Pub Date : 2025-11-25DOI: 10.1016/j.contraception.2025.111252
Parth Aphale, Himanshu Shekhar, Shashank Dokania
{"title":"Expanding the discourse on patient perceptions of LARC: Beyond trust and relief","authors":"Parth Aphale, Himanshu Shekhar, Shashank Dokania","doi":"10.1016/j.contraception.2025.111252","DOIUrl":"10.1016/j.contraception.2025.111252","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"153 ","pages":"Article 111252"},"PeriodicalIF":2.3,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145584141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-07DOI: 10.1016/j.contraception.2025.111286
Antoinette Oot , Natalie DiCenzo , Holly A. Rankin , Megan Masten , Christina Jung
Objective
To examine current Complex Family Planning (CFP) fellows’ experience with induction of fetal asystole.
Study Design
Cross-sectional web-based survey of trainees enrolled in United States accredited CFP fellowships.
Results
Of the 52/66 (79%) of fellows who responded, 36/52 (69%) plan to provide induction of fetal asystole post-fellowship. Thirty-six (69%) received training, most commonly by digoxin (31/52, 60%) transabdominal (31/31, 100%) intrafetal (26/31, 83%) injections. Twenty-four (46%) predicted competence upon graduation.
Conclusions
More CFP fellows planned to practice induction of fetal asystole in their future practice than the fewer than half of respondents who predicted they will be able to independently practice this skill upon graduation.
Implications
CFP fellowship programs can expand availability and comprehensiveness of training to support graduates in independent practice of induction of fetal asystole.
{"title":"Training to perform injections to induce fetal asystole across complex family planning fellowship sites","authors":"Antoinette Oot , Natalie DiCenzo , Holly A. Rankin , Megan Masten , Christina Jung","doi":"10.1016/j.contraception.2025.111286","DOIUrl":"10.1016/j.contraception.2025.111286","url":null,"abstract":"<div><h3>Objective</h3><div>To examine current Complex Family Planning (CFP) fellows’ experience with induction of fetal asystole.</div></div><div><h3>Study Design</h3><div>Cross-sectional web-based survey of trainees enrolled in United States accredited CFP fellowships.</div></div><div><h3>Results</h3><div>Of the 52/66 (79%) of fellows who responded, 36/52 (69%) plan to provide induction of fetal asystole post-fellowship. Thirty-six (69%) received training, most commonly by digoxin (31/52, 60%) transabdominal (31/31, 100%) intrafetal (26/31, 83%) injections. Twenty-four (46%) predicted competence upon graduation.</div></div><div><h3>Conclusions</h3><div>More CFP fellows planned to practice induction of fetal asystole in their future practice than the fewer than half of respondents who predicted they will be able to independently practice this skill upon graduation.</div></div><div><h3>Implications</h3><div>CFP fellowship programs can expand availability and comprehensiveness of training to support graduates in independent practice of induction of fetal asystole.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111286"},"PeriodicalIF":2.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145484288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-06DOI: 10.1016/j.contraception.2025.111289
Elaine Cristina Fontes de Oliveira , Rossana Cristina Fontes Cotta , Ana Luiza Lunardi Rocha
Pulmonary hypertension is rare but carries high morbidity in women of reproductive age. Effective contraception is essential, with long-acting reversible contraceptives preferred. However, intrauterine device insertion is often restricted to surgical settings, limiting access. This case series reports outpatient Levonorgestrel-Releasing Intrauterine System insertions in this high-risk population.
{"title":"Outpatient insertions of the levonorgestrel-releasing intrauterine system in women with pulmonary hypertension: A case series","authors":"Elaine Cristina Fontes de Oliveira , Rossana Cristina Fontes Cotta , Ana Luiza Lunardi Rocha","doi":"10.1016/j.contraception.2025.111289","DOIUrl":"10.1016/j.contraception.2025.111289","url":null,"abstract":"<div><div>Pulmonary hypertension is rare but carries high morbidity in women of reproductive age. Effective contraception is essential, with long-acting reversible contraceptives preferred. However, intrauterine device insertion is often restricted to surgical settings, limiting access. This case series reports outpatient Levonorgestrel-Releasing Intrauterine System insertions in this high-risk population.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111289"},"PeriodicalIF":2.3,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-06DOI: 10.1016/j.contraception.2025.111288
Erica Torres, Sarah Elliott, Gentry Carter, Alexandra L. Woodcock, Madeline Mullholand, David K. Turok
Objective
We assessed no-cost uptake of the two FDA approved emergency contraception methods via University of Utah pharmacies.
