Increasing access to effective birth control after childbirth may meet many women’s preferences and reduce short interpregnancy interval rates. Eliminating out-of-pocket costs for contraception has ...been reported to increase the use of the most effective methods among women with employer-based insurance, but the prevalence and effects of patient cost sharing for contraception have not been studied during the postpartum period.
This study aimed to examine the association between cost sharing for long-acting reversible contraception and postpartum contraception use patterns and pregnancies in the 12 months after delivery.
We conducted a retrospective cohort analysis of commercially insured women undergoing childbirth from 2014 to 2018 using Optum’s (Eden Prairie, MN) de-identified Clinformatics Data Mart database. This large national database includes nonretired employees and their dependents who are enrolled in health insurance plans sponsored by large- or medium-sized US-based employers. Women with 12 months of continuous enrollment postpartum were included. Childbirth, pregnancy, and contraceptive method (female sterilization, long-acting reversible contraceptives, other hormonal methods, and no prescription method observed) were identified using claims data. Contraceptive use patterns were observed at 3, 6, and 12 months postpartum and adjusted for individual and plan characteristics. Median out-of-pocket costs were $0 for sterilization and other hormonal methods but nonzero for long-acting reversible contraception. We therefore used simple and multivariable logistic regressions to examine the association between plan-level cost sharing (no cost sharing, $0; low cost sharing, >$0–<$200; and high cost sharing, ≥$200 out-of-pocket cost) for any long-acting reversible contraceptive insertion and contraceptive use patterns and short interpregnancy interval rates, controlling for age, household income, race and ethnicity, region, and insurance plan type.
Among 25,298 plans with cost sharing data, we identified 172,941 women with continuous enrollment for 12 months postpartum, including 82,500 (47.7%) in no cost sharing, 22,595 (13.1%) in low cost sharing, and 67,846 (39.2%) in high cost sharing plans. The percentage of postpartum women in the study sample using any prescription contraceptive method was 39.5% by 3 months, 43.8% by 6 months, and 46.0% by 12 months. At all time points, postpartum women in no cost sharing plans had a higher predicted probability of long-acting reversible contraceptive use (eg, at 12 months: no cost sharing, 22.0%; low cost-sharing, 17.5%; high cost sharing, 18.3%; P<.001) and a lower predicted probability of no prescription method use (eg, at 12 months: no cost sharing, 51.8%; low cost sharing, 55.0%; high cost sharing, 54.9%; P<.001) than those in low or high cost sharing plans. Predicted probabilities of female sterilization and other hormonal method use did not differ substantively by plan cost sharing for long-acting reversible contraception at any time point. The proportion of women experiencing a short interpregnancy interval was low (1.9% by 3 months, 1.9% by 6 months, 2.0% by 12 months) and did not differ by plan cost sharing for long-acting reversible contraception at any time point.
Out-of-pocket costs for long-acting reversible contraception influence the method of contraception used by postpartum women with employer-based insurance. Eliminating financial barriers to long-acting reversible contraception access after childbirth may help women initiate their preferred method and increase the use of long-acting reversible contraceptives among interested women who otherwise might utilize less effective methods.
Abstract Objective To document the use of contraception by a representative sample of Australian women aged 16–49 years and compare it with 2001–2002. Methods Women were asked about their use of ...contraception and method used or reason for non-use during computer-assisted telephone interviews in 2012–2013. Women were sampled by random digit dialling of landline and mobile phones (participation rate 67.2%). Results Of a weighted sample of 5654 heterosexually active women interviewed 81% were using a method of contraception including sterilisation; this amounts to 66% of all women aged 16–49. Of those who were not using a method, 42% were pregnant or wanted a baby, 25% said they or their partners were infertile, 5% were currently not having intercourse, 3% were past menopause and 25% were apparently at risk of unintended pregnancy. Of those who used a method, 33% used oral contraceptives, 30% condoms and 19% sterilisation as their primary method. Use of condoms, intrauterine devices, implants and emergency contraception has increased since 2002, and use of sterilisation has fallen. Method used varied by age group, location, occupational group, relationship status and parity. A third of women had ever used emergency contraception, with the highest rate among women in their 20s. Conclusion Australian women have access to a wide range of effective contraceptive methods. Implications Given the high levels of use, most unintended pregnancies in Australia are likely to be attributable to method failure or inconsistent use.
