Beliefs and behaviors regarding abortion counseling among U.S. clinicians caring for adolescents.

Study Objective: To determine clinician factors associated with discussing abortion during pregnancy options counseling among adolescents.

Methods: We recruited and surveyed a convenience sample of U.S.

Patient and obstetrician-gynecologist perspectives on considering long-acting reversible contraception for postpartum patients who desire permanent contraception.

Objective(s): We sought to understand patients' and obstetrician-gynecologists' priorities in seeking or recommending long-acting reversible contraceptive methods (LARC; intrauterine devices and contraceptive implants) versus permanent contraception in the postpartum period when permanent contraception was the patient's initial contraceptive preference.

Study Design: We interviewed 81 postpartum patients who desired permanent contraception and their delivering obstetrician-gynecologist (n = 67) from four US institutions to explore patient and obstetrician-gynecologist (OBGYN) perspectives navigating permanent contraception counseling and decision-making. We used thematic content analysis to analyze interview transcripts using NVivo 12 Pro software.

Clinician Perspectives on Adolescent Contraceptive Counseling Following Dobbs v. Jackson: Implications for Young People's Contraceptive Autonomy.

Objective: The objective of this study is to understand whether clinicians who provide contraceptive counseling to adolescent patients perceive that the Dobbs decision has influenced their counseling.

Study Design: We conducted in-depth interviews with a convenience sample of 16 clinicians who provide contraceptive counseling to adolescents at the American Academy of Pediatrics annual conference in October 2022. We used thematic content analysis and an iterative process of constant comparison to identify themes inductively.

Long-Acting Reversible Contraception Use after Non-Receipt of Postpartum Permanent Contraception: A Retrospective Analysis.

To evaluate long-acting reversible contraception (LARC) use versus permanent contraception (PC) use at hospital discharge through 1 year postpartum after an unfulfilled immediate postpartum PC request. We present a secondary analysis of a retrospective cohort study of patients across four study sites between 2018 and 2019 with PC as their documented inpatient postpartum contraceptive plan. We abstracted demographic and clinical characteristics, contraceptive plans and time to contraceptive fulfillment, reasons for non-fulfillment, and pregnancy incidence up to 1 year postpartum from medical records.

Beyond stigma: Clinician bias in contraceptive counseling to sexual and gender minority youth.

Objectives: Sexual and gender minority (SGM) youth experience disparities in sexual and reproductive health; however, little is known about how clinicians engage in contraceptive counseling with this patient population. This study describes pediatric clinician patterns and biases in contraceptive counseling with SGM youth.

Study Design: We conducted 16 in-depth interviews with a convenience sample of clinicians who counsel adolescents on contraception.

Asymmetry in contraceptive information at two sites in Burkina Faso.

Background: Family planning programs are foundationally important to public health, but like any medical intervention, contraception has drawbacks in addition to its benefits. Knowledge of these drawbacks in addition to benefits is essential for informed choice. Despite a general consensus among family planning researchers and providers that contraceptive counseling should be unbiased, little quantitative research has assessed the extent of bias in contraceptive counseling, and in people's contraceptive knowledge more broadly.

Exploring primary care physician biases in adolescent contraceptive counseling.

Objective(s): While previous literature has shown clinician bias in adult contraceptive counseling, less is known on the biases clinicians may exhibit when counseling adolescents about contraception. Our study aimed to describe long-acting reversible contraception (LARC) counseling and prescribing practices of adolescent-serving clinicians.

Study Design: This study used a cross-sectional discrete choice experiment mixed methods design.

Exploring adolescent-facing US clinicians' perceptions of their contraceptive counseling and use of shared decision-making: A qualitative study.

Background: Adolescent contraceptive decision-making is influenced by a number of patient and clinician-driven factors. Although the AAP continues to endorse an efficacy-based model of contraceptive counseling, many professional organizations are shifting to a shared decision-making model as the optimal approach for providing unbiased and patient-driven contraceptive counseling. While SDM is intended to reduce the influence of clinician bias, it can exacerbate inequity if a clinician tailors a conversation based on their assumptions of a patient's goals or preferences.

Uncertainty in Postpartum Permanent Contraception Decision-Making: Physician and Patient Perspectives.

Purpose: We sought to understand how patients and physicians conceptualize uncertainty in the permanent contraception decision-making process.

Basic Procedures: In 2022-2023, we interviewed postpartum patients with a documented desire for permanent contraception (n = 81) and their delivering physicians (n = 67). Eligible patients gave birth at one of our four study hospitals in California, Ohio, Illinois, and Alabama.

Ongoing contraceptive goals of patients who did not achieve desired postpartum permanent contraception prior to hospital discharge.

Objective: To evaluate reasons for non-fulfillment and ongoing contraceptive plans of patients who desired but did not receive inpatient postpartum permanent contraception (PC).

Study Design: Multi-site retrospective cohort study of 1254 patients with unfulfilled inpatient postpartum PC. We analyzed the reason for PC non-fulfillment, documented contraceptive plan, and method prescription or provision at hospital discharge, six-weeks, and one-year postpartum.

Neighbourhood socioeconomic position, prenatal care and fulfilment of postpartum permanent contraception: Findings from a multisite cohort study.

