Contraception最新文献

{"title":"Association of Obstetric Comorbidity Index Score with Postpartum Contraception Use among Medicaid Recipients in the United States.","authors":"Maria I Rodriguez, Thomas Ha Meath, Ashley Daly, Kelsey Watson, Aaron B Caughey, Hyunjee Kim","doi":"10.1016/j.contraception.2025.111005","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.111005","url":null,"abstract":"<p><strong>Objective: </strong>Little is known about postpartum contraceptive use among people at high risk for severe maternal morbidity (SMM). Our objective was to evaluate the association between risk for severe maternal morbidity (SMM) and postpartum contraceptive use.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of live births to Medicaid recipients from 2016 to 2020 across 44 US states. We evaluated risk for SMM by calculating the Obstetric Comorbidity Index (OCI) scores for each enrollee into lowest risk (OCI = 0) and highest risk (top quartile) groups. We determined the association between the highest quartile OCI score with use of most or moderately effective postpartum contraception and attendance at outpatient postpartum visits within 60 days. Models adjusted for maternal age, mode of delivery, and comorbidities.</p><p><strong>Results: </strong>Of 3,342,568 deliveries, 2,474,020 deliveries were associated with an OCI score of 0 (Q0; no risk factors for SMM), while the highest quartile of non-zero OCI scores (Q4) ranged from 13 to 96 (mean risk of SMM 19.7%, SD 7.1) and encompassed 868,548 deliveries. Individuals with the highest risk for SMM were more likely to use postpartum contraception (40.0% vs. 32.6%), although after removing sterilization, the difference was modest (32.6% vs. 30.1%). There was no meaningful difference in rates of outpatient postpartum visit among people with the highest and lowest OCI scores (46.1% vs. 45.6%).</p><p><strong>Conclusion: </strong>Medicaid recipients with high OCI scores are only slightly more likely to use postpartum contraception as their low-risk peers, and over half will not have outpatient postpartum visit by 60 days.</p><p><strong>Implications: </strong>Medicaid recipients at high risk for maternal morbidity are only slightly more likely to use postpartum contraception.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111005"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565565","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":"Use of PROMIS Global-10 to measure changes in health-related quality of life among contraceptive initiators; a feasibility study.","authors":"Emily S Barker, Rachel Paul, Megan Dorsey, Jennifer A Reeves, Tessa Madden","doi":"10.1016/j.contraception.2025.111004","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.111004","url":null,"abstract":"<p><strong>Objective: </strong>To assess the feasibility of recruiting initiators of combined oral contraceptives (COC) or the levonorgestrel intrauterine device (LNG-IUD) and using PROMIS Global-10 to compare the change in health-related quality of life (HRQOL) between baseline and six months.</p><p><strong>Study design: </strong>We recruited patients aged 18-45 years initiating COC or LNG-IUD at a single academic medical center. We also enrolled patients using a coitally dependent or no contraceptive method (hormonal contraception [HC] non-users) for comparison. Participants completed PROMIS Global-10 at baseline and six months. PROMIS Global-10 measures physical and mental health quality of life with higher scores indicating better health. We calculated the change in t-scores from baseline to six months using appropriate non-parametric tests.</p><p><strong>Results: </strong>We enrolled 150 participants (50 per group) over a 12-month period. Of these, 39 (78%) COC, 44 (88%) LNG-IUD, and 43 (86%) HC non-users completed six months of follow-up. We did not observe a significant change in t-scores in paired-sample analyses (physical: median 0.0, IQR: -3.1, 3.8, p=0.35; mental: median 0.1, IQR: -4.3, 4.7, p=0.78) between baseline and 6 months for COC or LNG-IUD users. T-scores were similar between the three groups at baseline (physical: p=0.32; mental: p=0.20) and six months (physical: p=0.20; mental: p=0.12).</p><p><strong>Conclusion: </strong>In our setting, recruitment of COC or LNG-IUD initiators was slower than anticipated. We did not observe a difference in physical and mental HRQOL among patients initiating COC and LNG-IUD at six months compared to baseline, nor compared to patients not initiating hormonal contraception, using the PROMIS Global-10.</p><p><strong>Implications: </strong>Using PROMIS Global-10 to measure HRQOL, we did not observe significant changes in health-related quality of life in the six months after starting LNG-IUDs or COC compared to baseline and to people not using hormonal contraception.