Study Design
In January 2023, we began providing levonorgestrel 1.5 mg (available over the counter) and ulipristal acetate 30 mg (requires a prescription) to Utah residents aged 18+ (complying with University interpretation of state law), without cost or gender restrictions. A limited informational campaign informed people they could access up to three doses of each emergency contraception type through the University’s MyChart patient portal, without requiring prior provider visits. The portal provided information about both emergency contraception options including greater efficacy of ulipristal acetate. Requests underwent advanced practice clinician review, prescription preparation and fulfillment. Medication pickup occurred at any University of Utah pharmacy location in-person or through mail delivery system. We analyzed de-identified electronic health record data to assess user demand, demographics and emergency contraception preference.
Results
During the two-year study period, we received a total of 2559 requests, 1279 in 2023 and 1280 in 2024. We provided 1094 individuals (42.8%) with levonorgestrel 1.5 mg, resulting in 2318 dispensed pills and 1465 individuals (57.2%) with ulipristal acetate 30 mg resulting in 3259 dispensed pills. Most levonorgestrel (690/1094, 63.1%) and ulipristal acetate (981/1465 67.0%) users requested multiple doses. In-person pharmacy dispensing increased from 860 recipients (67.2%) in 2023 to 1001 (78.2%) in 2024 (p < 0.001) with corresponding shipments decreases across 13 Utah counties.
Conclusion
Eliminating cost and provider visit barriers resulted in sustained demand and patient preference for ulipristal acetate, the more effective emergency contraception method.
Implications
This study supports removing cost and access barriers to emergency contraception, showing high demand for ulipristal acetate, and sustained use when offered without provider visits. This model demonstrates an innovative and feasible approach to deliver equitable access across diverse populations and regions via electronic portals and mail delivery systems.
{"title":"Enhancing access to emergency contraception: Results from a no-cost program in Utah","authors":"Erica Torres, Sarah Elliott, Gentry Carter, Alexandra L. Woodcock, Madeline Mullholand, David K. Turok","doi":"10.1016/j.contraception.2025.111288","DOIUrl":"10.1016/j.contraception.2025.111288","url":null,"abstract":"<div><h3>Objective</h3><div>We assessed no-cost uptake of the two FDA approved emergency contraception methods via University of Utah pharmacies.</div></div><div><h3>Study Design</h3><div>In January 2023, we began providing levonorgestrel 1.5 mg (available over the counter) and ulipristal acetate 30 mg (requires a prescription) to Utah residents aged 18+ (complying with University interpretation of state law), without cost or gender restrictions. A limited informational campaign informed people they could access up to three doses of each emergency contraception type through the University’s MyChart patient portal, without requiring prior provider visits. The portal provided information about both emergency contraception options including greater efficacy of ulipristal acetate. Requests underwent advanced practice clinician review, prescription preparation and fulfillment. Medication pickup occurred at any University of Utah pharmacy location in-person or through mail delivery system. We analyzed de-identified electronic health record data to assess user demand, demographics and emergency contraception preference.</div></div><div><h3>Results</h3><div>During the two-year study period, we received a total of 2559 requests, 1279 in 2023 and 1280 in 2024. We provided 1094 individuals (42.8%) with levonorgestrel 1.5 mg, resulting in 2318 dispensed pills and 1465 individuals (57.2%) with ulipristal acetate 30 mg resulting in 3259 dispensed pills. Most levonorgestrel (690/1094, 63.1%) and ulipristal acetate (981/1465 67.0%) users requested multiple doses. In-person pharmacy dispensing increased from 860 recipients (67.2%) in 2023 to 1001 (78.2%) in 2024 <strong>(</strong>p < 0.001) with corresponding shipments decreases across 13 Utah counties.</div></div><div><h3>Conclusion</h3><div>Eliminating cost and provider visit barriers resulted in sustained demand and patient preference for ulipristal acetate, the more effective emergency contraception method.</div></div><div><h3>Implications</h3><div>This study supports removing cost and access barriers to emergency contraception, showing high demand for ulipristal acetate, and sustained use when offered without provider visits. This model demonstrates an innovative and feasible approach to deliver equitable access across diverse populations and regions via electronic portals and mail delivery systems.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111288"},"PeriodicalIF":2.3,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/j.contraception.2025.111287
Jacques B.E. Versailles, Luis Bahamondes, Ana C. Marcelino, Paula da Cunha Pereira, M. Valeria Bahamondes, Cassia R.T. Juliato
Objectives
To evaluate the willingness and ability of intrauterine device (IUD) users to self-remove their device.
