Contraception最新文献

{"title":"PROVISION OF PATIENT-CENTERED CONTRACEPTIVE CARE FOR BALTIMORE LATINA/É PATIENTS","authors":"DN Carvajal,&nbsp;KG Bevilacqua,&nbsp;C Dehlendorf","doi":"10.1016/j.contraception.2025.111068","DOIUrl":"10.1016/j.contraception.2025.111068","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to assess the association between patient characteristics and receipt of patient-centered contraceptive care among a sample of Latina/é patients in Baltimore, MD.</div></div><div><h3>Methods</h3><div>We assessed receipt of patient-centered contraceptive care among Latina/é patients aged 15-45 by audio-recording visits with six clinicians across four facilities. Patient-centeredness was assessed via analysis of the audio recordings using the Four Habits Coding Scheme (4HCS). Patients completed surveys using the Patient Centered Contraceptive Counseling (PCCC) measure. Multivariable logistic regression models tested the association between patient characteristics and PCCC and 4HCS scores. Qualitative interviews with a patient subset further characterized their experiences.</div></div><div><h3>Results</h3><div>A total of 52 visits and 29 interviews were analyzed. Some 64% of patients reported the highest possible ratings of patient-centered contraceptive counseling (PCCC). Researcher-reported 4HCS scores were notably less reflective of true patient-centered care provision. In adjusted models, neither PCCC nor 4HCS scores were significantly associated with patient characteristics. The discrepancy between PCCC and 4HCS scores is contextualized by interviews in which patients explain that compared to previous healthcare experiences, counseling received during the study period focused on their contraceptive preferences and involved interactions with kind, communicative clinicians/staff.</div></div><div><h3>Conclusions</h3><div>Positive ratings of experiences by Latina/é patients in the context of suboptimal patient-centered care on audio recordings suggests there may be a “low bar” of care, particularly for historically and currently marginalized groups. Provision of patient-centered contraceptive care requires attention to both patient-reported experiences and researcher-observed quality measures.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111068"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278313","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}

{"title":"Copyright info/Contents","authors":"","doi":"10.1016/S0010-7824(25)00382-8","DOIUrl":"10.1016/S0010-7824(25)00382-8","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"150 ","pages":"Article 111191"},"PeriodicalIF":2.3,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917913","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}

{"title":"Fluidity in contraceptive decision-making throughout pregnancy and the postpartum period among patients at an urban county hospital in Ohio","authors":"Brooke W. Bullington ,&nbsp;Molly Platt ,&nbsp;Tyler Soy ,&nbsp;Lauren Coombs ,&nbsp;Grace A. Trompeter ,&nbsp;Elizabeth Pleasants ,&nbsp;Kavita Shah Arora","doi":"10.1016/j.contraception.2025.111047","DOIUrl":"10.1016/j.contraception.2025.111047","url":null,"abstract":"<div><h3>Objectives</h3><div>Contraceptive decision-making is a complex, dynamic process influenced by personal values, experiences, and circumstances. Existing research often captures contraceptive decisions at a single time point, limiting understanding of how preferences evolve over time. This study prospectively examines the fluidity of contraceptive preferences and plans throughout pregnancy and postpartum among patients receiving care at an urban county hospital in Ohio.</div></div><div><h3>Study design</h3><div>We conducted a prospective, longitudinal study of pregnant patients (<em>N</em> = 123) in 2023 at five time points: three during pregnancy and two postpartum. Participants reported contraceptive method preferences, attitudes, and perceptions at each follow-up survey. We descriptively analyzed changes in planned postpartum contraceptive method and key factors, including contraceptive attributes and perceptions, influencing contraceptive decision-making.</div></div><div><h3>Results</h3><div>Method effectiveness was the most important contraceptive attribute for included participants at all time points, regardless of contraceptive plan. One-third of participants maintained a consistent contraceptive plan across all five visits. Participants’ contraceptive plans sometimes did not align with their stated method attribute preferences.</div></div><div><h3>Conclusions</h3><div>Contraceptive decision-making in the perinatal period is a fluid and evolving process. Our findings underscore the need for patient-centered counseling that acknowledges this variability and supports individuals in navigating changing preferences over time.</div></div><div><h3>Implications</h3><div>Contraceptive plans shift throughout pregnancy and postpartum and may not always align with patients’ stated priorities. Clinicians should provide ongoing, patient-centered counseling that acknowledges the fluidity of contraceptive decision-making and supports individuals in navigating evolving reproductive goals.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111047"},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769458","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}