Background. Evidence-informed priority setting is vital to improved investment in public health interventions. This is particularly important as South Africa (SA) makes the shift to universal health ...coverage and institution of National Health Insurance.Objectives. To measure the financial impact of increasing the demand for modern contraceptive methods in the SA public health sector. We estimated the total cost of providing contraceptives, and specifically the budgetary impact of premature removals of long-acting reversible contraceptives.Methods. We created a deterministic model in Microsoft Excel to estimate the costs of contraception provision over a 5-year time horizon (2018 - 2023) from a healthcare provider perspective. Only direct costs of service provision were considered, including drugs, supplies and personnel time. Costs were not discounted owing to the short time horizon. Scenario analyses were conducted to test uncertainty.Results. The base-case cost of current contraceptive use in 2018 was estimated to be ZAR1.64 billion (ZAR29 per capita). Injectable contraceptives accounted for ~47% of total costs. To meet the total demand for family planning, SA would have to spend ~30% more than the estimate for current contraceptive use. In the year 2023, the ‘current use’ of modern contraceptives would increase to ZAR2.2 billion, and fulfilling the total demand for family planning would require ZAR2.9 billion. The base-case cost of implantable contraceptives was estimated at ZAR54 million. Assuming a normal removal rate, the use of implants is projected to increase by 20% during the 5-year period between 2019 and 2023, with an estimated 46% increase in costs. The cost of early removal of Implanon NXT is estimated at ZAR75 million, with total contraception costs estimated at ZAR102 million in 2019, compared with ZAR56 million when a normal removal rate is applied.Conclusions. The costs of scaling up modern contraceptives in SA are substantial. Early and premature removals of implantable contraceptives are costly to the nation and must be minimised. The government should consider conducting appropriate health technology assessments to inform the introduction of new public health interventions as SA makes the shift to universal health coverage by means of National Health Insurance.
Contraception for adolescents Braverman, Paula K.; Adelman, William P.; Alderman, Elizabeth M. ...
Pediatrics (Evanston),
10/2014, Letnik:
134, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Contraception is a pillar in reducing adolescent pregnancy rates. The American Academy of Pediatrics recommends that pediatricians develop a working knowledge of contraception to help adolescents ...reduce risks of and negative health consequences related to unintended pregnancy. Over the past 10 years, a number of new contraceptive methods have become available to adolescents, newer guidance has been issued on existing contraceptive methods, and the evidence base for contraception for special populations (adolescents who have disabilities, are obese, are recipients of solid organ transplants, or are HIV infected) has expanded. The Academy has addressed contraception since 1980, and this policy statement updates the 2007 statement on contraception and adolescents. It provides the pediatrician with a description and rationale for best practices in counseling and prescribing contraception for adolescents. It is supported by an accompanying technical report.
Background and Aims
Unintended pregnancy rates are high among women with substance use disorders (SUDs), which could be explained partly by lower use of and adherence to contraception. We aimed to ...test: (1) the association of SUD with prescription contraceptive use, contraceptive method selection and adherence; (2) whether practices participating in the Patient‐Centered Medical Home Initiative (PCMHI) had better contraceptive use and adherence for patients with SUD; and (3) for differences in the association of SUD with adherence by type of contraceptive used.
Design
Retrospective cohort analysis of claims and encounter data.
Setting
Massachusetts, USA.
Participants
A total of 47 902 women aged 16–45 years enrolled in Medicaid or Commonwealth Care in Massachusetts between 2010 and 2014.
