Pub Date : 2025-10-27DOI: 10.1016/j.contraception.2025.111249
Melissa Madera , Rosann Mariappuram , Candi Mundon King , Charlane Oliver , Julie von Haefen , Fran Linkin
The right to contraception has been protected under the U.S. Constitution since the U.S. Supreme Court decisions in Griswold v. Connecticut (1965) and Eisenstadt v. Baird (1972). However, even with these constitutional protections in place, there have been increased direct attacks from conservative state legislators on contraception using state legislation. But state legislators supportive of reproductive health, rights, and justice continue to push forward on proactive progressive legislation and policies that safeguard contraception. The State Innovation Exchange’s (SiX) Reproductive Rights team launched the Reproductive Freedom Leadership Council (RFLC) in 2018 to support state legislators who champion progressive policies focused on reproductive health, rights, and justice with, among other resources, the tracking and translation of scientific research on family planning and sexual, reproductive, and maternal health, and connecting them with the researchers who produce those data. In this commentary, we provide an overview of how state legislators champion progressive contraceptive policies in their states and offer observations on the role of research from state legislators within the RFLC network. Our objective for this commentary is to share best practices and guidance from legislators themselves about how researchers can make their research more accessible to legislators as they push back against conservative attacks on bodily autonomy.
自1965年格里斯沃尔德诉康涅狄格州案（Griswold v. Connecticut）和1972年艾森施塔特诉贝尔德案（Eisenstadt v. Baird）以来，避孕权一直受到美国宪法的保护。然而，即使有了这些宪法保护，保守的州议员对使用州立法避孕的直接攻击也越来越多。但支持生殖健康、权利和正义的州议员继续推动积极进取的立法和政策，保护避孕。州创新交易所（SiX）生殖权利团队于2018年启动了生殖自由领导委员会（RFLC），以支持支持以生殖健康、权利和正义为重点的进步政策的州立法者，其中包括跟踪和翻译有关计划生育和性、生殖和孕产妇健康的科学研究，并将他们与生成这些数据的研究人员联系起来。在本评论中，我们概述了州议员如何在其州倡导进步的避孕政策，并就州议员在RFLC网络中的研究作用提供了意见。我们这篇评论的目的是分享立法者自己的最佳实践和指导，关于研究人员如何在立法者反击保守派对身体自主权的攻击时使他们的研究更容易获得立法者。
{"title":"Bridging the gap: How SiX supports U.S. state legislators in transforming research into policy","authors":"Melissa Madera , Rosann Mariappuram , Candi Mundon King , Charlane Oliver , Julie von Haefen , Fran Linkin","doi":"10.1016/j.contraception.2025.111249","DOIUrl":"10.1016/j.contraception.2025.111249","url":null,"abstract":"<div><div>The right to contraception has been protected under the U.S. Constitution since the U.S. Supreme Court decisions in <em>Griswold v. Connecticut</em> (1965) and <em>Eisenstadt v. Baird</em> (1972). However, even with these constitutional protections in place, there have been increased direct attacks from conservative state legislators on contraception using state legislation. But state legislators supportive of reproductive health, rights, and justice continue to push forward on proactive progressive legislation and policies that safeguard contraception. The State Innovation Exchange’s (SiX) Reproductive Rights team launched the Reproductive Freedom Leadership Council (RFLC) in 2018 to support state legislators who champion progressive policies focused on reproductive health, rights, and justice with, among other resources, the tracking and translation of scientific research on family planning and sexual, reproductive, and maternal health, and connecting them with the researchers who produce those data. In this commentary, we provide an overview of how state legislators champion progressive contraceptive policies in their states and offer observations on the role of research from state legislators within the RFLC network. Our objective for this commentary is to share best practices and guidance from legislators themselves about how researchers can make their research more accessible to legislators as they push back against conservative attacks on bodily autonomy.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111249"},"PeriodicalIF":2.3,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497808","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 : 2025-10-27DOI: 10.1016/j.contraception.2025.111238
Elizabeth J. Jones, Michael S. Policar, Kimberly Diaz Scott
Synergy is the interaction or cooperation of two or more forces to produce a combined effect greater than the sum of their parts. As generators of new clinical knowledge for the sexual and reproductive health field and conveners for collaborative efforts to mobilize for state policy change, Contraceptive Access Initiatives (CAIs) have strengthened the Title X family planning program. Conversely, Title X is an essential source of care for millions of patients that face barriers to accessing contraceptive services. By linking CAIs with a broad and diverse network of service sites that stand to benefit from their innovations, the Title X program bridges research-to-practice gaps and supports improved population-level outcomes through changes in practice, systems, and policy. CAIs also can lean on Title X networks to support aspects of implementation and post-implementation sustainability, leveraging the broader scope of confidential services they provide at no cost or discounted rates, their training infrastructure, and the inroads they have built with community stakeholders and policymakers since the program’s inception over 50 years ago. Given the uncertainty of the current funding landscape, such partnerships are critical to keeping access points to person-centered contraceptive services open, particularly for individuals with low incomes, without insurance, and in need of confidential services.
