Contraception最新文献

{"title":"PATIENT OUTCOMES WITH EARLY PREGNANCY COMPLICATIONS AFTER EXPOSURE TO AN EARLY PREGNANCY ASSESSMENT CLINIC","authors":"SI Amaya,&nbsp;J Zhang,&nbsp;A Chen,&nbsp;SK Mulwa,&nbsp;E Booker,&nbsp;TS Gémesi,&nbsp;A Henkel,&nbsp;K Shaw,&nbsp;J Shorter","doi":"10.1016/j.contraception.2024.110630","DOIUrl":"10.1016/j.contraception.2024.110630","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to evaluate the healthcare burden experienced by patients with early pregnancy complications seen in an early pregnancy assessment clinic (EPAC) and those never seen in an EPAC.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study evaluating patients 18 years and older who presented during the first 12 weeks of pregnancy with a complication including vaginal bleeding or pain, early pregnancy loss (EPL), pregnancy of unknown location (PUL), ectopic, or molar pregnancy. The primary outcome was the healthcare burden for patients seen in an EPAC compared to patients never seen in an EPAC. Healthcare burden was defined as the total number of encounters and the average time spent in the healthcare system.</div></div><div><h3>Results</h3><div>We obtained data from 241 patients between January 2021 and June 2022. Patients never seen in EPAC were more likely to be of Hispanic ethnicity (52% vs 30%, p&lt;0.001), have public or no insurance (59% vs 25%, p&lt;0.001), and report a non-English primary language (33% vs 10%, p&lt;0.001) compared with patients seen in an EPAC. The median (range) total number of healthcare encounters was 4 (2, 5.5) and 3 (2,5) in the EPAC and non-EPAC groups, respectively (p=0.3). The mean in-person healthcare encounter time (hours) was significantly higher in the non-EPAC group (327 vs 120, p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Patients never seen in an EPAC were more likely to have socioeconomic and language barriers compared to those seen in an EPAC. Increasing access to expedited evaluation and management of early pregnancy complications may improve patients’ healthcare experience.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110630"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426191","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":"DOES PSYCHOSOCIAL BURDEN DIFFER WHEN ACCESSING MEDICATION ABORTION USING NO-TEST, TELEHEALTH CARE COMPARED TO IN-PERSON CARE WITH ULTRASOUND?","authors":"MA Biggs,&nbsp;C Baba,&nbsp;LJ Ralph,&nbsp;R Schroeder,&nbsp;C McNicholas,&nbsp;A Hagstrom Miller,&nbsp;D Grossman","doi":"10.1016/j.contraception.2024.110622","DOIUrl":"10.1016/j.contraception.2024.110622","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to explore whether no-test, telehealth abortion care reduces the psychosocial burden of abortion care-seeking.</div></div><div><h3>Methods</h3><div>As part of a study on the safety and effectiveness of telehealth abortion care, from May 2021-March 2023, we surveyed and abstracted medical record data for 583 patients obtaining medication abortion ≤ 70 days gestation, English- or Spanish-speaking, ages ≥ 15 years at four abortion clinic organizations in six US states. We assessed three psychosocial burden dimensions (structural challenges, five items, α=0.80; lack of autonomy, three items, α=0.73; and others’ reactions to the pregnancy, two items, α=0.88, range 0–3) by study group (1) telehealth and mailing medications, (2) no-test and pick-up medications, and (3) in-person with ultrasound.</div></div><div><h3>Results</h3><div>A total 403 enrolled participants completed psychosocial burden items. In adjusted analyses, telehealth by mail was associated with fewer structural challenges than in-person care (-0.12, 95% CI -0.23,-0.00), mostly due to less difficulty traveling for care (24% vs 32%, p&lt;0.05). While mean lack of autonomy scores did not differ by study group, the telehealth by mail (11%) and no-test and pick-up (12%) groups were less likely to feel forced to wait for the abortion after making the decision, when compared to the in-person with ultrasound group (22%, p&lt;0.05). The no-test and pick-up group (35%) was also less likely to be worried about friends/family members’ reaction to the pregnancy than the in-person care group (42%, p&lt;0.05).</div></div><div><h3>Conclusions</h3><div>No-test, telehealth medication abortion care may reduce the psychosocial burden of abortion-seeking, in particular the burden of travel and feeling forced to wait for care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110622"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426199","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":"POSTPARTUM PERMANENT CONTRACEPTIVE PROCEDURES: A 360-DEGREE QUALITATIVE INVESTIGATION","authors":"K Crofton,&nbsp;A Johnston,&nbsp;S Kaszubinski,&nbsp;S Betstadt,&nbsp;E Tal,&nbsp;R Flink-Bochacki","doi":"10.1016/j.contraception.2024.110628","DOIUrl":"10.1016/j.contraception.2024.110628","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to explore interdisciplinary factors affecting completion of postpartum permanent contraceptive procedures after vaginal delivery.