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Funding policies and postabortion long-acting reversible contraception: results from a cluster randomized trial.
Am J Obstet Gynecol 2016; 214(6):716.e1-8AJ

Abstract

BACKGROUND

Almost one-half of women having an abortion in the United States have had a previous procedure, which highlights a failure to provide adequate preventive care. Provision of intrauterine devices and implants, which have high upfront costs, can be uniquely challenging in the abortion care setting.

OBJECTIVE

We conducted a study of a clinic-wide training intervention on long-acting reversible contraception and examined the effect of the intervention, insurance coverage, and funding policies on the use of long-acting contraceptives after an abortion.

STUDY DESIGN

This subanalysis of a cluster, randomized trial examines data from the 648 patients who had undergone an abortion who were recruited from 17 reproductive health centers across the United States. The trial followed participants 18-25 years old who did not desire pregnancy for a year. We measured the effect of the intervention, health insurance, and funding policies on contraceptive outcomes, which included intrauterine device and implant counseling and selection at the abortion visit, with the use of logistic regression with generalized estimating equations for clustering. We used survival analysis to model the actual initiation of these methods over 1 year.

RESULTS

Women who obtained abortion care at intervention sites were more likely to report intrauterine device and implant counseling (70% vs 41%; adjusted odds ratio, 3.83; 95% confidence interval, 2.37-6.19) and the selection of these methods (36% vs 21%; adjusted odds ratio, 2.11; 95% confidence interval, 1.39-3.21). However, the actual initiation of methods was similar between study arms (22/100 woman-years each; adjusted hazard ratio, 0.88; 95% confidence interval, 0.51-1.51). Health insurance and funding policies were important for the initiation of intrauterine devices and implants. Compared with uninsured women, those women with public health insurance had a far higher initiation rate (adjusted hazard ratio, 2.18; 95% confidence interval, 1.31-3.62). Women at sites that provide state Medicaid enrollees abortion coverage also had a higher initiation rate (adjusted hazard ratio, 1.73; 95% confidence interval, 1.04-2.88), as did those at sites with state mandates for private health insurance to cover contraception (adjusted hazard ratio, 1.80; 95% confidence interval, 1.06-3.07). Few of the women with private insurance used it to pay for the abortion (28%), but those who did initiated long-acting contraceptive methods at almost twice the rate as women who paid for it themselves or with donated funds (adjusted hazard ratio, 1.94; 95% confidence interval, 1.10-3.43).

CONCLUSIONS

The clinic-wide training increased long-acting reversible contraceptive counseling and selection but did not change initiation for abortion patients. Long-acting method use after abortion was associated strongly with funding. Restrictions on the coverage of abortion and contraceptives in abortion settings prevent the initiation of desired long-acting methods.

Authors+Show Affiliations

Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA. Electronic address: corinne.rocca@ucsf.edu.Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA.Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA.Planned Parenthood Federation of America and the Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY.Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

26692178

Citation

Rocca, Corinne H., et al. "Funding Policies and Postabortion Long-acting Reversible Contraception: Results From a Cluster Randomized Trial." American Journal of Obstetrics and Gynecology, vol. 214, no. 6, 2016, pp. 716.e1-8.
Rocca CH, Thompson KM, Goodman S, et al. Funding policies and postabortion long-acting reversible contraception: results from a cluster randomized trial. Am J Obstet Gynecol. 2016;214(6):716.e1-8.
Rocca, C. H., Thompson, K. M., Goodman, S., Westhoff, C. L., & Harper, C. C. (2016). Funding policies and postabortion long-acting reversible contraception: results from a cluster randomized trial. American Journal of Obstetrics and Gynecology, 214(6), pp. 716.e1-8. doi:10.1016/j.ajog.2015.12.009.
Rocca CH, et al. Funding Policies and Postabortion Long-acting Reversible Contraception: Results From a Cluster Randomized Trial. Am J Obstet Gynecol. 2016;214(6):716.e1-8. PubMed PMID: 26692178.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Funding policies and postabortion long-acting reversible contraception: results from a cluster randomized trial. AU - Rocca,Corinne H, AU - Thompson,Kirsten M J, AU - Goodman,Suzan, AU - Westhoff,Carolyn L, AU - Harper,Cynthia C, Y1 - 2015/12/12/ PY - 2015/09/17/received PY - 2015/11/06/revised PY - 2015/12/07/accepted PY - 2015/12/23/entrez PY - 2015/12/23/pubmed PY - 2017/5/26/medline KW - abortion KW - insurance KW - long-acting reversible contraceptive KW - policy KW - postabortion contraception SP - 716.e1 EP - 8 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 214 IS - 6 N2 - BACKGROUND: Almost one-half of women having an abortion in the United States have had a previous procedure, which highlights a failure to provide adequate preventive care. Provision of intrauterine devices and implants, which have high upfront costs, can be uniquely challenging in the abortion care setting. OBJECTIVE: We conducted a study of a clinic-wide training intervention on long-acting reversible contraception and examined the effect of the intervention, insurance coverage, and funding policies on the use of long-acting contraceptives after an abortion. STUDY DESIGN: This subanalysis of a cluster, randomized trial examines data from the 648 patients who had undergone an abortion who were recruited from 17 reproductive health centers across the United States. The trial followed participants 18-25 years old who did not desire pregnancy for a year. We measured the effect of the intervention, health insurance, and funding policies on contraceptive outcomes, which included intrauterine device and implant counseling and selection at the abortion visit, with the use of logistic regression with generalized estimating equations for clustering. We used survival analysis to model the actual initiation of these methods over 1 year. RESULTS: Women who obtained abortion care at intervention sites were more likely to report intrauterine device and implant counseling (70% vs 41%; adjusted odds ratio, 3.83; 95% confidence interval, 2.37-6.19) and the selection of these methods (36% vs 21%; adjusted odds ratio, 2.11; 95% confidence interval, 1.39-3.21). However, the actual initiation of methods was similar between study arms (22/100 woman-years each; adjusted hazard ratio, 0.88; 95% confidence interval, 0.51-1.51). Health insurance and funding policies were important for the initiation of intrauterine devices and implants. Compared with uninsured women, those women with public health insurance had a far higher initiation rate (adjusted hazard ratio, 2.18; 95% confidence interval, 1.31-3.62). Women at sites that provide state Medicaid enrollees abortion coverage also had a higher initiation rate (adjusted hazard ratio, 1.73; 95% confidence interval, 1.04-2.88), as did those at sites with state mandates for private health insurance to cover contraception (adjusted hazard ratio, 1.80; 95% confidence interval, 1.06-3.07). Few of the women with private insurance used it to pay for the abortion (28%), but those who did initiated long-acting contraceptive methods at almost twice the rate as women who paid for it themselves or with donated funds (adjusted hazard ratio, 1.94; 95% confidence interval, 1.10-3.43). CONCLUSIONS: The clinic-wide training increased long-acting reversible contraceptive counseling and selection but did not change initiation for abortion patients. Long-acting method use after abortion was associated strongly with funding. Restrictions on the coverage of abortion and contraceptives in abortion settings prevent the initiation of desired long-acting methods. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/26692178/Funding_policies_and_postabortion_long_acting_reversible_contraception:_results_from_a_cluster_randomized_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(15)02490-4 DB - PRIME DP - Unbound Medicine ER -