Contraception最新文献

{"title":"Reshaping access: Community-led action for contraceptive access in rural Appalachian Kentucky","authors":"Alecia Fields ,&nbsp;Kelsie Williams ,&nbsp;Dustin Miracle ,&nbsp;Joanne Brown ,&nbsp;Kyla Preece","doi":"10.1016/j.contraception.2025.111278","DOIUrl":"10.1016/j.contraception.2025.111278","url":null,"abstract":"<div><div>Access to contraception in the United States varies greatly based on geography. In Eastern Kentucky (EKY), access is limited due to geographic isolation, provider shortages, limited transportation and deeply rooted stigma around reproductive health services. All Access Eastern Kentucky (AAEKY) is a community-driven program that focuses on patient and provider education and access to contraception through an innovative no cost mailing system. This commentary reviews the initiative impacts, key insights and lessons learned through clinic and participant surveys. Since 2016, AAEKY has faced a global pandemic, adapted to a quickly changing political landscape, overcome regional flooding and expanded from a 10 county regional focus to a statewide initiative that is helping to reshape how Kentuckians perceive and access contraception.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111278"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433027","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":"Contraceptive access initiatives and Title X: A synergistic partnership","authors":"Elizabeth J. Jones,&nbsp;Michael S. Policar,&nbsp;Kimberly Diaz Scott","doi":"10.1016/j.contraception.2025.111238","DOIUrl":"10.1016/j.contraception.2025.111238","url":null,"abstract":"<div><div><em>Synergy</em> is the interaction or cooperation of two or more forces to produce a combined effect greater than the sum of their parts. As generators of new clinical knowledge for the sexual and reproductive health field and conveners for collaborative efforts to mobilize for state policy change, Contraceptive Access Initiatives (CAIs) have strengthened the Title X family planning program. Conversely, Title X is an essential source of care for millions of patients that face barriers to accessing contraceptive services. By linking CAIs with a broad and diverse network of service sites that stand to benefit from their innovations, the Title X program bridges research-to-practice gaps and supports improved population-level outcomes through changes in practice, systems, and policy. CAIs also can lean on Title X networks to support aspects of implementation and post-implementation sustainability, leveraging the broader scope of confidential services they provide at no cost or discounted rates, their training infrastructure, and the inroads they have built with community stakeholders and policymakers since the program’s inception over 50 years ago. Given the uncertainty of the current funding landscape, such partnerships are critical to keeping access points to person-centered contraceptive services open, particularly for individuals with low incomes, without insurance, and in need of confidential services.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111238"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098454","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":"Recommendations for policies enabling pharmacist–prescribed contraceptive services","authors":"Sally Rafie ,&nbsp;Jenny L. Newlon ,&nbsp;Jennifer A. Campi ,&nbsp;Veronica Vernon ,&nbsp;Krystalyn Weaver ,&nbsp;E. Michael Murphy","doi":"10.1016/j.contraception.2025.111346","DOIUrl":"10.1016/j.contraception.2025.111346","url":null,"abstract":"<div><div>Overly prescriptive legislation, regulations, and protocols dictating pharmacists’ scope to prescribe contraception prevent the realization of the full potential benefits of the policy. Despite pharmacists’ interest and willingness to improve patients’ access to contraceptive care, suboptimal or inflexible policies impede implementation. We have compiled policy recommendations that consider barriers and facilitators to implementation of pharmacist-prescribed contraception, including pharmacist training, pharmacy operations, and payment for services. Armed with the recommendations from our commentary, we expect policymakers and advocates for pharmacist-provided services will be better prepared to propose and revise state policies that support implementation of contraceptive services and improve patients’ access.