</div></div><div><h3>Methods</h3><div>We conducted a multi-center qualitative study on completion or non-completion of postpartum permanent contraceptive procedures at three academic institutions from July 2023-March 2024. We recruited postpartum patients who desired permanent contraceptive procedures following vaginal delivery. We conducted semi-structured interviews with patients and their nursing, obstetric, and anesthesia teams. We double-coded transcripts using Dedoose and performed inductive thematic content analysis, concluding data collection after thematic saturation.</div></div><div><h3>Results</h3><div>We interviewed 19 patients (11 completed and 9 non-completed procedures) and 47 staff (mean 2.5/patient). We identified three major themes: (1) Standard perioperative counseling can be overshadowed by a focus on overcoming obstacles to completion (<em>“What did [your doctors] tell you to expect?” “Really nothing, they just asked if I was sure I want it…”</em>); (2) Healthcare workers’ personal values influence the prioritization of these procedures <em>(“I believe that some are elective and some are more urgent”)</em>; (3) Procedure completion often relies on one champion to optimize interdisciplinary communication and push past barriers (<em>“We could not get a slot for her on day 1…and then we did on day 2, mostly because [attending] advocated for her</em>”).</div></div><div><h3>Conclusions</h3><div>Unlike most surgeries, the completion of postpartum permanent contraceptive procedures centers around overcoming barriers to access rather than patient needs. The propensity for clinician advocacy to detract from perioperative patient care is a novel finding, and it sustains a culture where contraceptive requests are actualized based on care-team factors rather than patient factors.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110628"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426202","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":"ATTRIBUTES OF PROVIDER COUNSELING ASSOCIATED WITH CONTRACEPTIVE SATISFACTION","authors":"N Luche,&nbsp;E Mosley,&nbsp;N Zite,&nbsp;S Borrero","doi":"10.1016/j.contraception.2024.110646","DOIUrl":"10.1016/j.contraception.2024.110646","url":null,"abstract":"<div><h3>Objectives</h3><div>High-quality contraceptive counseling is associated with increased use of contraception. However, little is known about how counseling influences patient satisfaction with contraceptive method. This study sought to assess characteristics of counseling associated with method satisfaction.</div></div><div><h3>Methods</h3><div>Pregnant participants aged 21-45 years considering postpartum tubal sterilization were recruited from three sites and randomized to receipt of the MyDecision/MiDecisión decision aid tool vs. standard care. Surveys at three months postpartum included eight Likert scale items characterizing perinatal contraceptive counseling quality, and one item assessing current contraceptive method satisfaction. Response options of “strongly agree” (positively worded items) or “strongly disagree” (negatively worded items) were considered optimal. We examined bivariate associations between optimal counseling and optimal method satisfaction. Logistic regression models were then conducted, adjusted for randomization arm and confounding variables (p&lt;0.10) identified in bivariate analysis (age, site).</div></div><div><h3>Results</h3><div>Of 244 participants, 160 (65.6%) reported optimal method satisfaction. In bivariate analysis, optimal ratings on feeling respected, feeling pressured into sterilization or other methods, receiving adequate explanations regarding sterilization or other methods, receiving answers to questions, and counseling satisfaction were all associated with optimal method satisfaction (all p&lt;0.01). In adjusted analysis, optimal ratings on feeling respected (adjusted OR (aOR):5.80;95%CI:2.32-14.49), receiving adequate explanations regarding non-sterilization contraception (aOR:2.14;95%CI:1.07-4.30), feeling minimally pressured into non-sterilization methods (aOR:2.30;95%CI:1.01-5.22), receiving answers (aOR:3.35;95%CI:1.43-7.83), and counseling satisfaction (aOR:4.61;95%CI:2.18-9.74) remained significantly associated with method satisfaction.</div></div><div><h3>Conclusions</h3><div>Aspects of provider contraception counseling that are aligned with patient-centered care are significantly associated with contraceptive method satisfaction. Provision of high-quality contraceptive counseling may have implications both for uptake and continued use of methods.