{"title":"Racial and ethnic differences in risk for hysterectomy following insertion of a levonorgestrel-releasing intrauterine device: A retrospective cohort study","authors":"Michael J. Green ,&nbsp;Kemi M. Doll ,&nbsp;Mollie E. Wood ,&nbsp;Annie G. Howard ,&nbsp;Lauren G. Anderson ,&nbsp;Joacy G. Mathias ,&nbsp;Natalie A. Rivadeneira ,&nbsp;Erin T. Carey ,&nbsp;Timothy S. Carey ,&nbsp;Wanda Nicholson ,&nbsp;Til Stürmer ,&nbsp;Evan R. Myers ,&nbsp;Whitney R. Robinson","doi":"10.1016/j.contraception.2025.111046","DOIUrl":"10.1016/j.contraception.2025.111046","url":null,"abstract":"<div><h3>Objectives</h3><div>Evidence regarding risk for hysterectomy following treatment for benign gynecological conditions with a levonorgestrel-releasing intrauterine device (LNG-IUD) is limited. We assess whether race and ethnicity are associated with hysterectomy risk and moderate associations between other patient characteristics and hysterectomy risk.</div></div><div><h3>Study design</h3><div>From health care records (US South; 2014–2019), we identified a retrospective cohort of 783 patients (aged 18–44 years; non-Hispanic White <em>n</em> = 455; non-Hispanic Black <em>n</em> = 208; Hispanic <em>n</em> = 120) receiving LNG-IUD treatment for a benign condition, followed to hysterectomy or study end (September 18, 2019). Indices measuring preinsertion bleeding, gynecological pain, and bulk symptom severity were abstracted from 4 months’ medical records preceding insertion. Associations between race and ethnicity, age, symptom severity, presence of fibroids and endometriosis, prior IUD use, parity, and insurance and hysterectomy risk were investigated with Kaplan-Meier estimates and Cox regression.</div></div><div><h3>Results</h3><div>Seventy-six patients (9.7%) underwent hysterectomy (median follow-up: 1.7 years). Hysterectomy rates were 7.0% within 1 year, climbing to 14.9% at 4 years post-insertion. Hysterectomy rates did not differ significantly by race and ethnicity. Age at treatment, symptom severity, fibroids, parity, and insurance status were associated with hysterectomy, but only age (hazard ratio per unit increase: 1.04 [95% CI: 1.00–1.09]), bleeding severity (1.05 [1.00–1.10]), and bulk severity (1.15 [1.00–1.32]) remained associated with adjustment. There was no evidence that race and ethnicity moderated these associations.</div></div><div><h3>Conclusions</h3><div>We did not find statistically significant differences in hysterectomy risk for Black, Hispanic, and White LNG-IUD patients. Patients who were older and had more severe pre-insertion uterine bleeding and bulk symptoms were more likely to undergo hysterectomy. These associations did not differ by race and ethnicity.</div></div><div><h3>Implications</h3><div>Among patients being treated with LNG-IUDs for benign gynecological conditions, Black, Hispanic, and White patients did not differ significantly in hysterectomy risk, but older patients and those with more severe bleeding and bulk symptoms were more likely to undergo hysterectomies.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111046"},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769459","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}

{"title":"Copyright info/Contents","authors":"","doi":"10.1016/S0010-7824(25)00213-6","DOIUrl":"10.1016/S0010-7824(25)00213-6","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"149 ","pages":"Article 111022"},"PeriodicalIF":2.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144725059","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}

