May 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:
Offering over-the-counter birth control is one way to reduce unintended pregnancies in young people as it increases access to affordable contraception. This study modified a telehealth platform that checks COVID symptoms to simulate pharmacist prescribed birth control and received feedback from young people age 15 to 21 about its usability. All of the study’s participants agreed or strongly agreed that the app makes it easier for teens to access birth control and also that it reduces birth control stigma. However, three main issues were identified with the prototype telehealth platform. First, participants struggled with the questions about their medical history and CDC medical eligibility criteria. Second, technical glitches were identified. Third, participants suggested that adding images or links would increase their engagement.
This study found that compared to people who received their birth control prescription from a provider, people who received a pharmacist prescription for birth control were 61% more likely to continue using contraception after 12 months. However, the results also showed that most people in both groups experienced some break in coverage (anywhere between one and 29 days between prescriptions) over the course of six months.
With data from National Surveys of Family between 2015-2019, the authors of this study determined that among low-income women age 15 to 49, 23% of those using birth control said they would use another method and 39% of those not using contraception said they would begin if cost were not an issue. Furthermore, compared to people using birth control with private or public health insurance, those who had recently received publicly supported contraceptive care described significantly higher levels of unfulfilled contraceptive preferences because of cost. Those using birth control were more likely to report a desire to use a different method of birth control than their current method and those not using birth control were more likely to express a desire to use any form of birth control. However, people using who received person-centered contraceptive counseling had slightly lower rates of unfulfilled preferences due to cost.
Although clinical guidelines support IUD insertion prior to leaving the hospital postpartum, inpatient placement is not common often partially due to upfront cost and inconsistent private insurance reimbursement. This study examined the relationship between cost and unintended pregnancy based on when an IUD was inserted. Results found that while patients paid more in immediate costs for inpatient placement, the overall cost was much lower compared to those who had their IUD placed in an outpatient setting. For every 1,000 people who indicated they preferred postpartum insertion there was an associated savings of more than $211,000 and 37 unintended pregnancies that did not occur. The authors note that their findings support the case that private insurance companies should fully and separately reimburse inpatient postpartum IUD insertion.
Oral levonorgestrel emergency contraception (LNG EC) can provide an effective method of birth control to prevent pregnancy when used up to five days after unprotected or under-protected sex. FDA guidelines permit LNG EC to be dispensed without a prescription, parental consent, age limits, or ID required for purchase. However, pharmacists who dispense LNG EC may have variable knowledge about the regulations and proper use. In this study, the authors contacted more than 500 pharmacies in West Virginia. They found that 49% of contacted pharmacies provided accurate information about effective timing of LNG EC use, with chain pharmacies more likely to answer accurately than independent pharmacies. Similarly, only 57% of pharmacies answered appropriately regarding the prescription requirement, 44% for the ID requirement, and 57% for inquiries regarding parental consent, with independent pharmacies again less likely to have correct information.
Analysis from the Guttmacher Institute shows a total of 1,338 abortion restrictions have been enacted since Roe v. Wade was handed down in 1973—44% of these in the past decade alone. Yet not enough is known about the implications of these policies on birth outcomes. Using a state-level index based on 18 restrictive abortion policies and data from the 2005-2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files this study found that the relationship between restrictive abortion policies and adverse birth outcomes was not significant on a national level; of 2.5 million live births 12% were per-term and 8% were low birth weight. However, the regional implications were more pronounced. More policies were enacted in the Midwest, for example, where results also showed a 2% increase in pre-term birth rates. Overall, in three of four regions studied restrictive abortion policies were associated with adverse birth outcomes.
Despite being approved for medication abortion by the FDA in 2000, mifepristone is subject to Risk Evaluation and Mitigation Strategy (REMS) criteria that make it difficult for family physicians to provide it in primary care settings. Interviews with 56 family physicians across the US who were not opposed to abortion found that 41% said the REMS criteria were a barrier that added a difficult-to-navigate layer of complexity even for those trained to provide abortion care. They reported that the REMS “require substantial involvement of clinic administration, who can be unsupportive” and that “the complexity of navigating the REMS results in physicians and clinic administration in primary care viewing medication abortion as not worth the effort, since it is only a small component of services offered in primary care.” The authors note that removing the REMS would not only simplify the abortion care process in primary care but could also increase access to and reduce stigma around abortion care.
This article, written by two Senior Research Assistants at Brookings, advocates for increased focus on family planning in light of the recent leak of the draft Supreme Court decision in Dobbs v. Jackson Women's Health Organization. The authors note the copious evidence that restrictions on abortion access have a negative impact on people’s lives including financial stress and educational consequences. They argue that widespread access to family planning—in the form of birth control or abortion—has a positive impact on people’s lives in the long-term by giving them the ability to decide if, when, and under what circumstances to get pregnant and have a child. This is especially important as a number of the states with plans to restrict or eliminate abortion access in the near future already have high rates of unintended pregnancy. For example, Louisiana, which will immediately outlaw abortion if Roe is struck down, has a 43% unplanned pregnancy rate. Meanwhile, states like Delaware and Colorado that have already invested in family planning have seen improved outcomes for women.
Patients seeking abortion in the US may face barriers to care depending on the state they live in. These state-level barriers may influence how patients afford and travel to abortion clinics as well as when they present for care. In this survey, the authors sought out patients seeking abortion care in Texas, a state with an already high level of abortion restrictions (the study was conducted prior to the passage of SB 8), in comparison with California, a relatively less restrictive state. Among a total of 434 patients, the authors found that Texas patients were more likely to sell something of value, delay paying another expense to pay for their abortion, or to miss work to seek abortion care. They also traveled further for their abortion.
Patients seeking abortion may face many barriers to care, particularly in a changing political landscape. This may be particularly true for those who do not physically live within close range of an abortion clinic. Eighty-nine percent of counties in the US do not have a single abortion provider and traveling longer distances for abortion care has been associated with other related burdens, including transportation costs, need for childcare, having to take time off of work/school, and needing to disclose the abortion. In this study of patients seeking information about abortion clinics online, participants were surveyed to determine how initial distance from an abortion clinic affected pregnancy outcomes. Of more than 1,000 patients identified, approximately 19% of participants lived more than 50 miles from the nearest abortion clinic, and these participants were more likely to report travel-related barriers to abortion access, such as needing to gather transportation costs. In comparison with participants who lived five miles or less from the nearest clinic, patients living more than 50 miles were twice as likely to still be seeking abortion or to have decided to continue the pregnancy at follow-up four weeks after enrolling in the study.
Sexual and Reproductive Health
Improved access to birth control is a recognized area for improvement around the US, supported by professional societies and government recommendations. Many patients most frequently interact with health care providers in the primary care setting, however not all primary care providers offer the full range of reproductive health care services, including abortion. The authors of this study sought to explore patient preferences regarding reproductive health care services, including abortion care, in primary care, and to examine whether these preferences differed between rural and urban settings. An anonymous survey was administered to patients at rural and urban clinics in Washington, Idaho, and Wyoming. Most respondents expressed that all contraceptive options should be available in primary care, and that abortion and miscarriage services should also be offered. More respondents in urban clinics thought that IUDs and abortions should be available.