Contraception最新文献

{"title":"Interest in period pills in the United States: A nationally representative survey, 2021-2022.","authors":"Ushma D Upadhyay, Cari Sietstra, Leah R Koenig, Jennifer Ko, M Antonia Biggs","doi":"10.1016/j.contraception.2025.110980","DOIUrl":"10.1016/j.contraception.2025.110980","url":null,"abstract":"<p><strong>Objectives: </strong>Period pills are a method used to induce bleeding when a menstrual period is late and pregnancy is suspected but not confirmed. This practice enables people to ensure they are not pregnant, without first confirming the existence of a pregnancy. We aimed to measure the extent of interest in period pills.</p><p><strong>Study design: </strong>We used data from a nationally representative panel survey implemented from December 2021 to January 2022 among people ages 15 to 49 assigned female sex at birth to explore interest in and support for period pills after reading descriptive information about them. We estimated the weighted national prevalence of interest in potentially using the pills and support for their availability. We used weighted bivariate logistic regression to examine factors associated with these two outcomes.</p><p><strong>Results: </strong>Among the 6964 participants in the analytic sample, one-quarter (24%, 95% confidence interval [CI]: 22%, 25%) reported that they would consider personally using period pills, and another 19% (95% CI: 17%, 20%) were uncertain. Half of the participants (52%, 95% CI: 50%, 53%) said they were in favor of period pills being available, and another 24% (95% CI: 23%, 26%) were uncertain. Factors associated with both considering using or supporting their availability include being ages 18 to 29 (vs 40-49), completing college, never having been married, having a prior abortion, identifying as lesbian, gay, bisexual, queer or another non-straight sexual orientation, and having experienced barriers to sexual and reproductive health services.</p><p><strong>Conclusions: </strong>There is substantial public interest in and support for period pills, which supports expanding options that enable people to control their fertility.</p><p><strong>Implications: </strong>Given the substantial interest in period pills found in this study, clinicians should consider offering them to patients as an additional option to control their fertility.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110980"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251320","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":"Pharmacist-prescribed contraception using clinical protocols: A review of the gray literature.","authors":"Victoria Anne Chisari, Helen Benson, Shalom Charlie Benrimoj, Therese Foran, Sarah Dineen-Griffin, Kylie Williams","doi":"10.1016/j.contraception.2025.110979","DOIUrl":"10.1016/j.contraception.2025.110979","url":null,"abstract":"<p><strong>Background: </strong>Many women face barriers to starting and continuing contraception due to difficulties in accessing primary care. Pharmacist-prescribed contraceptives have emerged as a strategy to improve access. This approach offers an additional pathway for women to access contraceptive care, with benefits such as lower costs, shorter wait times, and extended hours.</p><p><strong>Objectives: </strong>This review aims to analyze clinical protocols used by community pharmacists to prescribe and continue hormonal contraceptives and evaluate their quality.</p><p><strong>Methods: </strong>This review utilized gray literature since protocols are often not formally published. The search involved four processes: searching a gray literature database, using Google, reviewing health agency websites, and consulting international experts. Records were included if they met the definition of a clinical protocol, were for community pharmacist prescribing or continuation of hormonal contraception, and were written in English. Grounded Theory was used for analysis. Quality appraisal was performed using the Appraisal of Guidelines for Research and Evaluation II tool.</p><p><strong>Results: </strong>Thirty clinical protocols were identified from the USA (n = 23), Canada (n = 2), the UK (n = 2), New Zealand (n = 1), and Australia (n = 2). Pharmacists were authorized to prescribe and continue contraceptives in 27 protocols and continue contraceptives only in three. Key requirements included age restrictions, measurement of blood pressure and body mass index, review by a health professional, patient self-completed screening tools, and use of best-practice guidelines. The lowest-scoring domains in the quality assessment were \"Editorial Independence,\" \"Applicability,\" and \"Rigor of Development.\"</p><p><strong>Conclusions: </strong>The review provides insights into the current international landscape of pharmacist-prescribed contraception and highlights key components of clinical protocols. It offers valuable information for policymakers to support the development of frameworks for pharmacist-prescribed contraception globally.