November 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 12 stories from the last month we thought you might find interesting:
Birth Control
An increasing body of research on safety supports making oral contraceptive pills (OCPs) available over the counter (OTC), but FDA approval for OTC status requires that consumers demonstrate the ability to understand label messages regarding the safety and efficacy of the OTC product.
In this pilot study, researchers conducted more than 160 interviews with patients age 12-49 to assesses their ability to understand several key endpoints related to the safety of OCP use, including risks and contraindications. Over 95% of participants understood 10 out of 11 primary safety endpoints, and 89% understood the 11th (related to the safety of OCPs with a history of blood clots). While the final FDA approval of label comprehension will be linked to the actual approved OCP product, findings suggest that consumers are able to understand key label messaging for safe and effective use of an OTC birth control pill.
Using two years of data from the National Survey of Family Growth this study examined provision of person-centered contraceptive counseling at Title X-funded clinics, non-Title X publicly funded clinics, and private clinics. Of 2,225 patients, 6.9% received care at a Title X-funded clinic, 8.2% at a non-Title X publicly-funded clinic, and 84.9% at a private clinic. Patients who attended a Title X-funded clinic were as likely (51.3%) to receive person-centered contraceptive counseling as those who received care in the at a non-Title X publicly-funded clinic (52.4%) or a private clinic (50.6%).
Pregnancy and Birth
Acceptability and Usability of ‘One Key Question'® in Australian Primary Health Care
This study evaluated whether One Key Question was acceptable to patients and feasible to use in two general primary care practices in Sydney, Australia. Ten general practitioners participated, and 56 patients were asked One Key Question. Most patients were happy to be asked about their reproductive choices. All of the participating providers agreed that it was easy to incorporate One Key Question into the visit, although some reported it extended the visit by a few minutes.
This study sought to better understand how a person’s health insurance status, geography, and race and ethnicity influence the quality of postpartum care they receive. Using 2016-2019 Pregnancy Risk Assessment Monitoring System data from 43 states, multiple differences were found in receipt of postpartum care by these socio-demographic factors. For example, patients with Medicaid, those living in rural areas, and non-white patients were significantly less likely to receive depression screening or contraceptive counseling.
Abortion
Physician Beliefs about Contraceptive Methods as Abortifacients
Contraception, including emergency contraception (EC), helps to prevent ovulation or fertilization, but does not prevent pregnancy once an egg has been fertilized. However, numerous misconceptions persist about the mechanisms of contraceptive medications. The authors of this research letter surveyed almost 900 physicians at the University of Wisconsin School of Medicine and Public Health, to characterize their beliefs regarding contraceptive methods including the pill, ring, patch, and IUDs, along with EC. While 95% of the surveyed providers care for reproductive aged females, one in six physicians incorrectly believed that some contraceptive methods, particularly EC, are abortifacients— including obstetrician-gynecologists (though in smaller proportion). With abortion restrictions on the rise, it is important to ensure that both providers and patients understand how contraception works so that it can be prescribed and used appropriately.
Previous research has suggested that Black, Latinx, and other people of color are less likely than other groups to choose medication abortion over an abortion procedure. In this qualitative study, the authors conducted focus groups with Black and Latinx women as well as interviews with abortion providers and reproductive justice community-based organization leaders. They identified multiple levels of barriers to abortion care for communities of color. Participants suggested that solutions would need to incorporate a multi-level approach, including promoting story-sharing through social media, policy advocacy oriented on reproductive justice, diversification of clinic staffing, and increased flexibility of clinic schedules and fees.
Sexual and Reproductive Health
Nearly 7,500 adolescents were surveyed before and after completing a statewide California sexual health education program to assess changes in their perception of barriers, facilitators, and intentions to use sexual and reproductive health (SRH) services. Following program completion, young people’s perception of cost and staff judgment as barriers were reduced, but there were small increases in confidentiality concerns. Intentions to use SRH services increased from 90.6% to 96.2%. Increases in perceptions of facilitators and intentions were greater among younger adolescents, female adolescents, and black adolescents (relative to Hispanic adolescents).
This study used data from 38 states participating the 2008-2018 School Health Profiles, a Centers for Disease Control and Prevention surveillance system which surveys lead health teachers regarding school health policies and practices. The authors examined trends in the SRH topics taught in mandatory health education classes in Grades 6-12. Overall, most states had no changes in the SRH topics taught as part of health education over the decade examined. However, there were also findings that suggest some improvement—more states had increases in the percentage of schools teaching about condom use topics than decreases.
This qualitative study presents findings from interviews with family planning clinic staff at 55 sites in Arizona, Iowa, and Wisconsin to better understand challenges providing care during the pandemic and adaptations to service provision that were made. Interviews were conducted in late 2020 and early 2021 and analyzed thematically. Decreased revenue and staff burnout were two of many challenges identified. Three common areas of change were: implementation of COVID-19 safety procedures, rapid shift to telehealth, and adjusting service delivery and staffing to better meet patients’ needs (e.g., refilling contraception prescriptions without in-person appointments).
Using 2011-2019 data from sexually active adolescent women participating in the National Survey of Family Growth, this study looked at differences in receipt of STI and HIV testing, contraceptive counseling and method use, and emergency contraception (EC) counseling and method use by sexual orientation and race/ethnicity. While receipt of services was low overall, there were disparities by these characteristics. Women who have sex with women only were least likely to receive each service. Women who have sex with both women and men were more likely to receive STI and HIV testing and EC counseling than those who have sex with men only. Black women had higher prevalence of STI and HIV testing than their white peers, but white women were more likely to receive birth control than Black and Hispanic women. Racial disparities remained when the data were analyzed separated based on the sex of sexual partners.
Integrating Reproductive Justice (RJ) principles in reproductive health programs is critical to ensuring that efforts aimed at addressing racial/ethnic disparities in sexual and reproductive health do not actually cause further harm. This paper details the integration of RJ into a 2016 North Carolina program initially focused on increasing access to long-active reversible contraceptive (LARC) methods. After community partners raised concerns about this emphasis on LARC methods, program leaders explicitly incorporated an RJ framework as part of their strategy, hosted RJ trainings, and updated language to emphasize the full range of contraceptive methods and reproductive autonomy.
Changes in the Clinical Workforce Providing Contraception and Abortion Care in the US, 2019-2021
This study used medical claims data from 2019-2021 to examine changes in the number of clinicians providing contraception and abortion. The authors hypothesized that the COVID-19 pandemic and restrictions on abortion care may be associated with a declining workforce. Results show that the number of physicians decreased in 2020 for all reproductive health services examined except medication abortion, and the number of physicians providing in-person contraception had not returned to pre-pandemic levels in 2021. However, the number of advanced practice clinicians remained stable from 2019 to 2020 and exceeded pre-pandemic levels in 2021.