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111004"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531719","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":"Characteristics of people obtaining mifepristone and misoprostol and misoprostol-only telehealth medication abortion services in the United States.","authors":"Dana M Johnson, Terri-Ann Thompson, Fiona Scovack, Melissa Grant","doi":"10.1016/j.contraception.2025.111001","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.111001","url":null,"abstract":"<p><strong>Objectives: </strong>This study compares the characteristics of people using mifepristone/misoprostol, and misoprostol-only telehealth medication abortion regimens in the United States (US).</p><p><strong>Study design: </strong>We abstracted and analyzed characteristics for all clients using a virtual clinic between April 27, 2020, and May 31, 2022. We compare sociodemographic characteristics between clients who used either mifepristone and misoprostol, or misoprostol-only. We conducted multivariable analyses to identify characteristics associated with using each regimen.</p><p><strong>Results: </strong>The analytic sample included 8,790 clients: 84% used mifepristone and misoprostol, and 16% used misoprostol-only. Most clients (54%) were aged 26-35. Characteristics of having fewer years of education, living in the Mid-Atlantic or Midwest, and reporting a lower income were positively associated with using misoprostol-only. Characteristics of identifying as white or a race other than Black or white, as well as having higher levels of education and reporting a higher income, were positively associated with using mifepristone/misoprostol. Although not directly tested, associated characteristics indicate that a difference in regimen price may have influenced regimen use.</p><p><strong>Conclusions: </strong>Findings demonstrate the range of people who have telehealth medication abortions and suggest some differences between clients who used mifepristone/misoprostol and clients who used misoprostol-only.</p><p><strong>Implications: </strong>As mifepristone continues to be restricted and telehealth abortions are a growing share of the medication abortions provided in the US, these findings inform service delivery for clinics considering expanding into telehealth to provide misoprostol-only regimens. Findings also inform expanding policies aimed at the affordability of services, including expanding coverage from private, public, and Medicaid insurance programs.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111001"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531716","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":"Disparities in Perceptions of Long-Acting Reversible Contraceptives among Patients in Delaware Title X Clinics.","authors":"Collin W Mueller, Constanza Hurtado-Acuna, Heide M Jackson","doi":"10.1016/j.contraception.2025.111002","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.111002","url":null,"abstract":"<p><strong>Objectives: </strong>We examined whether there were racial/ethnic and insurance status differences in patients reporting a sense of relief with the idea of using LARCs and whether these differences were attenuated by provider trust and fertility concerns among Title X patients.</p><p><strong>Study design: </strong>We analyzed two waves of data from a repeated cross-sectional patient survey designed to capture a representative sample of Title X patient health encounters in Delaware (N=797), fielded in the context of a larger study designed to evaluate a statewide intervention to improve patient access to highly effective contraceptive methods.</p><p><strong>Results: </strong>We found that a majority of patients reported a sense of relief associated with the idea of using LARCs and differences by race/ethnicity and insurance status. Insurance coverage differences were attenuated by adjusting for reversibility concerns, fertility concerns, and patient-provider trust, but racial/ethnic disparities remained. 59% (95% CI = 55%-63%) of Black respondents reported a sense of relief at the idea of having a LARC, compared with 67% (95% CI = 63%-71%) and 65% (95% CI = 62%-67%) of White and Hispanic/Latinx patients, respectively. Patients who did not trust their provider to remove an IUD on request had a predicted probability of 50% (95% CI = 43%-57%) of viewing LARC with a sense of relief compared with 70% (95% CI = 64%-76%) of patients who reported trust in their provider to do so.</p><p><strong>Conclusions: </strong>This study contributes to the growing body of research on reproductive autonomy by shedding further light on how decisions regarding contraceptive usage are made in the context of perceived agency constraints in healthcare settings.