Contraception最新文献

{"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}

{"title":"OUTCOMES OF UNDESIRED RAPE-RELATED PREGNANCIES WITH HYDE-ONLY COMPARED TO FULL MEDICAID COVERAGE OF ABORTIONS: A COST-EFFECTIVENESS ANALYSIS","authors":"KM Schaefer,&nbsp;MI Rodriguez","doi":"10.1016/j.contraception.2024.110575","DOIUrl":"10.1016/j.contraception.2024.110575","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to estimate the cost-effectiveness and pregnancy outcomes of undesired rape-related pregnancies (RRP) when Medicaid abortion coverage is limited to Hyde restrictions compared to full Medicaid coverage of abortions.</div></div><div><h3>Methods</h3><div>We used a theoretical cohort of 80,000 individuals on Medicaid who have an undesired RRP, with cohort size determined by CDC data. We used TreeAge to model RRP outcomes when abortions are covered only by Medicaid as permitted under the Hyde amendment and compare this to outcomes when abortions are covered by Medicaid under any circumstances over a ten year span. Outcomes include cost to Medicaid, quality-adjusted life-years, Medicaid-covered abortions, out-of-pocket abortions, first trimester abortions, second trimester abortions, and uncomplicated and complicated pregnancies resulting in births. Probabilities, costs, and utilities were derived from the literature. A Medicaid perspective was assumed.</div></div><div><h3>Results</h3><div>Our model demonstrated that among RRPs, limiting abortion coverage to Hyde restrictions results in fewer Medicaid-paid abortions, more out-of-pocket abortions, and more pregnancies resulting in births compared to the counterfactual of full Medicaid abortion coverage. In a Hyde-only coverage scenario, there would be 44,228 fewer Medicaid-paid abortions – a 96% decrease relative to Medicaid-paid abortions with full coverage – and 21,577 more out-of-pocket abortions. Full Medicaid coverage of abortion in this population would avert 22,988 pregnancies with cost-savings of $313.6 million.</div></div><div><h3>Conclusions</h3><div>This study suggests that limiting Medicaid coverage of abortions to strictly Hyde Amendment exceptions decreases payment for and access to abortions for rape-related pregnancies, despite these abortions meeting Hyde criteria for federal funding. This demonstrates a failure of Medicaid to pay for 96% of abortions for undesired RRP and comes at a significantly increased cost to Medicaid.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110575"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426169","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":"IS TIKTOK THE NEW CONTRACEPTIVE COUNSELOR? DESCRIBING CONTRACEPTIVE SIDE EFFECTS DISCOURSE ON TIKTOK","authors":"E Pleasants,&nbsp;B Whitfield,&nbsp;ZH Pleasure,&nbsp;C Smith,&nbsp;E Norrell,&nbsp;C Fallon,&nbsp;L Lindberg","doi":"10.1016/j.contraception.2024.110632","DOIUrl":"10.1016/j.contraception.2024.110632","url":null,"abstract":"<div><h3>Objectives</h3><div>To quantify the frequency and characterize discussions of contraceptive side effects in popular TikTok videos.</div></div><div><h3>Methods</h3><div>We used two third-party TikTok scrapers to collect the most-viewed TikToks using hashtags (#contraception, #birthcontrol) and search terms (“contraception”, “birth control”). The study team screened each TikTok for mention of the effects of using or not using contraception (‘side effects’), excluding irrelevant videos. Qualitative thematic analysis captured the contraceptive method(s) and side effect(s) discussed.</div></div><div><h3>Results</h3><div>We identified 805 relevant TikToks with at least one-million views. Preliminarily, 54% discussed contraceptive side effects, and video creators included contraceptive users, healthcare providers, and wellness influencers. In TikToks about side effects, videos most commonly discussed the contraceptive pill (28%), intrauterine device (IUD) (13%), and implant (9%). Nearly one-quarter of videos were about unspecified hormonal methods. Discussions of side effects mostly focused on people’s experiences with the effects of using or stopping contraceptives, including changes in weight, mood, attraction to sexual/romantic partners, and pain from device insertion. A substantial portion of videos focused on the perceived short- and long-term risks of hormonal contraception and discontinuation of hormonal contraception as an empowering health decision.</div></div><div><h3>Conclusions</h3><div>Over half of the most-viewed TikToks about contraception discussed side effects, suggesting that these videos perform well in the TikTok algorithm as highly resonant or attention-capturing. Our findings suggest that individuals who search TikTok for contraception information likely see videos about side effects, which has ramifications for contraceptive perceptions and use. Providers should continue to consider the influences of TikTok on contraceptive perceptions and decision making.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110632"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426204","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":"DECEIVED, PRAGMATIC, STRATEGIC: ABORTION-SEEKERS’ APPROACHES TO CONTACTING CRISIS PREGNANCY CENTERS FOLLOWING TEXAS SENATE BILL 8","authors":"A Chatillon,&nbsp;W Arey,&nbsp;K Lerma,&nbsp;G Alemán,&nbsp;J Draper,&nbsp;A Beasley,&nbsp;K White","doi":"10.1016/j.contraception.2024.110590","DOIUrl":"10.1016/j.contraception.2024.110590","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to explore pregnant Texans’ experiences with crisis pregnancy centers (CPCs) following implementation of Senate Bill 8 (SB8), which prohibited abortions after embryonic cardiac activity.