{"title":"Contraceptive access initiatives and Title X: A synergistic partnership","authors":"Elizabeth J. Jones, Michael S. Policar, Kimberly Diaz Scott","doi":"10.1016/j.contraception.2025.111238","DOIUrl":"10.1016/j.contraception.2025.111238","url":null,"abstract":"<div><div><em>Synergy</em> is the interaction or cooperation of two or more forces to produce a combined effect greater than the sum of their parts. As generators of new clinical knowledge for the sexual and reproductive health field and conveners for collaborative efforts to mobilize for state policy change, Contraceptive Access Initiatives (CAIs) have strengthened the Title X family planning program. Conversely, Title X is an essential source of care for millions of patients that face barriers to accessing contraceptive services. By linking CAIs with a broad and diverse network of service sites that stand to benefit from their innovations, the Title X program bridges research-to-practice gaps and supports improved population-level outcomes through changes in practice, systems, and policy. CAIs also can lean on Title X networks to support aspects of implementation and post-implementation sustainability, leveraging the broader scope of confidential services they provide at no cost or discounted rates, their training infrastructure, and the inroads they have built with community stakeholders and policymakers since the program’s inception over 50 years ago. Given the uncertainty of the current funding landscape, such partnerships are critical to keeping access points to person-centered contraceptive services open, particularly for individuals with low incomes, without insurance, and in need of confidential services.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111238"},"PeriodicalIF":2.3,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098454","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 : 2025-10-27DOI: 10.1016/j.contraception.2025.111253
Kimberly M. Schaefer , Haley Burns , Jonas J. Swartz , Alison B. Edelman , Maria I. Rodriguez
Objective
To evaluate the association between individuals’ experiences with healthcare and over-the-counter (OTC) pill use.
Study design
We conducted a cross-sectional online baseline survey of individuals aged 15–45 obtaining oral contraception (OTC or by prescription) for pregnancy prevention in a convenience sample across the United States (US). We collected demographic information, clinical information, and measured contraceptive autonomy using three validated measures: Contraceptive Agency Scale (CAS), the Person-Centered Contraceptive Care (PCCC) measure, and the Discrimination in Medical Settings (DMS) survey. We compared these characteristics between people using prescription and OTC pills and built logistic regression models to evaluate the association between OTC pill use and each of these three measures.
Results
Our sample included 497 individuals (OTC 22.5%, n = 112; prescription 77.5%, n = 385) who received contraceptive counseling within the past year. Compared to participants with a prescription, users of OTC pills were older, more commonly uninsured (18.8% vs. 2.9%, p < 0.001), on Medicaid (24.1% vs. 10.1%, p < 0.001), and more likely to be Black (18.8% vs. 5.7%, p < 0.001). Less than half of OTC pill users were already using a more effective method of contraception prior to survey completion, compared to the majority of prescription users (47.3% vs. 82.9%, p < 0.001). Based on adjusted multivariable models, key autonomy outcomes of low contraceptive agency and non person-contraceptive care were both associated with increased probability of OTC pill use.
Conclusion
The OTC pill may fill an important gap in improving contraception access, particularly among individuals with past negative healthcare interactions.
Implications
Our study suggests that individuals reporting lower contraceptive agency and less person-centered care are more likely to use over-the-counter than prescription oral contraception. Expanding over-the-counter access may reduce barriers for marginalized populations with poor healthcare interactions, supporting more equitable contraceptive access across diverse demographic and insurance groups in the U.S.