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111346"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806752","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 Focus Forward Oklahoma Program: A description of the planning, development, and implementation of a statewide contraceptive access initiative","authors":"Mary Gowin ,&nbsp;Elisabeth Ponce-Garcia ,&nbsp;Gale Hann ,&nbsp;Lauren Oliver ,&nbsp;Monica Henning ,&nbsp;Katie Smith ,&nbsp;Olivia Lust ,&nbsp;Sarah Hall ,&nbsp;Kathryn Klump ,&nbsp;Melissa Eldredge ,&nbsp;Rachel Jillson ,&nbsp;Alexa Benedict","doi":"10.1016/j.contraception.2025.111354","DOIUrl":"10.1016/j.contraception.2025.111354","url":null,"abstract":"<div><h3>Objective</h3><div>Describe the planning, development, and implementation of the Focus Forward Oklahoma Program, a statewide contraceptive access initiative focused on increasing access to the full range of contraceptive options through three strategies: 1) policy change, 2) communication, and 3) workforce development.</div></div><div><h3>Study design</h3><div>An implementation science framework was used for planning, development, and implementation. Planning and development included four components: 1) establishing an advisory committee, 2) conducting a needs assessment, 3) developing primary strategies, and 4) identifying baseline metrics. Implementation used iterative action cycles to continually assess and adapt implementation to ensure success.</div></div><div><h3>Results</h3><div>Eighteen policy issues were identified with 14 resolved as of publication. The communication strategy resulted in collaboration among organizations, alignment of priorities, and the development of training materials, guidance documents, and a resource library. Workforce development resulted in 663 clinicians receiving contraceptive access training.</div></div><div><h3>Conclusions</h3><div>The planning, development, and implementation of the program demonstrates that implementation science-based efforts can produce strategies that address systemic barriers to contraceptive access. Aligning payer policies, coalition-building, and responsive training are all key activities of the program and process adaptations and lessons learned have contributed to the continued viability of the program.</div></div><div><h3>Implications</h3><div>Increasing contraceptive access requires a multifaceted approach in which key barriers are addressed. Clinicians can contribute to addressing access via their personal practice and through participation in broader programs such as this one.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111354"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145936815","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 over-the-counter birth control pill use and contraceptive autonomy among oral contraceptive users","authors":"Kimberly M. Schaefer ,&nbsp;Haley Burns ,&nbsp;Jonas J. Swartz ,&nbsp;Alison B. Edelman ,&nbsp;Maria I. Rodriguez","doi":"10.1016/j.contraception.2025.111253","DOIUrl":"10.1016/j.contraception.2025.111253","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association between individuals’ experiences with healthcare and over-the-counter (OTC) pill use.</div></div><div><h3>Study design</h3><div>We conducted a cross-sectional online baseline survey of individuals aged 15–45 obtaining oral contraception (OTC or by prescription) for pregnancy prevention in a convenience sample across the United States (US). We collected demographic information, clinical information, and measured contraceptive autonomy using three validated measures: Contraceptive Agency Scale (CAS), the Person-Centered Contraceptive Care (PCCC) measure, and the Discrimination in Medical Settings (DMS) survey. We compared these characteristics between people using prescription and OTC pills and built logistic regression models to evaluate the association between OTC pill use and each of these three measures.</div></div><div><h3>Results</h3><div>Our sample included 497 individuals (OTC 22.5%, <em>n</em> = 112; prescription 77.5%, <em>n</em> = 385) who received contraceptive counseling within the past year. Compared to participants with a prescription, users of OTC pills were older, more commonly uninsured (18.8% vs. 2.9%, <em>p</em> &lt; 0.001), on Medicaid (24.1% vs. 10.1%, <em>p</em> &lt; 0.001), and more likely to be Black (18.8% vs. 5.7%, <em>p</em> &lt; 0.001). Less than half of OTC pill users were already using a more effective method of contraception prior to survey completion, compared to the majority of prescription users (47.3% vs. 82.9%, <em>p</em> &lt; 0.001). Based on adjusted multivariable models, key autonomy outcomes of low contraceptive agency and non person-contraceptive care were both associated with increased probability of OTC pill use.