Pub Date : 2026-01-01Epub Date: 2025-09-20DOI: 10.1016/j.contraception.2025.111232
Megan Fuerst, Haley Burns, Kaitlin Schrote, Maria Rodriguez
Objective
To assess patient interest in receiving a 12-month supply of contraception (13 cycles dispensed at once) in states with extended contraceptive supply policies and identify potential factors associated with non-receipt of an extended supply of contraception among those interested.
Study design
We conducted a cross-sectional survey among individuals receiving a prescription contraceptive at US pharmacies about their interest in a 12-month contraceptive supply and their experience receiving their prescription at a pharmacy.
Results
Nearly three-quarters of participants (72.9%, N = 358) expressed interest in a 12-month supply citing reasons such as convenience and avoiding prescription lapses. Only 17.6% (N = 85/491) had previously been offered a 12-month supply by a provider. Less than half of extended supply prescriptions were appropriately dispensed at pharmacies.
Conclusion
There is unmet patient need for obtaining a 12-month supply contraception, even in states where policies promote insurance coverage for an extended supply of oral contraception.
{"title":"Patient interest in and availability of a 12-month supply of contraception: A cross-sectional analysis","authors":"Megan Fuerst, Haley Burns, Kaitlin Schrote, Maria Rodriguez","doi":"10.1016/j.contraception.2025.111232","DOIUrl":"10.1016/j.contraception.2025.111232","url":null,"abstract":"<div><h3>Objective</h3><div>To assess patient interest in receiving a 12-month supply of contraception (13 cycles dispensed at once) in states with extended contraceptive supply policies and identify potential factors associated with non-receipt of an extended supply of contraception among those interested.</div></div><div><h3>Study design</h3><div>We conducted a cross-sectional survey among individuals receiving a prescription contraceptive at US pharmacies about their interest in a 12-month contraceptive supply and their experience receiving their prescription at a pharmacy.</div></div><div><h3>Results</h3><div>Nearly three-quarters of participants (72.9%, <em>N</em> = 358) expressed interest in a 12-month supply citing reasons such as convenience and avoiding prescription lapses. Only 17.6% (<em>N</em> = 85/491) had previously been offered a 12-month supply by a provider. Less than half of extended supply prescriptions were appropriately dispensed at pharmacies.</div></div><div><h3>Conclusion</h3><div>There is unmet patient need for obtaining a 12-month supply contraception, even in states where policies promote insurance coverage for an extended supply of oral contraception.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"153 ","pages":"Article 111232"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126591","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 : 2026-01-01Epub Date: 2025-09-20DOI: 10.1016/j.contraception.2025.111212
Andréa Becker , Stef M. Shuster , Leah R. Koenig , Jennifer Ko , Ushma D. Upadhyay
Objectives
Transgender, nonbinary, and gender-expansive patients need abortion care. However, little is known about trans and gender expansive patients’ experiences with telehealth abortion care, a growing model of abortion service post-Dobbs.
Study design
We conducted 15 in-depth interviews with trans and gender expansive patients of three US virtual abortion clinics who obtained telehealth abortion care between April 2021 and May 2024. Interviews were transcribed and analyzed abductively using NVivo.
Results
Telehealth abortion reduced barriers for trans and gender expansive patients. Many interviewees appreciated the ability to avoid entering an abortion clinic, a space typically associated with “women’s health.” Telehealth allowed patients to circumvent barriers to care such as potential gender discrimination or uncomfortable gender-related interactions. Additionally, patients reported an increased sense of privacy due to being able to report their chosen name and/or pronouns on intake forms, or not disclose their gender identity altogether. As a result, patients were able to cultivate positive relationships with providers.
Conclusion
Telehealth abortion care is highly acceptable and beneficial for trans and gender expansive patients, as they benefit from an at-home experience coupled with reduced gender discrimination. Findings can help direct gender-affirming abortion care in person and in virtual clinics.
Implications
Healthcare providers should prioritize delivery of care models that allow patients to either disclose their chosen name and pronouns or keep their gender identity and presentation private. As part of this, a telehealth model is an integral element of trans-inclusive abortion provision.