</div></div><div><h3>Methods</h3><div>Between October 2021 and August 2022, we conducted in-depth interviews with English-speaking Texans aged ≥15 years who were seeking abortion about their experiences navigating to care. We recruited participants through online ads and by providing flyers to abortion facilities in seven states. We interviewed Texans with varied pregnancy outcomes, including out-of-state abortions, self-managed abortions, and continued pregnancies, all of whom initially sought abortion in Texas. We used inductive and deductive coding to identify themes in participants’ understandings of and experiences with CPCs.</div></div><div><h3>Results</h3><div>Of 120 participants, 36 contacted CPCs. Roughly half the 36 were <em>deceived</em>: they reached out for support accessing abortion care, unaware of CPCs’ mission to prevent abortion. Most remaining participants contacted CPCs <em>pragmatically</em>: unaware of CPCs’ missions, they were simply drawn to the organizations’ free and accessible pregnancy tests/ultrasounds. A minority, however, knew of CPCs’ missions and used CPCs’ pregnancy confirmation/dating <em>strategically</em> to determine next steps toward an abortion. Participants with pragmatic interactions more often reported positive experiences with CPCs, while those who were deceived or strategic frequently described negative experiences. Regardless of motivation, participants noted the importance of having free and accessible services, including pregnancy tests and ultrasounds, in their communities.</div></div><div><h3>Conclusions</h3><div>In a restrictive abortion setting with limited access to reproductive and pregnancy-related healthcare services, pregnant Texans sought free services from CPCs instead of medical professionals, including for pragmatic or strategic reasons.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110590"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASSOCIATION BETWEEN EXPERIENCES OF DISCRIMINATION AND CONCERNS ABOUT ACCESSING CONTRACEPTIVE CARE AMONG COMMUNITY COLLEGE STUDENTS IN TEXAS AND CALIFORNIA","authors":"LA Tello Perez,&nbsp;J Yarger,&nbsp;HK Hecht,&nbsp;K Hopkins,&nbsp;I Rossetto,&nbsp;C Harper","doi":"10.1016/j.contraception.2024.110640","DOIUrl":"10.1016/j.contraception.2024.110640","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to identify whether experiences of discrimination are associated with students’ concerns about accessing contraception.</div></div><div><h3>Methods</h3><div>We analyzed baseline data (n=2,086) from an ongoing cluster randomized trial in Texas and California with sexually active community college students aged 18-25, assigned female at birth (gender- inclusive). Experiences of Discrimination (EOD) were measured using a validated and reliable scale (α = 0.8). We examined the association between EOD and concerns about being judged or disrespected by a medical provider, and whether the student felt comfortable discussing contraception with a provider. We used mixed effects logistic regression for clustered data, controlling for key sociodemographic factors.</div></div><div><h3>Results</h3><div>Overall, 21% of participants reported concerns about being judged or disrespected, and 17% reported feeling uncomfortable discussing contraception. EOD positively correlated with concerns about judgment or disrespect (adjusted OR (aOR)=1.13, CI 95% 1.09-1.16) and discomfort discussing contraception (aOR=1.04, CI 95% 1.01-1.08). Asian/Pacific Islanders had higher odds of worrying about judgment/disrespect (aOR=1.95, CI 95% 1.28-2.99) and discomfort discussing contraception (aOR=1.99, CI 95% 1.25-3.16) compared to White students. Latinx students also had higher odds of discomfort discussing contraception (aOR=1.52, CI 95% 1.04-2.23) as did first-generation college students (aOR=1.37, CI 95% 1.04-1.80). Finally, not speaking English at home was associated with concerns about judgment or disrespect (aOR=1.31, CI 95% 1.01-1.70).</div></div><div><h3>Conclusions</h3><div>Experiences of discrimination are associated with concerns about being judged or disrespected, as well as discomfort discussing contraception with providers. Healthcare providers and institutions should recognize and work to reduce the impact of discrimination on patients, particularly among young and marginalized patient communities.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110640"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426891","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":"USING THE SOCIAL VULNERABILITY INDEX AND ABORTIONFINDER.ORG TO DETERMINE THE RELATIONSHIP BETWEEN SOCIAL VULNERABILITY AND SPATIAL ACCESS TO SECOND TRIMESTER ABORTION","authors":"E Dindinger,&nbsp;RH Cohen,&nbsp;WB Allshouse,&nbsp;J Sheeder","doi":"10.1016/j.contraception.2024.110604","DOIUrl":"10.1016/j.contraception.2024.110604","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to assess the relationship between social vulnerability and driving distances from each US county to the closest second trimester abortion clinic as of October 2023.</div></div><div><h3>Methods</h3><div>Using AbortionFinder.org, we calculated drive time from the centroid of each US county to the closest second trimester abortion facility. Data was joined to the Social Vulnerability Index (SVI) by county FIPS code. Counties were stratified into three SVI tertiles. We compared the median driving distance for states where second trimester abortions were legal vs not-legal. We used logistic regression models to determine the SVI predictors (lowest tertile vs highest tertile) of living in a county with a &gt;2-hour driving distance of a second trimester abortion facility (adjusted for state legality of second trimester abortions).