</div></div><div><h3>Conclusion</h3><div>The OTC pill may fill an important gap in improving contraception access, particularly among individuals with past negative healthcare interactions.</div></div><div><h3>Implications</h3><div>Our study suggests that individuals reporting lower contraceptive agency and less person-centered care are more likely to use over-the-counter than prescription oral contraception. Expanding over-the-counter access may reduce barriers for marginalized populations with poor healthcare interactions, supporting more equitable contraceptive access across diverse demographic and insurance groups in the U.S.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111253"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402968","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":"Implementing SINC (Self-Identified Need for Contraception) screening: A mixed methods case study","authors":"Lisa LeRoy ,&nbsp;Linda Chamiec-Case ,&nbsp;Michela Garrison ,&nbsp;Madeline Mador ,&nbsp;Laura Perez ,&nbsp;Kirsten Meisinger ,&nbsp;Samantha Fox","doi":"10.1016/j.contraception.2025.111315","DOIUrl":"10.1016/j.contraception.2025.111315","url":null,"abstract":"<div><h3>Objectives</h3><div>This mixed-methods case study examined implementation of an adapted Self-Identified Need for Contraception (SINC) screening for all genders aged 12–44 in four Cambridge Health Alliance (CHA) primary care sites. We focused on assigned-male-at-birth (AMAB) patients, who are not typically exposed to routine opportunities to discuss contraception. We explored these study questions: How did screening rates vary over time by site and patient characteristics (sex, age and language)?; What did healthcare staff perceive as facilitators or challenges to implementation?; and how acceptable was adapted-SINC screening to AMAB patients?</div></div><div><h3>Study Design</h3><div>We estimated mixed effects models to analyze electronic health record (EHR) data on screening and need rates by site, sex, age, and language. We conducted interviews with CHA staff (<em>n</em> = 11) across two time points about implementation, and with AMAB patients (<em>n</em> = 28) about experiences and acceptability of screening. We used a convergent design, analyzing EHR and interview data in parallel and integrating findings.</div></div><div><h3>Results</h3><div>By quarter 4 (9–12 months after screening initiation) adjusted screening rates were significantly higher than quarter 1. At 15–18 months, unadjusted (raw) rates ranged from 39.0% to 79.0% by site and were 56.4%/44.6% for assigned-female-at-birth/AMAB patients. Interviews revealed key learnings about implementation facilitators. Both staff and AMAB patients found screening manageable, acceptable, and beneficial. All patient interviewees reported comfort with screening.</div></div><div><h3>Conclusions</h3><div>Findings provide actionable guidance for SINC implementation, including strategies to build buy-in, increase adoption, anticipate barriers, adapt workflows, and establish realistic timelines. Screening likely helped normalize contraceptive care and identify unmet contraceptive needs.</div></div><div><h3>Implications statement</h3><div>Implementing an adapted version of SINC screening in primary care with patients of all genders ages 12–44 was manageable and acceptable to staff and AMAB patients. The study contributes original insights from AMAB patients. This adapted-SINC likely helped normalize contraceptive care and surface unmet needs. Findings offer actionable guidance for organizations seeking to implement SINC.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111315"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703383","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":"Improving, expanding, and scaling contraceptive access efforts","authors":"Jessica Danaux,&nbsp;Jamie Hart","doi":"10.1016/j.contraception.2025.111280","DOIUrl":"10.1016/j.contraception.2025.111280","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111280"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411009","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":"Call to action: Bringing sexual and reproductive health equity into how we quantify the impact of contraceptive access","authors":"Megan L. Kavanaugh ,&nbsp;Sheila Desai ,&nbsp;Sonya Borrero ,&nbsp;Anu Manchikanti Gómez ,&nbsp;Jenny Higgins ,&nbsp;Kelsey Holt ,&nbsp;Nikita Malcolm ,&nbsp;Jenny O’Donnell ,&nbsp;Alicia VandeVusse ,&nbsp;Jeannette Wade ,&nbsp;Mia Zolna ,&nbsp;Jennifer Frost","doi":"10.1016/j.contraception.2025.111234","DOIUrl":"10.1016/j.contraception.2025.111234","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111234"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310313","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":"What