IU Indianapolis ScholarWorks :: Browsing by Subject "Contraception"

Browsing by Subject "Contraception"

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A human-centered designed outreach strategy for a youth contraception navigator program
(Elsevier, 2022) Wilkinson, Tracey A.; Hawryluk, Bridget; Moore, Courtney; Peipert, Jeffrey F.; Carroll, Aaron E.; Wiehe, Sarah; Fortenberry, J. Dennis; Pediatrics, School of Medicine
Objective: To identify key elements of an outreach strategy for a youth contraception navigator program designed to help young people overcome barriers to contraception access. Methods: A human-centered design approach was used to engage adolescents aged 15-17 in co-design sessions. Human-centered design techniques, such as affinity diagramming and model building were used to inform key elements of the communication model and the final outreach strategy messages. Results: Messages focused on the individual, normalizing talking about birth control, acknowledging the challenges to obtaining birth control, explaining how the navigator program works resonate with young people. Having images of diverse participants, offering information about birth control, and showing images of reputable sources will enhance trust. Conclusions: A name (IN Control) and key elements of an outreach strategy were determined for the navigator program. It is important to work with key stakeholders and co-design the optimal strategy and messages to assure that the intended audience is reached, and the desired behavior change is achieved. Innovation: Human-centered design techniques can be used to provide insight into programmatic outreach strategies for a contraception navigator program to increase their impact and ultimate success.
Adolescent and Young Adults’ Ability to Self-Screen for Contraindications to Contraception and the Role of Chronic Illness
(Elsevier, 2021) Wilkinson, Tracey A.; Meredith, Ashley H.; Rafie, Sally; Katz, Amy J.; Vielott, Thomas L.; Meagher, Carolyn G.; Ott, Mary A.; Pediatrics, School of Medicine
Purpose: Multiple states allow pharmacists to prescribe hormonal contraception but can have age restrictions. The study objective was to examine how age influences adolescents' and young adults' (AYAs) ability to self-report potential contraindications to hormonal contraception compared with physician reports (our "gold standard"). Methods: Between February 2017 and August 2018, girls aged 14-21 years and their physicians were recruited in outpatient adolescent primary and subspecialty care clinics. Screeners were completed separately for medical conditions that are potential contraindications to hormonal contraception as defined by the Centers for Disease Control Medical Eligibility Criteria. Overall, discordance was defined as differences between the patient's and provider's answers, and potential unsafe discordance was defined as AYAs underreporting of contraindications. Multivariable logistic regression was used to examine predictors of overall and unsafe discordance. Results: Of 394 AYA/physician pairs, 45% were from subspecialty clinics, 35% identified as African American, the mean age was 16.7 ± 1.9 years, and 38% were sexually active. Fifty percent of patients reported potential contraindications to hormonal contraception. There was only an 18% rate of unsafe discordance, with no statistical difference by age but a higher rate in subspecialty clinics (28% vs. 10%). No variables were predictive of higher rates of unsafe discordance in general or subspecialty clinics. Conclusions: Potential overall and unsafe discordance between AYAs' and physicians' reports of medical contraindications to combined hormonal contraception were not related to younger age and thus support expansion of pharmacy access to adolescents. Pediatric subspecialists need to proactively address hormonal contraceptive needs and safety as pharmacy access expands.
Assessment of Adolescent Decision-Making Capacity for Pharmacy Access to Hormonal Contraception
(Elsevier, 2023) Wilkinson, Tracey A.; Meredith, Ashley H.; Katz, Amy J.; Meagher, Carolyn G.; Ott, Mary A.; Pediatrics, School of Medicine
Objectives: To examine adolescents' decision-making capacity for pharmacsist-prescribed hormonal contraception. Study design: A subset of 60 females, ages 14-21, were recruited to complete the MacArthur Competence Assessment Tool-Treatment. Overall scores were compared by age and demographic factors and variation examined. Results: Participants scored high on the MacArthur Competence Assessment Tool-Treatment with little variation in the scores (18.8 [±1.9]/20 total points). Factors such as chronic illness, health literacy, and family affluence were not associated with of overall scores. Conclusions: Adolescents and young adults have the capacity to make decisions regarding contraception in the pharmacy access settings.