</div></div><div><h3>Results</h3><div>We assessed 3,143 US counties; 67.1% of counties were within a two-hour drive of a second trimester abortion facility. The median travel time for counties in states with legal second trimester abortion was 1.6 (range:0.1–7.3) vs 4.2 (range:0.9–12.0) hours p&lt;0.001. In logistic regression, counties with the lowest socioeconomic SVI score had increased odds of a &gt;2-hour drive (adjusted OR (aOR) 1.63;95%CI:1.28–2.17) and counties with the lowest racial/ethnic SVI score had increased odds of a &gt;2-hour drive (aOR 1.56;95%CI:1.18–2.04).</div></div><div><h3>Conclusions</h3><div>Abortion bans disproportionately affect not only those living in restrictive states but also those who are more socially vulnerable. Current legislative and judicial efforts further threaten access to first trimester abortions including medication abortion nationwide. The necessity for second trimester abortions and inequity in access may increase.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110604"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426176","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":"COMPARISON OF BLEEDING PATTERNS WITH REPLACEMENT VERSUS EXTENDED USE OF THE CONTRACEPTIVE IMPLANT","authors":"SK Mody,&nbsp;G Kully,&nbsp;MC Hildebrand,&nbsp;S Averbach","doi":"10.1016/j.contraception.2024.110633","DOIUrl":"10.1016/j.contraception.2024.110633","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to compare bleeding days and spotting days and satisfaction among individuals who replaced their contraceptive implant at three years versus those who extended use of the implant past three years.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study. Participants reported number of bleeding and spotting days for 30 days prior to their implant appointment, decided to replace (replacers) or extend (extenders) use, and then reported number of bleeding and spotting days for 30 days after. Participants also recorded their satisfaction with the amount of bleeding and/or spotting. We used Wilcoxon Rank Sum tests to compare unadjusted median differences between groups and multivariable median (quantile) regression to adjust for co-variates.</div></div><div><h3>Results</h3><div>Among 52 participants, there was no significant difference between the two groups 30 days before or 30 days after replacing or extending use of the implant for spotting only days (0 vs 0, p=1.00) or any bleeding days (0 vs. 0, p=0.39). There were more spotting days 30 days prior to the appointment among those who decided to replace their implant, however the difference was not statistically significant (2 vs. 1, p=0.06). We found no statistically significant differences in median number of days reporting satisfaction with bleeding/spotting patterns from before and after 30 days (0 vs. -1, p=0.85).</div></div><div><h3>Conclusions</h3><div>Neither implant replacers nor extenders experienced significant changes in bleeding 30 days before or after replacing or extending. This data can help clinicians counsel patients regarding bleeding patterns when they are deciding to keep or replace their contraceptive implant at three years.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110633"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426189","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":"COMPARISON OF SAFETY AND EFFICACY BETWEEN TELEMEDICINE AND CLINIC-BASED MEDICATION ABORTION AT A SINGLE ACADEMIC CENTER","authors":"R Patil,&nbsp;R Woofter,&nbsp;J Gipson,&nbsp;M Sudhinaraset","doi":"10.1016/j.contraception.2024.110605","DOIUrl":"10.1016/j.contraception.2024.110605","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite the rise in telemedicine medication abortion rates in the US, there is limited evidence comparing this model (NTMA) to traditional clinic-based medication abortion (CBMA). We aim to further the evidence around safety and efficacy of telemedicine medication abortion by comparing NTMA to CBMA to address the growing demand for abortion access.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study comparing safety and efficacy outcomes using electronic medical records for patients who either had a CBMA(n=800) or NTMA(n=171) up to 77 days of gestation between June 1, 2018 and December 31, 2022, at a large academic health center in California. Secondary outcomes included comparing completion rates of post-treatment follow-up and assessing the four-week home pregnancy test results for NTMA patients.</div></div><div><h3>Results</h3><div>A total of 91% of CBMA and 92% of NTMA patients had successful abortions without surgical intervention (p&gt;0.05). After controlling for covariates, successful abortion rates did not statistically significantly differ by modality [adjusted OR (aOR) 1.10, p&gt;0.05]. Less than 1% of both groups experienced an adverse event (p&gt;0.05), with no missed ongoing or missed ectopic pregnancies for either modality. A greater proportion of NTMA patients completed a first follow-up visit compared to CBMA patients, although this difference was not statistically significant [aOR 1.78, p&gt;0.05]. Approximately 18% of NTMA patients had positive pregnancy tests at a four-week follow-up appointment.</div></div><div><h3>Conclusions</h3><div>NTMA is an equally safe and effective abortion care model as CBMA. If not already offered, the provision of telemedicine medication abortion should be considered to meet the growing demand for abortion access.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110605"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426198","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}