{"title":"Association of over-the-counter birth control pill use and contraceptive autonomy among oral contraceptive users","authors":"Kimberly M. Schaefer , Haley Burns , Jonas J. Swartz , Alison B. Edelman , Maria I. Rodriguez","doi":"10.1016/j.contraception.2025.111253","DOIUrl":"10.1016/j.contraception.2025.111253","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association between individuals’ experiences with healthcare and over-the-counter (OTC) pill use.</div></div><div><h3>Study design</h3><div>We conducted a cross-sectional online baseline survey of individuals aged 15–45 obtaining oral contraception (OTC or by prescription) for pregnancy prevention in a convenience sample across the United States (US). We collected demographic information, clinical information, and measured contraceptive autonomy using three validated measures: Contraceptive Agency Scale (CAS), the Person-Centered Contraceptive Care (PCCC) measure, and the Discrimination in Medical Settings (DMS) survey. We compared these characteristics between people using prescription and OTC pills and built logistic regression models to evaluate the association between OTC pill use and each of these three measures.</div></div><div><h3>Results</h3><div>Our sample included 497 individuals (OTC 22.5%, <em>n</em> = 112; prescription 77.5%, <em>n</em> = 385) who received contraceptive counseling within the past year. Compared to participants with a prescription, users of OTC pills were older, more commonly uninsured (18.8% vs. 2.9%, <em>p</em> < 0.001), on Medicaid (24.1% vs. 10.1%, <em>p</em> < 0.001), and more likely to be Black (18.8% vs. 5.7%, <em>p</em> < 0.001). Less than half of OTC pill users were already using a more effective method of contraception prior to survey completion, compared to the majority of prescription users (47.3% vs. 82.9%, <em>p</em> < 0.001). Based on adjusted multivariable models, key autonomy outcomes of low contraceptive agency and non person-contraceptive care were both associated with increased probability of OTC pill use.</div></div><div><h3>Conclusion</h3><div>The OTC pill may fill an important gap in improving contraception access, particularly among individuals with past negative healthcare interactions.</div></div><div><h3>Implications</h3><div>Our study suggests that individuals reporting lower contraceptive agency and less person-centered care are more likely to use over-the-counter than prescription oral contraception. Expanding over-the-counter access may reduce barriers for marginalized populations with poor healthcare interactions, supporting more equitable contraceptive access across diverse demographic and insurance groups in the U.S.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111253"},"PeriodicalIF":2.3,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402968","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 : 2025-10-27DOI: 10.1016/j.contraception.2025.111271
Riley J. Steiner , Sarah M. Axelson , Claudia Nuñez-Eddy , Kelsie Williams , Sonya Borrero , Sheila Desai , Jenny Dodson Mistry , Christina I. Fowler , Laura D. Lindberg , Isaac Maddow-Zimet , Whitney Rice , Corinne H. Rocca , Michael G. Smith , Tracey A. Wilkinson
Objectives
Despite the importance of access to contraception for sexual and reproductive well-being, there is a lack of consensus about what “contraceptive access” entails. We present a multi-level and multi-dimensional framework for conceptualizing contraceptive access and discuss how it can be used to inform research, policy, and practice.
Study design
As the foundation for the contraceptive access framework, we used the social-ecological model and two frameworks for health care access, along with findings from an environmental scan of literature relevant to contraceptive access. To develop an initial version, we aligned contraceptive access concepts with the broader conceptual frameworks. We refined our framework based on input from an expert workgroup.
Results
The conceptual framework includes multi-level modifiable factors (i.e., underlying factors that create the conditions of contraceptive access) and modification strategies (i.e., actionable interventions or approaches that can be used to change the modifiable determinants) aligned with six dimensions of access: awareness, availability, accessibility, accommodation, acceptability, and affordability. The modification strategies influence modifiable determinants, which create the access conditions for individual-level pathways to seeking and obtaining one’s preferred contraceptive method or long-acting reversible contraception removal services.
Conclusions
We call on the sexual and reproductive health community to apply the framework to inform research, policy, and clinical and public health practice. Specific applications include measure development, surveillance, policy advocacy, clinic-based quality improvement, and state-level contraceptive access initiatives. The opportunities and challenges of using the framework in these ways can inform how it evolves to best reflect contraceptive access.
Implications
The conceptual framework can provide a shared understanding of how contraceptive access can be restricted or expanded. The framework can be used to strengthen efforts to assess and improve contraceptive access so that it is just, person-centered, and attainable for all.
