Contraception最新文献

{"title":"Physical disability and postpartum contraception use in Ontario, Canada: A population-based study.","authors":"Hilary K Brown, Natalie V Scime, Isobel Sharpe, Erin A Brennand","doi":"10.1016/j.contraception.2026.111744","DOIUrl":"https://doi.org/10.1016/j.contraception.2026.111744","url":null,"abstract":"<p><strong>Objectives: </strong>To explore postpartum use of permanent contraception, intrauterine devices, oral contraception, and injectable contraception in people with and without physical disabilities.</p><p><strong>Study design: </strong>We undertook a population-based cohort study of 15 to 49-year-olds with (n=178,400) and without physical disabilities (n=1,557,304) who had an obstetrical delivery without hysterectomy in Ontario, Canada, 2007-2021. Groups were compared using Cox proportional hazards regression on use of permanent contraception, intrauterine devices, oral contraception, and injectable contraception by 6 months postpartum, censoring on subsequent conception, hysterectomy, outmigration, or death. Models adjusted for age, parity, income quintile, rurality, immigration, and delivery year.</p><p><strong>Results: </strong>Individuals with physical disabilities had greater hazards than those without physical disabilities of using permanent contraception (5.1% vs. 3.9%; aHR 1.30, 95% CI 1.27-1.33), intrauterine devices (11.2% vs. 10.1%; aHR 1.17, 95% CI 1.13-1.21), oral contraception (12.8% vs. 11.9%; aHR 1.08, 95% CI 1.04-1.11), and injectable contraception (4.0% vs. 3.3%; aHR 1.23, 95% CI 1.16-1.31) by 6 months postpartum. Findings were similar by 12 and 24 months postpartum.</p><p><strong>Conclusion: </strong>Individuals with physical disabilities were more likely than those without physical disabilities to have postpartum contraception use, including permanent contraception. Future studies should explore the reasons for these patterns to inform family planning supports.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111744"},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Response to \"Data interpretation of changes in abortion volume of graduating obstetrics and gynecology residents\".","authors":"Anita Pershad, Alyssa Wilkinson, Thomas Kimble","doi":"10.1016/j.contraception.2026.111742","DOIUrl":"https://doi.org/10.1016/j.contraception.2026.111742","url":null,"abstract":"","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111742"},"PeriodicalIF":2.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Did Dobbs impact access to and use of preferred contraception and related outcomes?: Quasi-experimental evidence from three states in the US.","authors":"Mia Zolna, Lauren Mitchell, Megan L Kavanaugh","doi":"10.1016/j.contraception.2026.111743","DOIUrl":"https://doi.org/10.1016/j.contraception.2026.111743","url":null,"abstract":"<p><strong>Objectives: </strong>The 2022 United States Supreme Court Dobbs v. Jackson Women's Health Organization (Dobbs) decision to overturn federal protections for abortion access has impacted contraceptive use and access. This study aimed to examine whether Dobbs further impacted contraceptive preference fulfillment and related outcomes.</p><p><strong>Study design: </strong>We used panel and cross-sectional data from household-based Surveys of Women representative of women ages 18-44 in three states with varying abortion policy contexts post-Dobbs: Arizona and Wisconsin (more restrictive; n=2525 pre-Dobbs 2021 timepoint; n=4052 early post-Dobbs 2022-2023 timepoint) and New Jersey (less restrictive; n=1186 pre; n=2025 early post). We examined the impact of Dobbs on four contraceptive preference-related outcomes via quasi-experimental difference-in-difference models.</p><p><strong>Results: </strong>We found an association between Dobbs and receipt of contraceptive care; predicted probabilities among women in more restrictive states were 8.21 percentage points higher (95% CI: 1.96, 14.47) than among those in the less restrictive state. There were no differential impacts of Dobbs on barriers to preferred contraception, contraceptive use, and preference fulfillment among users of methods other than female permanent contraception. In restrictive states, barriers to preferred contraception increased, contraceptive use including non-condom barriers declined, and use of emergency contraception increased pre- to early post-Dobbs. In both contexts, female permanent contraceptive use declined.</p><p><strong>Conclusions: </strong>Immediately post Dobbs, people in more restrictive policy settings may have changed contraceptive care and method seeking differentially compared to those in the less restrictive setting; we observed no change in contraceptive preference fulfillment among users of methods other than female permanent contraception.