South Carolina’s Choose Well Initiative to Reduce Unintended Pregnancy: Rationale, Implementation Design, and Evaluation Methodology

Smith, M.G.H.; Hale, Nathan; Kelley, Sarah; Satterfield, Katherine; Beatty, Kate E.; Khoury, Amal

doi:10.2105/ajph.2022.306889

Cited by 7 publications

(10 citation statements)

References 16 publications

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“…The survey instrument, initially developed by the University of Maryland, was cognitively tested and adapted for the study population. The survey was designed to assess the landscape of contraceptive use before a statewide contraceptive access initiative that was implemented in South Carolina in 2017–2022 14 …”

Section: Methodsmentioning

confidence: 99%

“…The survey was designed to assess the landscape of contraceptive use before a statewide contraceptive access initiative that was implemented in South Carolina in 2017-2022. 14 A probability-based sample survey was conducted from October 2017 through April 2018 by NORC at the University of Chicago. Households were randomly selected based on address sampling methods using the US Postal Service computerized delivery sequence file supplemented by age-targeted lists for improved sample efficiency.…”

Section: Data and Study Populationmentioning

confidence: 99%

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Association of Health Insurance with Contraceptive Use and Interpersonal Quality of Contraceptive Care in the Southeast United States

Beatty¹,

Hale²,

Khoury³

et al. 2023

Southern Medical Journal

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Objectives: Health insurance remains an important dimension of contraceptive access. This study investigated the role of insurance in contraceptive use, access, and quality in South Carolina and Alabama. Methods:The study used a cross-sectional statewide representative survey that assessed reproductive health experiences and contraceptive use among reproductive-age women in South Carolina and Alabama. The primary outcomes were current contraceptive method use, barriers to access (inability to afford wanted method, delay/trouble obtaining wanted method), receipt of any contraceptive care in the past 12 months, and perceived quality of care. The independent variable was insurance type. Generalized linear models were applied to estimate prevalence ratios for each outcome's association with insurance type while adjusting for potentially confounding variables.Results: Nearly 1 in 5 women (17.6%) was uninsured, and 1 in 4 women (25.3%) reported not using a contraceptive method at the time of the survey. Compared with women with private insurance, women with no insurance had a lower likelihood of current method use (adjusted prevalence ratio 0.75; 95% confidence interval 0.60-0.92) and receipt of contraceptive care in the past 12 months (adjusted prevalence ratio 0.61; 95% confidence interval 0.45-0.82). These women also were more likely to experience cost barriers to access care. The insurance type was not significantly associated with the interpersonal quality of contraceptive care.Conclusions: Findings highlight the need for expanding Medicaid in states that did not do so under the Patient Protection and Affordable Care Act, interventions to increase the number of providers who accept Medicaid patients, and protections to Title X funding as key elements for enhancing contraceptive access and population health outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Data and Study Populationmentioning

confidence: 99%

Association of Health Insurance with Contraceptive Use and Interpersonal Quality of Contraceptive Care in the Southeast United States

Beatty¹,

Hale²,

Khoury³

et al. 2023

Southern Medical Journal

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“…The initiative launched in 2017 with a focus on promoting equitable access to contraception without coercion . Choose Well was designed as a 6-year initiative (2017-2022) with plans to sustain the initiative beyond its initial funding period.…”

Section: Introductionmentioning

confidence: 99%

“…Choose Well was designed as a 6-year initiative (2017-2022) with plans to sustain the initiative beyond its initial funding period. Originally designed to narrow contraceptive access gaps for the uninsured and underinsured, many individuals benefit from Choose Well activities, regardless of ability to pay . Choose Well focused on ensuring contraceptive access by offsetting the cost of contraceptives, developing infrastructure and workforce, capacity building and training, marketing and communications, and strategic learning and sustainability across various clinical sectors.…”

Section: Introductionmentioning

confidence: 99%

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Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative

Hale,

Lee,

de Jong

et al. 2024

JAMA Netw Open

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ImportanceEvaluating the impact of statewide contraceptive access initiatives is necessary for informing health policy and practice.ObjectiveTo examine changes in contraceptive method use among a cohort of women of reproductive age in South Carolina during the Choose Well contraceptive access initiative.Design, Setting, and ParticipantsIn this cohort study, baseline data from the initial Statewide Survey of Women administered from October 1, 2017, to April 30, 2018, to a probability-based sample of women of reproductive age in South Carolina and a peer state (Alabama) were linked with 3 follow-up surveys given in 2019, 2020, and 2021. Responses about contraception use from the initial survey were compared with responses across follow-up surveys using the regression-based differences-in-differences method. Data analysis was performed from October 2023 to February 2024.ExposureThe South Carolina Choose Well contraceptive access initiative seeks to fill contraceptive access gaps and increase provision of a full range of contraceptive methods through engagement with a wide range of health care organizations across the state.Main Outcomes and MeasuresChanges in contraceptive method use, including long-acting reversible contraception (LARC), intrauterine devices (IUDs), implants, short-acting hormonal injection, and barrier or other methods between the baseline survey (2017-2018) and 3 subsequent surveys (2019-2021).ResultsA total of 1344 female participants (mean [SD] age, 34 [7] years) completed the first survey (667 in Alabama and 677 in South Carolina). Use of LARC significantly increased in South Carolina (119 [17.6%] to 138 [21.1%]) compared with Alabama (120 [18.0%] to 116 [18.1%]; P = .004). Use of IUDs increased in South Carolina (95 [14.0%] to 114 [17.4%]) compared with Alabama (92 [13.8%] to 102 [15.9%]; P = .003). These associations persisted in the adjusted analysis, with a significant increase in the odds of LARC (adjusted odds ratio, 1.24; 95% CI, 1.06-1.44) and IUD (adjusted odds ratio, 1.19; 95% CI, 1.06-1.32) use at follow-up in South Carolina compared with Alabama.Conclusions and RelevanceIn this cohort study of 1344 participants, increases in the use of IUDs in South Carolina were noted after the implementation of the South Carolina Choose Well initiative that were not observed in a peer state with no intervention. Our findings may provide support in favor of statewide contraceptive access initiatives and their role in promoting access to reproductive health services.

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Reproductive care in community health centers: Multi-method evaluation of the Illinois Contraceptive Access Now (ICAN!) demonstration program

Wolff,

McHugh,

Qadir

et al. 2024

Contraception

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South Carolina’s Choose Well Initiative to Reduce Unintended Pregnancy: Rationale, Implementation Design, and Evaluation Methodology

Cited by 7 publications

References 16 publications

Association of Health Insurance with Contraceptive Use and Interpersonal Quality of Contraceptive Care in the Southeast United States

Association of Health Insurance with Contraceptive Use and Interpersonal Quality of Contraceptive Care in the Southeast United States

Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative

Reproductive care in community health centers: Multi-method evaluation of the Illinois Contraceptive Access Now (ICAN!) demonstration program

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