{"title":"What is contraceptive access? A comprehensive, multi-level framework to inform research, policy, and practice","authors":"Riley J. Steiner , Sarah M. Axelson , Claudia Nuñez-Eddy , Kelsie Williams , Sonya Borrero , Sheila Desai , Jenny Dodson Mistry , Christina I. Fowler , Laura D. Lindberg , Isaac Maddow-Zimet , Whitney Rice , Corinne H. Rocca , Michael G. Smith , Tracey A. Wilkinson","doi":"10.1016/j.contraception.2025.111271","DOIUrl":"10.1016/j.contraception.2025.111271","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite the importance of access to contraception for sexual and reproductive well-being, there is a lack of consensus about what “contraceptive access” entails. We present a multi-level and multi-dimensional framework for conceptualizing contraceptive access and discuss how it can be used to inform research, policy, and practice.</div></div><div><h3>Study design</h3><div>As the foundation for the contraceptive access framework, we used the social-ecological model and two frameworks for health care access, along with findings from an environmental scan of literature relevant to contraceptive access. To develop an initial version, we aligned contraceptive access concepts with the broader conceptual frameworks. We refined our framework based on input from an expert workgroup.</div></div><div><h3>Results</h3><div>The conceptual framework includes multi-level modifiable factors (i.e., underlying factors that create the conditions of contraceptive access) and modification strategies (i.e., actionable interventions or approaches that can be used to change the modifiable determinants) aligned with six dimensions of access: awareness, availability, accessibility, accommodation, acceptability, and affordability. The modification strategies influence modifiable determinants, which create the access conditions for individual-level pathways to seeking and obtaining one’s preferred contraceptive method or long-acting reversible contraception removal services.</div></div><div><h3>Conclusions</h3><div>We call on the sexual and reproductive health community to apply the framework to inform research, policy, and clinical and public health practice. Specific applications include measure development, surveillance, policy advocacy, clinic-based quality improvement, and state-level contraceptive access initiatives. The opportunities and challenges of using the framework in these ways can inform how it evolves to best reflect contraceptive access.</div></div><div><h3>Implications</h3><div>The conceptual framework can provide a shared understanding of how contraceptive access can be restricted or expanded. The framework can be used to strengthen efforts to assess and improve contraceptive access so that it is just, person-centered, and attainable for all.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111271"},"PeriodicalIF":2.3,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552469","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 : 2025-10-27DOI: 10.1016/j.contraception.2025.111248
Jessica Danaux, Nikita Malcolm, Jamie Hart
The Coalition to Expand Contraceptive Access and Emory University’s Center for Reproductive Health Research in the Southeast led a collaborative effort to convene statewide contraceptive access initiatives (SCAI) to identify opportunities to meaningfully advance sexual and reproductive health equity (SRHE) in ongoing and future initiatives. The effort engaged more than 40 stakeholders representing ten SCAI and assessed published literature to draw collective insights, successes, and lessons learned. This commentary outlines four concrete recommendations derived from this effort: (1) center communities in all phases of the initiative, (2) foster flexibility and responsiveness in initiative activities, (3) align goals with comprehensive measures, and (4) prioritize sustainable approaches. The commentary also explores how these recommendations connect to the principles of SRHE and how implementers, evaluators, funders, and supporters of contraceptive access initiatives can implement them to advance SRHE.
{"title":"How statewide contraceptive access initiatives can advance sexual and reproductive health equity","authors":"Jessica Danaux, Nikita Malcolm, Jamie Hart","doi":"10.1016/j.contraception.2025.111248","DOIUrl":"10.1016/j.contraception.2025.111248","url":null,"abstract":"<div><div>The Coalition to Expand Contraceptive Access and Emory University’s Center for Reproductive Health Research in the Southeast led a collaborative effort to convene statewide contraceptive access initiatives (SCAI) to identify opportunities to meaningfully advance sexual and reproductive health equity (SRHE) in ongoing and future initiatives. The effort engaged more than 40 stakeholders representing ten SCAI and assessed published literature to draw collective insights, successes, and lessons learned. This commentary outlines four concrete recommendations derived from this effort: (1) center communities in all phases of the initiative, (2) foster flexibility and responsiveness in initiative activities, (3) align goals with comprehensive measures, and (4) prioritize sustainable approaches. The commentary also explores how these recommendations connect to the principles of SRHE and how implementers, evaluators, funders, and supporters of contraceptive access initiatives can implement them to advance SRHE.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111248"},"PeriodicalIF":2.3,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497830","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 : 2025-10-27DOI: 10.1016/j.contraception.2025.111246
Michael G. Smith , Liwen Zeng , Amal J. Khoury
Objective
Choose Well is the first statewide contraceptive access initiative in the southeastern US. Launched in 2017 in South Carolina (SC), Choose Well aims to reduce unintended pregnancy and increase access to evidence-based contraception. The initiative provided capacity building, training and infrastructure, and workforce support to clinical partners across SC. We assess the impact of Choose Well on patient-reported experiences with contraceptive counseling. Examining patient experiences in addition to contraceptive utilization is essential for assessing reproductive autonomy.
Study design
The Women’s Longitudinal Study collected data on contraceptive counseling experiences of patients recruited in Choose Well-participating (intervention) clinics and those recruited in comparison clinics in a demographically and culturally comparable state. Overall, 2221 eligible patients were recruited from 37 clinics. Patient experiences of person-centered counseling, overall satisfaction, and accessibility of post-appointment care were assessed. Multivariable linear regression and modified Poisson regression models assessed Choose Well’s impact on counseling experiences.