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111002"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531717","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":"Telehealth use among publicly funded family planning clinics in the United States: Results from a national survey.","authors":"Madeleine Haas, Priscille Osias, Jennifer Mueller, Alicia VandeVusse","doi":"10.1016/j.contraception.2025.111003","DOIUrl":"10.1016/j.contraception.2025.111003","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to examine the scope of telehealth contraceptive services at publicly supported family planning clinics.</p><p><strong>Study design: </strong>We surveyed a sample of 446 publicly supported family planning clinics in the United States.</p><p><strong>Results: </strong>Most clinics offer some services via telehealth, but provision varies widely by clinic type, with Planned Parenthood clinics offering telehealth most frequently, and by service, with certain contraceptive services, sexually transmitted infections (STI) testing and treatment, and medication abortion less frequently available than messaging services.</p><p><strong>Conclusions: </strong>Health departments and federally qualified health centers may need more support and infrastructure to implement telehealth for contraceptive care.</p><p><strong>Implications: </strong>Many publicly supported family planning clinics in the United States offer telehealth for contraceptive care, but clinics vary in the types of services available via telehealth. Clinics and patients who want or need to use telehealth for contraceptive care may need more supportive infrastructure to do so.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"111003"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531718","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":"Expanding contraceptive options: A scoping review of medically approved contraceptive methods that are not in the WHO Medical Eligibility Criteria.","authors":"Sameera Mokkarala, Asantesana Kamuyango, James Kiarie, Nancy Kidula, Li Jiang, Sarita Sonalkar","doi":"10.1016/j.contraception.2025.110983","DOIUrl":"10.1016/j.contraception.2025.110983","url":null,"abstract":"<p><strong>Objectives: </strong>The World Health Organization's (WHO) Medical Eligibility Criteria for contraceptive use (MEC) provides recommendations on the safety and efficacy of a range of contraceptive methods for users with various medical conditions. However, there are methods with medical regulatory agency approval that are not included in WHO guidance. Our objectives were to evaluate the evidence on methods that have regulatory approval for use in any member state, but which are not included in the MEC 2015, and to determine whether the evidence should be systematically reviewed to inform possible inclusion in a new WHO guideline.</p><p><strong>Study design: </strong>We conducted a scoping review of experimental studies found through two bibliographic databases (PubMed, Embase) from database inception to December 2023. Two reviewers screened abstracts and full texts to determine eligibility based on a priori inclusion and exclusion criteria; one additional reviewer resolved conflicts. Reviewers extracted data on method safety, efficacy, and acceptability using a standardized tool.</p><p><strong>Results: </strong>We identified three methods that met our review criteria: ormeloxifene, quinestrol-containing contraception, and mifepristone for emergency contraception (EC). Our initial search strategies yielded 386 total results. Five publications related to ormeloxifene, five to quinestrol-containing contraception, and 10 to mifepristone for EC were included. The data on these methods was highly variable.</p><p><strong>Conclusion: </strong>Rigorous systematic reviews of the evidence on safety, efficacy and dosage of ormeloxifene, quinestrol-containing contraception, and mifepristone for EC are needed to inform WHO recommendations on these methods. As these methods are already being used, international guidance for practitioners is essential.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110983"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369709","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":"Potassium chloride intracardiac fetal injection and tissue degeneration at fetal autopsy following induction abortion.","authors":"Kelvin Chui, Jefferson Terry, Jennifer A Hutcheon, Chantal Mayer, Jessica Liauw","doi":"10.1016/j.contraception.2025.110986","DOIUrl":"10.1016/j.contraception.2025.110986","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the impact of potassium chloride intracardiac injection (KCl) on tissue degeneration at fetal autopsy, which may help inform termination care and autopsy expectations.</p><p><strong>Study design: </strong>In this retrospective cohort of induction abortions with fetal autopsies (N = 266), we estimated the association between KCl and fetal tissue degeneration (qualitative assessment and quantitative ratio of basophilia:eosinophilia). We used log binomal and linear regression to calculate risk ratios and mean differences with 95% confidence intervals.