Association of Comprehensive Immediate Postpartum Contraception with Infant Outcomes
(American Medical Association, 2022) Wilkinson, Tracey A.; Peipert, Jeffrey F.; Pediatrics, School of Medicine
Barriers and facilitators to implementing a patient-centered model of contraceptive provision in community health centers
(BMC, 2016-11-08) Politi, Mary C.; Estlund, Amy; Milne, Anne; Buckel, Christina M.; Peipert, Jeffrey F.; Madden, Tessa; Obstetrics and Gynecology, School of Medicine
Background The Contraceptive CHOICE Project developed a patient-centered model for contraceptive provision including: (1) structured, evidence-based counseling; (2) staff and health care provider education; and (3) removal of barriers such as cost and multiple appointments to initiate contraception. In preparation for conducting a research study of the CHOICE model in three community health settings, we sought to identify potential barriers and facilitators to implementation. Methods Using a semi-structured interview guide guided by a framework of implementation research, we conducted 31 qualitative interviews with female patients, staff, and health care providers assessing attitudes, beliefs, and barriers to receiving contraception. We also asked about current contraceptive provision and explored organizational practices relevant to implementing the CHOICE model. We used a grounded theory approach to identify major themes. Results Many participants felt that current contraceptive provision could be improved by the CHOICE model. Potential facilitators included agreement about the necessity for improved contraceptive knowledge among patients and staff; importance of patient-centered contraceptive counseling; and benefits to same-day insertion of long-acting reversible contraception (LARC). Potential barriers included misconceptions about contraception held by staff and providers; resistance to new practices; costs associated with LARC; and scheduling challenges required for same-day insertion of LARC. Conclusions In addition to staff and provider training, implementing a patient-centered model of contraceptive provision needs to be supplemented by strategies to manage patient and system-level barriers. Community health center staff, providers, and patients support patient-centered contraceptive counseling to improve contraception provision if organizations can address these barriers.
Changes in body composition in women using long-acting reversible contraception
(Elsevier, 2017-04) De Nazaré Silva dos Santos, Priscilla; Madden, Tessa; Omvig, Karen; Peipert, Jeffrey F.; Obstetrics and Gynecology, School of Medicine
OBJECTIVE: Users of hormonal long-acting reversible contraception (LARC) report weight gain as a side effect, but few studies have assessed body composition change among LARC users. We evaluated weight and body composition of healthy women using the levonorgestrel intrauterine system (LNG-IUS), copper intrauterine device (copper IUD) or etonogestrel implant (ENG implant). We hypothesized that weight gain and body composition over 12 months would not differ between copper IUD, LNG-IUS and ENG implant users. STUDY DESIGN: We performed a prospective cohort study of a subgroup of women enrolled in the Contraceptive CHOICE Project who initiated the LNG-IUS, copper IUD or ENG implant. Inclusion criteria included lack of metabolic and eating disorders or change in body weight of more than 5% in the 6 months before enrollment. We measured changes in weight and body composition (body fat percentage, total body fat mass, total lean mass and total body mass) in women who continued their method for 12 months. RESULTS: We analyzed data from 149 participants: 85 LNG-IUS users, 31 copper IUD users and 33 ENG implant users. The mean age was 25.9 years, 56.4% were White, 82.5% had some college education and 67.6% were nulliparous. Although lean body mass increased over 12 months in LNG-IUS and copper IUD users but not in ENG implant users, changes in body weight and body composition did not differ between the groups. In the adjusted model, Black race was associated with change in total body mass (p<.05). CONCLUSIONS: Among those who continued the method for 12 months, changes in body weight and composition did not differ between copper IUD, LNG-IUS and ENG implant users. IMPLICATIONS STATEMENT: Changes in body weight and composition over 12 months did not differ between copper IUD users and LNG-IUS and ENG implant users among those with 12 months of continuous use.
"Churches in the Vanguard:" Margaret Sanger and the Morality of Birth Control in the 1920s
(2015-03-30) Maurer, Anna C.; Robertson, Nancy Marie; Cramer, Kevin; Lantzer, Jason S.
