Contraception最新文献

{"title":"Facilitators and barriers to implementation of immediate postpartum long-acting reversible contraception programs within Pennsylvania hospitals 7 years after Pennsylvania Medicaid reimbursement","authors":"Grace Ferguson ,&nbsp;Emma G. Guare ,&nbsp;Candace Bordner ,&nbsp;Cynthia H. Chuang ,&nbsp;Sarah Horvath","doi":"10.1016/j.contraception.2025.111009","DOIUrl":"10.1016/j.contraception.2025.111009","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate facilitators and barriers to implementation of immediate postpartum long-acting reversible contraception (IPLARC) within Pennsylvania (PA) hospitals 7 years after PA Medicaid adopted coverage of IPLARC outside the pregnancy care bundled payment, with particular attention to rural, small, or nonacademic hospitals.</div></div><div><h3>Study Design</h3><div>We conducted 10 qualitative interviews representing 10 unique hospitals from an opt-in subset of participants in our quantitative survey of clinician leaders at PA Labor and Delivery units. Transcripts were analyzed using grounded theory methodology. We coded and analyzed transcripts using MAXQDA software.</div></div><div><h3>Results</h3><div>Several themes emerged from the data, three of which are novel. First, that passage of Medicaid reimbursement was necessary but not sufficient for widespread implementation of IPLARC. We also found that hospital mergers and consolidations facilitated the capacity of smaller hospitals to implement and sustain IPLARC and that the Pennsylvania Perinatal Quality Collaborative was a utilized resource.</div></div><div><h3>Conclusion</h3><div>Medicaid coverage of IPLARC is a necessary facilitator but not sufficient for all hospitals to implement this service. Smaller, nonurban hospitals may benefit more from network-level support and state Perinatal Quality Collaboratives than their larger, academic urban hospital counterparts.</div></div><div><h3>Implications</h3><div>Medicaid coverage of IPLARC was a necessary facilitator but not sufficient for all PA hospitals to implement this care. Internal support from larger hospital systems via buyouts/mergers and external support programs (state Perinatal Quality Collaboratives) may play a larger role in implementation at smaller, rural, or nonacademic hospitals.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"150 ","pages":"Article 111009"},"PeriodicalIF":2.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577262","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":"Association of Obstetric Comorbidity Index score with postpartum contraception use among Medicaid recipients in the United States","authors":"Maria I. Rodriguez ,&nbsp;Thomas H.A. Meath ,&nbsp;Ashley Daly ,&nbsp;Kelsey Watson ,&nbsp;Aaron B. Caughey ,&nbsp;Hyunjee Kim","doi":"10.1016/j.contraception.2025.111005","DOIUrl":"10.1016/j.contraception.2025.111005","url":null,"abstract":"<div><h3>Objectives</h3><div>Little is known about postpartum contraceptive use among people at high risk for severe maternal morbidity (SMM). Our objective was to evaluate the association between risk for SMM and postpartum contraceptive use.</div></div><div><h3>Study design</h3><div>We conducted a retrospective cohort study of live births to Medicaid recipients from 2016 to 2020 across 44 US states. We evaluated the risk for SMM by calculating the Obstetric Comorbidity Index (OCI) scores for each enrollee into lowest risk (OCI = 0) and highest risk (top quartile) groups. We determined the association between the highest quartile OCI score with the use of most or moderately effective postpartum contraception and attendance at outpatient postpartum visits within 60 days. Models adjusted for maternal age, mode of delivery, and comorbidities.</div></div><div><h3>Results</h3><div>Of 3,342,568 deliveries, 2,474,020 deliveries were associated with an OCI score of 0 (Q0; no risk factors for SMM), while the highest quartile of nonzero OCI scores (Q4) ranged from 13 to 96 (mean risk of SMM 19.7%, SD 7.1) and encompassed 868,548 deliveries. Individuals with the highest risk for SMM were more likely to use postpartum contraception (40.0% vs 32.6%), although after removing sterilization, the difference was modest (32.6% vs 30.1%). There was no meaningful difference in rates of outpatient postpartum visit among people with the highest and lowest OCI scores (46.1% vs 45.6%).</div></div><div><h3>Conclusions</h3><div>Medicaid recipients with high OCI scores are only slightly more likely to use postpartum contraception as their low-risk peers, and over half will not have outpatient postpartum visit by 60 days.</div></div><div><h3>Implications</h3><div>Medicaid recipients at high risk for maternal morbidity are only slightly more likely to use postpartum contraception.