Contraception最新文献

Objectives: To assess longitudinal trends in contraceptive prescribing following medication abortion (MA) in general practice.

Study design: Retrospective cohort study of patients aged 14-49 years who were provided MA in the Australian general practice setting between 2013 and 2022. Data, including prescribed medications, were sourced from the national general practice dataset, MedicineInsight. The primary outcome was the proportion prescribed a contraceptive within 60 days of MA.

Results: Among 4543 undergoing MA, 1841 (40.5%) received a contraceptive prescription within 60 days, with a modest increase over time from 32.0% in 2013-41.3% in 2022. Among those prescribed contraceptives, the most common types were the combined oral contraceptive pill (34.0%), levonorgestrel intrauterine device (27.0%), implant (24.6%) and injection (11.2%), with 931 (50.6%) of prescriptions provided on the same day as MA. The likelihood of receiving a contraceptive prescription was higher among those aged 14-19 years (RR 1.40; 1.21-1.62) and 20-24 years (RR 1.20; 1.08-1.34) compared with the 30-34-year-old group, and in those who were existing patients than new to the practice at time of MA provision (RR 1.15; 1.02-1.31). A positive linear relationship was observed between increasing socioeconomic status and increasing remoteness and higher rates of contraceptive prescription (both p < 0.001).

Conclusions: Less than half of patients undergoing MA in the general practice setting are provided a contraceptive prescription within 60 days of MA, most commonly the combined oral contraceptive pill. A most increase in contraceptive provision is evident over time, with provision varying significantly according to contraceptive type and patient characteristics.

Implications: Further research is required to understand underlying reasons for observed variation in contraceptive provision following MA in the general practice setting to ensure all individuals are being provided access to appropriate contraceptive information and services as part of high-quality abortion care.

Objectives: We examined changes in abortion numbers and characteristics between two different practice settings in western Pennsylvania (PA) before and after the Dobbs v. Jackson Women's Health Organization Supreme Court decision.

Study design: We conducted a retrospective cohort study of abortions performed at an academic medical center (in-hospital) and a freestanding abortion clinic (out-of-hospital) between July 1, 2021 and May 31, 2023. We collected data on total number of abortions, gestational duration (GD), proportion performed in the second trimester, type of abortion, and patient age and state of residence. We compared abortions between July 1, 2021 and May 31, 2022 (pre-Dobbs) to those between July 1, 2022 and May 31, 2023 (post-Dobbs) using t tests, Mann-Whitney U tests, and Chi-square tests. We repeated the analysis stratifying by practice setting.

Results: The total number of abortions across the two sites was 3114 pre-Dobbs and 3153 post-Dobbs. Post-Dobbs in-hospital abortions had a lower median GD than pre-Dobbs (9 vs. 12 weeks, p < 0.01) and were less likely to be from out-of-state (41/467 (8.8%) vs. 59/450 (13.1%), p = 0.04). In contrast, post-Dobbs out-of-hospital abortions had a higher median GD than pre-Dobbs (9 vs. 8 weeks, p < 0.01) and were more likely to be from out-of-state (714/2686 (26.6%) vs. 434/2664 (16.3%), p < 0.01).

Conclusions: Out-of-hospital abortions were more likely to be from out-of-state and occurred at later gestational durations post-Dobbs compared with pre-Dobbs, while the opposite trends were seen for in-hospital abortions. The differences between sites suggest that the burden of increased demand from out-of-state patients was disproportionately absorbed by community abortion providers.

Objective: To understand if patients who travel out-of-state for abortion care are aware of medications by mail options for medication abortion and explore predictors of awareness.

Study design: We recruited patients at family planning clinics in three western states (OR, UT, and WA) between September 2024 and February 2025. Individuals who traveled to a clinic outside of their home state, were 18 years of age or older, and spoke English or Spanish were eligible for participation in the cross-sectional survey. Participants self-reported data on socio-demographics, gestational age, reason for travel, and awareness of medication abortion pills-by-mail options. We assessed differences in, and predictors of awareness of pills-by-mail using chi squared test for categorical data and logistic regression.

Results: The final analytic sample included 113 unique individuals. Most participants, 82 (73%), identified their gestational age to be < 11 weeks. Just over a third (n = 41, 37%) were aware of pills-by-mail. Among those who were aware, 21 (51%) learned about the pills-by-mail option online, 10 (24%) from social media, and 5 (12%) learned from a healthcare provider. Participants provided no dominant reason for traveling. Seven (17%) participants who were previously aware of pills-by-mail options indicated that they traveled because they desired a procedural abortion over a medication abortion. Individuals who completed the survey in Spanish (OR 3.66, 95% CI 1.03-13.10), and those with public health insurance (OR 3.85, 95% CI 1.25-11.86) were more likely to be aware of medications by mail options.

Conclusions: Most participants traveling out of state for abortion were unaware of medications by mail options despite being < 11 weeks.

Implications: These findings represent a lack of awareness of medications by mail options and warrant additional research. Increasing awareness of safe and legal abortion options, particularly medications by mail options, may increase access for individuals who may otherwise travel.

