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":"The association of social deprivation index and contraception care in a statewide contraceptive access initiative","authors":"Caitlin Bernard ,&nbsp;Brownsyne Tucker Edmonds ,&nbsp;Kelly Kean ,&nbsp;Rebecca Evans ,&nbsp;Surya S. Bhamidipalli ,&nbsp;Yan Tong ,&nbsp;Steven A. Brown ,&nbsp;Maria Fernandez ,&nbsp;Kathleen Wendholt ,&nbsp;Jeffrey F. Peipert ,&nbsp;Tracey A. Wilkinson","doi":"10.1016/j.contraception.2025.110833","DOIUrl":"10.1016/j.contraception.2025.110833","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine the association of social deprivation index (SDI) and contraception care in a statewide contraceptive access initiative (PATH4YOU) in Indiana.</div></div><div><h3>Study design</h3><div>A cross-sectional analysis was performed to examine associations of participant’s chosen appointment type and contraceptive method with age and SDI.</div></div><div><h3>Results</h3><div>Of the 1201 participants, 45.2% chose a short-acting contraception, 76.9% received in-person care. Those within the highest SDI quartile (greatest social deprivation) chose in-person care (93.1% vs. 63.4%) and long-acting contraception (62.8% vs. 35.6%) when compared to participants within the lowest quartile (<em>p</em> &lt; 0.01). This was confirmed by multivariable analysis, which showed that as SDI quartiles increased, OR for in-person care and long-acting contraception increased.</div></div><div><h3>Conclusions</h3><div>Participant chosen type of appointment and contraceptive method were associated with levels of social deprivation.</div></div><div><h3>Implications</h3><div>Analysis of appointment type and contraceptive method within a statewide contraceptive initiative in Indiana (PATH4YOU) was done and showed differences based on social deprivation quartiles. Those living in geographic areas of greatest social deprivation chose in-person care (vs. telehealth) and long-acting contraception.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"145 ","pages":"Article 110833"},"PeriodicalIF":2.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076675","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":"Where do female contraceptive users get their methods, and does this differ by insurance coverage? A state-level examination","authors":"Hannah Olson,&nbsp;Megan L. Kavanaugh","doi":"10.1016/j.contraception.2025.110834","DOIUrl":"10.1016/j.contraception.2025.110834","url":null,"abstract":"<div><h3>Objective</h3><div>Describe where female contraceptive users obtained their method, by insurance and state.</div></div><div><h3>Study design</h3><div>Using 2022 Behavioral Risk Factor Surveillance System data from female contraceptive users in 26 states, we describe source of contraception by state and type of insurance coverage.</div></div><div><h3>Results</h3><div>Most female contraceptive users utilized private providers, but those with public or no insurance often used community health centers and family planning clinics, which commonly receive public funding.</div></div><div><h3>Conclusion</h3><div>People who are publicly insured or uninsured often rely on publicly supported providers.</div></div><div><h3>Implications</h3><div>Supporting a variety of providers may facilitate people accessing care, regardless of income.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"145 ","pages":"Article 110834"},"PeriodicalIF":2.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076687","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":"Web traffic and Google Trends data show increased interest in novel male contraception following the Supreme Court’s Dobbs v. Jackson ruling","authors":"Claudia Brewer ,&nbsp;Brian T. Nguyen","doi":"10.1016/j.contraception.2025.110835","DOIUrl":"10.1016/j.contraception.2025.110835","url":null,"abstract":"<div><h3>Objectives</h3><div>Explore online public interest in male contraception in the United States after the Supreme Court’s <em>Dobbs v</em>. <em>Jackson</em> ruling.</div></div><div><h3>Study design</h3><div>We used Google Trends to examine relative search volumes for “male birth control” and observed the number of daily visits to two male contraception research websites during the weeks before and after the ruling.</div></div><div><h3>Results</h3><div>The mean relative search volume for “male birth control” more than doubled during the period after the ruling was publicized (<em>p</em> = 0.002). Daily visits to both male contraception websites peaked immediately following the ruling.</div></div><div><h3>Conclusions</h3><div>The overturning of federal abortion protections preceded a spike in United States public interest in male contraception.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"145 ","pages":"Article 110835"},"PeriodicalIF":2.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076680","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}