Contraception最新文献

{"title":"Development of a novel scale to measure health care professionals’ patient-centered contraceptive counseling competency","authors":"Elizabeth Janiak ScD ,&nbsp;Sarah L. Johns MPH ,&nbsp;Lillian W. Acton MPH ,&nbsp;Natasha M. Lerner DrPH MPA ,&nbsp;Armide Storey MD ,&nbsp;Katharine O. White MD MPH","doi":"10.1016/j.contraception.2025.111284","DOIUrl":"10.1016/j.contraception.2025.111284","url":null,"abstract":"<div><h3>Objectives</h3><div>Standardized and valid assessment of the patient-centeredness of clinical care requires validated quality measures. Validated patient-reported measures of patient-centeredness exist, but provider-reported self-assessment measures are lacking. We aimed to fill this gap by developing a novel scale as part of Partners in Contraceptive Choice and Knowledge (PICCK), a statewide contraceptive access program in Massachusetts.</div></div><div><h3>Study Design</h3><div>We developed an initial pool of 82 candidate scale items through a review of existing measures of related constructs such as interpersonal bias, understanding of principles of Reproductive Justice (RJ), and best practices in counseling for health topics other than contraception. A panel of 8 experts (5 clinicians and 3 lay community members) rated the face validity of the candidate items using a modified Delphi method, reducing the pool to 57 items. The 57-item scale was fielded with a convenience sample of 103 contraceptive providers (clinicians, nurses, medical assistants, and health educators).</div></div><div><h3>Results</h3><div>We performed an exploratory factor analysis on 92 responses (11 responses dropped due to missing data). We utilized an oblique rotation to yield a 3-factor solution with a total of 25 items in three subscales measuring 1) patient-centered counseling behaviors, 2) cultural/structural competency for working with patients with diverse backgrounds, 3) agreement with principles of RJ. Internal consistency reliability of the scale was strong (Cronbach’s alpha&gt;0.80).</div></div><div><h3>Conclusions</h3><div>The novel scale shows promise for future psychometric testing. Further development of this measure could yield a useful tool for quality assurance and impact evaluation of contraceptive access interventions.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111284"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440341","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":"Heeding lessons of our past: Centering sociohistorical context and health equity in efforts to expand contraceptive access","authors":"Erin Wingo,&nbsp;Lindsey Gibson,&nbsp;Christine Dehlendorf","doi":"10.1016/j.contraception.2025.111270","DOIUrl":"10.1016/j.contraception.2025.111270","url":null,"abstract":"<div><div>Contraceptive access initiatives and programs to expand contraceptive access over the past two decades, following the fervor of the CHOICE project, were often inattentive to health equity and the sociohistorical context of care. While these initiatives improved access to contraception and, in particular, long-acting reversible methods, the enthusiasm for these methods and the framing of them as a panacea for social ills contributed to the entrenchment of non-patient-centered models of contraceptive care and harmful targeting of low-income communities of color. In this commentary we describe a recent Quality Improvement Learning Collaborative grounded in the sociohistorical context of reproductive health care and that used person-centered data and equity-informed quality improvement strategies as an alternative approach to improving access to high-quality contraceptive care. We provide two case studies from community health centers that participated in the learning collaborative, one from primary care and one from a sexual and reproductive care setting, highlighting how equity-informed lessons and data can be applied into different health care settings. This model focuses on promoting non-coercive and person-centered contraceptive care practices at the healthcare level. Contraceptive access initiatives, which work at multiple levels of the health system, can leverage such models and combine them with equity-focused policy interventions and stakeholder-engaged processes to advance equity-informed access more broadly. In the face of ever-changing and increasing threats to reproductive health, rights, and justice, we must stay continuously reflective, attentive to history, and stalwart in our commitment to reproductive autonomy and wellbeing in all efforts to improve contraceptive care access.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111270"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314376","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-level contraceptive access policies and preventive sexual and reproductive health service use outcomes","authors":"Whitney S. Rice ,&nbsp;Sara K. Redd ,&nbsp;Alina A. Luke ,&nbsp;Sofia Filippa ,&nbsp;Kimberly Jacob Arriola ,&nbsp;Kelli Stidham Hall ,&nbsp;Kelli Komro ,&nbsp;Monica S. Aswani","doi":"10.1016/j.contraception.2025.111279","DOIUrl":"10.1016/j.contraception.2025.111279","url":null,"abstract":"<div><h3>Objective</h3><div>Contraceptive access provides opportunity for related preventive health care. Thus, we explore whether changes in state contraceptive access policies relate to preventive health service use inequities.