{"title":"Measuring contraceptive agency in the community","authors":"Maria I. Rodriguez ,&nbsp;Katrina Rapp ,&nbsp;Haley Burns ,&nbsp;Cynthia C. Harper ,&nbsp;Corinne H. Rocca","doi":"10.1016/j.contraception.2025.111044","DOIUrl":"10.1016/j.contraception.2025.111044","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate the Contraceptive Agency Scale (CAS), developed as a clinic-based measure, within a community population and to assess how agency varied by demographic and reproductive characteristics.</div></div><div><h3>Study design</h3><div>We conducted a cross-sectional survey of 1917 participants aged 15–45 years living in Oregon in 2023. Participants responded to the 7-item CAS, comprised items relating to active decision-making, freedom from coercion, and nonjudgmental care during their last health care visit involving contraceptive counseling. We assessed the dimensionality of the CAS and fit data to a partial credit model to analyze its psychometric performance in our community-based sample. Differences in agency by characteristics were assessed with multivariable linear regression.</div></div><div><h3>Results</h3><div>The CAS showed adequate to good internal consistency reliability (Cronbach alpha: 0.78). The CAS items mostly loaded onto a single factor and demonstrated reasonable fit to a partial credit model (information-weighted fit statistics ranged from 0.73 to 1.01). While participants identifying as Black had lower CAS scores than White participants (β coefficient: −1.39 [−2.19, −0.59], <em>p</em> &lt; 0.001), Asian/Pacific Islander, Latino/a, and multiracial participants had significantly higher levels of contraceptive agency than White participants. Not desiring pregnancy was associated with higher contraceptive agency (β coefficient: 1.27 [0.72, 1.82], <em>p</em> &lt; 0.001) In contrast, lower education, some college or less vs college or above (β coefficient: −2.14 [−2.69, −1.60], <em>p</em> &lt; 0.001) and nonbinary/transgender identity vs female gender identity (β coefficient: −1.32 [−2.15, −0.50], <em>p</em> &lt; 0.01) were associated with lower contraceptive agency.</div></div><div><h3>Conclusions</h3><div>The CAS can be used in a community sample to evaluate patient centered contraceptive decision making as a standard of care.</div></div><div><h3>Implications</h3><div>Analysis of contraceptive agency among a community-based participant population offers valuable insights into experiences with contraceptive counseling.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111044"},"PeriodicalIF":2.3,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736095","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}

{"title":"Not actively dying: An inductive categorization of obstetric cases negatively affected by post-Dobbs abortion bans","authors":"Katrina Kimport,&nbsp;Shelly Kaller","doi":"10.1016/j.contraception.2025.111043","DOIUrl":"10.1016/j.contraception.2025.111043","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to document categories of patient scenarios wherein the timing of pregnancy-related care in the United States has been negatively affected despite the risk of health harms by post-<em>Dobbs</em> abortion laws.</div></div><div><h3>Study design</h3><div>Between November 2022 and October 2024, we conducted semistructured phone interviews with 36 health care professionals in the United States who were involved in care for a pregnant patient who did not receive the standard of care due to post-<em>Dobbs</em> laws. We analyzed the interviews using a flexible coding approach and grounded theory.</div></div><div><h3>Results</h3><div>We identified three categories of patient scenarios wherein care that clinicians judged necessary to prevent or reduce future health harm was delayed or denied: patients who had an existing health condition whose severity was exacerbated by pregnancy; patients for whom the pregnancy itself was the health condition clinicians anticipated would lead to medical endangerment or death; and serious fetal health conditions that would result in inevitable fetal or infant death. In all three, the absence of a current life-threatening emergency — even when one was near certain in the future — prevented clinicians from offering abortion care and increased the risk of health harms.</div></div><div><h3>Conclusions</h3><div>Restrictive post-<em>Dobbs</em> laws’ inflexible focus on the patient’s and/or fetus’s current health status prevented clinicians from using their knowledge and experience to prevent future health harms, turning clinical care for pregnancy into an exclusively reactive practice. These laws reorient care for pregnant patients to only allow interventions based on present health and, in effect, prohibit care that will prevent or reduce future harm.</div></div><div><h3>Implications</h3><div>Restrictive post-<em>Dobbs</em> laws change the practice of obstetric medicine and constrain clinicians’ ability to offer pregnant patients care that will prevent or reduce future harm, illustrating a concerning policy outcome and highlighting the health dangers of these laws.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111043"},"PeriodicalIF":2.3,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736096","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}

{"title":"Retraction notice to “A pilot efficacy study with a single-rod contraceptive implant (Implanon®1) in 200 Indonesian women treated for ≤ 4 years” [Contraception 59/3 (1999) 167–174]","authors":"Biran Affandi ,&nbsp;Tjeerd Korver ,&nbsp;T.B. Paul Geurts ,&nbsp;Herjan J.T. Coelingh Bennink","doi":"10.1016/j.contraception.2025.110999","DOIUrl":"10.1016/j.contraception.2025.110999","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"150 ","pages":"Article 110999"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719268","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}

