June 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 eight stories from the last month we thought you might find interesting:
People attending community college are less likely to use birth control than those attending a four-year college, which the authors of this study postulate may be due to financial barriers. This study took data from five community colleges in California and Oregon (both states where Medicaid coverage has been expanded in these two states has been expanded to cover family planning services) and discovered that 49% of participants worried about the cost of birth control. Those with public insurance showed similar levels of concern over the cost of birth control to those without any insurance.
Allowing pharmacists to prescribe birth control could greatly expand contraceptive access for millions across the country. This study looked at birth control pill users in Oregon, where pharmacists can prescribe contraception, to determine how many people using the pill have a medical contraindication that could interfere with the pill’s effectiveness or increase the potential for side effects. Of the more than 3,700 people who received their contraception from a pharmacist, rates of prescribing to those people with a potential contraindication were not meaningfully different from those who received their birth control prescription from a clinical provider.
Pregnancy and Birth
This study analyzed data collected between 2013 and 2015 from seven local health departments implementing changes designed to address birth outcome inequities, which are prevalent and significant across the country. The intervention used two program types, both of which were practice-based approaches that identified community needs around equity in birth outcomes through community engagement, but one focused on large-scale policy and systems impact while the other focused on individual- and provider-level behavioral change. Results showed that while the first program type implemented more changes, the second’s changes had a higher intensity. Overall, the intervention seems promising though the authors caution that reversing disparities will take more than two years and long-term outcomes cannot be known from this study.
Throughout the COVID-19 pandemic many health care providers have had to adopt modified practices to safely deliver care. Many have implemented telehealth procedures for some types of sexual and reproductive care, including for telehealth protocol for medication abortion care. This study pinpoints factors that led to successfully using a telehealth protocol for abortion care at 15 clinical sites. Factors identified as contributing to successful care include: “access to formal and informal inter-organizational networks…organizational readiness for implementation… and motivated and effective clinic champions.”
To better understand why people have a self-managed abortion (SMA), how they get information and make decisions about SMA, and the method and results of a SMA, 14 thorough interviews with a diverse group of people who recently reported attempting a self-managed abortion were conducted. Though all participants knew that abortion was legally available, the primary reason for attempting a SMA was lack of access to a facility or lack of financial support to pay for a medical abortion. For participants who suspected they were pregnant but had not confirmed it, SMA was a way to both prioritize their privacy and also stop a potential pregnancy while it was still ambiguous if they were actually pregnant or not. Common SMA methods include herbs such as parsley, rose hips, and chamomile and medication such as oral birth control, caffeine pills, and antibiotics. Most listed safety over factors when deciding on a method. Of the nine participants with a confirmed pregnancy, six were still pregnant after their attempted SMA. Of the five non-confirmed people who attempted SMA, all had their period return.
Though existing research shows little to no difference in outcomes for women who received medication abortion in a pharmacy setting versus a clinical setting, overall, there is a lack of comparative research to confirm that effectiveness is not affected by setting. In particular, more should be known about patient experience in each setting and potential differences in the quality of service. This literature review confirms these conclusions and the authors emphasis the importance of more research on the subject because of the potential for pharmacy setting abortions to increase access to medical abortion for all.
Sexual and Reproductive Health
In this literature review the authors discuss previous research into “reproductive health goals, risks, and access barriers; clinician knowledge practices and challenges; and strategies for improving counseling practices” surrounding transgender and gender diverse (TGD) adolescents and young adults. Findings include:
- Previous research suggests that many TGD adults would like to have biological children while many TGD young people identified in this literature review would prefer to adopt or not be parents at all.
- High rates of high-risk sexual behavior among TGD young adults; a Canadian study showed that this population is six times more likely to have an STI than their cisgender peers.
- Many providers lack knowledge about the reproductive health needs of TGD individuals. Perhaps in part because of this, many TGD people are not comfortable discussing their reproductive needs or seeking reproductive health care.
Despite its effectiveness at reducing HIV transmission for high-risk individuals, pre-exposure prophylaxis (PrEP) is not as widely used among adolescent girls and young women as it could be. This analysis of a pilot study that offered birth control and PrEP counseling to girls and young women concluded that despite many opportunities to discuss HIV risk reduction alongside STI prevention strategies and other contraceptive information, only one of the 111 analyzed counseling sessions specifically mentioned PrEP.