Contraception最新文献

{"title":"Measuring abortion in claims data: What is the state of the science?","authors":"Alice Abernathy ,&nbsp;Maria I. Rodriguez ,&nbsp;Jonas J. Swartz","doi":"10.1016/j.contraception.2024.110750","DOIUrl":"10.1016/j.contraception.2024.110750","url":null,"abstract":"<div><div>Health care insurance claims are an increasingly common data source for health outcomes research. While researchers have successfully used several claims data sources for many obstetric and gynecologic questions, the use of claims data for abortion and contraception research poses a number of challenges. In this update on the state of the science in identifying abortion in claims data, we review claims data generally, describe commonly used claims data sources, and detail specific reasons why abortion may be underestimated in claims even when employing best practices. We provide examples of successful approaches for identifying abortion in claims and importantly, spell out limitations when making comparisons across site of care, states, and policy contexts. As increased attention is turned to identifying abortion across diverse settings, it is critical best practices are applied so that the most appropriate inferences regarding abortion incidence across contexts over time are drawn.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110750"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142650016","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":"The limitations of using Medicaid administrative data in abortion research","authors":"Brittni Frederiksen ,&nbsp;Emily Dennis ,&nbsp;Guodong Liu ,&nbsp;Doug Leslie ,&nbsp;Alina Salganicoff ,&nbsp;Sarah Roberts","doi":"10.1016/j.contraception.2024.110704","DOIUrl":"10.1016/j.contraception.2024.110704","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify limitations of abortion data in national Medicaid claims files by comparing abortion counts in Medicaid claims data with state abortion estimates.</div></div><div><h3>Study design</h3><div>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.</div></div><div><h3>Results</h3><div>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 &lt;10% of expected Medicaid-covered abortions (<em>n</em> = 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Implications</h3><div>Researchers should use caution when using the Medicaid Analytic eXtract and Transformed Medicaid Statistical Information System Analytic Files for abortion-related research questions.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110704"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303418","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":"Tennessee Medicaid patient immediate postpartum long-acting reversible contraception utilization","authors":"Megan Lacy Young ,&nbsp;Alicia Mastronardi ,&nbsp;Zach Shelton ,&nbsp;Jill M. Maples ,&nbsp;Nikki B. Zite","doi":"10.1016/j.contraception.2024.110721","DOIUrl":"10.1016/j.contraception.2024.110721","url":null,"abstract":"<div><h3>Objectives</h3><div>To understand immediate postpartum long-acting reversible contraception (IPP LARC) desire and utilization trends among publicly insured patients delivering at one academic hospital in a state with health care barriers and high short-interval birth rates.</div></div><div><h3>Study design</h3><div>We conducted a retrospective cohort study of electronic delivery records between March 2018 and June 2023 for publicly insured patients. Patient demographics, IPP LARC desire and utilization trends were compared using χ² or Fisher exact tests. Binary logistic regression explored the relationship between IPP LARC utilization and demographics. Multivariable logistic regression was performed on all statistically significant variables.</div></div><div><h3>Results</h3><div>Analysis included 10,472 delivery encounters; 2459 (23.5%) requested IPP LARC on admission and 464 (4.4%) changed contraception to IPP LARC after admission. Among those obtaining IPP LARC (<em>n</em> = 2523, 24.1%), 1224 (48.5%) selected arm implants and 1299 selected intrauterine devices (IUDs). Patients who self-reported as non-Hispanic Black and non-Hispanic Other or multiple races utilized IPP LARC less (adjusted Odds Ratio (aOR)=0.84, 95% CI: 0.72–0.98, aOR=0.68, CI 95%: 0.48–0.97, respectively). Patients with cesarean delivery (aOR=1.45, 95% CI: 1.31–1.61) or inadequate prenatal care (aOR=1.54, CI 95%: 1.35–1.75) were more likely to utilize IPP LARC. Maternal age and years of education were inversely associated with utilization. Primiparous patients were less likely to utilize IPP LARC.</div></div><div><h3>Conclusions</h3><div>Long-acting reversible contraception (LARC) utilization was 24.1% during the immediate postpartum period; higher than the 11% nationally reported interval LARC use among publicly insured patients. Understanding the demographics of those desiring IPP LARC could highlight accessibility gaps. The impact of IPP LARC utilization on rates of short-interval birth is being evaluated.</div></div><div><h3>Implications</h3><div>Understanding the demographics of IPP LARC utilizers may contribute to understanding accessibility gaps and facilitate discernment of factors impacting patient initiation. Evidence suggests that comprehensive contraception access during delivery admission is feasible, patient-desired, and essential.