{"title":"Navigating a new frontier: An exploratory study of clinicians’ confidence in their ability to help adolescents access abortion post-Dobbs","authors":"Amanda E. Bryson ,&nbsp;Michelle Oberman ,&nbsp;Lisa Soleymani Lehmann ,&nbsp;Lauren J. Ralph ,&nbsp;Claire D. Brindis ,&nbsp;Marissa Raymond-Flesch","doi":"10.1016/j.contraception.2025.111041","DOIUrl":"10.1016/j.contraception.2025.111041","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to assess clinicians’ confidence in helping adolescents access abortion.</div></div><div><h3>Study design</h3><div>This study used a 2024 cross-sectional, online survey of US adolescent-serving clinicians.</div></div><div><h3>Results</h3><div>Less than half of the 188 clinicians reported high confidence in their ability to help adolescents navigate seven of 11 logistical aspects of abortion access. Participants in states with post-<em>Dobbs</em> restrictions were less confident than those in states without such restrictions in their ability to help adolescents find abortion providers, know what documents are needed for appointments, and interpret their state’s laws.</div></div><div><h3>Conclusions</h3><div>Many clinicians lack confidence in helping adolescents navigate abortion access, particularly clinicians in states with post-<em>Dobbs</em> restrictions.</div></div><div><h3>Implications</h3><div>Clinicians’ lack of confidence in helping adolescents access abortion, regardless of state-level abortion laws, is concerning, given adolescents’ reliance on clinicians for reliable abortion information. Interventions must be developed across all states to increase clinician confidence in their ability to support their patients’ abortion access in the post-<em>Dobbs</em> shifting legal landscape.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111041"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719267","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}

{"title":"A Qualitative exploration of the impact of abortion restrictions on people with high risk pregnancies in Georgia","authors":"Nisha Verma ,&nbsp;AnnaMaria Maples ,&nbsp;Peggy Goedken ,&nbsp;Valentina Larrivey ,&nbsp;Vega Walke ,&nbsp;Melissa Kottke ,&nbsp;Carrie Cwiak","doi":"10.1016/j.contraception.2025.111042","DOIUrl":"10.1016/j.contraception.2025.111042","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to understand the barriers people with high risk pregnancies living in a restrictive US state face while attempting to access abortion care.</div></div><div><h3>Study design</h3><div>We conducted a qualitative study using semistructured virtual interviews with Georgia residents experiencing a high risk pregnancy and attempting to access abortion care. We recruited using flyers distributed at multiple health care facilities in Atlanta, Georgia, as well as an out-of-state clinic. The interviews focused on the participant’s pregnancy experience, abortion-seeking journey, and impact of Georgia’s restrictive laws. We transcribed, coded, and analyzed the interviews and present a subset of themes.</div></div><div><h3>Results</h3><div>We interviewed 19 people from January 2023 to February 2024. Participants described their pregnancies as “high risk” for a wide range of reasons and often described a lack of understanding of how HB481 would impact their ability to access abortion care in Georgia. They discussed ways in which they felt their specific abortion was necessary and should qualify for care. As participants attempted to access abortion care post-HB481, many described feeling betrayed and abandoned by the government, health care system, their individual support networks, and even God and/or the universe. Participants also shared how HB481 exacerbated their suffering as they attempted to navigate the “best” of multiple “bad” options available to them.</div></div><div><h3>Conclusions</h3><div>Our results indicate that, even when abortion bans include exceptions, people who see their pregnancies as high risk face barriers that ignore their medical circumstances, have adverse impacts even when care is received, leave patients feeling alone, and exacerbate suffering during already challenging times.</div></div><div><h3>Implications</h3><div>Our study furthers the understanding of how abortion bans affect people who see their pregnancies as high risk and highlights gaps in public knowledge about the impact of Georgia’s law. These results can be used to demonstrate the impact of abortion restrictions on people with a variety of “high risk” pregnancies and counter common political and public narratives that legal exceptions allow people to access needed care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111042"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719265","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}