July 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 11 stories from the last month we thought you might find interesting:
Authored by three Power to Decide staff members— Sarah Axelson, MSW; Gillian Sealy PhD, MPH; and Raegan McDonald-Mosley, MD, MPH—this paper presents the concept of reproductive well-being, describes the history behind the reproductive well-being movement, and outlines efforts to promote reproductive well-being at the national and local levels, with particular attention to contraceptive access.
This study aimed to better understand the acquisition and use of emergency contraceptive pills (ECP) among young women aged 15-24 years given the removal of age restrictions on all forms of ECP since 2014. From 2006-2008, ECP use was 18.2% whereas from 2015-2017, ECP use was 31.8%. From 2008-2010, about half (46%) of respondents last procured ECP from a community health center or family planning clinic; about one-third (32%) went to a pharmacy for ECP. From 2015-2017, only 18% of young women last obtained ECP at a clinic or health center while 70% went to a pharmacy.
This global literature review synthesized studies examining how young people’s values and preferences regarding contraception. From the 55 studies included in the review, the five most common topic areas included: 1) general preferences regarding contraception, (2) contraceptive method benefits, (3) contraceptive method drawbacks, (4) the influence of the social context, and (5) the influence of myths and misconceptions, including safety and side effects, on contraceptive choice.
Using data from the 2021 Guttmacher Survey of Reproductive Health Experiences, researchers found that 34% reported receiving contraceptive care in the last six months and that 17% of that group used telehealth to receive their most recent care. Those without insurance coverage in the six-month period were more likely to use telehealth than those with health insurance. Telehealth users were less likely to rate the care they received as excellent compared to those who received care in person.
This study examined patterns in contraceptive provision at community health centers in the US, considering differences between moderately and highly effective methods and implants and IUDs. Based on data from 2017-2019, nearly 115,000 women in 410 community health centers were provided contraception. While receipt of moderately and highly effective methods did not appear to vary by age, adolescents were more likely to receive an implant than an IUD.
Pregnancy and Birth
To better understand provider behavior related to provision of preconception care (PCC) in a variety of health care settings, researchers interviewed eight family medicine physicians, four OB/GYNs, seven nurse practitioners, and one nurse midwife. Although PCC practices varied, interviewees identified barriers to delivering PCC care that the authors categorized as related to lack of knowledge of PCC guidelines; perception of lack of preconception patient contact; pessimism around patient "compliance; opinion about scope of practice; clinical site structure; and reliance on the patient/provider relationship.
Using US birth certificate data from 2009-2017, this study compared adolescent (age 12-19) births before and after ACA implementation. Implementation of the ACA was associated with a 23% decrease in adolescent births among those with Medicaid and a 19% decrease among those with private insurance. Declines in births among adolescents using Medicaid seem to be related to whether their state expanded its Medicaid program.
This retrospective study looked at the safety, effectiveness, and acceptability of telehealth-provided self-managed abortion. Of the 2,797 people who confirmed use of abortion medications, about 96% reported that they had an abortion without the need for surgery. No deaths were reported, and only 1% of participants required treatment for a serious adverse event (0.6% required a blood transfusion and 0.5% received IV antibiotics). More than 98% of those who provided information about acceptability indicated that they were satisfied and 96% said that self-management was the right choice for them.
This research letter compared patient characteristics of adults seeking medication or procedural abortions at 7 clinics in Ohio between pregnancy discovery before and after 6 weeks. One-quarter of participants learned they were pregnant after 6 weeks’ gestation. Overall, 89% of those surveyed obtained an abortion, but median gestation at time abortion of was later for those who discovered they were pregnant after 6 weeks.
Sexual and Reproductive Health
Female patients age 18-50 who had received treatment for a substance use disorder (SUD) were surveyed to better understand the relationship between perceived stigma and access to reproductive health screening exams, birth control, and prenatal care. Women who reported higher levels of perceived stigma due to their SUD were more likely to report an inability to access screening exams and birth control.
This systematic review synthesized literature on adolescents’ views regarding privacy and confidentiality of technology-based sexual and reproductive health services. Most included studies addressed HIV, STIs, or general sexual health topics using the internet or a mobile app. Overall, most young people viewed technology-based health care as both private and confidential, though some concerns regarding more interactive services were noted (e.g., family or friends seeing notifications).