Contraception最新文献

Objectives: Sexual and gender minority (SGM) youth experience disparities in sexual and reproductive health; however, little is known about how clinicians engage in contraceptive counseling with this patient population. This study describes pediatric clinician patterns and biases in contraceptive counseling with SGM youth.

Study design: We conducted 16 in-depth interviews with a convenience sample of clinicians who counsel adolescents on contraception. Participants were recruited and interviewed in-person at the American Academy of Pediatrics National Conference in October 2022. We used codebook thematic analysis.

Results: When discussing contraceptive counseling among SGM youth, three major themes emerged: (1) participants' acceptance of SGM youth identities varied from support to suspicion and rejection; (2) participants' conceptualizations of their SGM youth patients' identities circumscribed the scope of the contraceptive care they provided; and (3) participants described using a universal approach to contraceptive counseling that disregarded the relevance of SGM youth identities. For transgender patients, many clinicians focused on menstrual regulation and overlooked potential pregnancy risk. When discussing sexual minority patients, clinicians overemphasized pregnancy prevention and encouraged the use of highly effective contraceptive methods rather than taking a shared decision-making approach to contraceptive care.

Conclusion: Many clinicians demonstrated bias in approaches to contraceptive care provision to SGM youth patients by holding patients accountable to normative assumptions in transgender medicine and family planning. Training and support for adolescent-facing clinicians in bias recognition and comprehensive contraceptive care are necessary to provide person-centered reproductive health care to SGM youth.

Objectives: To identify limitations of abortion data in national Medicaid claims files by comparing abortion counts in Medicaid claims data with state abortion estimates.

Study design: We used procedure (Current Procedural Terminology/Healthcare Common Procedure Coding System) and drug (National Drug Code) codes to identify abortion claims in 2009 and 2010 Medicaid Analytic eXtract (MAX) and 2020 Transformed Medicaid Statistical Information System Analytic File (TAF) data. We compared the number of abortions in MAX and TAF to the number of expected abortions covered by Medicaid overall and by state. Based on recent published research, we estimated expected Medicaid-covered abortions as 62% of total abortions in states using state funds to cover abortion services for Medicaid enrollees and 0.9% in states that follow Hyde restrictions.

Results: MAX data identified 11% (38,668/345,480) of expected Medicaid-covered abortions in 2009 and 13% (44,528/330,801) of expected Medicaid-covered abortions in 2010. In 2020 TAF data, we found 25% (69,728/279,048) of the expected Medicaid-covered abortions. Among the 16 states that used state funds to cover abortions for Medicaid enrollees in 2020, the majority had <10% of expected Medicaid-covered abortions (n = 8). Three states had between 10% and 50% of expected abortions. Four states had between 51% and 75% of expected abortions. One state had insufficient data for reporting.

Conclusions: Abortion claims in MAX/TAF are an undercount of abortions covered by Medicaid, and this undercount varies across states. Variation in reporting across states and across time likely introduces bias into research trying to use MAX/TAF abortion claims across states and time. Researchers should use extreme caution when using MAX/TAF for abortion-related research.

Implications: Researchers should use caution when using the Medicaid Analytic eXtract and Transformed Medicaid Statistical Information System Analytic Files for abortion-related research questions.

Objectives: To determine the relationship between area deprivation index (ADI) and obtaining single-visit long-acting reversible contraception (LARC).

Study design: We utilized Poisson regression to determine the association between area deprivation and single-visit LARC insertion within a state-wide healthcare system between 2019-2021.

Results: Among our cohort (N = 4417), 68.60% of patients desiring LARC obtained single-visit LARC. Participants living in high deprivation areas were less likely to receive single-visit LARC (aRR 0.72, 95% CI 0.65-0.80).

Conclusions: Living in areas of high deprivation is independently negatively associated with obtaining a single-visit LARC.

Implications: While access to single-visit LARC should be universally improved, reducing barriers for patientswith a higher ADI may help limit inequities in reproductive healthcare.

Objective(s): While previous literature has shown clinician bias in adult contraceptive counseling, less is known on the biases clinicians may exhibit when counseling adolescents about contraception. Our study aimed to describe long-acting reversible contraception (LARC) counseling and prescribing practices of adolescent-serving clinicians.

Study design: This study used a cross-sectional discrete choice experiment mixed methods design. We sent a survey containing vignettes and items pertaining to demographics and beliefs to a convenience sample of adolescent-serving clinicians across the United States.