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110979"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201057","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":"Progestin-only contraception and thrombosis: An updated systematic review.","authors":"Naomi K Tepper, Antoinette T Nguyen, Maura K Whiteman, Kathryn M Curtis","doi":"10.1016/j.contraception.2025.110978","DOIUrl":"10.1016/j.contraception.2025.110978","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence is limited on whether the use of progestin-only contraception (POC) is associated with the risk of thrombosis. Our objective was to update an earlier systematic review on POC and thrombosis risk.</p><p><strong>Methods: </strong>We searched for articles that examined risk of venous thromboembolism (VTE) (e.g., deep venous thrombosis or pulmonary embolism) or arterial thromboembolism (ATE) (e.g., myocardial infarction or stroke) among women with thrombogenic conditions or characteristics or in the general population using POC, compared with women using nonhormonal or no contraception, published during February 1, 2016 through November 30, 2022. We also included articles from a previous systematic review, with articles published through January 2016. We assessed quality for each study and certainty of evidence for all outcomes.</p><p><strong>Results: </strong>Thirty-three articles met inclusion criteria; one was good quality, 20 were fair quality, and 12 were poor quality. Seven articles were newly identified, and 26 were included in the previous review. Risk of VTE, but not ATE, was generally elevated with depot medroxyprogesterone acetate (DMPA) use among women with certain thrombogenic conditions or characteristics (e.g., diabetes or postpartum) and women in the general population. Risks of VTE and ATE were generally not elevated with use of other POC, including levonorgestrel intrauterine devices, implants, or progestin-only pills.</p><p><strong>Conclusions: </strong>Evidence suggests that risk of VTE, but not ATE, is increased with DMPA use compared with nonuse among women with certain thrombogenic conditions and women in the general population. Evidence does not suggest increased risk of VTE or ATE with use of other POC. While several studies examined thrombosis risk with POC use and thrombogenic conditions or characteristics, data are limited for individual conditions or characteristics and no evidence was identified for most conditions. The certainty of evidence is low or very low for all outcomes.</p><p><strong>Implications: </strong>Use of DMPA might increase the risk of VTE among women with medical conditions associated with thrombosis and among women in the general population. Evidence does not suggest an increased risk of thrombosis with other POC. Further study is needed on safety of POC use by women with thrombogenic conditions.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110978"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201058","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":"A systematic comparison of implementation strategies at three U.S. clinic settings that expanded access to self-administered injectable contraception.","authors":"Jennifer Karlin, Tammy Bennett, Leah Michael, Sally Rafie, Elise D Berlan","doi":"10.1016/j.contraception.2025.110972","DOIUrl":"10.1016/j.contraception.2025.110972","url":null,"abstract":"<p><strong>Objectives: </strong>To describe experiences and systematically compare three U.S. clinics that initiated or expanded access to depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) for self-administration during the COVID-19 pandemic.</p><p><strong>Study design: </strong>We used the Expert Recommendations for Implementing Change (ERIC) framework to systematically compare three case studies of implementation projects that expanded use of self-administered DMPA-SC in the United States during the COVID-19 pandemic.</p><p><strong>Results: </strong>All three settings used multiple implementation strategies and common strategies fell into five main categories including (1) increasing provider awareness about self-administration of DMPA-SC and continuing education for clinical staff, (2) providing patient education and counseling tailored to patients' needs, (3) supporting changes in clinic workflow, (4) addressing insurance coverage and payment, and (5) reducing barriers to filling prescriptions for self-administered DMPA-SC. Ongoing implementation challenges identified include mitigating additional payment barriers for DMPA-SC and increasing access points beyond physical clinical sites.</p><p><strong>Conclusion: </strong>The implementation strategies described in this study may be generalizable to other settings and help U.S.-based clinics and health care providers meet current recommendations for ensuring access to self-administration of DMPA-SC.