Many religious leaders in the early 1900s were afraid of the immoral associations and repercussions of birth control. The Catholic Church and some Protestants never accepted contraception, or accepted it much later, but many mainline Protestants leaders did change their tune dramatically between the years of 1920 and 1931. This investigation seeks to understand how Margaret Sanger was able to use her rhetoric to move her reform from the leftist outskirts and decadent, sexual connotations into the mainstream of family-friendly, morally virtuous, and even conservative religious approval. Securing the approval of religious leaders subsequently provided the impetus for legal and medical acceptance by the late-1930s. Margaret Sanger used conferences, speeches, articles, her magazine (Birth Control Review), and several books to reinforce her message as she pragmatically shifted from the radical left closer to the center and conservatives. She knew the power of the churches to influence their members, and since the United States population had undeniably a Judeo-Christian base, this power could be harnessed in order to achieve success for the birth control movement, among the conservative medical and political communities and the public at large. Despite the clear consensus against birth control by all mainline Christian churches in 1920, including Roman Catholics and Protestants alike, the decade that followed would bring about a great divide that would continue to widen in successive decades. Sanger put forward many arguments in her works, but the ones which ultimately brought along the relatively conservative religious leaders were those that presented birth control not as a gender equity issue, but rather as a morally constructive reform that had the power to save and strengthen marriages; lessen prostitution and promiscuity; protect the health of women; reduce abortions, infanticide, and infant mortality; and improve the quality of life for children and families. Initially, many conservatives and religious leaders associated the birth control movement with radicals, feminists, prostitutes, and promiscuous youth, and feared contraception would lead to immorality and the deterioration of the family. Without the threat of pregnancy, conservatives feared that youth and even married adults would seize the opportunity to have sex outside of marriage. Others worried the decreasing size of families was a sign of growing selfishness and materialism. In response, Sanger promoted the movement as a way for conservatives to stop the rising divorce rates by strengthening and increasing marriages, and to improve the lives of families by humanely increasing the health and standard of living, for women and children especially. In short, she argued that birth control would not lead to deleterious consequences, but would actually improve family moral values and become an effective humanitarian reform. She recognized that both liberals and conservatives were united in hoping to strengthen the family, and so she emphasized those virtues and actively courted those same conservative religious leaders that had previously shunned birth control and the movement. Throughout the 1920s, she emphasized the ways in which birth control could strengthen marriages and improve the quality of life of women and children, and she effectively won over the relatively conservative religious leaders that she needed to bring about the movement’s public, medical, and political progress.
Considerations in the Measurement and Reporting of Withdrawal: Findings from the 2018 National Survey of Sexual Health and Behavior
(Elsevier, 2019-08) Fu, Tsung-chieh; Hensel, Devon J.; Beckmeyer, Jonathon J.; Dodge, Brian; Herbenick, Debby; Medicine, School of Medicine
Introduction Although withdrawal use is routinely measured as part of contraceptive surveillance in the United States, its assessment may be prone to underreporting and measurement errors. Additionally, at the population level, little is known about subjective experiences of withdrawal. Aim To measure respondents’ frequency of and reasons for engaging in extra-vaginal ejaculation in the past year, and to compare contraceptive withdrawal vs extra-vaginal/anal ejaculation during the most recent sexual event. Methods The 2018 National Survey of Sexual Health and Behavior is a U.S. nationally representative probability survey of adolescents and adults. This study was administered in February–March 2018 via GfK Research’s KnowledgePanel. Respondents who reported consensual penile-vaginal intercourse in the past year were included in the analysis. Logistic regression was used to assess factors associated with finding extra-vaginal ejaculation sexy/arousing. Main Outcome Measures Main outcomes were the frequency of and reasons for extra-vaginal ejaculation in the past year, as well as reported contraceptive withdrawal use and the location of ejaculation at the most recent penile-vaginal intercourse. Results In the past year, approximately 60% of respondents reported engaging in any extra-vaginal ejaculation; pregnancy prevention and sexual pleasure were given as common reasons. Those who were men, white, or aged 25–29 were more likely to find extra-vaginal ejaculation sexy or arousing; no gender differences were observed in their partner’s perception of this act. Prevalence of selecting withdrawal on the contraceptive inventory was 12.2% (95% CI 10.6–14.0) at last sexual event, whereas extra-vaginal/anal ejaculation was reported by 20.8% (95% CI 18.7–23.0). This lack of concordance in differing measures was observed consistently across all age groups, and approximately 12% to 14% of individuals reported an ejaculation location that did not correspond to their withdrawal use. Clinical Implications The results of this study have implications for how healthcare providers discuss withdrawal with their patients and counsel them on using extra-vaginal ejaculation as part of their contraceptive use or part of their sexual repertoire. Strengths & Limitations This is the first nationally representative study to directly compare contraceptive withdrawal to extra-vaginal ejaculation. Limited data were collected at event level regarding motivations for extra-vaginal ejaculation, pregnancy attitudes, perceptions of condoms and sexually transmitted infection prevention, or exposure to erotic media, thus limiting further assessment of relationships between various factors and extra-vaginal/anal ejaculation. Conclusion We found that reporting of withdrawal as a contraceptive method vs extra-vaginal/anal ejaculation was inconsistent and that extra-vaginal/anal ejaculation was commonly used for reasons other than pregnancy prevention; future research should use more precise measures of “withdrawal.”