Results
Intervention clinic participants were more likely than comparison clinic participants to report that they received person-centered counseling (adjusted PR= 1.12; 95% CI: 1.00,1.25) and that providers verified that they could use their contraception correctly and consistently (aPR= 1.09; 95% CI: 1.02,1.18). No differences were found in the likelihood that patients reported being satisfied with their visit or leaving with the best method for them.
Conclusion
Choose Well implementation was associated with increased person-centered contraceptive counseling. Contraceptive access initiatives that prioritize optimal counseling along with equitable access to contraceptive methods can promote reproductive health and support women in achieving their reproductive goals.
Implications
Choose Well was associated with increases in person-centered contraceptive counseling while expanding access to contraceptive methods in SC. Ongoing and future SCAIs should prioritize equitable access to the full range of contraceptive methods and measures to assess and ensure that their efforts are not limiting the reproductive autonomy of patients.
{"title":"Evaluation of patient experiences with contraceptive counseling during the South Carolina Choose Well contraceptive access initiative","authors":"Michael G. Smith , Liwen Zeng , Amal J. Khoury","doi":"10.1016/j.contraception.2025.111246","DOIUrl":"10.1016/j.contraception.2025.111246","url":null,"abstract":"<div><h3>Objective</h3><div>Choose Well is the first statewide contraceptive access initiative in the southeastern US. Launched in 2017 in South Carolina (SC), Choose Well aims to reduce unintended pregnancy and increase access to evidence-based contraception. The initiative provided capacity building, training and infrastructure, and workforce support to clinical partners across SC. We assess the impact of Choose Well on patient-reported experiences with contraceptive counseling. Examining patient experiences in addition to contraceptive utilization is essential for assessing reproductive autonomy.</div></div><div><h3>Study design</h3><div>The Women’s Longitudinal Study collected data on contraceptive counseling experiences of patients recruited in Choose Well-participating (intervention) clinics and those recruited in comparison clinics in a demographically and culturally comparable state. Overall, 2221 eligible patients were recruited from 37 clinics. Patient experiences of person-centered counseling, overall satisfaction, and accessibility of post-appointment care were assessed. Multivariable linear regression and modified Poisson regression models assessed Choose Well’s impact on counseling experiences.</div></div><div><h3>Results</h3><div>Intervention clinic participants were more likely than comparison clinic participants to report that they received person-centered counseling (adjusted PR= 1.12; 95% CI: 1.00,1.25) and that providers verified that they could use their contraception correctly and consistently (aPR= 1.09; 95% CI: 1.02,1.18). No differences were found in the likelihood that patients reported being satisfied with their visit or leaving with the best method for them.</div></div><div><h3>Conclusion</h3><div>Choose Well implementation was associated with increased person-centered contraceptive counseling. Contraceptive access initiatives that prioritize optimal counseling along with equitable access to contraceptive methods can promote reproductive health and support women in achieving their reproductive goals.</div></div><div><h3>Implications</h3><div>Choose Well was associated with increases in person-centered contraceptive counseling while expanding access to contraceptive methods in SC. Ongoing and future SCAIs should prioritize equitable access to the full range of contraceptive methods and measures to assess and ensure that their efforts are not limiting the reproductive autonomy of patients.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111246"},"PeriodicalIF":2.3,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098503","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 : 2025-10-26DOI: 10.1016/j.contraception.2025.111279
Whitney S. Rice , Sara K. Redd , Alina A. Luke , Sofia Filippa , Kimberly Jacob Arriola , Kelli Stidham Hall , Kelli Komro , Monica S. Aswani
Objective
Contraceptive access provides opportunity for related preventive health care. Thus, we explore whether changes in state contraceptive access policies relate to preventive health service use inequities.
Study design
We examined associations between a 2006–2017 state contraceptive access policy index and probabilities of individual-level receipt of pelvic exam, Pap test, and sexually transmitted infection (STI) services during the last year, as reported during time-corresponding cycles of the National Survey of Family Growth (NSFG). We used multivariate logistic regression and linear probability models, that accounted for survey weights and adjusted for individual- and state-level characteristics and state and year fixed effects. We further tested interaction effects by race/ethnicity, socioeconomic status, education, and sexual orientation.
Results
Among 21,537 NSFG respondents (mean age 29 years) from 2006 to 2017, 52% reported receiving a Pap test, 50% reported receiving a pelvic exam, and 20% reported receiving STI services. Main effects models testing the relationship between the contraceptive access policy index and the three outcomes among the entire population produced null findings. However, models testing interaction effects by social group found significant interactions between state contraceptive policy environments and individual-level race/ethnicity, education, income level, sexual orientation for receipt of Pap tests, pelvic exams, and STI services, revealing increased preventive services for certain social groups defined by lower education and income.