</p><p><strong>Implications: </strong>Three sites that successfully expanded access to self-administration in the U.S. demonstrate the importance of the following implementation strategies: (1) increasing provider awareness about self-administration of DMPA-SC and continuing education for clinical staff, (2) providing patient education and counseling tailored to patient's needs, (3) supporting changes in clinic workflows, (4) addressing insurance coverage and payment, and (5) reducing barriers to filling prescriptions for self-administered DMPA-SC.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110972"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144964","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":"Comparative performance of ultrathin and standard latex condoms: A randomized multicentre trial.","authors":"Frederic Esclassan, Nina Tank, Alice Switonski, Markus J Steiner, Sarah Hood, Unnop Jaisamrarn","doi":"10.1016/j.contraception.2025.110970","DOIUrl":"10.1016/j.contraception.2025.110970","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the performance of a natural rubber latex condom with a thickness of 42 µm, compared with two currently marketed alternatives.</p><p><strong>Study design: </strong>In this blinded, three-way crossover, multicentre study, across four sites in Thailand, couples were randomized to receive one of three thicknesses of condom (42, 55, or 70 µm) at first visit. Couples received the remaining condoms at visits two and three, respectively. Participants were given seven condoms at each visit and asked to use at least five condoms of each thickness and report any clinical failures (slippage or breakage during intercourse or withdrawal from the vagina). Participants recorded adverse events and clinical failures within 2 hours of use.</p><p><strong>Results: </strong>A total of 225 couples completed the study. Clinical failure rates were 1.37% (95% confidence intervals [CIs] 0.78, 2.22) in the 42 µm group, 2.12% (95% CI 1.38, 3.11) in the 55 µm group, and 1.68% (95% CI 1.03, 2.58) in the 70 µm group. The 42 µm condom was noninferior compared with each of the reference condoms and had a similar safety profile.</p><p><strong>Conclusions: </strong>This ultrathin, natural rubber latex condom of <50 µm has been clinically tested to current International Organization for Standardization standards. The 42 µm condom was as effective as the 55 and 70 µm condoms, demonstrating that performance in terms of failure rate, slippage, or breakage was not altered by its thinness.</p><p><strong>Implications: </strong>This ultrathin NRL condom of <50 µm has been clinically tested to current International Organization for Standardization standards. This could help to ease concerns about whether ultrathin condoms might compromise reliability and increase failure rate.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110970"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144969","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":"Implementing digital sexual and reproductive health tools: Challenges and recommendations post-Dobbs.","authors":"Lisa S Callegari, Elizabeth A Mosley, Sonya Borrero, Mehret Birru Talabi, Traci M Kazmerski, Greer Donley, Tamar Krishnamurti","doi":"10.1016/j.contraception.2025.110969","DOIUrl":"10.1016/j.contraception.2025.110969","url":null,"abstract":"<p><p>Abysmal sexual and reproductive health (SRH) outcomes in the United States persist due to multiple factors, including diminishing SRH care access and inequities in care for socially or economically marginalized populations. Digital innovations have the potential to address gaps in SRH care as scalable, low-cost, patient-centered solutions that supplement the formal healthcare system. Our multidisciplinary team has developed a suite of patient-facing digital tools to help address suboptimal SRH care delivery for marginalized individuals capable of pregnancy, including those with chronic medical conditions. These tools-MyPath for reproductive preferences, prepregnancy health, and contraception; MyVoice for SRH needs of people with rheumatic/autoimmune disease or cystic fibrosis; MyDecision for tubal sterilization; and MyHealthyPregnancy for tailored pregnancy support-are guided by principles of community engagement, person-centeredness, and health equity. In the wake of the Dobbs v. Jackson Women's Health Organization 2022 Supreme Court decision overturning federal abortion protections, as well as the rapidly shifting policy landscape under the current administration, there are new considerations for use and implementation of digital SRH tools. In this commentary, we draw directly from lessons learned in our work to discuss emerging concerns related to data privacy and pregnancy criminalization, trust in healthcare providers and systems, and research. We then propose recommendations for researchers seeking to create, implement, and evaluate these tools with the goal of safeguarding reproductive autonomy and achieving health equity in this new policy context.