Study Design
A cross-sectional study was conducted at the Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Brazil. We enrolled users of copper- or levonorgestrel 52 mg- IUDs who requested a device removal for any reason. Women with non-visible strings or partial IUD expulsion were excluded. Participants were instructed to insert their fingers into the vagina, with or without gloves according to their preference, to locate the IUD strings and attempt removal. If unsuccessful, removal was performed by a health care provider.
Results
A total of 238 women were included, with a mean ± SD age of 35.4 ± 8.0 years. Regarding willingness, 174 (73.1%) declined to attempt IUD self-removal, mainly due to fear (77/174; 44.5%). Among the 64 women who attempted self-removal, 8 (12.5%) were successful. The primary reason for failure was the inability to palpate or locate the strings.
Conclusions
Although a low number of participants were willing to attempt self-removal, some perceived it to increase autonomy and engage in self-exploration. Nevertheless, most preferred removal by a health care provider, due to fear of pain and perceived procedural complexity. Enhancing patient education and addressing concerns may improve the feasibility and acceptability of IUD self-removal, potentially empowering more women in their reproductive health decisions.
Implications
Our study highlights that although the success rate of IUD self-removal was low, interest in the practice was notable among users. Fear and reliance on health care providers were key barriers to attempts. Our findings suggest that incorporating clear, evidence-based counseling about IUD self-removal at IUD placement may support reproductive autonomy and informed decision-making.
{"title":"Acceptability and challenges of self-removal of intrauterine devices in Campinas, Brazil","authors":"Jacques B.E. Versailles, Luis Bahamondes, Ana C. Marcelino, Paula da Cunha Pereira, M. Valeria Bahamondes, Cassia R.T. Juliato","doi":"10.1016/j.contraception.2025.111287","DOIUrl":"10.1016/j.contraception.2025.111287","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the willingness and ability of intrauterine device (IUD) users to self-remove their device.</div></div><div><h3>Study Design</h3><div>A cross-sectional study was conducted at the Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Brazil. We enrolled users of copper- or levonorgestrel 52 mg- IUDs who requested a device removal for any reason. Women with non-visible strings or partial IUD expulsion were excluded. Participants were instructed to insert their fingers into the vagina, with or without gloves according to their preference, to locate the IUD strings and attempt removal. If unsuccessful, removal was performed by a health care provider.</div></div><div><h3>Results</h3><div>A total of 238 women were included, with a mean ± SD age of 35.4 ± 8.0 years. Regarding willingness, 174 (73.1%) declined to attempt IUD self-removal, mainly due to fear (77/174; 44.5%). Among the 64 women who attempted self-removal, 8 (12.5%) were successful. The primary reason for failure was the inability to palpate or locate the strings.</div></div><div><h3>Conclusions</h3><div>Although a low number of participants were willing to attempt self-removal, some perceived it to increase autonomy and engage in self-exploration. Nevertheless, most preferred removal by a health care provider, due to fear of pain and perceived procedural complexity. Enhancing patient education and addressing concerns may improve the feasibility and acceptability of IUD self-removal, potentially empowering more women in their reproductive health decisions<em><strong>.</strong></em></div></div><div><h3>Implications</h3><div>Our study highlights that although the success rate of IUD self-removal was low, interest in the practice was notable among users. Fear and reliance on health care providers were key barriers to attempts. Our findings suggest that incorporating clear, evidence-based counseling about IUD self-removal at IUD placement may support reproductive autonomy and informed decision-making.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111287"},"PeriodicalIF":2.3,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.contraception.2025.111285
Fabian Dávila , Favio Cala-Vitery
Objective
We analyzed contraceptive market dynamics in Colombia by comparing pricing, utilization patterns, and population coverage between insurance-covered and out-of-pocket purchase groups to identify barriers to equitable reproductive health access.