Introduction: Research suggests neighbourhood socioeconomic vulnerability is negatively associated with women's likelihood of receiving adequate prenatal care and achieving desired postpartum permanent contraception. Receiving adequate prenatal care is linked to a greater likelihood of achieving desired permanent contraception, and access to such care may be critical for women with Medicaid insurance given that the federally mandated Medicaid sterilization consent form must be signed at least 30 days before the procedure. We examined whether adequacy of prenatal care mediates the relationship between neighbourhood socioeconomic position and postpartum permanent contraception fulfilment, and examined moderation of relationships by insurance type.

Comparing Cervical Cancer Screening Strategies in an Incarcerated Population.

To describe the prevalence of cervical intraepithelial neoplasia (CIN), high-risk human papillomavirus (hrHPV) infection, and cervical cancer in a high-risk, underscreened incarcerated population and to evaluate the performance of current cervical cancer screening options to detect cervical precancer (CIN 2/3) in this population. Deidentified data were obtained from all cytological, hrHPV DNA, and histopathological testing of cervical biopsies performed on people incarcerated at the North Carolina Correctional Institute for Women between January 1, 2013, and December 31, 2020. These were linked to corresponding demographic data.

Documentation of prenatal contraceptive counseling and fulfillment of permanent contraception: a retrospective cohort study.

Background: Barriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling.

Perceptions of access to long-acting reversible contraception removal among women in Burkina Faso.

Objectives: Long-acting reversible contraception (LARC) initiation has been well-studied and intervened upon. Because LARC requires provider intervention for initiation and removal, it is critical to measure informed choice at the time of desired discontinuation as well. We examined perceptions of access to LARC discontinuation among women at two sites in Burkina Faso, where LARC is the dominant method in the contraceptive mix.

Association Among Race, Ethnicity, Insurance Type, and Postpartum Permanent Contraception Fulfillment.

Objective: To evaluate the association among race, ethnicity, insurance type, and fulfillment of permanent contraception requests.

Methods: This is a secondary analysis of a retrospective cohort of patients who delivered at 20 or more gestational weeks in a 2-year time period at four hospitals across the United States: University of California San Francisco, Northwestern Memorial Hospital, MetroHealth Medical Center in Cleveland, and University of Alabama at Birmingham. All patients included had permanent contraception documented as their postpartum contraceptive plan.

Assessing trends and reasons for unsuccessful implant discontinuation in Burkina Faso and Kenya between 2016 and 2020: a cross-sectional study.

Objectives: Contraceptive implant use has grown considerably in the last decade, particularly among women in Burkina Faso and Kenya, where implant use is among the highest globally. We aim to quantify the proportion of current implant users who have unsuccessfully attempted implant removal in Burkina Faso and Kenya and document reasons for and location of unsuccessful removal.

Methods: We use nationally representative data collected between 2016 and 2020 from a cross-section of women of reproductive age in Burkina Faso and Kenya to estimate the prevalence of implant use, proportion of current implant users who unsuccessfully attempted removal and proportion of all removal attempts that have been unsuccessful.

Exploring Upward and Downward Provider Biases in Family Planning: The Case of Parity.

Introduction: Provider bias has become an important topic of family planning research over the past several decades. Much existing research on provider bias has focused on the ways providers restrict access to contraception. Here, we propose a distinction between the classical "downward" provider bias that discourages contraceptive use and a new conception of "upward" provider bias that occurs when providers pressure or encourage clients to adopt contraception.

Medicaid and Fulfillment of Postpartum Permanent Contraception Requests.

Objective: To evaluate the association between Medicaid insurance and fulfillment of postpartum permanent contraception requests.

Methods: We conducted a retrospective cohort study of 43,915 patients across four study sites in four states, of whom 3,013 (7.1%) had a documented contraceptive plan of permanent contraception at the time of postpartum discharge and either Medicaid insurance or private insurance.

Assessing the Suitability of Unmet Need as a Proxy for Access to Contraception and Desire to Use It.

Unmet need for contraception is a widely used but frequently misunderstood indicator. Although calculated from measures of pregnancy intention and current contraceptive use, unmet need is commonly used as a proxy measure for (1) lack of access to contraception and (2) desire to use it. Using data from a survey in Burkina Faso, we examine the extent to which unmet need corresponds with and diverges from these two concepts, calculating sensitivity, specificity, and positive/negative predictive values.

Measuring Contraceptive Autonomy at Two Sites in Burkina Faso: A First Attempt to Measure a Novel Family Planning Indicator.

There is growing consensus in the family planning community around the need for novel measures of autonomy. Existing literature highlights the tension between efforts to pursue contraceptive targets and maximize uptake on the one hand, and efforts to promote quality, person-centeredness, and contraceptive autonomy on the other hand. Here, we pilot a novel measure of contraceptive autonomy, measuring it at two Health and Demographic Surveillance System sites in Burkina Faso.

Contraceptive stockouts in Western Kenya: a mixed-methods mystery client study.

Background: The prevalence of modern contraception use is higher in Kenya than in most countries in Sub-Saharan Africa. The uptake has however slowed down in recent years, which, among other factors, has been attributed to challenges in the supply chain and increasing stockouts of family planning commodities. Research on the frequency of contraceptive stockouts and its consequences for women in Kenya is still limited and mainly based on facility audits.