</p><p><strong>Implications: </strong>Our findings signal that conceptualizations of contraceptive preferences, which were originally conceived in a pre-Dobbs research landscape, may need to be revisited and interrogated for its salience in a post-Dobbs landscape, especially in states where people's reproductive choices are severely constrained. More broadly, our findings on changes in specific method use from pre- to post-Dobbs-especially decreases in female permanent contraceptive use documented across state contexts-challenge findings from several other studies documenting increases in this outcome from pre-to post-Dobbs among different study populations.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111743"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reasons for using telehealth medication abortion: adolescents and young adults compared with adults.","authors":"Kalani K Phillips, Leah R Koenig, Lisa Peters, Jennifer Ko, M Antonia Biggs, Ushma D Upadhyay","doi":"10.1016/j.contraception.2026.111741","DOIUrl":"https://doi.org/10.1016/j.contraception.2026.111741","url":null,"abstract":"<p><strong>Objectives: </strong>While telehealth abortion is now widely available in the United States, research on adolescent and young adult (AYA) use of telehealth abortion is limited. We described AYAs' reasons for using telehealth for abortion and compared them to adults' reasons.</p><p><strong>Study design: </strong>We analyzed survey data from 1,632 telehealth abortion patients (462 AYAs ages 16-24, including eight adolescents <18 years, and 1,170 adults >24) in 2021-2022. We used logistic regression to compare reasons between AYAs and adults. We also analyzed 462 open-ended AYA responses using inductive thematic analysis and deductive coding.</p><p><strong>Results: </strong>AYAs (ages 16-24) were more likely than adults (ages 25+) to cite lower costs (67% vs. 55%; p<0.001) and fear of what would happen at a clinic (27% vs. 16%; p<0.001) as reasons for using telehealth. Conversely, AYAs were less likely than adults to use telehealth to avoid arranging child or dependent care (10% vs. 18%; p<0.001), because of COVID-19 concerns (7% vs. 13%; p=0.002), or because they liked the company mission (27% vs. 33%; p=0.034). Qualitative responses reinforced these findings, highlighting themes of financial constraints, privacy, transportation, and conflicts with school or work. Among AYA participants, 158 (34%) mentioned both telehealth-related reasons and reasons related to their young age (e.g., parental concerns, being in school, or lack of transportation due to age).</p><p><strong>Conclusions: </strong>Telehealth abortion successfully served AYAs who reported compounded financial, logistical, and privacy-related barriers to in-person care. Expanding access to telehealth abortion may help AYAs continue to overcome these barriers.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov (NCT04432792).</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111741"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data interpretation of changes in abortion volume of graduating obstetrics and gynecology residents.","authors":"Mitchell D Creinin","doi":"10.1016/j.contraception.2026.111729","DOIUrl":"https://doi.org/10.1016/j.contraception.2026.111729","url":null,"abstract":"","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111729"},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Society of Family Planning Committee Statement: Management and removal of deep and nonpalpable contraceptive implants.","authors":"Paula M Castaño, Mitchell D Creinin, David L Eisenberg, Mark Hathaway, Lisa G Hofler, Neena Qasba, Sarita Sonalkar, Rachel Steward","doi":"10.1016/j.contraception.2026.111567","DOIUrl":"https://doi.org/10.1016/j.contraception.2026.111567","url":null,"abstract":"<p><p>This Committee Statement provides evidence-informed, person-centered guidance to optimize the identification, evaluation, management, and removal of deep and nonpalpable contraceptive implants. This guidance applies to clinicians removing the implants themselves or facilitating timely referral for removal. Appropriate referral includes a Center of Experience in the U.S. or similar tertiary experts outside the U.S. We discuss preventing the need for deep and nonpalpable implant removal by following proper subdermal placement techniques. When approaching removal of deep and nonpalpable implants, we recommend following a standardized protocol that addresses localization, positioning, marking the contraceptive implant location and measuring the depth, the necessary instruments, and removal techniques. When removing multi-rod contraceptive implants, we recommend that clinicians confirm both the number and location of the rods and adjust their removal approach accordingly. Finally, we discuss using the most appropriate diagnostic and procedural codes for deep or nonpalpable contraceptive implant removal services.