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"150 ","pages":"Article 111005"},"PeriodicalIF":2.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565565","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)00181-7","DOIUrl":"10.1016/S0010-7824(25)00181-7","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"148 ","pages":"Article 110990"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518819","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":"Characteristics of people obtaining mifepristone and misoprostol and misoprostol-only telehealth medication abortion services in the United States","authors":"Dana M. Johnson ,&nbsp;Terri-Ann Thompson ,&nbsp;Fiona Scovack ,&nbsp;Melissa Grant","doi":"10.1016/j.contraception.2025.111001","DOIUrl":"10.1016/j.contraception.2025.111001","url":null,"abstract":"<div><h3>Objectives</h3><div>This study compares the characteristics of people using mifepristone/misoprostol and misoprostol-only telehealth medication abortion regimens in the United States.</div></div><div><h3>Study design</h3><div>We abstracted and analyzed characteristics for all clients using a virtual clinic between April 27, 2020, and May 31, 2022. We compare sociodemographic characteristics between clients who used either mifepristone and misoprostol or misoprostol only. We conducted multivariable analyses to identify characteristics associated with using each regimen.</div></div><div><h3>Results</h3><div>The analytic sample included 8790 clients: 84% used mifepristone and misoprostol, and 16% used misoprostol only. Most clients (54%) were aged 26 to 35 years. Characteristics of having fewer years of education, living in the Mid-Atlantic or Midwest, and reporting a lower income were positively associated with using misoprostol only. Characteristics of identifying as White or a race other than Black or White, as well as having higher levels of education and reporting a higher income, were positively associated with using mifepristone/misoprostol. Although not directly tested, associated characteristics indicate that a difference in regimen price may have influenced regimen use.</div></div><div><h3>Conclusions</h3><div>Findings demonstrate the range of people who have telehealth medication abortions and suggest some differences between clients who used mifepristone/misoprostol and clients who used misoprostol only.</div></div><div><h3>Implications</h3><div>As mifepristone continues to be restricted and telehealth abortions are a growing share of the medication abortions provided in the United States, these findings inform service delivery for clinics considering expanding into telehealth to provide misoprostol-only regimens. Findings also inform expanding policies aimed at the affordability of services, including expanding coverage from private, public, and Medicaid insurance programs.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"150 ","pages":"Article 111001"},"PeriodicalIF":2.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531716","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":"Telehealth use among publicly funded family planning clinics in the United States: Results from a national survey","authors":"Madeleine Haas,&nbsp;Priscille Osias,&nbsp;Jennifer Mueller,&nbsp;Alicia VandeVusse","doi":"10.1016/j.contraception.2025.111003","DOIUrl":"10.1016/j.contraception.2025.111003","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine the scope of telehealth contraceptive services at publicly supported family planning clinics.</div></div><div><h3>Study design</h3><div>We surveyed a sample of 446 publicly supported family planning clinics in the United States.</div></div><div><h3>Results</h3><div>Most clinics offer some services via telehealth, but provision varies widely by clinic type, with Planned Parenthood clinics offering telehealth most frequently, and by service, with certain contraceptive services, sexually transmitted infections (STI) testing and treatment, and medication abortion less frequently available than messaging services.</div></div><div><h3>Conclusions</h3><div>Health departments and federally qualified health centers may need more support and infrastructure to implement telehealth for contraceptive care.</div></div><div><h3>Implications</h3><div>Many publicly supported family planning clinics in the United States offer telehealth for contraceptive care, but clinics vary in the types of services available via telehealth. Clinics and patients who want or need to use telehealth for contraceptive care may need more supportive infrastructure to do so.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"150 ","pages":"Article 111003"},"PeriodicalIF":2.