{"title":"Transgender, nonbinary, and gender expansive experiences with telehealth medication abortion and implications for health equity in the United States","authors":"Andréa Becker , Stef M. Shuster , Leah R. Koenig , Jennifer Ko , Ushma D. Upadhyay","doi":"10.1016/j.contraception.2025.111212","DOIUrl":"10.1016/j.contraception.2025.111212","url":null,"abstract":"<div><h3>Objectives</h3><div>Transgender, nonbinary, and gender-expansive patients need abortion care. However, little is known about trans and gender expansive patients’ experiences with telehealth abortion care, a growing model of abortion service post-Dobbs.</div></div><div><h3>Study design</h3><div>We conducted 15 in-depth interviews with trans and gender expansive patients of three US virtual abortion clinics who obtained telehealth abortion care between April 2021 and May 2024. Interviews were transcribed and analyzed abductively using NVivo.</div></div><div><h3>Results</h3><div>Telehealth abortion reduced barriers for trans and gender expansive patients. Many interviewees appreciated the ability to avoid entering an abortion clinic, a space typically associated with “women’s health.” Telehealth allowed patients to circumvent barriers to care such as potential gender discrimination or uncomfortable gender-related interactions. Additionally, patients reported an increased sense of privacy due to being able to report their chosen name and/or pronouns on intake forms, or not disclose their gender identity altogether. As a result, patients were able to cultivate positive relationships with providers.</div></div><div><h3>Conclusion</h3><div>Telehealth abortion care is highly acceptable and beneficial for trans and gender expansive patients, as they benefit from an at-home experience coupled with reduced gender discrimination. Findings can help direct gender-affirming abortion care in person and in virtual clinics.</div></div><div><h3>Implications</h3><div>Healthcare providers should prioritize delivery of care models that allow patients to either disclose their chosen name and pronouns or keep their gender identity and presentation private. As part of this, a telehealth model is an integral element of trans-inclusive abortion provision.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"153 ","pages":"Article 111212"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126627","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 : 2026-01-01Epub Date: 2025-10-01DOI: 10.1016/j.contraception.2025.111242
Brooke W. Bullington , Katherine Tumlinson , Leigh Senderowicz , Joanna Maselko , Kavita Shah Arora , Jessie K. Edwards , Audrey Pettifor
Objective(s)
Traditional measures of success in family planning research focus on contraceptive uptake and use. Scholars have increasingly challenged these outcomes, calling for rights-based, person-centered measures that capture whether individuals can fulfill their reproductive preferences or desires. We sought to evaluate a family planning program using a novel, person-centered measure of perceived pressure to adopt contraception.
Study design
We use secondary data collected as part of the Postpartum Intrauterine Device (PPIUD) Study, a step-wedged, cluster-randomized trial of a provider-focused PPIUD intervention conducted in Sri Lanka from 2015 to 2018. We used logistic regression to assess the association between the PPIUD intervention and perceived pressure to adopt contraception at 18-month follow-up and converted estimates into risk differences.
Results
About 18 months following the PPIUD intervention, 13% of participants were not using contraception, most (82%) were using contraception and did not report feeling pressured to adopt their method, and 5% were using contraception and did report feeling pressured. While the PPIUD intervention was associated with increased contraceptive use, it was also associated with increased perceived pressure to adopt contraception (risk difference comparing intervention and control group: 4.5%; 95% confidence interval: −2.7%, 11.7%). Perceived pressure to adopt contraception was higher among IUD users compared to users of other contraceptive methods.
Conclusion
While expanding access to contraceptive methods – including the IUD – is imperative to promote choice in contraceptive decision-making, our findings highlight the importance of evaluating interventions not just based on use or uptake of specific contraceptive methods, but also using person-centered outcomes that capture reproductive autonomy.
Implications
Evaluating family planning programs solely on contraceptive use overlooks critical aspects of reproductive autonomy. We find that a postpartum IUD intervention in Sri Lanka was associated with increased contraceptive use but also increased perceived pressure to adopt contraception. Our findings emphasize the importance of assessing programs using rights-based, person-centered measures.
