 2023

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Background Individuals with complex, chronic diseases are now living longer, making reproductive health an important topic to address in the health care setting. Self-respondent surveys are a feasible way to collect past contraceptive use and pregnancy history to assess contraceptive safety and effectiveness. Because sensitive topics, such as contraception and pregnancy outcomes, can vary across social groups or cultures, piloting questions and evaluating survey administration procedures in the target population are necessary for precise and reliable responses before wide distribution. Objective This study aimed to develop a precise and reliable survey instrument and related procedures among individuals with cystic fibrosis regarding contraceptive use and obstetrical history. Methods We piloted and tested web-based questions related to contraceptive use and pregnancy history among 50 participants with and those without cystic fibrosis aged 18 to 45 years using a 3-tier process. Findings from each tier informed changes to the questionnaire before testing in the subsequent tier. Tier 1 used cognitive pretesting to assess question understanding and the need for memory prompts. In tier 2, we used test-retest self- and interviewer-administered approaches to assess question reliability, evaluate response missingness, and determine confidence between 2 types of survey administration approaches. In tier 3, we tested the questionnaire for clarity, time to complete, and whether additional prompts were necessary. Results In tier 1, respondents suggested improvements to the web-based survey questions and to the written and visual prompts for better recall regarding past contraceptive use. In tier 2, the test-retest reliability between self- and interviewer-administrative procedures of “ever use” contraceptive method questions was similar, with percent absolute agreement ranging between 84% and 100%. When the survey was self-administered, the percentage of missing responses was higher and respondent confidence about month and year when contraceptive methods were used was lower. Most respondents reported that they preferred the self-administered survey because it was more convenient and faster to complete. Conclusions Our 3-tier process to pilot web-based survey questions related to contraceptive and obstetrical history in our complex disease population helped us tailor content and format questions before wide dissemination to our target population. Results from this pilot study informed the subsequent larger study design to include a 10% respondent test-retest self- and interviewer-administered quality control component to better inform imputation procedures of missing data.

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Removing Unnecessary Medical Barriers to Contraception: Celebrating a Decade of the U.S. Medical Eligibility Criteria for Contraceptive Use

Cited by 5 publications

References 34 publications

Hormonal Contraception and the Risk of Breast Cancer in Women of Reproductive Age: A Meta-Analysis

Hormonal Contraception and the Risk of Breast Cancer in Women of Reproductive Age: A Meta-Analysis

Optimizing postpartum contraception for high-risk obstetric patients

Web-Based Survey Piloting Process as a Model for Developing and Testing Past Contraceptive Use and Pregnancy History: Cystic Fibrosis Case Study

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