Conclusion
Individual preventive health service use associated with state contraceptive access environments varied by sociodemographic factors, highlighting the potential for state policy to act as a lever to alleviate inequities in access to care.
Implications
Overarchingly, more expansive contraceptive access is associated with increased preventive sexual and reproductive health care use for certain social groups. Thus, state policies expanding contraceptive access may mitigate broader inequities in access to care by facilitating opportunities for receipt of other preventive services, particularly Pap tests and pelvic exams.
{"title":"State-level contraceptive access policies and preventive sexual and reproductive health service use outcomes","authors":"Whitney S. Rice , Sara K. Redd , Alina A. Luke , Sofia Filippa , Kimberly Jacob Arriola , Kelli Stidham Hall , Kelli Komro , Monica S. Aswani","doi":"10.1016/j.contraception.2025.111279","DOIUrl":"10.1016/j.contraception.2025.111279","url":null,"abstract":"<div><h3>Objective</h3><div>Contraceptive access provides opportunity for related preventive health care. Thus, we explore whether changes in state contraceptive access policies relate to preventive health service use inequities.</div></div><div><h3>Study design</h3><div>We examined associations between a 2006–2017 state contraceptive access policy index and probabilities of individual-level receipt of pelvic exam, Pap test, and sexually transmitted infection (STI) services during the last year, as reported during time-corresponding cycles of the National Survey of Family Growth (NSFG). We used multivariate logistic regression and linear probability models, that accounted for survey weights and adjusted for individual- and state-level characteristics and state and year fixed effects. We further tested interaction effects by race/ethnicity, socioeconomic status, education, and sexual orientation.</div></div><div><h3>Results</h3><div>Among 21,537 NSFG respondents (mean age 29 years) from 2006 to 2017, 52% reported receiving a Pap test, 50% reported receiving a pelvic exam, and 20% reported receiving STI services. Main effects models testing the relationship between the contraceptive access policy index and the three outcomes among the entire population produced null findings. However, models testing interaction effects by social group found significant interactions between state contraceptive policy environments and individual-level race/ethnicity, education, income level, sexual orientation for receipt of Pap tests, pelvic exams, and STI services, revealing increased preventive services for certain social groups defined by lower education and income.</div></div><div><h3>Conclusion</h3><div>Individual preventive health service use associated with state contraceptive access environments varied by sociodemographic factors, highlighting the potential for state policy to act as a lever to alleviate inequities in access to care.</div></div><div><h3>Implications</h3><div>Overarchingly, more expansive contraceptive access is associated with increased preventive sexual and reproductive health care use for certain social groups. Thus, state policies expanding contraceptive access may mitigate broader inequities in access to care by facilitating opportunities for receipt of other preventive services, particularly Pap tests and pelvic exams.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111279"},"PeriodicalIF":2.3,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395968","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 : 2025-10-20DOI: 10.1016/j.contraception.2025.111274
Marlena G. Plagianos , Tracy X. Chen , Narender Kumar , Shelli Graham , Heather Sussman , Harvey Kushner , George Creasy , Brian Bernick , Lisa B. Haddad
Objectives
To evaluate effects of tampon co-usage on the pharmacokinetics of segesterone acetate (SA) and ethinyl estradiol (EE) released from Annovera Contraceptive Vaginal Ring System with a 21-day in/7-day out regimen.
Study design
We enrolled 24 participants in an open-label crossover study in Canada and the United States. Participants used combined oral contraceptive pills for 28 days before randomization (1:1) to either Annovera alone or Annovera while using four tampons daily on days 2–5 for one 28-day cycle; in the next cycle, participants switched treatments. We evaluated the steady-state interval for SA and EE from days 2-5 for concomitant Annovera and tampon use. We measured serum SA and EE using validated liquid chromatography-tandem mass spectrometry. The primary end point was the area under the curve (AUC) of SA and EE on cycle days 2-3 (AUC(2–3)). Bioequivalence is established if the 90% confidence interval (CI) of the geometric mean ratio (GMR) for AUC(2–3) is wholly contained within (0.80–1.25).
Results
We observed bioequivalence for SA with GMR of 0.98 (90% CI: 0.921, 1.043) and EE with GMR of 0.97 (90% CI: 0.91, 1.026), for AUC(2–3), and also for AUC from days 2-5 with GMRs of 1.02 (90% CI: 0.99, 1.06) for SA and 1.02 (90% CI: 0.97, 1.087) for EE. We observed no safety issues or serious adverse events.
Conclusions
Individuals using Annovera with 4 consecutive days of tampon use experienced no change in SA or EE absorption. Light/regular tampon co-usage for up to 4 consecutive days should not impact contraceptive efficacy or bleeding profile.