{"title":"Assessing the association between a postpartum intrauterine device intervention and perceived pressure to adopt contraception in Sri Lanka","authors":"Brooke W. Bullington , Katherine Tumlinson , Leigh Senderowicz , Joanna Maselko , Kavita Shah Arora , Jessie K. Edwards , Audrey Pettifor","doi":"10.1016/j.contraception.2025.111242","DOIUrl":"10.1016/j.contraception.2025.111242","url":null,"abstract":"<div><h3>Objective(s)</h3><div>Traditional measures of success in family planning research focus on contraceptive uptake and use. Scholars have increasingly challenged these outcomes, calling for rights-based, person-centered measures that capture whether individuals can fulfill their reproductive preferences or desires. We sought to evaluate a family planning program using a novel, person-centered measure of perceived pressure to adopt contraception.</div></div><div><h3>Study design</h3><div>We use secondary data collected as part of the Postpartum Intrauterine Device (PPIUD) Study, a step-wedged, cluster-randomized trial of a provider-focused PPIUD intervention conducted in Sri Lanka from 2015 to 2018. We used logistic regression to assess the association between the PPIUD intervention and perceived pressure to adopt contraception at 18-month follow-up and converted estimates into risk differences.</div></div><div><h3>Results</h3><div>About 18 months following the PPIUD intervention, 13% of participants were not using contraception, most (82%) were using contraception and did not report feeling pressured to adopt their method, and 5% were using contraception and did report feeling pressured. While the PPIUD intervention was associated with increased contraceptive use, it was also associated with increased perceived pressure to adopt contraception (risk difference comparing intervention and control group: 4.5%; 95% confidence interval: −2.7%, 11.7%). Perceived pressure to adopt contraception was higher among IUD users compared to users of other contraceptive methods.</div></div><div><h3>Conclusion</h3><div>While expanding access to contraceptive methods – including the IUD – is imperative to promote choice in contraceptive decision-making, our findings highlight the importance of evaluating interventions not just based on use or uptake of specific contraceptive methods, but also using person-centered outcomes that capture reproductive autonomy.</div></div><div><h3>Implications</h3><div>Evaluating family planning programs solely on contraceptive use overlooks critical aspects of reproductive autonomy. We find that a postpartum IUD intervention in Sri Lanka was associated with increased contraceptive use but also increased perceived pressure to adopt contraception. Our findings emphasize the importance of assessing programs using rights-based, person-centered measures.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"153 ","pages":"Article 111242"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226561","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 : 2026-01-01Epub Date: 2025-09-24DOI: 10.1016/j.contraception.2025.111236
Paige D. Kendall , Jeanelle Sheeder , Nancy Fang
Objectives
To reduce opioid use and provision while maintaining analgesia and patient satisfaction with osmotic dilators for cervical preparation before dilation and evacuation (D&E).
Study design
We conducted a quality improvement initiative to reduce opioid use by studying an analgesia protocol change from the existing “routine opioid provision” to a novel “opioid-sparing” protocol. We collected data through patient surveys from patients undergoing overnight osmotic dilators before D&E from 16 to 26 weeks of gestation. We assessed pain on a numeric rating scale (0–10) before dilator placement (baseline) and D&E. The primary outcome was median change in individual pain score from baseline to maximum overnight with osmotic dilators in place.
Results
Opioid provision (93.9% vs 10.3%, p < 0.001) and opioid use (57.6% vs 7.7%, p < 0.001) were lower in the novel opioid-sparing group. Median change in individual pain score was lower in the novel opioid-sparing group (7.0 [0–10]) compared to the existing routine opioid group (8.0 [0–10]) (p = 0.01).
Conclusions
The novel opioid-sparing protocol reduced opioid provision and use while also demonstrating lower pain scores and maintaining satisfaction in patients undergoing osmotic dilators before D&E.
Implications
Limiting opioid use for cervical preparation with osmotic dilators before second-trimester dilation and evacuation can reduce opioid provision and use, while maintaining analgesia efficacy and patient satisfaction.
{"title":"Decreasing opioid provision and use while maintaining analgesia efficacy in cervical preparation with osmotic dilators before dilation and evacuation: A quality improvement initiative","authors":"Paige D. Kendall , Jeanelle Sheeder , Nancy Fang","doi":"10.1016/j.contraception.2025.111236","DOIUrl":"10.1016/j.contraception.2025.111236","url":null,"abstract":"<div><h3>Objectives</h3><div>To reduce opioid use and provision while maintaining analgesia and patient satisfaction with osmotic dilators for cervical preparation before dilation and evacuation (D&E).</div></div><div><h3>Study design</h3><div>We conducted a quality improvement initiative to reduce opioid use by studying an analgesia protocol change from the existing “routine opioid provision” to a novel “opioid-sparing” protocol. We collected data through patient surveys from patients undergoing overnight osmotic dilators before D&E from 16 to 26 weeks of gestation. We assessed pain on a numeric rating scale (0–10) before dilator placement (baseline) and D&E. The primary outcome was median change in individual pain score from baseline to maximum overnight with osmotic dilators in place.</div></div><div><h3>Results</h3><div>Opioid provision (93.9% vs 10.3%, <em>p</em> < 0.001) and opioid use (57.6% vs 7.7%, <em>p</em> < 0.001) were lower in the novel opioid-sparing group. Median change in individual pain score was lower in the novel opioid-sparing group (7.0 [0–10]) compared to the existing routine opioid group (8.0 [0–10]) (<em>p</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>The novel opioid-sparing protocol reduced opioid provision and use while also demonstrating lower pain scores and maintaining satisfaction in patients undergoing osmotic dilators before D&E.</div></div><div><h3>Implications</h3><div>Limiting opioid use for cervical preparation with osmotic dilators before second-trimester dilation and evacuation can reduce opioid provision and use, while maintaining analgesia efficacy and patient satisfaction.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"153 ","pages":"Article 111236"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180836","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 : 2026-01-01Epub Date: 2025-09-28DOI: 10.1016/j.contraception.2025.111239
Brenna Ryan , Anne Brezovec , Saixia Ying , Shauna Stahlman , Bruce Pier
Objective
To determine a possible association of hormonal contraception use with military stress fractures given impact of readiness and hypothesized fracture risk with continuous contraceptive use while deployed.