Study Design
We conducted a retrospective analysis (2020–2025) using Colombia's national pharmaceutical databases (SISMED, BDUA, CUM-INVIMA). We examined pricing (maximum cost per minimum dispensable unit), annual market values, utilization (defined daily dose per 1000 women-years), and population coverage (couple years of protection) by comparing insurance-covered versus out-of-pocket purchase groups.
Results
Hormonal IUDs showed minimal price variation ($144.00 insurance versus $145.11 out-of-pocket). Injectable contraceptives achieved 72% price reductions while emergency contraception maintained substantial price disparities with out-of-pocket prices up to 25 times higher than insurance-covered prices. Out-of-pocket purchase groups accumulated 64–70% of the total annual market value ($29.9–48.6M) through oral contraceptives and emergency contraception. Insurance-covered purchase groups accounted for 31–36% ($17.0–29.0M), specializing in subdermal implants. Out-of-pocket groups dominated total contraceptive utilization (78–86% of defined daily doses) versus 14–22% for insurance-covered groups. National contraceptive protection increased from 28% (2020) to 37% (2022), then stabilized at 33% (2023–2024). Insurance-covered groups reached only eight to10% of the population despite providing highly effective methods.
Conclusions
Colombia's contraceptive market demonstrates persistent segmentation and structural barriers beyond pricing. Policy interventions require strengthening insurance-covered service delivery capacity and implementing targeted out-of-pocket sector reforms to ensure equitable access.
Implications
Policy makers should strengthen institutional capacity for long-acting reversible methods while ensuring commercial equity for comprehensive contraceptive access.
{"title":"Contraceptive market, utilization patterns, and coverage in Colombia (2020–2025)","authors":"Fabian Dávila , Favio Cala-Vitery","doi":"10.1016/j.contraception.2025.111285","DOIUrl":"10.1016/j.contraception.2025.111285","url":null,"abstract":"<div><h3>Objective</h3><div>We analyzed contraceptive market dynamics in Colombia by comparing pricing, utilization patterns, and population coverage between insurance-covered and out-of-pocket purchase groups to identify barriers to equitable reproductive health access.</div></div><div><h3>Study Design</h3><div>We conducted a retrospective analysis (2020–2025) using Colombia's national pharmaceutical databases (SISMED, BDUA, CUM-INVIMA). We examined pricing (maximum cost per minimum dispensable unit), annual market values, utilization (defined daily dose per 1000 women-years), and population coverage (couple years of protection) by comparing insurance-covered versus out-of-pocket purchase groups.</div></div><div><h3>Results</h3><div>Hormonal IUDs showed minimal price variation ($144.00 insurance versus $145.11 out-of-pocket). Injectable contraceptives achieved 72% price reductions while emergency contraception maintained substantial price disparities with out-of-pocket prices up to 25 times higher than insurance-covered prices. Out-of-pocket purchase groups accumulated 64–70% of the total annual market value ($29.9–48.6M) through oral contraceptives and emergency contraception. Insurance-covered purchase groups accounted for 31–36% ($17.0–29.0M), specializing in subdermal implants. Out-of-pocket groups dominated total contraceptive utilization (78–86% of defined daily doses) versus 14–22% for insurance-covered groups. National contraceptive protection increased from 28% (2020) to 37% (2022), then stabilized at 33% (2023–2024). Insurance-covered groups reached only eight to10% of the population despite providing highly effective methods.</div></div><div><h3>Conclusions</h3><div>Colombia's contraceptive market demonstrates persistent segmentation and structural barriers beyond pricing. Policy interventions require strengthening insurance-covered service delivery capacity and implementing targeted out-of-pocket sector reforms to ensure equitable access.</div></div><div><h3>Implications</h3><div>Policy makers should strengthen institutional capacity for long-acting reversible methods while ensuring commercial equity for comprehensive contraceptive access.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111285"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-31DOI: 10.1016/j.contraception.2025.111282
Chelsea B. Polis , Sarah E.K. Bradley , Elizabeth A. Micks , Markus J. Steiner
{"title":"Contraceptive effectiveness: A synthesis of the literature","authors":"Chelsea B. Polis , Sarah E.K. Bradley , Elizabeth A. Micks , Markus J. Steiner","doi":"10.1016/j.contraception.2025.111282","DOIUrl":"10.1016/j.contraception.2025.111282","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111282"},"PeriodicalIF":2.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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