Implications
A significant proportion of reproductive-age women use tampons when experiencing vaginal bleeding; they can be reassured that tampon and contraceptive ring co-usage should not affect the contraceptive efficacy of the SA/EE contraceptive vaginal ring.
{"title":"Effects of tampon co-usage on the pharmacokinetics of segesterone acetate and ethinyl estradiol released from Annovera vaginal ring system","authors":"Marlena G. Plagianos , Tracy X. Chen , Narender Kumar , Shelli Graham , Heather Sussman , Harvey Kushner , George Creasy , Brian Bernick , Lisa B. Haddad","doi":"10.1016/j.contraception.2025.111274","DOIUrl":"10.1016/j.contraception.2025.111274","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate effects of tampon co-usage on the pharmacokinetics of segesterone acetate (SA) and ethinyl estradiol (EE) released from Annovera Contraceptive Vaginal Ring System with a 21-day in/7-day out regimen.</div></div><div><h3>Study design</h3><div>We enrolled 24 participants in an open-label crossover study in Canada and the United States. Participants used combined oral contraceptive pills for 28 days before randomization (1:1) to either Annovera alone or Annovera while using four tampons daily on days 2–5 for one 28-day cycle; in the next cycle, participants switched treatments. We evaluated the steady-state interval for SA and EE from days 2-5 for concomitant Annovera and tampon use. We measured serum SA and EE using validated liquid chromatography-tandem mass spectrometry. The primary end point was the area under the curve (AUC) of SA and EE on cycle days 2-3 (AUC<sub>(2–3)</sub>). Bioequivalence is established if the 90% confidence interval (CI) of the geometric mean ratio (GMR) for AUC<sub>(2–3)</sub> is wholly contained within (0.80–1.25).</div></div><div><h3>Results</h3><div>We observed bioequivalence for SA with GMR of 0.98 (90% CI: 0.921, 1.043) and EE with GMR of 0.97 (90% CI: 0.91, 1.026), for AUC<sub>(2–3)</sub>, and also for AUC from days 2-5 with GMRs of 1.02 (90% CI: 0.99, 1.06) for SA and 1.02 (90% CI: 0.97, 1.087) for EE. We observed no safety issues or serious adverse events.</div></div><div><h3>Conclusions</h3><div>Individuals using Annovera with 4 consecutive days of tampon use experienced no change in SA or EE absorption. Light/regular tampon co-usage for up to 4 consecutive days should not impact contraceptive efficacy or bleeding profile.</div></div><div><h3>Implications</h3><div>A significant proportion of reproductive-age women use tampons when experiencing vaginal bleeding; they can be reassured that tampon and contraceptive ring co-usage should not affect the contraceptive efficacy of the SA/EE contraceptive vaginal ring.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111274"},"PeriodicalIF":2.3,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338341","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 : 2025-10-18DOI: 10.1016/j.contraception.2025.111273
Emily Freeman , Rachel Paul , Megan Dorsey , Jennifer A. Reeves , Tessa Madden
Objectives
To compare the interpersonal quality of contraceptive counseling delivered via telephone vs video.
Study design
We conducted a pilot randomized controlled trial at a single Title X clinic. Staff informed patients about the study during appointment scheduling. Research staff contacted patients to assess for eligibility and interest, then enrolled and randomized participants to telephone- or video-based contraceptive counseling. Participants completed an electronic survey after counseling. The primary outcome was quality of contraceptive counseling, assessed using the Interpersonal Quality in Family Planning scale. Participants completed questions adapted from the Telehealth Usability Questionnaire, a validated measure of the quality of the telehealth services. We conducted intention-to-treat and per-protocol analyses for video vs telephone visits using appropriate bivariate tests.
Results
Between May 2022 and June 2023, 269 patients scheduled telehealth counseling appointments. We screened 245 (91%) for eligibility; 232 (95%) were eligible. Of the eligible participants, 214 (92%) were enrolled and randomized; 200 (94%) completed counseling and the survey. Participant demographics were similar between groups. In the intention-to-treat analysis, most participants in the video and telephone groups had high interpersonal quality of counseling, defined as a top score on Interpersonal Quality in Family Planning (80% vs 75%, p = 0.44); quality of counseling was similar for the per-protocol comparison (79% video vs 76% telephone, p = 0.62). Participants reported a high level of usability with both counseling modalities.
Conclusions
Participants reported high interpersonal quality with telephone and video visits for contraceptive counseling. Telephone-based telehealth can further increase access to care, especially for patients with limited access to web-based video conferencing.