Study Design
This IRB approved case-control study used incidence density sampling to assess associations between hormonal contraceptives and stress fracture. Up to four controls were matched to each case of stress fracture based on race/ethnicity, service branch, age, and time in service. Cases with <4 months of service were excluded. Crude and adjusted incidence rate ratios and 95% confidence intervals (CIs) were calculated to estimate effects of hormonal contraceptive use to incident stress fracture diagnosis. Intrauterine devices (IUDs), implants, and injectables were analyzed separately and oral contraceptives (OC), patches, and vaginal rings were analyzed combined given their similar mechanisms.
Results
Cases (n = 1689) were more likely to be enlisted, vitamin D deficient, obese, and have a history of bone disease. Before adjustment, no hormonal contraceptives were associated with increased risk of fracture. After adjustment for obesity and rank, only the combination of OC/patches/vaginal rings demonstrated a statistically significant association with stress fracture after 2-3 years of use (IRR 2.17, 95% CI 1.10-4.28, p value 0.03).
Conclusions
Our study suggests limited or no associations between recent hormonal contraceptive use and increased risk for stress fracture. This potential association should be investigated further.
Implications
This study finds that hormonal contraceptives are not associated with an increased risk of stress fracture and supports knowledge of hormonal effects on bone and prescribing considerations in highly active women.
目的：确定激素避孕药的使用与军人应力性骨折的关系，考虑到服役女性比男性有更高的风险，影响战备状态，以及在服役期间持续使用避孕药可能增加骨折的风险。研究设计：这项经IRB批准的病例对照研究采用发生率密度抽样来评估处方激素避孕药与偶发性应力性骨折诊断之间的关系。根据种族/民族、服务部门、年龄（一年内）和服务类别时间，每个应力性骨折病例最多匹配四个对照组。服务时间< 4个月的病例被排除在外。使用比例风险模型计算粗发生率比和调整发生率比以及相关的95%置信区间（ci），以估计在意外应力性骨折诊断前两年内使用激素避孕药的影响。考虑到节育器、植入物和注射剂的生物学机制相似，将其单独分析，将口服避孕药、贴片和阴道环联合分析。最后的多变量模型对匹配组、等级和肥胖进行了调整。结果：病例（n= 1,689）更有可能应征入伍，维生素D缺乏，肥胖，并有骨病史。在调整肥胖和等级之前，没有激素避孕药与骨折风险增加相关。在调整肥胖和等级后，只有口服避孕药/贴片/阴道环的组合在使用2 - 3年后与应力性骨折有统计学意义的关联（IRR 2.17, 95% CI 1.10-4.28， p值0.03）。结论：我们的研究表明，最近使用激素避孕药与军人应力性骨折风险增加之间的联系有限或没有联系。口服避孕药/贴片/阴道环与应力性骨折之间的潜在联系应进一步调查。这项研究发现，在现役女性服役人员中，激素避孕药的使用与应力性骨折的风险增加无关。这项研究支持了荷尔蒙对骨骼的影响，以及对高运动女性的处方考虑。
{"title":"Contraceptive use and fracture risk in active-duty females - A case control study","authors":"Brenna Ryan , Anne Brezovec , Saixia Ying , Shauna Stahlman , Bruce Pier","doi":"10.1016/j.contraception.2025.111239","DOIUrl":"10.1016/j.contraception.2025.111239","url":null,"abstract":"<div><h3>Objective</h3><div>To determine a possible association of hormonal contraception use with military stress fractures given impact of readiness and hypothesized fracture risk with continuous contraceptive use while deployed.</div></div><div><h3>Study Design</h3><div>This IRB approved case-control study used incidence density sampling to assess associations between hormonal contraceptives and stress fracture. Up to four controls were matched to each case of stress fracture based on race/ethnicity, service branch, age, and time in service. Cases with <4 months of service were excluded. Crude and adjusted incidence rate ratios and 95% confidence intervals (CIs) were calculated to estimate effects of hormonal contraceptive use to incident stress fracture diagnosis. Intrauterine devices (IUDs), implants, and injectables were analyzed separately and oral contraceptives (OC), patches, and vaginal rings were analyzed combined given their similar mechanisms.</div></div><div><h3>Results</h3><div>Cases (<em>n</em> = 1689) were more likely to be enlisted, vitamin D deficient, obese, and have a history of bone disease. Before adjustment, no hormonal contraceptives were associated with increased risk of fracture. After adjustment for obesity and rank, only the combination of OC/patches/vaginal rings demonstrated a statistically significant association with stress fracture after 2-3 years of use (IRR 2.17, 95% CI 1.10-4.28, <em>p</em> value 0.03).</div></div><div><h3>Conclusions</h3><div>Our study suggests limited or no associations between recent hormonal contraceptive use and increased risk for stress fracture. This potential association should be investigated further.</div></div><div><h3>Implications</h3><div>This study finds that hormonal contraceptives are not associated with an increased risk of stress fracture and supports knowledge of hormonal effects on bone and prescribing considerations in highly active women.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"153 ","pages":"Article 111239"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202322","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}