</p><p><strong>Results: </strong>Those who received KCl were more likely to have qualitative tissue degeneration than those who did not (RR 2.8 [95% CI 1.3-6.1]). Quantitative basophilia:eosinophilia ratios were lower among those with KCl (mean difference in cardiac tissues of -0.031 [95% CI -0.039 to -0.023]), which further supports increased tissue degeneration in these cases.</p><p><strong>Conclusions: </strong>Fetal autopsies from induction abortions that had KCl fetal injection had increased risk of tissue degeneration compared with those that did not.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110986"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340776","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":"Three cases of second trimester uterine evacuation in patients with partially or undiagnosed Mullerian anomalies.","authors":"Kaleigh Olmsted, Amber Priester, Annika Van Oosbree, Madalyn Snoddy, Angela Dempsey","doi":"10.1016/j.contraception.2025.110985","DOIUrl":"10.1016/j.contraception.2025.110985","url":null,"abstract":"<p><p>Mullerian anomalies complicate abortion care. Published experience to guide clinicians is scant. We present three cases of second trimester procedural abortion in patients with undiagnosed or partially diagnosed Mullerian anomalies and offer strategies that clinicians may implement when caring for similar patients.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110985"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340777","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":"State-funded insurance coverage of abortions for undocumented immigrants in the United States.","authors":"Kimberly M Schaefer, Meesha Vullikanti, Rachel Feldman, Maria Bazan, Maria I Rodriguez, Deborah Bartz, Rose L Molina","doi":"10.1016/j.contraception.2025.110982","DOIUrl":"10.1016/j.contraception.2025.110982","url":null,"abstract":"<p><strong>Objectives: </strong>To describe governmental insurance coverage and philanthropic fund options for abortion among undocumented immigrants.</p><p><strong>Study design: </strong>Internet-based review of publicly available information from state Medicaid and philanthropic abortion fund websites regarding abortion coverage for undocumented immigrants in the United States.</p><p><strong>Results: </strong>Ten states have abortion coverage for undocumented immigrants. Of these, six state websites offered translations into multiple languages. We identified no immigration status requirements for state or national philanthropic funds.</p><p><strong>Conclusions: </strong>Most states do not provide Medicaid funding for abortion for undocumented immigrants. The limited information on state websites about this abortion coverage increases barriers for an already marginalized population.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110982"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487448","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":"Safeguarding autonomy: Examining the complexities and implications of under-regulated period-tracking apps and paired devices in a post-Roe landscape.","authors":"Bridget G Kelly, Ornsiree Junchaya, Jie Min, Michael Burdan","doi":"10.1016/j.contraception.2025.110981","DOIUrl":"10.1016/j.contraception.2025.110981","url":null,"abstract":"<p><p>Period-tracking applications (PTA) and paired data-tracking devices have become popular tools for promoting reproductive health, offering features to monitor menstrual cycles and track fertility. However, these apps present significant concerns regarding the privacy of sensitive health data as the current legal landscape provides inadequate coverage to ensure user safety, leaving the collection, usage, management, and disclosure of data to be determined by company leaders. While the Federal Trade Commission (FTC) has regulatory mechanisms to hold PTAs accountable for their business practices, security concerns remain. Fears around personal health data security have intensified after the U.S. Supreme Court's 2022 decision to overturn Roe v. Wade as experts warn digital reproductive health data derived from PTAs could be used as criminal evidence in states with abortion restrictions. In the absence of a federal standard protecting the right to abortion, a comprehensive approach to safeguarding digital reproductive health data is required to ensure PTAs can remain health literacy tools that promote reproductive health and autonomy. This commentary reviews the current regulatory environment in the U.S. regarding PTAs, highlighting the risks to user privacy and data security-as evidenced by the 2020 FTC complaint against Flo Health, Inc. for sharing sensitive user data with third parties-and the broader implications of regulatory gaps in a post-Roe landscape.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110981"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295517","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}