</div></div><div><h3>Study design</h3><div>We examined associations between a 2006–2017 state contraceptive access policy index and probabilities of individual-level receipt of pelvic exam, Pap test, and sexually transmitted infection (STI) services during the last year, as reported during time-corresponding cycles of the National Survey of Family Growth (NSFG). We used multivariate logistic regression and linear probability models, that accounted for survey weights and adjusted for individual- and state-level characteristics and state and year fixed effects. We further tested interaction effects by race/ethnicity, socioeconomic status, education, and sexual orientation.</div></div><div><h3>Results</h3><div>Among 21,537 NSFG respondents (mean age 29 years) from 2006 to 2017, 52% reported receiving a Pap test, 50% reported receiving a pelvic exam, and 20% reported receiving STI services. Main effects models testing the relationship between the contraceptive access policy index and the three outcomes among the entire population produced null findings. However, models testing interaction effects by social group found significant interactions between state contraceptive policy environments and individual-level race/ethnicity, education, income level, sexual orientation for receipt of Pap tests, pelvic exams, and STI services, revealing increased preventive services for certain social groups defined by lower education and income.</div></div><div><h3>Conclusion</h3><div>Individual preventive health service use associated with state contraceptive access environments varied by sociodemographic factors, highlighting the potential for state policy to act as a lever to alleviate inequities in access to care.</div></div><div><h3>Implications</h3><div>Overarchingly, more expansive contraceptive access is associated with increased preventive sexual and reproductive health care use for certain social groups. Thus, state policies expanding contraceptive access may mitigate broader inequities in access to care by facilitating opportunities for receipt of other preventive services, particularly Pap tests and pelvic exams.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111279"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395968","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":"Changes in contraceptive services during a statewide initiative to expand patient-centered contraceptive care in Massachusetts","authors":"Elizabeth G. Henry ,&nbsp;Yasuyo Abe ,&nbsp;Emily Decker ,&nbsp;Madeline Mador ,&nbsp;Lisa LeRoy","doi":"10.1016/j.contraception.2025.111327","DOIUrl":"10.1016/j.contraception.2025.111327","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate how access to and quality of contraceptive care changed among health centers supported by Upstream USA during a statewide contraceptive access initiative in Massachusetts.</div></div><div><h3>Study design</h3><div>Our mixed-method study reported on 12 health centers that encompass 63 sites, annually serving 72,225 patients of reproductive age (assigned female at birth, ages 15–44). We examined contraceptive care metrics extracted from electronic health records (EHR) to identify trends in reproductive health screening and contraceptive service provision before and after the intervention. We assessed the quality of contraceptive care through a post visit patient experience survey. Further insights from qualitative implementation reports were integrated to contextualize observed outcomes.</div></div><div><h3>Results</h3><div>All health centers increased EHR documentation of screening for contraceptive need, and we observed an increase in the provision of contraceptive services from 8.2 to 14.3 per 100 patients of reproductive age. Service rates increased across all method types except for emergency contraception. Service provision increased across sites within health centers, indicating expanded points-of-access for patients. Patient-reported outcome measures indicate high levels of autonomy in method choice during the visit and patient-centeredness of counseling. Factors critical to sustaining practice change included EHR-embedded screening questions, on-site coaching on workflow, using real-time data feedback loops, and securing leadership support for the integration of contraceptive care into routine primary care.</div></div><div><h3>Conclusions</h3><div>Findings from this study provide empirical evidence of the impact of key interventions of a statewide contraceptive access initiative to expand access to patient-centered contraceptive care within the primary care setting of community health centers.</div></div><div><h3>Implications</h3><div>This study demonstrated that embedding screening–based contraceptive care workflows into primary care and providing training and technical assistance to strengthen clinic capacity for the provision of all contraceptive method types are feasible strategies that can be used to expand access to high-quality, noncoercive, patient-centered contraceptive care at community health centers.