Abortion is banned or severely restricted in nearly half of the United States. Research on the impact of these restrictions and abortion care has never been more critical. Yet the surveillance and criminalization of people seeking abortion care, self-managing an abortion, providing abortion care, or helping people access abortion care present significant threats and concerns to them and abortion researchers. This paper reviews foundational concepts in digital and data security, and provides key suggestions, specifically for abortion researchers conducting qualitative research studies.
In this article, an expert panel discusses, suggests, and organizes best practices in digital and data privacy and security for qualitative abortion research. We suggest that all abortion researchers develop a digital and data security protocol (DDSP) through threat modeling for each individual research project, but our recommendations focus specifically on issues relevant to qualitative research studies. Components of a DDSP include: (1) determining what minimal data is necessary, (2) describing potential threats, (3) determining a mitigation plan, and (4) assessing efficacy of strategies using test scenarios. Research participants should be informed of potential risks including breach of privacy and confidentiality, and criminalization as well as the DDSP during the research informed consent process. Although this paper focuses on qualitative research, the basic data and digital security principles and tools discussed will be of use to all researchers regardless of the study type (e.g. mixed methods, quantitative, chart reviews, clinical, oral history, etc.).
{"title":"Society of Family Planning Research Practice Support: Digital and data security for abortion research in a post-Dobbs era—A primer for qualitative researchers","authors":"Melissa Madera , Amanda Bennett , Katherine Bertash , Erica P. Cahill","doi":"10.1016/j.contraception.2025.111208","DOIUrl":"10.1016/j.contraception.2025.111208","url":null,"abstract":"<div><div>Abortion is banned or severely restricted in nearly half of the United States. Research on the impact of these restrictions and abortion care has never been more critical. Yet the surveillance and criminalization of people seeking abortion care, self-managing an abortion, providing abortion care, or helping people access abortion care present significant threats and concerns to them and abortion researchers. This paper reviews foundational concepts in digital and data security, and provides key suggestions, specifically for abortion researchers conducting qualitative research studies.</div><div>In this article, an expert panel discusses, suggests, and organizes best practices in digital and data privacy and security for qualitative abortion research. We suggest that all abortion researchers develop a digital and data security protocol (DDSP) through threat modeling for each individual research project, but our recommendations focus specifically on issues relevant to qualitative research studies. Components of a DDSP include: (1) determining what minimal data is necessary, (2) describing potential threats, (3) determining a mitigation plan, and (4) assessing efficacy of strategies using test scenarios. Research participants should be informed of potential risks including breach of privacy and confidentiality, and criminalization as well as the DDSP during the research informed consent process. Although this paper focuses on qualitative research, the basic data and digital security principles and tools discussed will be of use to all researchers regardless of the study type (e.g. mixed methods, quantitative, chart reviews, clinical, oral history, etc.).</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"153 ","pages":"Article 111208"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066749","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 : 2026-01-01Epub Date: 2025-09-23DOI: 10.1016/j.contraception.2025.111213
John Dinelli , Kevin Espino , Frances Casey
Obstructed hemivagina and ipsilateral renal anomaly is a Mullerian anomaly with variable presentations. A patient with this syndrome had a superinfected fluid collection in an obstructed hemivagina after mifepristone and misoprostol administration for an embryonic demise, identifying a potential complication in this population.