Objectives: To explore how patients considering permanent contraception and their delivering obstetrician-gynecologist (OB-GYN) address partner vasectomy in contraceptive counseling.

Study design: From 2021-2023, we conducted in-depth semi-structured interviews with postpartum patients desiring tubal permanent contraception and OB-GYNs at four US institutions as a part of a larger study. For this analysis, we used thematic content analysis to assess factors that shaped conversations surrounding vasectomy.

Results: We included 65 postpartum patients and 52 OB-GYNs in this analysis. Although many OB-GYNs considered vasectomy to be a part of their standard prenatal counseling, only half of patients reported counseling about vasectomy. Both patients and OB-GYNs linked lack of counseling to social and clinical factors. Some OB-GYNs either forgot or hesitated to counsel on vasectomy when the male partner was not their patient or wasn't in the exam room. Lack of vasectomy counseling thus prompted patients to seek vasectomy information on their own or opt for female permanent contraception methods. Some OB-GYNs relied on their perceptions of patients' relationship stability or partners' ability to obtain a vasectomy to guide whether they would counsel regarding vasectomy. Lastly, some patients and OB-GYNs prioritized route of delivery, surgical ease, and cancer risk reduction as reasons to obtain tubal permanent contraception versus vasectomy contraception.

Conclusions: OB-GYNs frequently deemphasized vasectomy due to their level of comfort counseling about vasectomy and tubal PC, perceptions around male involvement in contraception, and the organization of care. Instead, vasectomy should be introduced as a viable permanent contraceptive method during standard contraceptive counseling.

Implications: Our study suggests that while patients may be interested in vasectomy as an option for permanent contraception, counseling and referral pathways to vasectomy are limited. Clinicians should use a shared decision-making approach with couples, offer educational resources, and refer to vasectomy providers as appropriate.

A 45-year-old woman developed persistent tachycardia, elevated D-dimer (899 ng/mL), Raynaud-like episodes, and a persistent non-pruritic erythematous rash one month after NuvaRing initiation. Complete symptom resolution occurred within ten days of discontinuation, except for persistent rash. This represents a novel systemic thromboinflammatory syndrome.

Objective: Understanding alignment of contraceptive preferences and method selection among women living with HIV (WLWH) may improve contraceptive counseling. We examined whether method attribute preferences aligned with method attributes used among WLWH, and identified preference clusters.

Study design: We used baseline survey data from WLWH enrolled in a cluster randomized controlled trial of a reproductive health counseling intervention in Kenya. Women using eligible modern contraception at baseline were included (N = 2599). We used Poisson regression models to characterize 11 relationships between method attributes preferred vs. used, and principal component analysis (PCA) to identify preferences clusters.

Results: Women who preferred methods that are long-acting (adjusted Prevalence Ratio [aPR]:1.63, 95% Confidence Interval [CI]:1.19-2.24), avoid daily dosing (aPR:1.11, 95% CI:1.07-1.16), permit self-discontinuation (aPR:1.32, 95% CI:1.14-1.52), and are concealable (aPR:1.06, 95% CI:1.01-1.12) were significantly more likely to use aligned methods. Attribute preferences clustered on three dimensions: (1) avoiding heavy bleeding, weight changes, libido changes, and non-hormonal; (2) long-acting, avoiding daily dosing, permitting self-discontinuation, and avoiding intermittent bleeding; and (3) concealability without an effectiveness preference. Immediate return to fertility was modeled independently due to lack of clustering. The first dimension was positively correlated with condom use and inversely with implant use. The second was also positively correlated with condom use, and use of both implants and tubal ligation, while inversely with injectable and oral contraceptive pill use. The third was correlated with injectable use.

Conclusion: Method attribute preferences do not always align with methods used and may cluster in ways that cannot be satisfied by existing methods.

Implications: Preferences for methods that are long-acting, avoid daily dosing, and permit self-discontinuation are widely held and related to method selection, but cannot be met by a single method when held in combination. Client-centered counseling that elicits relative strength of preferences and tailors guidance accordingly may help improve method satisfaction.

Objectives: To evaluate the variability in abortion identification across four published algorithms using Medicaid claims data in states where abortion is covered by Medicaid for all indications.

Study design: We analyzed 2020 Medicaid Transformed Medicaid Statistical Information System Analytic Files from 14 states with Medicaid abortion coverage. Female recipients aged 15 to 44 were included. Four previously published algorithms, each using different combinations of diagnosis, procedure (Current Procedural Terminology/Healthcare Common Procedure Coding System), and medication (National Drug Classification) codes, were applied to identify abortion-related claims. For each algorithm, we calculated the number of identified abortions by state and examined variability in identification patterns and code types.

Results: Among 9.67 million Medicaid enrollees, the number of identified abortions varied substantially by algorithm and state. The max-to-min ratio across algorithms was lowest in Hawaii (2.09) and highest in New Jersey (138.59). Algorithms differed in their use of diagnosis-only, procedure-only, or both code types, with the proportion of claims containing both codes ranging from 0.4% (New Jersey) to 86.2% (Vermont). Abortions identified solely by Healthcare Common Procedure Coding System codes for mifepristone or misoprostol varied from 0.1% to 32.6% by state. No algorithm consistently performed well across all states.