Measurements
We examined three dependent variables: (1) use of a reversible prescription contraceptive during 2012; (2) the contraceptive methods used; and (3) the proportion of days covered by a prescription contraceptive in the year following the first prescription contraceptive claim. The primary predictor was diagnosed SUD, defined as at least one claim for an alcohol or drug use disorder.
Findings
SUD was associated with lower rates of prescription contraceptive use during 2012 19.2 versus 23.9%; adjusted odds ratio (aOR) = 0.79, P < 0.001. SUD was associated with decreased selection of long‐acting reversible contraception (LARC) compared with short‐acting contraception (SARC) (42.8 versus 44.5%; aOR = 0.83, P = 0.011). There was no significant association between SUD and adherence (aOR = 0.84, P = 0.068). PCMHI enrollment did not alter the relationship between SUD and contraceptive use or adherence. Contraceptive method did not impact the relationship between SUD and adherence.
Conclusion
Women with substance use disorders are less likely to use prescription contraceptives, especially long‐acting methods, but are not significantly less likely to adhere to them once prescribed than women without substance use disorders.
Contraceptive use is the principal method by which women avoid unintended pregnancy. An unintended pregnancy can induce long-term distress related to the medical, emotional, and social consequences ...of carrying that pregnancy to term.
This review investigates the effects of modern contraception techniques such as birth control pills, long-acting reversible contraceptives (e.g., intrauterine devices, implants), and condoms on mental health status.
We searched multiple databases from inception until February 2022, with no geographical boundaries. RCTs underwent a quality assessment using the GRADE approach while the quality of observational studies was assessed using the Downs and Black scoring system. Data were analyzed through meta-analysis and relative risk and mean difference were calculated and forest plots were created for each outcome when two or more data points were eligible for analysis.
The total number of included studies was 43. In women without previous mental disorders, both RCTs (3 studies, SMD 0.18, 95% CI 0.02, 0.34, high quality of evidence) and cohort studies (RR 1.04 95% CI 1.03, 1.04) detected a slight increase in the risk of depression development. In women with previous mental disorders, both RCTs (9 studies, SMD - 0.15, 95% CI -0.30, -0.00, high quality of evidence) and cohort studies (SMD - 0.26, 95% CI -0.37, -0.15) detected slight protective effects of depression development. It was also noticed that HC demonstrated protective effects for anxiety in both groups (SMD - 0.20, 95% CI -0.40, -0.01).
Among women with pre-existing mental disorders who use hormonal contraceptives, we reported protective association with decreased depressive symptoms. However, the study also draws attention to some potential negative effects, including an increase in the risk of depression and antidepressant use among contraceptive users, a risk that is higher among women who use the hormonal IUD, implant, or patch/ring methods. Providers should select contraceptive methods taking individual aspects into account to maximize benefits and minimize risks.
Objective
To assess how use of postpartum contraception (PPC) changed during the COVID‐19 public health emergency.
Methods
Billing and coding data from a single urban institution (n = 1797) were used ...to compare use of PPC in patients who delivered from March to June 2020 (COVID Cohort, n = 927) and from March to June 2019 (Comparison Cohort, n = 895). χ2 and multivariable logistic regression models assessed relationships between cohorts, use of contraception, and interactions with postpartum visits and race/ethnicity.
Results
In the COVID Cohort, 585 women (64%) attended postpartum visits (n = 488, 83.4%, via telemedicine) compared to 660 (74.7%, in‐person) in the Comparison Cohort (P < 0.01). Total use of PPC remained similar: 30.4% (n = 261) in the COVID Cohort and 29.6% (n = 278) in the Comparison Cohort (P = 0.69). Compared to in‐person visits in the Comparison Cohort, telemedicine visits in the COVID Cohort had similar odds of insertion of long‐acting reversible contraception (LARC) (adjusted odds ratio aOR 1.13, 95% confidence interval CI 0.78–1.6), but higher odds of inpatient insertion (aOR 6.4, 95% CI 1.7–24.9). Black patients compared to white patients were more likely to initiate inpatient LARC (aOR 7.29, 95% CI 1.81–29.4) compared to the Comparison Cohort (aOR 3.63, 95% CI 0.29–46.19).
