November 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 10 stories from the last month we thought you might find interesting:
As more states specifically address the use of long-acting reversible contraceptives (LARCs) immediately postpartum, it’s not yet clear how the 38 states with such policies describe payment. This review of publicly available statewide policy language on the subject found all of the policies enacted in the 38 states identified Medicaid as the payor, while only two states also included non-Medicaid plans. In 23 of the states, reimbursement separate from the global obstetric fee for insertion was allowed, but in six states it was not. Thirty-one states allow device cost reimbursement separate from the fee, but 4 do not.
Implementation of a state policy mandating universal access to immediate postpartum LARC at three Cleveland Clinic Ohio was associated with a 11.1% increase in inpatient LARC initiation. This retroactive study identified 17,848 deliveries pre-policy implementation and 18,555 deliveries post-implementation. Of these deliveries only .5% of patients had a postpartum LARC inserted, while 11.6% of patients chose to have a LARC inserted postpartum after the policy’s implementation.
Immediate postpartum access to LARCs are a best practice but many hospitals face significant barriers to offering these services. A promising approach to increasing LARC access in the immediate postpartum period are implementation toolkits, “packages of resources and strategies to facilitate the implementation of new services.” This study looked at the feasibility of a toolkit-based implementation of postpartum LARCs at a large medical center between 2017 and 2020. At the end of the study period 70% of clinicians were “extremely” or “somewhat” satisfied with the implementation process. Postpartum LARC counseling rates increased throughout 2019 and utilization of LARCs postpartum increased as well from 5.46% pre-study to 8.58% post-study. Overall results showed “high acceptability but mixed healthcare quality outcomes,” indicating the toolkit needs further refinement.
In a review of articles published between 2005-2020, researchers found that across all four groups (pregnant women, postpartum women, women seeking emergency contraception, and women seeking abortion care) values and preferences for birth control were influenced by method effectiveness, access and availability of preferred method, convenience, cost, side effects, previous experience, partner approval, and societal norms. No single birth control method had all of the features that all users deemed important, but many studies emphasized LARCs. This systematic review emphasizes how important access to the full range of birth control methods is for people’s reproductive well-being.
In this study of 511 people, 92.5% reported continuing their birth control during the course of the pandemic, most often for health reasons, because they use a LARC method, because they have access to telehealth, or because of the increased importance of preventing an unplanned pregnancy. More than half (52.6%) of those who used pre-exposure prophylaxis (PrEP) reported that have already or plan to soon stop their PrEP regimen The most common reasons given for the decision to stop PrEP were temporary abstinence and trouble accessing in-person care.
As policy changes are increasingly allowing pharmacists to prescribe hormonal birth control, research is needed to understand patient experience with the service. This study surveyed people who received pharmacist prescribed hormonal contraception between December 2017 and January 2019 and found 74% sought pharmacist prescribed birth control because it was faster than waiting for an appointment with a provider. Ninety-seven percent reported being satisfied with the service overall, while 94% felt comfortable with their pharmacist, 86% felt comfortable with the counseling they received, and 74% felt comfortable with the level of privacy. Ninety-six percent said they were likely to use a pharmacy again in the future for contraception and 95% said they would recommend it to a friend.
This study compared pregnancy rates among women provided a 12-month of short-acting hormonal contraceptives and those who received less than a year’s supply. Results showed that those who received a 12-month supply are less likely to become pregnant within the year and are also less likely to use emergency contraception. Additionally, 99.4% of those with a 12-month supply refilled their birth control after the year while only 63.9% of those who received less than a 12-month supply did the same.
Sexual and Reproductive Health
Despite steep declines in the US teen birth rate in recent years, it is still higher than many peer nations and disparities exist between races/ethnicities. In hopes of addressing disparities specifically among the Latino population, some schools and communities with a high number of Latino teens require tailored teen pregnancy prevention program, Re:MIX. This study looked at Re:MIX’s ability to impact early sex, unprotected sex, and key mediators from 2015-2020. Among other findings, it concluded that the curriculum was well received by students and in both the short- and long-term improved students’ knowledge about sexual and reproductive health, how to obtain birth control in their community, and their ability to ask for and give consent.
American Indian and Alaska Native (AI/AN) people experience a disproportionately poor sexual and reproductive health outcomes, and intimate partner and sexual violence contribute to those poor outcomes. After conducting to interviews with AI/AN people researchers found that 100% described multiple experiences with violence and limited access to confidential reproductive health services and education. To combat these experiences as well as improve the health and well-being of future generations, researchers recommend the creation and implementation of culturally informed interventions and access to culturally responsible health and advocacy services.
In October 2021, HHS’s Office of Population Affairs released an amended version of the Title X Family Planning Rule. The amended rule replaces the one issued in 2019 by the Trump administration, the effects of which significantly reduced the size of the Title X network and the number of clients it served. The amended rule restores many parts of the Title X program including allowing abortion referrals, allowing abortion services to happen in the same location as other health care services, and adding confidentiality protections for young people under age 18.