April 2022: Power Updates Edition
There are plenty of articles, publications, and stories published every month. To help you distinguish fact from fiction, save time in your already busy day, and share news you may not have otherwise seen, here are nine stories from the last month we thought you might find interesting:
When comparing Title X-funded clinics to those not funded by the federal program, this study found that between 2016-2018 Title X clinics provided more most and moderately effective forms of birth control across all age groups than non-Title X clinics. These clinics also supplied 52% more of most effective methods (IUDs and implants) to those at risk of pregnancy compared to non-Title X clinics. The authors note that these findings support the importance of Title X clinics across the country and encourage the Biden-Harris administration to continue making support of the program a priority.
Pregnancy and Birth
This study compared the use of health care services and money spent among people who gave birth under Medicaid and continued to receive postpartum care under Medicaid versus those who switched to commercial insurance postpartum. The results showed that those who had commercial insurance postpartum were more likely to use primary care and less likely to visit the emergency department compared to those who continued using Medicaid. However, those who used Medicaid had fewer out-of-pocket costs during the postpartum period.
Findings from this study suggest that users of emergency Medicaid were less likely to receive the postpartum birth control method they wanted before discharge compared to those who had non-emergency Medicaid. And at 12 weeks postpartum, only approximately 50% of those in both Medicaid groups had obtained their desired contraceptive method.
Pre-ACA, 55% of those who gave birth under Medicaid lost their insurance soon after delivery. With 2012-2019 data from the Pregnancy Risk Assessment Monitoring System, this study examined how post-ACA Medicaid expansion impacted the use of birth control postpartum. It found that Medicaid expansion was associated with a 7% increase in postpartum LARC usage, 3% decrease in short-acting birth control uptake, and a nearly 4% decrease in non-prescription method use. Further findings broke these results down by race and ethnicity, but overall, the changes suggest that Medicaid expansion improved access to birth control postpartum.
Due to the Hyde Amendment no federal funding may cover abortion care in the US. Additionally, many states have their own restrictions that prevent private insurance from covering abortion care. Since this means that many people must pay for abortion out of pocket, this study sought to better understand the cost of three types of abortion—medication abortion, first trimester abortion procedures, and second trimester abortion procedures. Between 2017 and 2020 the median price of medication abortion rose from $495 to $560 and first trimester abortion procedures from $475 to $575. However, the median cost of second trimester abortion procedures fell from $935 to $895. Overall, the change in pricing varied by region with facilities in the South had lower costs overall.
Sexual and Reproductive Health
State-level data from 2017 and district-level data from the 2015 and 2017 Youth Risk Behavior Survey showed that students in the intervention group who experienced school-based sex education had significant knowledge gains compared to those who did not. Students’ sexual health knowledge was evaluated at the beginning and end of middle and high school sex ed classes and compared to their sexual behavior as reported in the Survey. Specifically, those in the intervention group were significantly more likely to use condoms and less likely to have had sex with four or more people or report drug or alcohol use prior to sex.
Surveys routinely show that the general public supports sex education in schools, yet the number of school-based sex ed programs continued to decline. This analysis of 15 surveys (14 of which were nationwide) confirmed this overwhelmingly with nearly 90% of respondents supporting sexual health education in schools. The authors do note that support for sexual health education may have a different definition for different people with some believing it should focus on abstinence and refusal skills while other may prioritize birth control and sexuality.
The CDC’s Division of Adolescent and School Health developed a middle and high school-based program aimed at preventing the transmission of HIV and other STIs, unintended pregnancy, and other, related, health risk behaviors. This paper summarizes the program, the evidence upon which it’s based, and its implications for adolescent health professionals and organizations if successful. Broadly, the model can be divided into three key strategies—sexual health education, sexual health services, and safe and support environments—and three areas—strengthening staff capacity, increasing student access to programs and services, and engaging parents and community partners.
Power to Decide’s One Key Question® (OKQ) provides a framework for health care providers, social service providers, and champions to routinely ask their patients about pregnancy desires and goals and offer personalized counseling and care based on their response. This study explored barriers and facilitators to OKQ implementation. The staff and clinicians from one OB-GYN and one family medicine clinic previously trained in OKQ were surveyed and interviewed to understand their experience. Reported facilitators of OKQ implementation included: “the simplicity of the tool, engagement of clinic leadership, and compatibility between the perceived goals of the tool and those of practice staff and clinicians.” Barriers reported included concerns about pre-implementation time, asking OKQ at every patient visit, and distracting from the visit agenda.