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110646"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426205","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":"DISTANCES TRAVELLED FOR ABORTIONS AND INEQUITIES FOR RURAL RESIDENTS IN OREGON","authors":"EC Nacev,&nbsp;A Mandelbaum,&nbsp;MF Fuerst,&nbsp;MI Rodriguez","doi":"10.1016/j.contraception.2024.110616","DOIUrl":"10.1016/j.contraception.2024.110616","url":null,"abstract":"<div><h3>Objectives</h3><div>Abortion access is dire in most rural areas of the US. Recent studies have shown that most reproductive-aged women live greater than a 30 minute drive from the nearest abortion clinic. True travel distances to abortion care may be even higher, given restrictions in availability by type of abortion and gestational age. This study aims to describe the burden of travel to abortion care for residents of Oregon, a state with no legal restrictions on abortion, by rurality of residence.</div></div><div><h3>Methods</h3><div>We conducted a descriptive study of vital statistics from the Oregon Health Authority of all abortions in Oregon from 2015 to 2021. We calculated distances between county of residence and county of abortion occurrence.</div></div><div><h3>Results</h3><div>Of 57,533 abortions, 90% (n=51,781) were to Oregon residents. Individuals from every county in Oregon needed abortion care during our study period, however abortions were provided in only 25% of counties (n=9). Those that travelled outside their county for abortion care (n=21,808, 37.4%) travelled an average of 56 miles for abortion care. Residents of rural counties (n=4,284) had an average travel distance of 103 miles, with maximum distance travelled of 432 miles.</div></div><div><h3>Conclusions</h3><div>This recent, real-world study describes a high burden of travel for rural residents, even in a state where abortion is legal. This data can support efforts to creatively, strategically, and equitably increase access to abortion, particularly for those with geographic challenges to access.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110616"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426438","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":"TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) FOR PAIN CONTROL DURING FIRST-TRIMESTER PROCEDURAL ABORTION: A BLINDED RANDOMIZED CONTROLLED TRIAL","authors":"A Henkel,&nbsp;EP Cahill,&nbsp;S Chavez,&nbsp;JM Shorter,&nbsp;SM Liu,&nbsp;SI Amaya,&nbsp;S Kaur,&nbsp;KA Shaw","doi":"10.1016/j.contraception.2024.110617","DOIUrl":"10.1016/j.contraception.2024.110617","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) to manage pain during first-trimester procedural abortion for those not eligible for or otherwise foregoing sedation.</div></div><div><h3>Methods</h3><div>This is a double-blinded, block-randomized superiority trial (IRB approved, NCT05320432) comparing TENS (placed posteriorly, T10-L1 and S2-S4) to sham for pain management during first-trimester procedural abortion. We enrolled pregnant people less than 12 weeks gestation, English- or Spanish-speaking at two outpatient clinics who were not receiving sedation. The primary outcome was self-reported pain by visual analog scale (VAS, 100 mm) with passage of largest cervical dilator. We planned to enroll 70 patients to show a 15 mm difference in median pain score (80% power, α = 0.05).</div></div><div><h3>Results</h3><div>Between January 2023 and March 2024, we enrolled 70 participants. Baseline demographics were balanced between groups: median (range) gestational duration 6.8 (5.1-11.8) weeks, 35.7% nulliparous. Median (range) reported pain with passage of largest dilator was 44mm (0–88) and 50mm (0–96) in the TENS and sham groups, respectively (p=0.56). We did not find a difference in median pain at any collected time point including placement of tenaculum, paracervical block, aspiration, or recovery. The active TENS group was more likely to say they would recommend this method of pain control to others (94mm vs 73mm, p=0.01). More participants receiving TENS unit correctly identified their group allocation (91.4% vs 63.6%, p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>While we did not demonstrate a difference in pain during the procedure, TENS is a non-pharmacologic alternative that may improve patient experience during uterine aspiration.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110617"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426439","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":"“IMAGINE A PREGNANCY”: PERSPECTIVES ON PREGNANCY, ABORTION, AND PARENTING OF LATINE EMERGING ADULTS IN AN AGRICULTURAL COMMUNITY IN CALIFORNIA","authors":"AE Bryson,&nbsp;PS Nordstrom Miranda,&nbsp;MS Zerofsky,&nbsp;AB Baez De Luna,&nbsp;AM Minnis,&nbsp;M Raymond-Flesch","doi":"10.1016/j.contraception.2024.110585","DOIUrl":"10.1016/j.contraception.2024.110585","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to describe perspectives on pregnancy, abortion, and parenting among Latine emerging adults.