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110721"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373830","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":"Levonorgestrel 52 mg intrauterine device placement without uterine sounding: A feasibility study","authors":"Jewel A. Brown ,&nbsp;Sheeva Yazdani,&nbsp;Nicole Economou,&nbsp;Holly A. Rankin,&nbsp;Anne N. Flynn,&nbsp;Mitchell D. Creinin","doi":"10.1016/j.contraception.2024.110722","DOIUrl":"10.1016/j.contraception.2024.110722","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate feasibility of levonorgestrel 52 mg intrauterine device (IUD) placement without uterine sounding.</div></div><div><h3>Study design</h3><div>We performed a three-phase feasibility study from February 2023-May 2024. In phase one, participants had levonorgestrel 52 mg IUD placement with sounding. In the experimental phases, placement occurred without sounding and with (phase two) or without (phase three) concurrent transabdominal sonography and participants had 3-month follow-up. We defined feasibility as successful IUD placement without uterine sounding based on ultrasound confirmation. We measured total instrumentation time from the sound or inserter touching the cervix to inserter removal. Participants reported maximal pain experienced using a 100-mm Visual Analog Scale when the inserter was removed. We calculated a sample size of 30 per phase so that if there was one failed placement, the lower 95% confidence interval of the successful placement rate would be no less than 90.0%.</div></div><div><h3>Results</h3><div>Successful placement without sounding occurred in 30(100%) participants in phase two and 28(93.3%) in phase three. Median instrumentation was longest in phase one (49.5 [interquartile range (IQR) 42.3–55.0] seconds) compared to phases two (16.0 [IQR12.0–28.0] seconds, <em>p</em> &lt; 0.0001) and three (25.0 [IQR 18.5–32.2] seconds, <em>p</em> &lt; 0.0001). Participants’ median placement pain was 21.0 (IQR 10.3–32.8) mm in phase one with no difference in phase two (25.5 [IQR 14.3–47.0] mm, <em>p</em> = 0.35), but was higher in phase three (36.0 [IQR 22.8, 61.0] mm, <em>p</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>Levonorgestrel 52 mg IUD placement without sounding is feasible with concurrent sonography. Placement without sounding results in shorter instrumentation time but does not decrease maximum placement pain.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110722"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Copyright info/Contents","authors":"","doi":"10.1016/S0010-7824(24)00509-2","DOIUrl":"10.1016/S0010-7824(24)00509-2","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110795"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143092565","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":"Assessing the impact of federal restrictions to the Title X program on reproductive health service provision between 2018 and 2022 in the United States","authors":"Sarah D. Compton ,&nbsp;Gentry Carter ,&nbsp;Alexandra Gero ,&nbsp;Jessica N. Sanders ,&nbsp;Caitlin Quade ,&nbsp;Jami Baayd ,&nbsp;Rebecca G. Simmons","doi":"10.1016/j.contraception.2024.110724","DOIUrl":"10.1016/j.contraception.2024.110724","url":null,"abstract":"<div><h3>Objectives</h3><div>In 2019, the Trump administration introduced rule changes, colloquially known as the “Domestic Gag Rule,” to the federal Title X program. As a result, many grantees withdrew from the program. This study aims to assess the impact of the rule change on service provision within the Title X program, both while the rule was in place and in the period following its reversal.</div></div><div><h3>Study design</h3><div>We obtained disaggregated Family Planning Annual Report data for all states from 2018 to 2022. Using a previously created variable determining the proportion of each state’s Title X capacity loss from the 2019 rule (0%, 1–24%, 25–50%, 50–89%, 90–99%, 100%), we conducted mixed effects linear regression exploring outcomes of interest (number of total clients served; number of female/male contraceptive methods provided; contraceptive method mix; sexually transmitted infection [STI] services provided) prerule change (2018), during the rule change (2019–2021), and postrule change (2022).</div></div><div><h3>Results</h3><div>During the rule change period, the average total number of services Title X provided decreased by 16% nationwide from the prerule change period. However, states with higher levels of reduced capacity saw significant additional losses in reproductive health service provision. The total number of clients, the number of female/male contraceptive methods, and the number of STI services provided did not improve in the postrule change period. In addition, the number of moderately effective methods provided decreased significantly during the rule change period and continued to decline postrule change.</div></div><div><h3>Conclusions</h3><div>Title X services were significantly impacted by the rule change, and subsequent recovery is slow.</div></div><div><h3>Implications</h3><div>During the 2019–2021 Title X rule change, there was a nationwide decrease in reproductive health services provided (contraceptive services, STI testing) through Title X. States with higher capacity loss had a more significant decline. Postrule change, service levels did not return to prerule change levels, indicating a slow recovery.