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111327"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776743","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":"Evaluation of patient experiences with contraceptive counseling during the South Carolina Choose Well contraceptive access initiative","authors":"Michael G. Smith ,&nbsp;Liwen Zeng ,&nbsp;Amal J. Khoury","doi":"10.1016/j.contraception.2025.111246","DOIUrl":"10.1016/j.contraception.2025.111246","url":null,"abstract":"<div><h3>Objective</h3><div>Choose Well is the first statewide contraceptive access initiative in the southeastern US. Launched in 2017 in South Carolina (SC), Choose Well aims to reduce unintended pregnancy and increase access to evidence-based contraception. The initiative provided capacity building, training and infrastructure, and workforce support to clinical partners across SC. We assess the impact of Choose Well on patient-reported experiences with contraceptive counseling. Examining patient experiences in addition to contraceptive utilization is essential for assessing reproductive autonomy.</div></div><div><h3>Study design</h3><div>The Women’s Longitudinal Study collected data on contraceptive counseling experiences of patients recruited in Choose Well-participating (intervention) clinics and those recruited in comparison clinics in a demographically and culturally comparable state. Overall, 2221 eligible patients were recruited from 37 clinics. Patient experiences of person-centered counseling, overall satisfaction, and accessibility of post-appointment care were assessed. Multivariable linear regression and modified Poisson regression models assessed Choose Well’s impact on counseling experiences.</div></div><div><h3>Results</h3><div>Intervention clinic participants were more likely than comparison clinic participants to report that they received person-centered counseling (adjusted PR= 1.12; 95% CI: 1.00,1.25) and that providers verified that they could use their contraception correctly and consistently (aPR= 1.09; 95% CI: 1.02,1.18). No differences were found in the likelihood that patients reported being satisfied with their visit or leaving with the best method for them.</div></div><div><h3>Conclusion</h3><div>Choose Well implementation was associated with increased person-centered contraceptive counseling. Contraceptive access initiatives that prioritize optimal counseling along with equitable access to contraceptive methods can promote reproductive health and support women in achieving their reproductive goals.</div></div><div><h3>Implications</h3><div>Choose Well was associated with increases in person-centered contraceptive counseling while expanding access to contraceptive methods in SC. Ongoing and future SCAIs should prioritize equitable access to the full range of contraceptive methods and measures to assess and ensure that their efforts are not limiting the reproductive autonomy of patients.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"155 ","pages":"Article 111246"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098503","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":"Sex differences in beliefs regarding abortion access as a women’s health issue","authors":"Anita Raj ,&nbsp;Clare Daniel ,&nbsp;Nicole E. Johns ,&nbsp;Priyanka Patel ,&nbsp;Namratha Rao ,&nbsp;Latona Giwa","doi":"10.1016/j.contraception.2025.111272","DOIUrl":"10.1016/j.contraception.2025.111272","url":null,"abstract":"<div><h3>Objective</h3><div>To assess sex differences in the belief that abortion access is important for women’s health.</div></div><div><h3>Study design</h3><div>A 2024 survey asked <em>N</em> = 3348 U.S. adults their agreement with this belief. Adjusted multinomial regression analyses were conducted.</div></div><div><h3>Results</h3><div>Most (58.3%), and a higher proportion of females than males, agreed with the statement. Subgroup analysis of sex by political leanings showed that observed sex differences in this belief holds for moderates with a trend seen for liberals and conservatives.</div></div><div><h3>Conclusion</h3><div>While most people agree with the statement, females across political leanings are more likely to endorse this belief compared to males.</div></div><div><h3>Implications</h3><div>The paper contributes to the discourse on abortion access as a health issue in the United States. We find that over half of U.S. participants agreed that abortion access is important for women's health, and females from across political parties were more likely than males to endorse this statement.