February 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 ten stories from the last month we thought you might find interesting:
LARC reimbursement rates—a challenge many providers face when accessing LARC methods—vary from state-to-state based on state-level policy. The authors of this study conducted a review of publicly available reimbursement policies of all 50 states to better understand the differences in strategy across the country. They found that only 42% of states with publicly available policies included language on LARC reimbursement. States also differed in how they categorized the reimbursement; 24% had coverage policies as a medical benefit, 33% as a pharmacy benefit, and 19% as both a medical benefit and pharmacy benefit. The authors suggest that further research should be conducted to understand if increased reimbursement improves access to the full range of birth control methods. They write, “State-level LARC device reimbursement policies that cover a greater proportion of the cost of the LARC device and enable providers to purchase LARC upfront may improve contraceptive access.”
Results of this study show a substantial difference in national rates of postpartum birth control use among Medicaid recipients. The data shows that overall, only 34.2% of Medicaid enrollees were using either sterilization, contraceptive implants, intrauterine devices, injectables, oral pills, patch, ring, or diaphragm as birth control within 60 days postpartum. The rate of contraceptive use varied considerably between states. For example, in Utah only 19.8% of postpartum Medicaid recipients were on birth control while in Louisiana that figure rose to 43.9%. The number of those using highly effective LARC methods was even smaller at 9.3% nationwide. Rhode Island saw the highest number of women using LARCs postpartum at 19.7%. The significant difference between states in birth control initiation in the first 60 days postpartum could be an opportunity for states and the federal government to create policies aimed at improving access to birth control for Medicaid enrollees during this period.
States can now choose to expand postpartum Medicaid coverage to mothers with low incomes for a year after delivery. Data analyzed in this study shows that doing so should improve outpatient health access, increase use of health care services, improve management of chronic diseases, and reduce overall care disparities for racial/ethnic groups over-represented in Medicaid. The study authors also suggest that expanding coverage may reduce the burden of late maternal mortality and improve birth outcomes by increasing access to birth control postpartum.
Among a nationally representative sample of sexually active young people age 15-19, this study tested associations between social determinants of health and use of any birth control at last sex as well as the effectiveness of the birth control used at last sex. It found 91.5% of adolescents used birth control the last time they had sex, however only 4.3% reported using a highly effective method such as the implant or IUD. A significant connection was found between those who used contraceptive and family structure (i.e., intact childhood family), employment, and education.
Pregnancy and Birth
In a survey of 316 Southern patients between October 2018 and June 2019, only 10% reported that their provider discussed all their options (adoption, abortion, and parenting). But discussing all options is associated with a more positive patient experience; patients were 80% more likely to rate their provider’s counseling as “excellent” if all options were reviewed. This more positive sentiment was share by those who planned to continue their pregnancy as well as by those who did not. Overall findings show that patients prefer supportive, nondirective counseling on all their pregnancy options.
This study looked at connection between those who faced barriers when seeking abortion care and those who have attempted self-managed abortions. Using data representative of all 50 states, the study found that self-managed abortions are higher among those who faced barriers to receiving abortion care. Of those surveyed 28% reported having attempted a self-managed abortion, the most common methods used were herbs, supplements, or vitamins (52%); emergency contraception or many birth control pills (19%); mifepristone and/or misoprostol (18%); and abdominal or other physical trauma (18%). The decision to attempt a self-managed abortion was associated with a number of factors including having to keep the abortion secret, fearing for one’s safety, needing to gather money for travel or for abortion care, and living far from an abortion facility.
Through 58, in-depth interviews with women in Maryland and Louisiana, these researchers determined that those living in Maryland believed abortion care was easy to find while those living in Louisiana had the opposite opinion. While this tracks with the general availability of abortion care and restrictions in each state, those who lived in Louisiana did not necessarily view abortion as unobtainable. These women already face restrictions in other areas of their lives and have developed coping strategies that they transferred to their efforts to find abortion care.
Sexual and Reproductive Health
SpeakOut is an intervention designed specifically to improve young people’s birth control knowledge and usage through structured counseling, online resources, and text reminders. This study evaluated its effectiveness based on contraceptive communication, knowledge, and use prior to the intervention, at three months, and at nine months after enrollment. Those who participated in SpeakOut were slightly less likely to stop using birth control within the nine-month study period, but not significantly so. Overall, the study found that SpeakOut did not improve communication, knowledge, or use of contraception among participants or their peers.
To better understand where young people learn about consent and how they communicate and understand consent and refusal in sexual situations, this study surveyed 150 males and females, age 14-24, 78% of whom were sexually active. The majority of both genders reported having discussed sexual consent with someone. While around 50% of males and females said they indicated consent with “no response,” results show significant disagreement between how males and females communicate and interpret consent and refusal. Around 95% of females used verbal cues to communication and interpret consent while in males only 77% used verbal cues to communicate and 54% to interpret. Similarly, nearly all females used verbal cues to communicate (98.7%) and interpret (90.7%) refusal. In males, verbal cues were used by on only 56.8% communicate and 59.1% interpret refusal. The study’s authors recommend that real-world scenarios about young people’s communication practices should be incorporated into sex ed to reduce sexual assault and promote healthy relationships.
As the number of telehealth interventions around the sexual health of young people have risen, it’s necessary to study their effects on outcomes related to sexual health so future interventions can be designed or adjusted to produce better results. This study reviewed 15 previous studies on telehealth interventions and found that they increased young people’s belief that they could successfully use condoms, the number of times adolescents practiced using condoms, and the number of young people being tested for STIs. The researchers believe that telehealth interventions could successfully provide an alternative to in-person provider visits.