{"title":"Infected products of conception in obstructed hemivagina after medical management of early pregnancy loss: A case report","authors":"John Dinelli , Kevin Espino , Frances Casey","doi":"10.1016/j.contraception.2025.111213","DOIUrl":"10.1016/j.contraception.2025.111213","url":null,"abstract":"<div><div>Obstructed hemivagina and ipsilateral renal anomaly is a Mullerian anomaly with variable presentations. A patient with this syndrome had a superinfected fluid collection in an obstructed hemivagina after mifepristone and misoprostol administration for an embryonic demise, identifying a potential complication in this population.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"153 ","pages":"Article 111213"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152227","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 : 2025-12-01Epub Date: 2025-09-04DOI: 10.1016/j.contraception.2025.111201
Carolina Sales Vieira , Lisa Eggebrecht , Igor Andre Milhoranca , Robert Neumann , Mariana Schiffer Acar , Sophia von Stockum , Ann-Kathrin Frenz
Objectives
This study aimed to validate the real-world performance of the MyIUS mobile application algorithm in predicting bleeding intensity and regularity in levonorgestrel intrauterine device (LNG-IUD) 52 mg, 19.5 mg, and 13.5 mg users following device insertion.
Study design
This was an observational real-world performance study conducted in Germany, Denmark, Sweden, Spain, Mexico, and Brazil, including women aged ≥ 18 years who provided electronic written informed consent and had used the MyIUS app for 90 days following LNG-IUD 52 mg, 19.5 mg, or 13.5 mg insertion. At day 90, participants received personalized bleeding predictions for one of three bleeding intensity clusters (predominantly amenorrhea, predominantly spotting, or predominantly bleeding), with those predicted predominantly spotting or predominantly bleeding receiving regular or irregular cycle predictions. After the 270-day data collection period, bleeding data self-reported from the last 180 days were evaluated and compared with the bleeding profile prediction.
Results
Based on 1734 participants with close-to-complete data sets, the overall multiclass area under the curve for the three LNG-IUDs was 0.81 (95% CI, 0.79–0.83) for bleeding intensity prediction, corresponding to sufficient discrimination in algorithm performance based on predefined thresholds. The overall area under the curve for menstrual cycle regularity prediction was 0.66 (95% CI, 0.63–0.68).
Conclusions
Results validated the bleeding intensity prediction algorithm in a real-world environment, providing evidence to support the global use of MyIUS for individualized insights into bleeding changes following LNG-IUD insertion. Further refinement of the algorithm, especially regarding its performance in predicting cycle regularity, and testing of its clinical utility are warranted.
Implications
This study validated the mobile application–housed bleeding prediction algorithm MyIUS in predicting bleeding intensity in LNG-IUD users following insertion in a real-world setting, supporting the global use of MyIUS for individualized insights into bleeding changes following LNG-IUD insertion.
