July 2021: Power Updates Edition
There are plenty of articles, publications, and stories published every month. In an effort 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:
Lack of access to contraception is a known barrier to care for many and contributes to the rate of undesired pregnancy. Short acting hormonal birth control, such as the pill, patch, ring, and shot, are highly effective when used correctly, but perfect use is rare. A common reason for incorrect or inconsistent use is that people run out of their method and are not able to obtain refills or new prescriptions when needed. Many states are in the process of expanding the scope of pharmacists to prescribe these short-acting hormonal contraceptive methods, which would greatly increase access. The authors of this paper conducted a prospective cohort study to determine whether uptake or perfect use of these methods varies depending on if prescriptions come from a clinician or a pharmacist. They found that prescriber type did not affect either utilization or rates of correct and consistent use of short acting hormonal contraception methods. However, patients receiving a prescription from a pharmacist were more likely to pay out-of-pocket costs.
Researchers used data from The 2017-2019 Behavioral Risk Factor Surveillance System to estimate the number of people of reproductive age at risk for unplanned pregnancy and in need of contraceptive services. Over the course of the study period, the overall percent of those considered at risk for unplanned pregnancy was 76.2%; however, the at-risk population varied greatly depending on the geographic area studied as well as the age group, race/ethnicity, and whether people lived in an urban or rural environment. The study identified the most popular forms of birth control as well as identifying that 30.3% of women were not using any method of contraception.
This study measured how many patients using Medicaid chose to begin a long-acting reversible contraceptive (LARC) method in their postpartum period. Using data from 2015-2017, researchers determined that prior to the implementation of reimbursement policies a third (33.5%) of LARC insertions happened within seven days of birth, while 20.5% occurred between one and eight weeks postpartum, and the rest (46%) happened more than nine weeks postpartum. After state policies were changed to reimburse for LARCs inserted within seven days of birth, a significant increase was seen—especially among Black and Hispanic populations—from 2.6 insertions per 100 deliveries to 16.8 per 100 deliveries.
Needing to travel to a provider is a known barrier to care, and increased travel time has been shown to negatively impact health outcomes for patients. Due to restrictive abortion laws in many US states, clinic closures have resulted in long travel times for individuals in many parts of the country. The authors of this study believed that greater travel distance would lead to lower abortion rates, and so they compared estimates of travel time to abortion rates across 48 states. Consistent with their hypothesis, researchers found that longer travel distance was associated with lower abortion rates. They estimated that as many as 70,000 more abortions would be provided per year if access was improved.
The authors of this study hypothesized that self-reported pregnancy histories are undercounted because women do not accurately report their abortion histories. Using data from the 2006–2015 National Survey of Family Growth (NSFG) they found that only 40% of abortions that happened in the five years preceding the survey were reported to NSFG. This translates to nearly 11% of pregnancies not being represented due to abortion underreporting.
Pregnancy and Birth
In this study of more than 1.6 million women age 15-54 who have given birth more than once between 2007 and 2012, less than one percent (.87%) had severe maternal morbidity. Data showed that those who became pregnant again less than six months after giving birth had a significantly increased risk of severe maternal morbidity compared to those who waited between 18 and 23 months to become pregnant again.
Data from the 2018 Pregnancy Risk Assessment Monitoring System showed that around 16% of women stated that they were ambivalent about pregnancy. These women were more likely than their peers who wanted a pregnancy to experience “inadequate prenatal care, inappropriate gestational weight gain, depression during pregnancy, intimate partner violence during pregnancy, third trimester smoking, no breastfeeding, no postpartum visit, postpartum depressive symptoms, and postpartum smoking.” Other findings spoke to the health outcomes for those who had an unwanted pregnancy or a mistimed pregnancy. The results of this study underscore the need for providers to deliver recommended screening and care during the preconception, prenatal, and postpartum periods.
Sexual and Reproductive Health
In this secondary data analysis, 62% of the 1,004 veterans interviewed at two Midwestern Department of Veterans Affairs health care systems reported having experienced sexual assault. These women were more likely to report having unprotected sex for a year or more following their assault and were also less likely to get a Pap test as a result of anxiety and fear stemming from their assault. Results showed that a person’s age affected their behavior, with women age 40-52 more likely to report more than a year of unprotected sex, teen pregnancy, and not seeking prenatal care with their first pregnancy.
Research has previously shown that underserved groups of people are less likely to be in optimal health prior to becoming pregnant. To better understand their preconception health indicators, this study surveyed 110 pregnant Latina women, around half (49.5%) of whom experienced chronic stress and half (50.5%) of whom did not. Results showed that neither group was likely to take specific actions such as taking vitamins or improving nutrition prior to pregnancy, but that chronically stressed women were more likely to be obese and less likely to have intended to become pregnant.
People of color are more likely than their white peers to have a sexually transmitted infection (STI), and researchers believe this is due to the prevalence of high-risk sexual behaviors, especially among young people. This article establishes high-risk sexual behaviors within a framework of systemic racism and also lays out research the authors believe could help create interventions that would help youth of color.