Contraception for Adolescents During the Coronavirus Disease 2019 Pandemic
(JAMA, 2021-03-01) Wilkinson, Tracey A.; Kottke, Melissa J.; Berlan, Elise D.; Pediatrics, School of Medicine
Our recent publication, Providing Contraception for Young People During a Pandemic is Essential Healthcare, was written in response to the sudden shift towards low-contact or no-contact medicine in the wake of the COVID-19 pandemic. Ensuring access to contraception is essential as every 6 months of lockdown can result in 47 million women losing access to contraception, resulting in an additional 7 million of unintended pregnancies. We welcome the letters submitted by Alouini/Venslauskaite and Uzoigwe/Ali as they exemplify common misperceptions within the medical community about contraception. The question of whether a physical exam is required prior to a contraception prescription, the safety of emergency contraception, and abstinence counseling are addressed below.
Contraceptive implant use duration is not associated with breakthrough pregnancy among women living with HIV and using efavirenz: a retrospective, longitudinal analysis
(Wiley, 2022) Stalter, Randy M.; Amorim, Gustavo; Mocello, A. Rain; Jakait, Beatrice; Shepherd, Bryan E.; Musick, Beverly; Bernard, Caitlin; Bukusi, Elizabeth A.; Wools-Kaloustian, Kara; Cohen, Craig R.; Yiannoutsos, Constantin T.; Patel, Rena C.; Implant/Efavirenz Study Group; East Africa IeDEA regional consortium; Biostatistics, School of Public Health
Introduction: Contraceptive implants containing etonogestrel and levonorgestrel have emerged as popular contraceptive options among women in areas of high HIV burden in sub-Saharan Africa. However, recent pharmacokinetic data have shown drug-drug interactions between implants and efavirenz-containing antiretroviral therapy (ART), reducing the effectiveness of the implants. Here, we evaluated pregnancy incidence in 6-month intervals following implant initiation among women using efavirenz and contraceptive implants to assess whether the risk of breakthrough pregnancy is higher after specific periods of implant use. Methods: We used data from a retrospective longitudinal analysis of women living with HIV ages 18-45 years in western Kenya who attended HIV-care facilities between 2011 and 2015. We used Cox proportional hazard models to compute hazard ratios (HRs) for breakthrough pregnancy by implant type and ART regimen. Depending on the model, we adjusted for socio-demographic and clinical factors, programme, site and interaction between calendar time and ART regimen. We utilized inverse probability weights (IPWs) to account for three sampling phases (electronic medical record [EMR], chart review and phone interview) and calculated overall parameter estimates. Results: Women contributed 14,768 woman-years from the largest sampling phase (EMR). The median age was 31 years. Women used etonogestrel implants for 26-69% of the time and levonorgestrel implants for 7-31% of the time, depending on the sampling phase. Women used efavirenz, nevirapine or no ART for 27-33%, 40-46% and 15-26% of follow-ups, respectively. When combining sampling phases, there was little evidence to suggest that the relative hazard of pregnancy among efavirenz-containing ART users relative to nevirapine-containing ART changed with length of time on implants: IPW-adjusted HR of 3.1 (CI: [1.5; 6.4]) at 12 months, 3.4 (CI: [1.8; 6.3]) at 24 months, 3.8 (CI: [1.9; 7.7]) at 36 months and 4.2 (CI: [1.6; 11.1]) at 48 months (interaction p-value = 0.88). Similarly, no significant change in HRs over time was found when comparing women not using ART to nevirapine-containing ART users (interaction p-value = 0.49). Conclusions: We did not find evidence to suggest implants being more fallible from drug-drug interactions with efavirenz at later time intervals of implant use. Thus, we would not recommend shortening the duration of implant use or replacing implants sooner when concomitantly used with efavirenz.

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