{"title":"Real-world validation of a bleeding prediction algorithm in levonorgestrel intrauterine device users using the MyIUS mobile app","authors":"Carolina Sales Vieira , Lisa Eggebrecht , Igor Andre Milhoranca , Robert Neumann , Mariana Schiffer Acar , Sophia von Stockum , Ann-Kathrin Frenz","doi":"10.1016/j.contraception.2025.111201","DOIUrl":"10.1016/j.contraception.2025.111201","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to validate the real-world performance of the MyIUS mobile application algorithm in predicting bleeding intensity and regularity in levonorgestrel intrauterine device (LNG-IUD) 52 mg, 19.5 mg, and 13.5 mg users following device insertion.</div></div><div><h3>Study design</h3><div>This was an observational real-world performance study conducted in Germany, Denmark, Sweden, Spain, Mexico, and Brazil, including women aged ≥ 18 years who provided electronic written informed consent and had used the MyIUS app for 90 days following LNG-IUD 52 mg, 19.5 mg, or 13.5 mg insertion. At day 90, participants received personalized bleeding predictions for one of three bleeding intensity clusters (<em>predominantly amenorrhea</em>, <em>predominantly spotting</em>, or <em>predominantly bleeding</em>), with those predicted <em>predominantly spotting</em> or <em>predominantly bleeding</em> receiving <em>regular</em> or <em>irregular</em> cycle predictions. After the 270-day data collection period, bleeding data self-reported from the last 180 days were evaluated and compared with the bleeding profile prediction.</div></div><div><h3>Results</h3><div>Based on 1734 participants with close-to-complete data sets, the overall multiclass area under the curve for the three LNG-IUDs was 0.81 (95% CI, 0.79–0.83) for bleeding intensity prediction, corresponding to sufficient discrimination in algorithm performance based on predefined thresholds. The overall area under the curve for menstrual cycle regularity prediction was 0.66 (95% CI, 0.63–0.68).</div></div><div><h3>Conclusions</h3><div>Results validated the bleeding intensity prediction algorithm in a real-world environment, providing evidence to support the global use of MyIUS for individualized insights into bleeding changes following LNG-IUD insertion. Further refinement of the algorithm, especially regarding its performance in predicting cycle regularity, and testing of its clinical utility are warranted.</div></div><div><h3>Implications</h3><div>This study validated the mobile application–housed bleeding prediction algorithm MyIUS in predicting bleeding intensity in LNG-IUD users following insertion in a real-world setting, supporting the global use of MyIUS for individualized insights into bleeding changes following LNG-IUD insertion.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"152 ","pages":"Article 111201"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008631","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}
This study aimed to explore patient experience and support needs in receiving asynchronous medication abortion care without a real-time provider visit.
Study design
We conducted semistructured interviews with individuals who received asynchronous medication abortion care through the Medication Abortion–Autonomous Self-Assessment Project study from May 2022 through February 2023. We asked participants about their decision-making, needs, and experiences with this method of medication abortion. We transcribed, coded, and analyzed the interviews. We identified major themes related to patient experience with asynchronous medication abortion care and synthesized suggestions for improving this care modality.
Results
We interviewed 18 individuals from August to October 2023 who received an asynchronous medication abortion through the Medication Abortion–Autonomous Self-Assessment Project study in either Minnesota or Colorado. Asynchronous medication abortion care offered patients psychosocial control, flexibility and convenience, autonomy, privacy, and the ability to avoid unnecessary medical contact. The majority of participants stated they would use this method again if needed and would recommend it to a friend. Participants found asynchronous medication abortion care to be acceptable, and many provided suggestions on how to improve this service, including offering synchronous contacts with providers in case of emergency, an optional synchronous follow-up contact, and more support for and information around the medication abortion experience generally.
Conclusions
Asynchronous medication abortion care was a highly acceptable alternative to real-time and in-person medication abortion care and allowed participants to avoid unnecessary contact with clinical providers. Participants expressed the need for more patient education about medication abortion and optional follow-up with clinical providers.
Implications
Asynchronous medication abortion care can lower barriers to abortion access for patients while increasing clinic and provider capacity for in-person care. Expansion of asynchronous medication abortion care services, especially in shield law states, and adequate insurance coverage for asynchronous care services can facilitate access to timely care.
{"title":"“On my own time”: A qualitative exploration of patient experiences receiving asynchronous medication abortion care in the United States, 2022–2023","authors":"Shay Gingras, Bridge McKye, Alison Ojanen-Goldsmith","doi":"10.1016/j.contraception.2025.111049","DOIUrl":"10.1016/j.contraception.2025.111049","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to explore patient experience and support needs in receiving asynchronous medication abortion care without a real-time provider visit.</div></div><div><h3>Study design</h3><div>We conducted semistructured interviews with individuals who received asynchronous medication abortion care through the Medication Abortion–Autonomous Self-Assessment Project study from May 2022 through February 2023. We asked participants about their decision-making, needs, and experiences with this method of medication abortion. We transcribed, coded, and analyzed the interviews. We identified major themes related to patient experience with asynchronous medication abortion care and synthesized suggestions for improving this care modality.</div></div><div><h3>Results</h3><div>We interviewed 18 individuals from August to October 2023 who received an asynchronous medication abortion through the Medication Abortion–Autonomous Self-Assessment Project study in either Minnesota or Colorado. Asynchronous medication abortion care offered patients psychosocial control, flexibility and convenience, autonomy, privacy, and the ability to avoid unnecessary medical contact. The majority of participants stated they would use this method again if needed and would recommend it to a friend. Participants found asynchronous medication abortion care to be acceptable, and many provided suggestions on how to improve this service, including offering synchronous contacts with providers in case of emergency, an optional synchronous follow-up contact, and more support for and information around the medication abortion experience generally.</div></div><div><h3>Conclusions</h3><div>Asynchronous medication abortion care was a highly acceptable alternative to real-time and in-person medication abortion care and allowed participants to avoid unnecessary contact with clinical providers. Participants expressed the need for more patient education about medication abortion and optional follow-up with clinical providers.</div></div><div><h3>Implications</h3><div>Asynchronous medication abortion care can lower barriers to abortion access for patients while increasing clinic and provider capacity for in-person care. Expansion of asynchronous medication abortion care services, especially in shield law states, and adequate insurance coverage for asynchronous care services can facilitate access to timely care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"152 ","pages":"Article 111049"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805435","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 : 2025-12-01Epub Date: 2025-08-19DOI: 10.1016/j.contraception.2025.111182
Alice F. Cartwright, Rubina Hussain, Lauren Mitchell, Megan L. Kavanaugh
Objectives
This study aimed to assess variation in three measures of pregnancy and childbearing attitudes across sociodemographic characteristics and over time.