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110724"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483225","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":"Symptomatic hypotensive episodes following Implanon NXT insertion: A case report","authors":"Nicole A. Milanko,&nbsp;Rajesh Gangaram","doi":"10.1016/j.contraception.2024.110730","DOIUrl":"10.1016/j.contraception.2024.110730","url":null,"abstract":"<div><div>This case report describes episodic symptomatic hypotension following Implanon NXT insertion and symptom resolution after removal. We aim to alert clinicians of episodic hypotension as a possible adverse drug reaction to Implanon NXT, facilitating early intervention and improved patient outcomes.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110730"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568614","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":"Vacuum-induced management of hemorrhage using intrauterine foley catheter: A report of two cases","authors":"Frank I. Jackson ,&nbsp;Leah Stork-Binyamin ,&nbsp;Matthew J. Blitz ,&nbsp;Sharon Gerber","doi":"10.1016/j.contraception.2024.110802","DOIUrl":"10.1016/j.contraception.2024.110802","url":null,"abstract":"<div><div>Hemorrhage is a common postpartum complication which can also occur during abortion. Most cases can be managed with uterine evacuation and uterotonics, but some require additional procedures. We present cases of hemorrhage following dilation and evacuation, and delayed postpartum hemorrhage, where a Foley catheter was used for vacuum-induced hemorrhage control.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110802"},"PeriodicalIF":2.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873632","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":"Hemiplegic migraine associated with etonogestrel 68 mg implant insertion case report","authors":"Hallie N. Nelson,&nbsp;Rebekah Sugarman,&nbsp;Melissa L. Wong","doi":"10.1016/j.contraception.2024.110783","DOIUrl":"10.1016/j.contraception.2024.110783","url":null,"abstract":"<div><div>We present a case of suspected induced intractable headaches and paralysis after receiving an etonogestrel 68 mg implant. After extensive neurological evaluation, the etonogestrel implant was removed and neurological symptoms resolved.</div><div>The case raises concerns about a potential rare risk of progestin-containing contraceptives in patients with migraines with aura warranting further investigation.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110783"},"PeriodicalIF":2.8,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840555","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":"Patient and obstetrician-gynecologist perspectives on considering long-acting reversible contraception for postpartum patients who desire permanent contraception","authors":"Madeline Thornton ,&nbsp;Brooke W. Bullington ,&nbsp;Kristen A. Berg ,&nbsp;Kari White ,&nbsp;Suzanna Larkin ,&nbsp;Margaret Boozer ,&nbsp;Tania Serna ,&nbsp;Emily S. Miller ,&nbsp;Jennifer L. Bailit ,&nbsp;Kavita S. Arora","doi":"10.1016/j.contraception.2024.110781","DOIUrl":"10.1016/j.contraception.2024.110781","url":null,"abstract":"<div><h3>Objective(s)</h3><div>We sought to understand patients’ and obstetrician-gynecologists’ priorities in seeking or recommending long-acting reversible contraceptive methods (LARC; intrauterine devices and contraceptive implants) versus permanent contraception in the postpartum period when permanent contraception was the patient’s initial contraceptive preference.</div></div><div><h3>Study design</h3><div>We interviewed 81 postpartum patients who desired permanent contraception and their delivering obstetrician-gynecologist (<em>n</em> = 67) from four US institutions to explore patient and obstetrician-gynecologist (OBGYN) perspectives navigating permanent contraception counseling and decision-making. We used thematic content analysis to analyze interview transcripts using NVivo 12 Pro software.</div></div><div><h3>Results</h3><div>Our analysis revealed a mismatch between patient and OBGYN priorities when considering permanent contraception versus LARC. Many OBGYNs in our study described a preference for LARC methods over permanent contraception and often prioritized factors such as reversibility and menstrual suppression. However, many patients sought permanent contraception for reasons that were not adequately addressed by LARC methods such as method permanence, desire to avoid menstrual suppression, cancer prevention, prior negative experiences with LARC, and a preference to avoid a foreign body.</div></div><div><h3>Conclusion(s)</h3><div>These results suggest that priorities in selecting a preferred contraceptive method may sometimes not be aligned between patients and clinicians and that LARC methods may not always be an acceptable alternative for patients who desire permanent contraception. The findings from this study highlight the importance of eliciting and centering a patient’s goals and desires for pursuing permanent contraception during contraceptive counseling. Clinicians should be aware of the various perspectives and values patients have on these methods and include them in patient-centered share decision-making.</div></div><div><h3>Implications</h3><div>Our study revealed a large discrepancy between patient and obstetrician-gynecologist priorities in seeking or recommending permanent contraception. Clinicians must avoid making assumptions about a patient’s priorities for a contraceptive choice to engage in truly patient-driven contraceptive counseling.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110781"},"PeriodicalIF":2.8,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793013","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}