Implications
We found similarly high interpersonal quality of contraceptive counseling performed via video and telephone telehealth visits. Our findings, along with others, can support policy changes to increase access to telephone-based telehealth.
{"title":"Pilot randomized control trial assessing interpersonal quality of contraceptive counseling via telephone vs video","authors":"Emily Freeman , Rachel Paul , Megan Dorsey , Jennifer A. Reeves , Tessa Madden","doi":"10.1016/j.contraception.2025.111273","DOIUrl":"10.1016/j.contraception.2025.111273","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare the interpersonal quality of contraceptive counseling delivered via telephone vs video.</div></div><div><h3>Study design</h3><div>We conducted a pilot randomized controlled trial at a single Title X clinic. Staff informed patients about the study during appointment scheduling. Research staff contacted patients to assess for eligibility and interest, then enrolled and randomized participants to telephone- or video-based contraceptive counseling. Participants completed an electronic survey after counseling. The primary outcome was quality of contraceptive counseling, assessed using the Interpersonal Quality in Family Planning scale. Participants completed questions adapted from the Telehealth Usability Questionnaire, a validated measure of the quality of the telehealth services. We conducted intention-to-treat and per-protocol analyses for video vs telephone visits using appropriate bivariate tests.</div></div><div><h3>Results</h3><div>Between May 2022 and June 2023, 269 patients scheduled telehealth counseling appointments. We screened 245 (91%) for eligibility; 232 (95%) were eligible. Of the eligible participants, 214 (92%) were enrolled and randomized; 200 (94%) completed counseling and the survey. Participant demographics were similar between groups. In the intention-to-treat analysis, most participants in the video and telephone groups had high interpersonal quality of counseling, defined as a top score on Interpersonal Quality in Family Planning (80% vs 75%, <em>p</em> = 0.44); quality of counseling was similar for the per-protocol comparison (79% video vs 76% telephone, <em>p</em> = 0.62). Participants reported a high level of usability with both counseling modalities.</div></div><div><h3>Conclusions</h3><div>Participants reported high interpersonal quality with telephone and video visits for contraceptive counseling. Telephone-based telehealth can further increase access to care, especially for patients with limited access to web-based video conferencing.</div></div><div><h3>Implications</h3><div>We found similarly high interpersonal quality of contraceptive counseling performed via video and telephone telehealth visits. Our findings, along with others, can support policy changes to increase access to telephone-based telehealth.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111273"},"PeriodicalIF":2.3,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338347","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 : 2025-10-17DOI: 10.1016/j.contraception.2025.111272
Anita Raj , Clare Daniel , Nicole E. Johns , Priyanka Patel , Namratha Rao , Latona Giwa
Objective
To assess sex differences in the belief that abortion access is important for women’s health.
Study design
A 2024 survey asked N = 3348 U.S. adults their agreement with this belief. Adjusted multinomial regression analyses were conducted.
Results
Most (58.3%), and a higher proportion of females than males, agreed with the statement. Subgroup analysis of sex by political leanings showed that observed sex differences in this belief holds for moderates with a trend seen for liberals and conservatives.
Conclusion
While most people agree with the statement, females across political leanings are more likely to endorse this belief compared to males.
Implications
The paper contributes to the discourse on abortion access as a health issue in the United States. We find that over half of U.S. participants agreed that abortion access is important for women's health, and females from across political parties were more likely than males to endorse this statement.
{"title":"Sex differences in beliefs regarding abortion access as a women’s health issue","authors":"Anita Raj , Clare Daniel , Nicole E. Johns , Priyanka Patel , Namratha Rao , Latona Giwa","doi":"10.1016/j.contraception.2025.111272","DOIUrl":"10.1016/j.contraception.2025.111272","url":null,"abstract":"<div><h3>Objective</h3><div>To assess sex differences in the belief that abortion access is important for women’s health.</div></div><div><h3>Study design</h3><div>A 2024 survey asked <em>N</em> = 3348 U.S. adults their agreement with this belief. Adjusted multinomial regression analyses were conducted.</div></div><div><h3>Results</h3><div>Most (58.3%), and a higher proportion of females than males, agreed with the statement. Subgroup analysis of sex by political leanings showed that observed sex differences in this belief holds for moderates with a trend seen for liberals and conservatives.</div></div><div><h3>Conclusion</h3><div>While most people agree with the statement, females across political leanings are more likely to endorse this belief compared to males.</div></div><div><h3>Implications</h3><div>The paper contributes to the discourse on abortion access as a health issue in the United States. We find that over half of U.S. participants agreed that abortion access is important for women's health, and females from across political parties were more likely than males to endorse this statement.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111272"},"PeriodicalIF":2.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331112","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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