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531718","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":"Disparities in perceptions of long-acting reversible contraceptives among patients in Delaware Title X clinics","authors":"Collin W. Mueller ,&nbsp;Constanza Hurtado-Acuna ,&nbsp;Heide M. Jackson","doi":"10.1016/j.contraception.2025.111002","DOIUrl":"10.1016/j.contraception.2025.111002","url":null,"abstract":"<div><h3>Objectives</h3><div>We examined whether there were racial/ethnic and insurance status differences in patients reporting a sense of relief with the idea of using long-acting reversible contraceptives (LARCs) and whether these differences were attenuated by provider trust and fertility concerns among Title X patients.</div></div><div><h3>Study design</h3><div>We analyzed two waves of data from a repeated cross-sectional patient survey designed to capture a representative sample of Title X patient health encounters in Delaware (<em>N</em> = 797), fielded in the context of a larger study designed to evaluate a statewide intervention to improve patient access to highly effective contraceptive methods.</div></div><div><h3>Results</h3><div>We found that a majority of patients reported a sense of relief associated with the idea of using LARCs and differences by race/ethnicity and insurance status. Insurance coverage differences were attenuated by adjusting for reversibility concerns, fertility concerns, and patient-provider trust, but racial/ethnic disparities remained. Fifty-nine percent (95% CI, 55%–63%) of Black respondents reported a sense of relief at the idea of having an LARC, compared with 67% (95% CI, 63%–71%) and 65% (95% CI, 62%–67%) of White and Hispanic/Latinx patients, respectively. Patients who did not trust their provider to remove an IUD on request had a predicted probability of 50% (95% CI, 43%–57%) of viewing LARC with a sense of relief compared with 70% (95% CI, 64%–76%) of patients who reported trust in their provider to do so.</div></div><div><h3>Conclusions</h3><div>This study contributes to the growing body of research on reproductive autonomy by shedding further light on how decisions regarding contraceptive usage are made in the context of perceived agency constraints in health care settings.</div></div><div><h3>Implications</h3><div>This study underscores the importance of efforts to improve equitable access to long-acting reversible contraceptives by promoting patient-provider trust, addressing patient concerns regarding the short- and long-term effects of LARCs, and ensuring patients have continued access to healthcare treatment.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"150 ","pages":"Article 111002"},"PeriodicalIF":2.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531717","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":"Expanding contraceptive options: A scoping review of medically approved contraceptive methods that are not in the WHO Medical Eligibility Criteria","authors":"Sameera Mokkarala ,&nbsp;Asantesana Kamuyango ,&nbsp;James Kiarie ,&nbsp;Nancy Kidula ,&nbsp;Li Jiang ,&nbsp;Sarita Sonalkar","doi":"10.1016/j.contraception.2025.110983","DOIUrl":"10.1016/j.contraception.2025.110983","url":null,"abstract":"<div><h3>Objectives</h3><div>The World Health Organization’s (WHO) Medical Eligibility Criteria for contraceptive use (MEC) provides recommendations on the safety and efficacy of a range of contraceptive methods for users with various medical conditions. However, there are methods with medical regulatory agency approval that are not included in WHO guidance. Our objectives were to evaluate the evidence on methods that have regulatory approval for use in any member state, but which are not included in the MEC 2015, and to determine whether the evidence should be systematically reviewed to inform possible inclusion in a new WHO guideline.</div></div><div><h3>Study design</h3><div>We conducted a scoping review of experimental studies found through two bibliographic databases (PubMed, Embase) from database inception to December 2023. Two reviewers screened abstracts and full texts to determine eligibility based on a priori inclusion and exclusion criteria; one additional reviewer resolved conflicts. Reviewers extracted data on method safety, efficacy, and acceptability using a standardized tool.</div></div><div><h3>Results</h3><div>We identified three methods that met our review criteria: ormeloxifene, quinestrol-containing contraception, and mifepristone for emergency contraception (EC). Our initial search strategies yielded 386 total results. Five publications related to ormeloxifene, five to quinestrol-containing contraception, and 10 to mifepristone for EC were included. The data on these methods was highly variable.