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111567"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical preparation and induction of fetal demise practices for dilation and evacuation abortion between 24- and 27- weeks' gestation.","authors":"Maureen Paul, Samantha P Ruggiero, Susan Yanow, Sarah E Baum","doi":"10.1016/j.contraception.2026.111525","DOIUrl":"10.1016/j.contraception.2026.111525","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to describe practices for cervical preparation and induction of fetal demise among physicians providing dilation and evacuation (D&E) for abortion between 24- and 27-weeks' gestation in ambulatory settings in the US.</p><p><strong>Study design: </strong>Between June and September 2024, we recruited physicians from 14 ambulatory abortion facilities to complete an online survey. We conducted follow-up interviews with respondents as needed for clarification or additional information. We compared practices among providers using closed- and open-ended responses.</p><p><strong>Results: </strong>Among 18 respondents working at 12 facilities, most provided care throughout the gestational range and reported few limitations for obstetrical conditions (e.g. history of Cesarean section or placenta previa). It was common to place osmotic dilators the day before the D&E, use adjunctive misoprostol on the day of the D&E, and induce fetal demise on the first day of 2- or 3-day procedures. Variations across practices included number of procedure days, use of adjunctive mifepristone, medications for induction of fetal demise, timing of misoprostol, and techniques to address inadequate dilation. We described pain management and patient comfort techniques, as well as factors that influenced individualized care plans.</p><p><strong>Conclusions: </strong>Later abortion providers report a wide range of practices and techniques which have been adapted from established second-trimester D&E practices to take care of patients with more advanced gestational durations. Physicians adjust their approach to accommodate the needs of the patient or clinical circumstances.</p><p><strong>Implications: </strong>Physicians who provide abortion care at or above 24 weeks' gestation play a key role in ensuring abortion access throughout pregnancy. Documenting the diversity of current practices and techniques will support training new clinicians and those who wish to expand the gestational limits of their practice.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111525"},"PeriodicalIF":2.3,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Canadians' experiences with belief-based denial of contraception and abortion care: Results from a qualitative study.","authors":"Anvita Dixit, Joyce Arthur, Sneha Ananth, Kyle Drouillard, Angel M Foster","doi":"10.1016/j.contraception.2026.111524","DOIUrl":"10.1016/j.contraception.2026.111524","url":null,"abstract":"<p><strong>Objective: </strong>Although some evidence suggests that belief-based denial of contraception and abortion care can lead to harmful outcomes, rigorous research exploring Canadian contraception and abortion patients' experiences is scant. We undertook this qualitative study to address this gap.</p><p><strong>Study design: </strong>We conducted in-depth interviews from November 2022 to March 2023 with 30 Canadians who had experienced refusal of contraception or abortion care in the prior 10 years. We used a multi-methods recruitment strategy and focused our efforts on Alberta, British Columbia, and Ontario. The development of the interview guide was informed by prior literature, policy discussions and consultation with our community partner. We analyzed our interviews for content and themes using deductive and inductive techniques.</p><p><strong>Results: </strong>Participants reported being denied a range of contraception and abortion services for reasons including age, parity, and the provider's religious beliefs or institutional affiliation. Participants reported feeling angry, disappointed, and frustrated after being denied care. They consistently voiced an opposition to policies allowing providers to refuse reproductive health services based on personal beliefs.</p><p><strong>Conclusions: </strong>Allowing healthcare providers to deny care based on their personal beliefs creates barriers to accessing necessary health services. Reforming these regulations and ensuring enforcement of professional standards appears warranted.