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111272"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331112","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 effectiveness: A synthesis of the literature","authors":"Chelsea B. Polis ,&nbsp;Sarah E.K. Bradley ,&nbsp;Elizabeth A. Micks ,&nbsp;Markus J. Steiner","doi":"10.1016/j.contraception.2025.111282","DOIUrl":"10.1016/j.contraception.2025.111282","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111282"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433073","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":"Outpatient insertions of the levonorgestrel-releasing intrauterine system in women with pulmonary hypertension: A case series","authors":"Elaine Cristina Fontes de Oliveira ,&nbsp;Rossana Cristina Fontes Cotta ,&nbsp;Ana Luiza Lunardi Rocha","doi":"10.1016/j.contraception.2025.111289","DOIUrl":"10.1016/j.contraception.2025.111289","url":null,"abstract":"<div><div>Pulmonary hypertension is rare but carries high morbidity in women of reproductive age. Effective contraception is essential, with long-acting reversible contraceptives preferred. However, intrauterine device insertion is often restricted to surgical settings, limiting access. This case series reports outpatient Levonorgestrel-Releasing Intrauterine System insertions in this high-risk population.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111289"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477131","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":"Training to perform injections to induce fetal asystole across complex family planning fellowship sites","authors":"Antoinette Oot ,&nbsp;Natalie DiCenzo ,&nbsp;Holly A. Rankin ,&nbsp;Megan Masten ,&nbsp;Christina Jung","doi":"10.1016/j.contraception.2025.111286","DOIUrl":"10.1016/j.contraception.2025.111286","url":null,"abstract":"<div><h3>Objective</h3><div>To examine current Complex Family Planning (CFP) fellows’ experience with induction of fetal asystole.</div></div><div><h3>Study Design</h3><div>Cross-sectional web-based survey of trainees enrolled in United States accredited CFP fellowships.</div></div><div><h3>Results</h3><div>Of the 52/66 (79%) of fellows who responded, 36/52 (69%) plan to provide induction of fetal asystole post-fellowship. Thirty-six (69%) received training, most commonly by digoxin (31/52, 60%) transabdominal (31/31, 100%) intrafetal (26/31, 83%) injections. Twenty-four (46%) predicted competence upon graduation.</div></div><div><h3>Conclusions</h3><div>More CFP fellows planned to practice induction of fetal asystole in their future practice than the fewer than half of respondents who predicted they will be able to independently practice this skill upon graduation.</div></div><div><h3>Implications</h3><div>CFP fellowship programs can expand availability and comprehensiveness of training to support graduates in independent practice of induction of fetal asystole.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111286"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145484288","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":"Acceptability and challenges of self-removal of intrauterine devices in Campinas, Brazil","authors":"Jacques B.E. Versailles,&nbsp;Luis Bahamondes,&nbsp;Ana C. Marcelino,&nbsp;Paula da Cunha Pereira,&nbsp;M. Valeria Bahamondes,&nbsp;Cassia R.T. Juliato","doi":"10.1016/j.contraception.2025.111287","DOIUrl":"10.1016/j.contraception.2025.111287","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the willingness and ability of intrauterine device (IUD) users to self-remove their device.</div></div><div><h3>Study Design</h3><div>A cross-sectional study was conducted at the Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Brazil. We enrolled users of copper- or levonorgestrel 52 mg- IUDs who requested a device removal for any reason. Women with non-visible strings or partial IUD expulsion were excluded. Participants were instructed to insert their fingers into the vagina, with or without gloves according to their preference, to locate the IUD strings and attempt removal. If unsuccessful, removal was performed by a health care provider.</div></div><div><h3>Results</h3><div>A total of 238 women were included, with a mean ± SD age of 35.4 ± 8.0 years. Regarding willingness, 174 (73.1%) declined to attempt IUD self-removal, mainly due to fear (77/174; 44.5%). Among the 64 women who attempted self-removal, 8 (12.5%) were successful. The primary reason for failure was the inability to palpate or locate the strings.</div></div><div><h3>Conclusions</h3><div>Although a low number of participants were willing to attempt self-removal, some perceived it to increase autonomy and engage in self-exploration. Nevertheless, most preferred removal by a health care provider, due to fear of pain and perceived procedural complexity. Enhancing patient education and addressing concerns may improve the feasibility and acceptability of IUD self-removal, potentially empowering more women in their reproductive health decisions<em><strong>.</strong></em></div></div><div><h3>Implications</h3><div>Our study highlights that although the success rate of IUD self-removal was low, interest in the practice was notable among users. Fear and reliance on health care providers were key barriers to attempts. Our findings suggest that incorporating clear, evidence-based counseling about IUD self-removal at IUD placement may support reproductive autonomy and informed decision-making.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"154 ","pages":"Article 111287"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461040","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}