</div></div><div><h3>Methods</h3><div>In a mixed-methods prospective cohort study of emerging adults followed since eighth grade, interviews were conducted (5/2023-1/2024) with a subset selected to achieve variation in current relationship experience. Directed content and inductive analyses of transcripts were completed.</div></div><div><h3>Results</h3><div>Forty-one participants (ages 18-21 years; n=21 female, n=18 male, n=2 non-binary; 12% first generation, 71% second generation, and 17% third generation immigrants) were interviewed. Participant-reported reasons to prevent pregnancy currently included educational goals, maturity, “not ready”, finances, desire not to disappoint parents, and other personal goals. When asked to imagine if they (or their partner) were pregnant now, many reported negative feelings (“…being pregnant would be the worst thing right now”), while few reported positive feelings. Participants were split between preferring abortion (“…I just feel like I would have to abort it just because I can’t even take care of myself”) and parenting (“I think if I had a child, I would really want to raise it and be involved in its life”). Adoption was rarely discussed and arose as a second-tier option if abortion was not available. Family values, support systems, and future goals were critical factors driving imagined pregnancy decisions.</div></div><div><h3>Conclusions</h3><div>We captured perspectives on pregnancy, abortion, and parenting of those typically underrepresented in abortion research, including emerging adults, male and non-binary individuals, and those with immigrant identities. Such research is critical to understanding how these populations are navigating their sexual and reproductive health in an evolving abortion policy landscape.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110585"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426707","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 EXPERIENCES OF DISCRIMINATION IN FAMILY PLANNING SETTINGS: AN EXPLORATORY FACTOR ANALYSIS","authors":"AA Luke,&nbsp;M Livingston,&nbsp;AM Gómez,&nbsp;AH Bennett,&nbsp;JM Sales,&nbsp;SK Redd,&nbsp;WS Rice","doi":"10.1016/j.contraception.2024.110647","DOIUrl":"10.1016/j.contraception.2024.110647","url":null,"abstract":"<div><h3>Objectives</h3><div>Given the importance of high-quality, person-centered care, particularly for communities who have experienced reproductive oppression, this study aimed to test the psychometric properties of a nine-item measure of lifetime experiences of discrimination in family planning settings developed by Bird and Bogart (2001).</div></div><div><h3>Methods</h3><div>Data came from the nationally representative Person-Centered Contraceptive Access Metrics survey (unweighted n=3,059). We performed an exploratory factor analysis using principal axis extraction and Promax rotation. We assessed reliability using the coefficient omega. To assess known-groups validity, we employed weighted linear regression with survey sampling weights, using race as the predictor and the discrimination scale score as the outcome variable.</div></div><div><h3>Results</h3><div>The factor analysis resulted in a two-factor solution using 7/9 discrimination items: (1) Interpersonal Discrimination in Family Planning Care, including items reflecting differential treatment and disrespect; and (2) Racial Stereotyping in Family Planning Care, capturing assumptions based on race/ethnicity about welfare status, family size, sexual behavior, and sexually transmitted diseases. The measure demonstrated strong reliability (coefficient omega 0.97) and goodness-of-fit (TLI=0.988, RMSEA=0.066). Known-groups validity testing indicated that people of color experienced higher levels of discrimination in family planning settings compared to White respondents.</div></div><div><h3>Conclusions</h3><div>The validation of this measure assessing experiences of discrimination in family planning settings provides a tool to support research on the prevalence of racial discrimination and its impact on reproductive autonomy, including preferred method use, and access to care. Understanding these impacts can inform interventions promoting access to high-quality, equitable, and just reproductive healthcare.