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110969"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145011","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":"Navigating FemTech app regulation in Switzerland: Challenges and opportunities from a public health perspective.","authors":"Marie-Hélène Peter-Spiess, Dylan Hofmann","doi":"10.1016/j.contraception.2025.110975","DOIUrl":"10.1016/j.contraception.2025.110975","url":null,"abstract":"<p><p>This article examines the Swiss legal framework governing FemTech applications (apps), particularly those dedicated to fertility tracking. It explores the challenges and opportunities associated with regulating these apps from a public health perspective, oriented towards the health of the collectivity rather than that of individuals alone. While these technologies hold great potential, they also raise various critical concerns. Against this background, this article considers ways to improve the current legal framework to better protect all stakeholders while promoting public health outcomes. By addressing the complex interplay between technological innovation and state responsibility, including the roles of governmental and regulatory bodies, this piece aims to explore ways to maximize the opportunities offered by FemTech while ensuring public well-being.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110975"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145014","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":"Smooth muscle relaxants for intrauterine device placement: A systematic review.","authors":"Emily M Snyder, Gopika Krishna, Lauren B Zapata, Antoinette T Nguyen, Maura K Whiteman, Kathryn M Curtis","doi":"10.1016/j.contraception.2025.110971","DOIUrl":"10.1016/j.contraception.2025.110971","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically review evidence on whether medications with smooth muscle relaxant properties improve patient and provider outcomes for intrauterine device (IUD) placement.</p><p><strong>Study design: </strong>We searched multiple databases through August 2022 for randomized clinical trials assessing smooth muscle relaxants for IUD placement. Primary outcomes were pain experienced with IUD placement, provider ease of placement, need for adjunctive placement measures, placement success, patient satisfaction with procedure, medication side effects occurring before clinic discharge, and adverse events occurring before clinic discharge. We extracted data from included articles, assessed risk of bias for each trial, narratively summarized results, and determined certainty of evidence for all outcomes.</p><p><strong>Results: </strong>Five placebo-controlled trials met inclusion criteria; four trials had low risk of bias and one had moderate risk. Two trials of topical nitroprusside gel or nitroglycerin ointment found no differences in patient pain, provider ease of placement, patient satisfaction, placement success, side effects, or adverse events. One trial suggested that drotaverine plus mefenamic acid reduced patient pain but did not improve placement success. Two trials suggested that isonicotinic acid hydrazide reduced patient pain, improved provider ease of placement and patient satisfaction, reduced need for analgesia and for cervical dilation (in one trial) and did not increase side effects; neither trial reported improved placement success.</p><p><strong>Conclusions: </strong>Evidence on smooth muscle relaxants for IUD placement remains sparse with inconsistent findings across specific medications. Certainty of evidence for all outcomes was low for topical nitroprusside gel and nitroglycerin ointment, very low for drotaverine plus mefenamic acid, and mostly high for isonicotinic acid hydrazide.</p><p><strong>Implications: </strong>Before IUD placement, healthcare providers can counsel patients on the potential for pain during placement and options for pain management. However, more evidence is needed on specific smooth muscle relaxants to determine their effectiveness as an intervention for IUD placement.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110971"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145015","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":"Abortion experiences of individuals with a history of trauma(s): A qualitative study.","authors":"Kristen Chalmers, Diana Marino-Nunez, Candice Norcott, Danielle Young, Julie Chor","doi":"10.1016/j.contraception.2025.110973","DOIUrl":"10.1016/j.contraception.2025.110973","url":null,"abstract":"<p><strong>Objective: </strong>Individual trauma is highly prevalent among reproductive age individuals who can become pregnant. We sought to elicit perspectives of individuals with a history of trauma about their abortion experiences, trauma-activating factors in abortion care, and how to optimally incorporate trauma-responsive principles into abortion care.