is contraceptive access? A comprehensive, multi-level framework to inform research, policy, and practice","authors":"Riley J. Steiner ,&nbsp;Sarah M. Axelson ,&nbsp;Claudia Nuñez-Eddy ,&nbsp;Kelsie Williams ,&nbsp;Sonya Borrero ,&nbsp;Sheila Desai ,&nbsp;Jenny Dodson Mistry ,&nbsp;Christina I. Fowler ,&nbsp;Laura D. Lindberg ,&nbsp;Isaac Maddow-Zimet ,&nbsp;Whitney Rice ,&nbsp;Corinne H. Rocca ,&nbsp;Michael G. Smith ,&nbsp;Tracey A. Wilkinson","doi":"10.1016/j.contraception.2025.111271","DOIUrl":"10.1016/j.contraception.2025.111271","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite the importance of access to contraception for sexual and reproductive well-being, there is a lack of consensus about what “contraceptive access” entails. We present a multi-level and multi-dimensional framework for conceptualizing contraceptive access and discuss how it can be used to inform research, policy, and practice.</div></div><div><h3>Study design</h3><div>As the foundation for the contraceptive access framework, we used the social-ecological model and two frameworks for health care access, along with findings from an environmental scan of literature relevant to contraceptive access. To develop an initial version, we aligned contraceptive access concepts with the broader conceptual frameworks. We refined our framework based on input from an expert workgroup.</div></div><div><h3>Results</h3><div>The conceptual framework includes multi-level modifiable factors (i.e., underlying factors that create the conditions of contraceptive access) and modification strategies (i.e., actionable interventions or approaches that can be used to change the modifiable determinants) aligned with six dimensions of access: awareness, availability, accessibility, accommodation, acceptability, and affordability. The modification strategies influence modifiable determinants, which create the access conditions for individual-level pathways to seeking and obtaining one’s preferred contraceptive method or long-acting reversible contraception removal services.</div></div><div><h3>Conclusions</h3><div>We call on the sexual and reproductive health community to apply the framework to inform research, policy, and clinical and public health practice. Specific applications include measure development, surveillance, policy advocacy, clinic-based quality improvement, and state-level contraceptive access initiatives. The opportunities and challenges of using the framework in these ways can inform how it evolves to best reflect contraceptive access.</div></div><div><h3>Implications</h3><div>The conceptual framework can provide a shared understanding of how contraceptive access can be restricted or expanded. The framework can be used to strengthen efforts to assess and improve contraceptive access so that it is just, person-centered, and attainable for all.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111271"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552469","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":"How statewide contraceptive access initiatives can advance sexual and reproductive health equity","authors":"Jessica Danaux,&nbsp;Nikita Malcolm,&nbsp;Jamie Hart","doi":"10.1016/j.contraception.2025.111248","DOIUrl":"10.1016/j.contraception.2025.111248","url":null,"abstract":"<div><div>The Coalition to Expand Contraceptive Access and Emory University’s Center for Reproductive Health Research in the Southeast led a collaborative effort to convene statewide contraceptive access initiatives (SCAI) to identify opportunities to meaningfully advance sexual and reproductive health equity (SRHE) in ongoing and future initiatives. The effort engaged more than 40 stakeholders representing ten SCAI and assessed published literature to draw collective insights, successes, and lessons learned. This commentary outlines four concrete recommendations derived from this effort: (1) center communities in all phases of the initiative, (2) foster flexibility and responsiveness in initiative activities, (3) align goals with comprehensive measures, and (4) prioritize sustainable approaches. The commentary also explores how these recommendations connect to the principles of SRHE and how implementers, evaluators, funders, and supporters of contraceptive access initiatives can implement them to advance SRHE.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111248"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497830","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}