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110647"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426892","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 METHOD CHOICES FOLLOWING DOBBS IN A STATEWIDE CONTRACEPTIVE ACCESS INITIATIVE: PATH4YOU","authors":"M Ruggles,&nbsp;BT Edmonds,&nbsp;J Peipert,&nbsp;R Evans,&nbsp;M Fernandez,&nbsp;K Wendholt,&nbsp;SS Bhamidipalli,&nbsp;TA Wilkinson,&nbsp;C Bernard","doi":"10.1016/j.contraception.2024.110645","DOIUrl":"10.1016/j.contraception.2024.110645","url":null,"abstract":"<div><h3>Objectives</h3><div>The <em>Dobbs v Jackson Women’s Health Organization</em> decision significantly impacted abortion access, and Indiana was the first state to legislate an abortion ban in August 2022. The objective of this study was to evaluate changes in contraceptive method choice among participants using our statewide contraceptive access initiative, PATH4YOU. Our hypothesis was that more people would choose contraceptive methods with higher effectiveness due to concern for lack of abortion access in case of unintended pregnancy.</div></div><div><h3>Methods</h3><div>We analyzed programmatic data of 1,224 reproductive-aged people receiving care through PATH4YOU from September 2021 to September 2023, including 178 pre-<em>Dobbs</em> and 1,034 post-<em>Dobbs</em>. All participants received pregnancy intention screening, comprehensive contraceptive counseling/decision support, and same-day, free reversible method access. We analyzed the study population via age and zip code, including the social deprivation index (SDI), and the method mix before and after the <em>Dobbs</em> decision.</div></div><div><h3>Results</h3><div>The average age of participants was 28 years; 77% received care in-person, 23% via telehealth. Based on zip code, 88% were urban and were evenly split among the SDI quartiles (22% in the most vs 26% in the least deprived quartiles). Overall, participants chose 35% LARC, 31% pill/patch/ring, 12% injectable, 3% barrier/EC, and 11% other/none. After the <em>Dobbs</em> decision, significantly more participants chose more effective methods, including LARC (37% vs 24%, <em>p&lt;0.001</em>) and injectables (13% vs 5%, <em>p=0.003</em>), while fewer chose pill/patch/ring (29% vs 41%, <em>p=0.03</em>).</div></div><div><h3>Conclusions</h3><div>The <em>Dobbs</em> decision and concerns about abortion access appear to have influenced contraceptive method choice for participants in PATH4YOU.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110645"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426895","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 FREQUENCY AND DECISION-MAKING FOR FEMALE PERMANENT CONTRACEPTION FOLLOWING THE DOBBS DECISION","authors":"R Flink-Bochacki,&nbsp;S Pogge,&nbsp;A Cai,&nbsp;S Horvath","doi":"10.1016/j.contraception.2024.110644","DOIUrl":"10.1016/j.contraception.2024.110644","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to compare the frequency of female permanent contraceptive procedures before and after the <em>Dobbs v Jackson Women’s Health Organization</em> decision, and to assess impact of political factors on patient decision-making.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of patients who underwent interval permanent contraceptive procedures in New York and Pennsylvania, comparing a pre-<em>Dobbs</em> (7/1/2020-6/30/2022) and post-<em>Dobbs</em> cohort (7/1/2022-6/30/2023). The primary outcome was change in procedure volume; secondary outcomes included differences in patient characteristics. We implemented standardized decision-making documentation beginning summer 2022, which allowed assessment of patient considerations in the post-<em>Dobbs</em> cohort. We performed Student t-tests, chi square tests, and descriptive statistics in Stata SE.</div></div><div><h3>Results</h3><div>There were 429 procedures pre-<em>Dobbs</em> and 310 post-<em>Dobbs</em>, including 194 (26.3%) procedures in New York and 545 (73.7%) in Pennsylvania. Volume grew significantly at both institutions, together increasing from an average 8.9 to 12.9 procedures/month (p=0.009). Patients post-<em>Dobbs</em> were more often under age 30 (31.7% vs. 39.0%, p=0.039) and nulliparous (10.7% vs. 21.0%, p&lt;0.001). Decision-making documentation was recorded for 96 patients and was similar between sites, with 20% of patients considering future access to permanent contraception, 18% considering future access to reversible contraception, and 23% considering future access to abortion. At both sites, 47% of patients said their decision was somewhat or very related to current political events.</div></div><div><h3>Conclusions</h3><div>In two states without new abortion restrictions, permanent contraception was sought by more patients post-<em>Dobbs</em>, particularly younger and nulliparous patients. Fear of losing access to future reproductive options is integrated into reproductive decision-making, illustrating the wide-reaching impact of political threats to patient autonomy.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110644"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426896","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}