</p><p><strong>Study design: </strong>Patients with a self-identified history of three types of trauma (sexual assault, interpersonal violence, adverse childhood experience) were recruited from family planning clinics in the Chicago-area to participate in semi-structured phone interviews. Qualitative data was analyzed using ATLAS.ti.</p><p><strong>Results: </strong>Analysis of thirty interviews identified trauma-activating factors and trauma-responsive strategies throughout the abortion experience. Participants reported that, pre-abortion, restricted access and limited options activated trauma-related feelings of autonomy loss and a desire for unbiased information. During procedures, participants described how physical pain/discomfort and healthcare professional use of insensitive language worsened their experience. In contrast, use of neutral language, warnings prior to touch, proper draping, and checking-in and offering options helped mitigate effects of prior history of trauma(s). Post-procedurally, participants desired mental health support specifically addressing abortion-related stigma, though this resource was rarely available.</p><p><strong>Conclusions: </strong>Throughout abortion care, numerous opportunities exist to help activate or mitigate trauma responses among individuals with a history of trauma. These opportunities exist at the level of the individual provider as well as the level of the clinic, and must be considered to fully address the needs of individuals seeking abortion who have experienced prior trauma(s).</p><p><strong>Implications: </strong>Healthcare providers and systems can influence abortion experiences in ways that range from aggravating to ameliorating prior trauma for individuals with prior trauma experience(s). Therefore, trauma-responsive principles must be universally applied throughout abortion care.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110973"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144966","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":"Provider confidence and willingness to insert and remove long-acting reversible contraception methods in Kenyan public facilities.","authors":"Katherine Tumlinson, Stephanie Chung, Brooke W Bullington, Dickens Otieno Onyango, Leigh Senderowicz, Abigael Mwanyiro, Ben Wekesa, Brian Frizzelle, Ginger Golub, Claire W Rothschild, Emilia Goland","doi":"10.1016/j.contraception.2025.110956","DOIUrl":"10.1016/j.contraception.2025.110956","url":null,"abstract":"<p><strong>Objective: </strong>Use of long-acting reversible contraception (LARC) in Kenya has grown over the last decade, yet emerging evidence points to challenges in LARC removal. The objective of this paper is to document provider training in LARC insertion/removal and to better understand provider experience, confidence, and willingness to both insert and remove LARC.</p><p><strong>Study design: </strong>In this paper we present a descriptive analysis of self-reported data from family planning providers working in all 137 public-sector healthcare facilities in Kisumu County (Western Kenya). We assess the frequency of public-sector provider training, experience, confidence, and willingness to insert and remove LARC, as well as the association between confidence and willingness to provide these services.</p><p><strong>Results: </strong>A substantial proportion of providers in our study lacked training in the insertion and removal of both implants and intrauterine devices (IUDs). Overall, providers reported that they were more experienced, confident, and willing to insert implants rather than remove them. A fifth of providers trained in IUD insertion were not confident in their ability to insert IUDs and nearly 10% were not willing to perform insertion. In contrast, 8% of providers trained in IUD insertion were not confident in their ability to remove IUDs and 6% were not willing to remove them. Provider confidence was significantly associated with willingness to insert/remove both implant and IUD. Less than two-thirds of facilities demonstrated stock of the implant (61%) or IUD (58%).</p><p><strong>Conclusion: </strong>Results raise important concerns about reproductive autonomy within the larger environment of family planning programs that heavily promote LARC use. Within Kisumu, public-sector providers require greater supplies and support to maintain confidence and ensure their willingness to engage in LARC insertion and removal in equal measure.</p><p><strong>Implications: </strong>We find that many providers at public sector healthcare facilities in Kisumu, Kenya lacked training in LARC insertion and removal. Providers reported that they were more experienced, confident, and willing to insert rather than remove implants, which poses a potential threat to reproductive autonomy.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110956"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133225","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}