Results: Of 296 clinicians, 80% were in pediatrics, and had geographic, practice setting, gender, and racial diversity. Most clinicians reported being up-to-date with current literature regarding contraception. Sixty-eight percent of respondent's practices administer contraceptive injections, but only 17% place intrauterine devices (IUDs). Of those who do insert IUDs, nearly half inserted five or fewer within the last year. Patients' younger age and Hispanic ethnicity were associated with lower odds, and history of pregnancy was associated with higher odds, of clinicians' recommending LARC. Across all vignettes, the top five reasons clinicians chose their first-choice method for the patient were adherence or compliance, efficacy, side effects, patient age, and reversibility.

Conclusion(s): Clinicians often recommend contraceptives based on adherence, efficacy, and age, and we found younger age, minoritized race or ethnicity, and history of pregnancy were all associated with LARC recommendations, indicating potential biases against teen parents and assumptions about adolescents' priorities. This may impede the provision of patient-centered contraceptive counseling for adolescents, and highlights the need for improved education and practice changes post-Dobbs.

Implications: We found that clinicians demonstrated several biases in how they provide contraceptive recommendations to adolescent patients. These biases were often associated with their personal beliefs and experiences. Our findings can guide the development of future interventions aimed at improving adolescent reproductive health counseling and care delivery in primary care settings.

Objectives: U.S. active-duty servicewomen experience barriers to abortion care that civilian women do not experience due to military regulations and federal law. This scoping review aims to address this gap in knowledge by evaluating the research in this area.

Study design: A scoping review protocol based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was used to search PubMed, Embase, and CINAHL for peer-reviewed publications and gray literature. Inclusion criteria included (1) abortion access for active-duty servicewomen; (2) knowledge, attitudes, or beliefs regarding abortion for active-duty servicewomen; or (3) the prevalence of abortion among active-duty servicewomen. Quality appraisal was completed according to Let Evidence Guide Every New Decision criteria.

Results: The search yielded 811 articles, of which 15 met the criteria for inclusion in this review. Nine were empirical research articles, and six were nonempirical. Overall, 66% (n = 10) had abortion coverage or access as the primary outcome of interest; 73% (n = 11) cited relevant legislation; 80% (n = 12) made policy recommendations; and 40% (n = 6) made future research recommendations. Three themes emerged (1) prevalence estimates, (2) barriers to care, and (3) lack of knowledge and training on military abortion policies.

Implications: More studies with abortion coverage and access for active-duty servicewomen as the primary outcome of interest should be conducted to better understand the scope of the issue and the impact on military readiness and to inform policy makers and future interventions to mitigate barriers to care.

Objective: To describe experiences with contraception counseling training and provision of obstetrics and gynecology residents training in California and Florida.

Study design: We conducted a mixed-methods study of obstetrics and gynecology residents training across 19 programs (with approximately 428 residents) in California and Florida from September 2022 through February 2023. We asked participants how often they use tiered-effectiveness counseling, their satisfaction with contraception counseling practices, and experiences with witnessing and recognizing contraception coercion. We asked about personal disappointment when patients decline long-acting reversible contraception (LARC) and pressure from faculty to prescribe LARC. To further explore resident contraception counseling education and behaviors, we conducted semi-structured telephone interviews with a subset of 20 survey volunteers.

Results: We received survey responses from 155 (36.2%) participants. Most (n = 113 [76.4%]) often or always reported using tiered-effectiveness counseling. While few participants (n = 17 [11.3%]) reported feeling pressure from faculty to convince a patient to keep a LARC, some (n = 34 [22.1%]) reported they often or always feel disappointed when a patient chooses LARC removal, with more Florida participants reporting disappointment (n = 19 [37.3%]) compared to California (n = 15 [14.6%], p = 0.01). We identified two main themes from the telephone interviews. First, residents feel they have limited formal education on how to provide contraceptive counseling and commonly learn these practices by emulating supervising faculty or peer counseling styles. Second, residents are informally taught, through feedback and interactions with supervising faculty and peers, that successful contraception counseling is the ability to convince patients to use highly effective contraception.

Conclusion: When residents lack formalized contraception counseling education, they adopt counseling behaviors that may not be patient centered.

Implications: When obstetrics and gynecology residents lack formalized contraception counseling education, they learn practices that may lead to coercive counseling behaviors during training. Resident education should include recognition and mitigation of contraception coercion and patient-centered counseling both through a formalized curriculum and socialization of trainees during their medical education.