</p><p><strong>Implications: </strong>Policymakers and clinicians should consider reforming regulations governing belief-based denial of care informed by patient experiences and with attention to patient-centered outcomes. Creating enforcement mechanisms to ensure that Canadians receive the comprehensive reproductive health services they want, need, and deserve is warranted.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111524"},"PeriodicalIF":2.3,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent experiences navigating contraceptive side effects and method satisfaction.","authors":"Vanya Manthena, Sophie Knifton, Madeline Quasebarth, Eryn Wanyonyi, Jessica Klugman, Katherine Rivlin, Lee Hasselbacher","doi":"10.1016/j.contraception.2026.111523","DOIUrl":"10.1016/j.contraception.2026.111523","url":null,"abstract":"<p><strong>Objectives: </strong>We explored adolescent contraceptive choices, their experiences with side effects, and how these experiences shaped perceptions of contraceptive use over time.</p><p><strong>Study design: </strong>We conducted in-depth narrative interviews with adolescents aged 13-18 in Illinois to understand their contraceptive journeys. Participants were recruited through outpatient reproductive health clinics, social media, and snowball sampling. Interviews were conducted online via Zoom between December 2023 and October 2024, audio-recorded, verified, transcribed, and coded using Dedoose.</p><p><strong>Results: </strong>Of the 27 adolescent participants, the majority are adolescents of color, with a mean age of 16.5 years. Participants' contraceptive journeys occurred in four stages: (a) balancing preferences in contraception initiation (b) navigating physical and emotional responses with the selected method, and either (c) method satisfaction or (d) method switching. Participants anticipated potential side effects, and experienced emotional responses including mood changes, anger, and frustration when side effects disrupted daily life. More than half (n = 16) of participants reported changing their contraceptive method at least once, but none reported discontinuing entirely. A few participants considered negative side effects as 'worth it' if the method provided benefits such as menstrual regulation or hormonal balance.</p><p><strong>Conclusion: </strong>Adolescents often chose to switch contraceptive methods, emphasizing the importance of finding the option that best fits their needs. Clinicians can support this process by acknowledging emotional responses about negative side effects and discussing the benefits and considerations of method switching to facilitate informed, shared decision-making.</p><p><strong>Implications: </strong>Results suggest that clinicians should engage adolescents in discussions about their experiences with side effects and emotional responses when using contraception in order to help them find contraceptive options aligned with their preferences, including supporting them in switching methods.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111523"},"PeriodicalIF":2.3,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical preparation prior to dilation and evacuation between 13 and 16 weeks gestation.","authors":"Lillian C Chen, Guillaume Stoffels, Kelly Wang, Shanell Morrison-Buckley, Katharine R Phillips, Monica V Dragoman","doi":"10.1016/j.contraception.2026.111522","DOIUrl":"10.1016/j.contraception.2026.111522","url":null,"abstract":"<p><strong>Objective: </strong>Compare differences in dilation and evacuation (D&E) outcomes after single-agent cervical preparation.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of patients receiving buccal misoprostol, oral mifepristone, or osmotic dilators prior to D&E between 13 and 16 weeks gestation. The primary outcome was procedure time and secondary outcomes were procedure complications.</p><p><strong>Results: </strong>From 277 D&E cases, there was no significant difference in adjusted procedure time (p = 0.11). Mifepristone was associated with a lower estimated blood loss (EBL) after adjusting for gestational age, however, this difference may not be clinically significant. There were few procedure complications across all methods of cervical preparation.</p><p><strong>Conclusions: </strong>All 3 methods of cervical preparation were associated with short procedure times and few complications. Selection of the cervical preparation method can be individualized to patient preferences and individual needs.</p><p><strong>Implications: </strong>There is currently no standardized recommendation for cervical preparation prior to D&E in the late first and early second trimesters; our findings demonstrate short procedure times and few complications for all methods of cervical preparation for D&E between 13 and 16 weeks gestation.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111522"},"PeriodicalIF":2.3,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}