</div></div><div><h3>Conclusion</h3><div>Rigorous systematic reviews of the evidence on safety, efficacy and dosage of ormeloxifene, quinestrol-containing contraception, and mifepristone for EC are needed to inform WHO recommendations on these methods. As these methods are already being used, international guidance for practitioners is essential.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"149 ","pages":"Article 110983"},"PeriodicalIF":2.3,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369709","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":"Potassium chloride intracardiac fetal injection and tissue degeneration at fetal autopsy following induction abortion","authors":"Kelvin Chui ,&nbsp;Jefferson Terry ,&nbsp;Jennifer A. Hutcheon ,&nbsp;Chantal Mayer ,&nbsp;Jessica Liauw","doi":"10.1016/j.contraception.2025.110986","DOIUrl":"10.1016/j.contraception.2025.110986","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the impact of potassium chloride intracardiac injection (KCl) on tissue degeneration at fetal autopsy, which may help inform termination care and autopsy expectations.</div></div><div><h3>Study design</h3><div>In this retrospective cohort of induction abortions with fetal autopsies (<em>N</em> = 266), we estimated the association between KCl and fetal tissue degeneration (qualitative assessment and quantitative ratio of basophilia:eosinophilia). We used log binomal and linear regression to calculate risk ratios and mean differences with 95% confidence intervals.</div></div><div><h3>Results</h3><div>Those who received KCl were more likely to have qualitative tissue degeneration than those who did not (RR 2.8 [95% CI 1.3–6.1]). Quantitative basophilia:eosinophilia ratios were lower among those with KCl (mean difference in cardiac tissues of −0.031 [95% CI −0.039 to −0.023]), which further supports increased tissue degeneration in these cases.</div></div><div><h3>Conclusions</h3><div>Fetal autopsies from induction abortions that had KCl fetal injection had increased risk of tissue degeneration compared with those that did not.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"150 ","pages":"Article 110986"},"PeriodicalIF":2.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340776","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":"Three cases of second trimester uterine evacuation in patients with partially or undiagnosed Mullerian anomalies","authors":"Kaleigh Olmsted ,&nbsp;Amber Priester ,&nbsp;Annika Van Oosbree ,&nbsp;Madalyn Snoddy ,&nbsp;Angela Dempsey","doi":"10.1016/j.contraception.2025.110985","DOIUrl":"10.1016/j.contraception.2025.110985","url":null,"abstract":"<div><div>Mullerian anomalies complicate abortion care. Published experience to guide clinicians is scant. We present three cases of second trimester procedural abortion in patients with undiagnosed or partially diagnosed Mullerian anomalies and offer strategies that clinicians may implement when caring for similar patients.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"150 ","pages":"Article 110985"},"PeriodicalIF":2.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340777","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":"State–funded insurance coverage of abortions for undocumented immigrants in the United States","authors":"Kimberly M. Schaefer ,&nbsp;Meesha Vullikanti ,&nbsp;Rachel Feldman ,&nbsp;Maria Bazan ,&nbsp;Maria I. Rodriguez ,&nbsp;Deborah Bartz ,&nbsp;Rose L. Molina","doi":"10.1016/j.contraception.2025.110982","DOIUrl":"10.1016/j.contraception.2025.110982","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe governmental insurance coverage and philanthropic fund options for abortion among undocumented immigrants.</div></div><div><h3>Study design</h3><div>Internet-based review of publicly available information from state Medicaid and philanthropic abortion fund websites regarding abortion coverage for undocumented immigrants in the United States.</div></div><div><h3>Results</h3><div>Ten states have abortion coverage for undocumented immigrants. Of these, six state websites offered translations into multiple languages. We identified no immigration status requirements for state or national philanthropic funds.</div></div><div><h3>Conclusions</h3><div>Most states do not provide Medicaid funding for abortion for undocumented immigrants. The limited information on state websites about this abortion coverage increases barriers for an already marginalized population.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"150 ","pages":"Article 110982"},"PeriodicalIF":2.3,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487448","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}