Conclusions: Substantial heterogeneity exists in the performance of abortion-identifying algorithms across states. These differences likely reflect variation in billing practices, Medicaid data reporting, and algorithm construction.

Implications: Researchers should exercise caution when using claims data to estimate abortion rates, particularly across multiple states. Validation of an algorithm using health record data is needed.

Objective: To examine reasons for contraception and LARC non-use.

Study design: Using baseline data from population-based, household surveys conducted in 2019-2020, we examined reasons for contraception non-use among a four-state random sample (Arizona, Iowa, New Jersey, Wisconsin; N = 2039) and reasons Iowans had never used LARC (N = 1604).

Results: Contraceptive non-users cited personal reasons more commonly (90.2%) than access barriers (2.9%). A larger proportion of LARC non-users cited access barriers (50.8%); however, personal reasons remained more common (88.3%).

Conclusions: Since personal reasons are a major driver of contraceptive behavior, care that respects diverse choices and supports informed, preference-aligned counseling is crucial.

Implications: Improving contraceptive care requires more than expanding access; approaches should respect patients' decisions not to use contraception, while working to address concerns about side effects and insertion and removal procedures.

Objectives: We examined health professionals' views on self-managed abortion (SMA) reporting and how these relate to child welfare-reporting views.

Study design: We collected self-administered survey data from U.S. health professionals registered for a webinar about pregnancy, drug use, and child welfare-reporting. The survey included two Likert-scaled SMA reporting statements: "I think clinicians should be required by law to report patients who attempt to end a pregnancy on their own to legal authorities" and "A clinician who sees a patient who attempted to end a pregnancy on their own has an ethical obligation to keep this information confidential;" and nine child welfare-reporting statements. We used descriptive, chi-square, and regression analyses to describe SMA-reporting beliefs and explore factors associated with them. Findings were similar across both SMA-reporting beliefs; thus we focus results presentation on one belief.

Results: Five-hundred-eighty-three survey participants completed SMA-reporting questions. Six percent agreed, 81% disagreed, and 13% were neutral that clinicians should be required to report. In contrast, 41% agreed, 37% disagreed, and 21% were neutral that they "would rather err on the side of overreporting to child welfare." More social workers (8%) and nurses (6%) than physicians (0%) agreed that clinicians should have an obligation to report SMA. While beliefs regarding SMA- and child welfare-reporting were associated, participants were more supportive of child welfare- than SMA-reporting.

Conclusions: Most health professionals did not support SMA-reporting, although views varied by profession. Views on SMA-reporting were related to, yet distinct from, views on child welfare-reporting.

Implications: Health professionals' beliefs regarding reporting pregnant and birthing patients to government authorities are not consistent across topics nor across professional roles. Professional training efforts should account for these differences.

Objective: To describe pregnancy remembrance preferences of patients undergoing procedural uterine evacuation.

Study design: We conducted a retrospective study of patients presenting at an academic referral center for procedural uterine evacuation for abortion or fetal demise from 2/1/2021-1/30/2022. Patients answered a questionnaire at their pre-procedure appointment regarding pregnancy remembrance preferences including viewing the ultrasound examination, receiving ultrasound pictures, information about multiple pregnancy or fetal sex, receiving fetal footprints, recitation of a blessing, and arranging private fetal disposition. We also asked if questioning induced emotional distress. We collected patient demographics, pregnancy gestational age, uterine evacuation indication, and questionnaire data from the electronic medical record. We categorized cases into maternal-fetal indications (fetal anomalies or demise, pregnancy or maternal health complications) and other indications. We tested for associations using chi-square, Fisher's exact, and Wilcoxon rank sum tests. We computed odds ratios using multivariate regression analysis adjusted for procedure indication, maternal age, gestational age, and parity.

Results: The 368 evaluable questionnaires included 94(25.5%) for maternal-fetal and 274(74.5%) for other indications. Overall, 272(74.1%) desired pregnancy remembrance (maternal-fetal indications 77[81.9%]; other indications 195[71.4%], aOR1.96, 95%CI 1.09-3.70). Patients with maternal-fetal indications, as compared to other indications, less frequently requested multiple gestation (16[17.0%] vs 103[37.7%]) and sex information (32[34.0%] vs 137[50.2%]), and more frequently requested footprints (56[59.6%] vs 85[31.1%]), blessing (42[44.7%] vs 68[24.9%]), and private disposition (28[30.1%] vs 16[5.9%]), all p ≤ 0.01. Patients with maternal-fetal indications more frequently reported emotional distress (27/91[29.7%] vs 37/254[14.6%]; aOR 2.11, 95%CI 1.15-3.82), but many (50/64[78.1%]) still desired remembrance.

Conclusion: Most patients desired pregnancy remembrances regardless of indication, including those patients who reported emotional distress with being asked.

Implications: Patients who choose uterine evacuation for both maternal-fetal and other indications commonly want some type of information related to remembering the pregnancy, although those with maternal-fetal indications more frequently desire footprints, fetal blessing and private disposition. Clinics should consider universal inquiry of a desire for pregnancy remembrances.