Study design
We used Survey of Women data from Arizona, New Jersey, and Wisconsin to compare responses between single-item measures of wanting to avoid pregnancy and childbearing and the Desire to Avoid Pregnancy (DAP) scale, as well as across two time points (2019–2020 and 2022–2023).
Results
The three measures were consistent across age and race/ethnicity categories, while the DAP scale reflected differences by financial status. There was an increase in the proportion of respondents who wanted to avoid childbearing (79% [95% CI 78%–81%] vs 82% [95% CI 81%–84%]) and in mean DAP scores (2.51 [95% CI 2.46–2.55] vs 2.62 [95% CI 2.58–2.67]) over time.
Conclusions
The ways in which people are asked about their pregnancy attitudes may yield different results.
Implications
Health professionals and researchers should consider using multiple items to measure pregnancy attitudes, understanding that variations may reflect the composition and social location of their samples.
目的：评估怀孕和生育态度的三个指标在社会人口特征和时间上的变化。研究设计：我们使用来自亚利桑那州，新泽西州和威斯康星州的女性调查数据来比较想要避免怀孕和生育的单项措施与避免怀孕的愿望（DAP）量表以及两个时间点（2019-2020年和2022-2023年）之间的反应。结果：三种测量方法在年龄和种族/民族类别中是一致的，而DAP量表反映了经济状况的差异。随着时间的推移，想要避免生育的受访者比例（79% [95% CI 78%-81%]对82% [95% CI 81%-84%]）和平均DAP分数（2.51 [95% CI 2.46-2.55]对2.62 [95% CI 2.58-2.67]）有所增加。结论：人们对怀孕态度的询问方式可能会产生不同的结果。含义：卫生专业人员和研究人员应考虑使用多种项目来衡量怀孕态度，了解变化可能反映其样本的组成和社会位置。
{"title":"Variation in three pregnancy attitude measures and changes from 2019–2020 to 2022–2023 in Arizona, New Jersey, and Wisconsin","authors":"Alice F. Cartwright, Rubina Hussain, Lauren Mitchell, Megan L. Kavanaugh","doi":"10.1016/j.contraception.2025.111182","DOIUrl":"10.1016/j.contraception.2025.111182","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to assess variation in three measures of pregnancy and childbearing attitudes across sociodemographic characteristics and over time.</div></div><div><h3>Study design</h3><div>We used Survey of Women data from Arizona, New Jersey, and Wisconsin to compare responses between single-item measures of wanting to avoid pregnancy and childbearing and the Desire to Avoid Pregnancy (DAP) scale, as well as across two time points (2019–2020 and 2022–2023).</div></div><div><h3>Results</h3><div>The three measures were consistent across age and race/ethnicity categories, while the DAP scale reflected differences by financial status. There was an increase in the proportion of respondents who wanted to avoid childbearing (79% [95% CI 78%–81%] vs 82% [95% CI 81%–84%]) and in mean DAP scores (2.51 [95% CI 2.46–2.55] vs 2.62 [95% CI 2.58–2.67]) over time.</div></div><div><h3>Conclusions</h3><div>The ways in which people are asked about their pregnancy attitudes may yield different results.</div></div><div><h3>Implications</h3><div>Health professionals and researchers should consider using multiple items to measure pregnancy attitudes, understanding that variations may reflect the composition and social location of their samples.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"152 ","pages":"Article 111182"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982557","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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