1. Public Funding for Contraception, Provider Training, and Use of Highly Effective Contraceptives: A Cluster Randomized Trial.
- Author
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Thompson KM, Rocca CH, Kohn JE, Goodman S, Stern L, Blum M, Speidel JJ, Darney PD, and Harper CC
- Subjects
- Adolescent, Adult, Contraceptive Agents, Female economics, Delayed-Action Preparations, Drug Implants economics, Education, Continuing, Family Planning Services education, Female, Health Knowledge, Attitudes, Practice, Health Personnel education, Humans, Intrauterine Devices economics, Intrauterine Devices statistics & numerical data, United States, Young Adult, Contraception economics, Contraception statistics & numerical data, Family Planning Services economics, Family Planning Services statistics & numerical data, Medicaid economics, Medicaid statistics & numerical data
- Abstract
Objectives: We determined whether public funding for contraception was associated with long-acting reversible contraceptive (LARC) use when providers received training on these methods., Methods: We evaluated the impact of a clinic training intervention and public funding on LARC use in a cluster randomized trial at 40 randomly assigned clinics across the United States (2011-2013). Twenty intervention clinics received a 4-hour training. Women aged 18 to 25 were enrolled and followed for 1 year (n = 1500: 802 intervention, 698 control). We estimated the effects of the intervention and funding sources on LARC initiation with Cox proportional hazards models with shared frailty., Results: Women at intervention sites had higher LARC initiation than those at control (22 vs 18 per 100 person-years; adjusted hazard ratio [AHR] = 1.43; 95% confidence interval [CI] = 1.04, 1.98). Participants receiving care at clinics with Medicaid family planning expansion programs had almost twice the initiation rate as those at clinics without (25 vs 13 per 100 person-years; AHR = 2.26; 95% CI = 1.59, 3.19). LARC initiation also increased among participants with public (AHR = 1.56; 95% CI = 1.09, 2.22) but not private health insurance., Conclusions: Public funding and provider training substantially improve LARC access.
- Published
- 2016
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