Conclusion
Use of PPC remained similar during COVID‐19 with a decrease of in‐person postpartum visits, new adoption of postpartum telemedicine visits, and an increase in inpatient insertion of LARC with higher odds of inpatient placement among black patients.
Synopsis
Little is known about the effect of COVID‐19 on postpartum contraception. Despite changes in types of postpartum visits, use of postpartum contraception overall remained similar.
Contraception for adolescents Ott, Mary A; Sucato, Gina S
Pediatrics (Evanston),
10/2014, Letnik:
134, Številka:
4
Journal Article
Recenzirano
Odprti dostop
A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent ...anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians' long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions.
A sweeping chronicle of women's battles for reproductive freedom throughout American history, Pregnancy and Power explores the many forces--social, racial, economic, and political--that have shaped ...women's reproductive lives in the United States. Leading historian Rickie Solinger argues that a woman's control over her body involves much more than the right to choose an abortion. Reproductive politics were at play when slaveholders devised breeding schemes, when the U.S. government took Indian children from their families in the nineteenth century, and when doctors pressed Latina women to be sterilized in the 1970s. Tracing the diverse plot lines of women's reproductive lives throughout American history, Solinger redefines the idea of reproductive freedom, putting race and class at the center of the effort to control sex and pregnancy in America over time. Solinger asks which women have how many children under what circumstances, and shows how reproductive experiences have been encouraged or coerced, rewarded or punished, honored or exploited over the last 250 years. Viewed in this way, the debate over reproductive rights raises questions about access to sex education and prenatal care, about housing laws, about access to citizenship, and about which women lose children to adoption and foster care. Pregnancy and Power shows that a complete understanding of reproductive politics must take into account the many players shaping public policy-- lawmakers, educators, employers, clergy, physicians--as well as the consequences for women who obey and resist these policies. Tracing the diverse plotlines of women's reproductive lives throughout American history, Solinger redefines the idea of reproductive freedom, putting race and class at the center of the struggle to control sex and pregnancy in America.
•Of 385 women with long-acting reversible contraception, 37 (9.6%) had early removal.•Of 314 women with an intrauterine device, 7.3% had an early removal.•Of 71 women with a subdermal implant, 19.7% ...had an early removal.•While non-significant, patients with any mental health diagnosis had twice the odds of early removal.
Having a mental health diagnosis is associated with contraceptive non-adherence and user-related contraceptive failures of short-acting methods. There is a lack of research on the relationship between mental health diagnoses and early discontinuation of highly effective long-acting reversible (LARC) methods such as the intrauterine device (IUD) and subdermal implant (SDI).
Using a Primary Care and Obstetrics and Gynecology Patient Data Registry, we conducted a cross-sectional analysis of the relationship between any mental health diagnosis (any anxiety disorder or depression) and early LARC removal (<1 year post-insertion) among 385 reproductive-aged (14–50 years) women in 2008–16. Adjusted logistic regression was used to calculate odds ratios and 95% confidence intervals.
Almost 10% (n = 37) of the sample had an early LARC removal, of which 62.2% were hormonal IUD and 37.8% were SDI. Women with a mental health diagnosis had a higher prevalence of early LARC removal (13.6% vs. 8.0%, p = =.090). Although non-significant, there was a trend in adjusted analyses indicating twice the odds of early removal for women with a mental health diagnosis versus no diagnosis (OR = =2.04, 95% CI = =0.97–4.27).
This study is limited by a small sample size and availability of variables from a reportable medical record database. Pregnancy intentions and side effects of method use could not be accounted for which may have impacted timing of removal.
Understanding why women choose early LARC removal can inform counseling to help women make informed choices about their contraceptive method that meets their reproductive needs.
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