Contraception最新文献

{"title":"Effects of multilevel postpartum family planning intervention on the reduction of unintended pregnancy and induced abortion rates within 12 months of delivery: A cluster randomized controlled study in China","authors":"Yuyan Li ,&nbsp;Yan Zhang ,&nbsp;Dong Yuan ,&nbsp;Li Shan ,&nbsp;Xiaojing Dong ,&nbsp;Liqun Wang ,&nbsp;Yuanzhong Zhou ,&nbsp;Weixin Liu ,&nbsp;Xiaojun Wang ,&nbsp;Lifang Jiang ,&nbsp;Xiaoyu Hu ,&nbsp;Wei Xia ,&nbsp;Xiaochen Huang ,&nbsp;Jiandong Song ,&nbsp;Liangping Wang ,&nbsp;Li Jiang ,&nbsp;Hanfeng Ye ,&nbsp;Yanfei Zhou ,&nbsp;Yan Che","doi":"10.1016/j.contraception.2024.110753","DOIUrl":"10.1016/j.contraception.2024.110753","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate the effects of a multilevel promoting postpartum family planning (PPFP) intervention on the reduction of unintended pregnancies and induced abortions in China.</div></div><div><h3>Study design</h3><div>We performed a cluster randomized intervention study to assess the effects of a multilevel PPFP intervention on the rates of unintended pregnancy and induced abortion within 12 months postpartum. Thirty-six hospitals were included and randomly allocated to two groups at a 1:1 ratio, enrolling 180 pregnant women per hospital starting in January 2019. The intervention included integrated contraceptive education and counseling at three critical stages, namely, the third trimester, delivery, and several postpartum time points. We used life table and multilevel Cox regression for data analysis.</div></div><div><h3>Results</h3><div>We recruited 6315 participants, namely, 3116 in the intervention group and 3199 in the control group. The 12-month cumulative rates of unintended pregnancy and induced abortion were significantly lower in the intervention group (2.74% [95% CI, 2.16–3.46] and 1.43% [95% CI, 1.01–2.03], respectively) than in the control group (6.99% [95% CI, 6.00–8.14] and 3.85% [95% CI, 3.09–4.79], respectively). Multilevel Cox regression revealed a 63% reduction in the risk of unintended pregnancy (hazard ratio 0.37 [95% CI, 0.19–0.71]) and a 66% reduction in the risk of induced abortion (hazard ratio 0.34 [95% CI, 0.16–0.69]) in the intervention group.</div></div><div><h3>Conclusions</h3><div>This multilevel PPFP intervention was effective in reducing the risk of unintended pregnancy and induced abortion within the first year after childbirth. We recommend scaling up this approach to other hospitals across the country that provide prenatal educational classes and postpartum contraceptive services.</div></div><div><h3>Implications</h3><div>Multifaceted PPFP interventions, which encompass contraceptive education during both pregnancy and the postpartum period, are effective in reducing unintended pregnancy rates in China. This strategy could be adopted in other similar health care settings worldwide.</div></div><div><h3>Clinical Trials</h3><div>ChiCTR1900023790</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110753"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678006","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":"Potential effect of immediate postpartum use of injectable contraception on lactogenesis","authors":"Maria F. Gallo ,&nbsp;Fernanda L. Schumacher ,&nbsp;Megan Lawley ,&nbsp;Sarah A. Keim ,&nbsp;Amy C. Dupper ,&nbsp;Lisa Keder","doi":"10.1016/j.contraception.2024.110726","DOIUrl":"10.1016/j.contraception.2024.110726","url":null,"abstract":"<div><h3>Objectives</h3><div>We evaluated the effect of immediate postpartum use of depot medroxyprogesterone acetate (DMPA) on the timing of lactogenesis stage II (LS-II).</div></div><div><h3>Study design</h3><div>The initial design randomly assigned adults who delivered a full-term infant in 2019–2021 to receive within 48 hours of delivery: (1) DMPA, (2) placebo injection, or (3) no injection. Due to low enrollment, we changed in 2021–2023 to a nonrandomized design using matching at recruitment for obesity and delivery method and propensity score weighting for analysis. We combined data from both designs to compare immediate postpartum DMPA use (<em>N</em> = 55) vs control (placebo or no injection) group (<em>N</em> = 95). We defined noninferiority a priori as being met if the upper bound of a two-sided 95% CI for mean difference in time to LS-II between groups was &lt;6 hours.</div></div><div><h3>Results</h3><div>The unweighted mean time to LS-II was 57.8 hours in the DMPA group (SD, 29.4) and 64.1 hours in the control group (SD, 36.1). Using propensity score weighting to make the groups comparable with respect to age, race, delivery method, and previous live births, the mean time to LS-II was 5.5 hours shorter (95% CI, −16.4, 5.5) for women in the DMPA relative to control group.</div></div><div><h3>Conclusions</h3><div>We found no evidence that DMPA use inhibits the onset of LS-II. Findings support immediate postpartum DMPA initiation among those intending to engage in human milk feeding.</div></div><div><h3>Implications</h3><div>A controlled trial (<em>N</em> = 150) did not detect any difference in time to lactogenesis stage II (“milk let-down”) between injectable contraception use within the first 48 hours postpartum and those without this exposure.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110726"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483227","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":"Corrigendum to Society of Family Planning Research Practice Support: Strategies and considerations for addressing race and racism in quantitative family planning studies [Contraception vol 139 (2024) 110534]","authors":"Nicole Quinones ,&nbsp;Liza Fuentes ,&nbsp;Asha Hassan ,&nbsp;Anna K. Hing ,&nbsp;Goleen Samari ,&nbsp;Monica McLemore","doi":"10.1016/j.contraception.2024.110736","DOIUrl":"10.1016/j.contraception.2024.110736","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110736"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633666","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":"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}