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IntroductionContraceptive counseling during the perinatal period is an important component of comprehensive perinatal care. We synthesized research about contraceptive counseling during the perinatal period, which has not previously been systematically compiled.MethodsWe developed search criteria to identify articles listed in PubMed, Embase, and Popline databases published between 1992 and July 2022 that address patients' preferences for, and experiences of, perinatal contraceptive counseling, as well as health outcomes associated with this counseling. Search results were independently reviewed by multiple reviewers to assess relevance for the present review. Methods were conducted in accordance with PRISMA guidelines.ResultsThirty-four articles were included in the final full text review. Of the included articles, 10 included implementation and evaluation of a contraceptive counseling method or protocol, and 24 evaluated preferences for or experiences of existing contraceptive counseling in the perinatal period. Common themes included the acceptability of contraceptive counseling in the peripartum and postpartum periods, and a preference for contraceptive counseling at some point during the antenatal period and before the inpatient hospital experience, and direct provider-patient discussion instead of video or written material. Multiple studies suggest that timing, content, and modality should be individualized. In general, avoiding actual or perceived directiveness and providing multi-modal counseling that includes both written educational materials and patient-provider conversations was desired.DiscussionThe perinatal period constitutes a critical opportunity to provide contraceptive counseling that can support pregnant and postpartum people's management of their reproductive futures. The reviewed studies highlight the importance of patient-centered approach to providing this care, including flexibility of timing, content, and modality to accommodate individual preferences.

Background: Adolescent contraceptive decision‐making is influenced by a number of patient and clinician‐driven factors. Although the AAP continues to endorse an efficacy‐based model of contraceptive counseling, many professional organizations are shifting to a shared decision‐making model as the optimal approach for providing unbiased and patient‐driven contraceptive counseling. While SDM is intended to reduce the influence of clinician bias, it can exacerbate inequity if a clinician tailors a conversation based on their assumptions of a patient's goals or preferences. In this qualitative study, we explored self‐reported contraceptive counseling practices among US‐based clinicians who see adolescent patients to assess how these practices create barriers or facilitators to SDM and person‐centered contraceptive care. Methods: We interviewed 16 clinicians at the 2022 AAP Annual Meeting who counsel adolescent patients about contraception. We used thematic content analysis to analyze interview transcripts using Dedoose. Results: We identified six aspects of contraceptive counseling that clinicians commonly employed with adolescent patients. These were: (1) sociodemographic characteristics driving counseling, (2) reliance on tiered effectiveness counseling, (3) initiating counseling conversations using "ask then explain" or "explain then ask" approaches, (4) emphasis on teen pregnancy prevention, (5) the influence of method accessibility on counseling, and (6) parental involvement in decision‐making and patient confidentiality. We describe how these themes align with or diverge from each component of the SDM framework. Conclusion: Clinicians in this study frequently engaged in non‐patient‐centered techniques during contraceptive counseling with adolescents. These findings can inform practice recommendations to support clinicians in providing high‐quality contraceptive counseling using shared decision‐making. [ABSTRACT FROM AUTHOR]

The promising results achieved in male hormonal contraceptive trials over the last decades suggest that new male contraceptives could hit the market soon. In shared decision‐making counseling, couples and their healthcare provider collaborate to make decisions about contraception choices. This model of contraceptive counseling could aid men in taking responsibility for contraception and women in trusting their partners in family planning. The shared decision‐making process in contraceptive counseling requires partners to provide input on their preferences, values, and desires, while healthcare professionals share medical knowledge and evidence‐based information.It has been proven that this method leads to higher adherence and satisfaction. To ensure that contraceptive counseling is inclusive, fair, and supportive of different reproductive experiences and needs, it is crucial to incorporate the Reproductive Justice Framework into counseling. [ABSTRACT FROM AUTHOR]

Keemi Ereme,1 Kaidee Akullo,2 Quetzal A Class,2 Erica Hinz2 1Obstetrics and Gynecology, University of Washington, Seattle, WA, USA; 2Obstetrics and Gynecology, University of Illinois-Chicago, Chicago, IL, USACorrespondence: Keemi Ereme, University of Washington, 1959 NE Pacific St, Box 356460, Seattle, WA, 98195, USA, Tel +1 301-704-4668, Email kereme@uw.eduIntroduction: The study examines the feasibility, quality of counseling, and knowledge after a virtual Group Contraception Counseling (GCC) session.Methods: At an urban academic hospital, we recruited English-speaking pregnant women aged 15– 49 who had access to a video-enabled electronic device. Participants engaged in a standardized 45-minute educational session about contraceptive methods in groups of two to five persons conducted over a video conferencing platform. The primary outcome was participant perceived quality of contraception counseling measured by the Person-Centered Contraception Counseling (PCCC) scale. The secondary outcomes were knowledge change before and after counseling, and postpartum contraception uptake. We used an adjusted multivariable linear regression model to analyze knowledge scores.Results: Twenty-two participants completed the study. Participants identified primarily as Black or Hispanic/Latinx (78%), in a partnership (50%), having completed college (59%), and having an annual income of less than &dollar;50,000 (78%). A total of 77% of participants recorded a perfect score for quality of counseling using the Person-Centered Contraceptive Counseling (PCCC) scale. There was an increase in knowledge after counseling (Mean difference (M)=0.07, p< 0.01). Notably, certain subsets of participants had decrease in knowledge scores after counseling. Participants who used postpartum contraception were more likely to have increase in knowledge after counseling compared to those who did not (Mean difference (M)=0.09, p< 0.01).Conclusion: Our findings suggest virtual group contraception counseling is feasible for providing high-quality counseling and can possibly increase contraceptive knowledge.Keywords: contraception, contraceptive counseling, group counseling, reproductive health, pregnancy, person-centered contraceptive counseling

Since 2006, iPLEDGE, a risk evaluation and mitigation strategy (REMS), has attempted to prevent fetal exposures in people taking isotretinoin through contraceptive requirements and regular pregnancy testing. There has been criticism of iPLEDGE’s requirements, results, and accessibility. iPLEDGE has placed significant burdens on physicians, patients, and administrative staff. Some level of burden is acceptable to prevent fetal exposures, but iPLEDGE burdens are so strenuous that physicians may choose not to prescribe isotretinoin because of them. There are several evidence-based adaptations that iPLEDGE and physicians can enact to improve the isotretinoin experience. First, physicians can practice shared-decision making in contraceptive counseling and educate patients on long-acting reversible contraceptives (LARCs) to improve the counseling process and outcomes. Second, physicians can take advantage of the reimbursed iPLEDGE contraceptive counseling sessions and refer patients accordingly. Finally, iPLEDGE should recognize the variation in efficacy among contraceptives. Specifically, LARCs and permanent surgical sterilization should be exempt from certain iPLEDGE requirements such as monthly pregnancy testing and attestations. iPLEDGE should work with dermatologists for the continual improvement of iPLEDGE. Communication, repetitive reassessment, and subsequent adaptations will result in better care for patients requiring isotretinoin. [ABSTRACT FROM AUTHOR]

Background/Aim: Hormonal contraceptives can carry risks, particularly for women with chronic conditions such as heart disease and diabetes. A wide range of basic science, animal, and human studies indicate an enduringly heightened risk of venous thromboembolism, hypertension, myocardial infarction, and ischemic stroke associated with birth control hormones (estrogen and progestogen). According to the guidelines, women aged 35 and over considering hormonal contraceptives should be evaluated for vascular diseases and cardiovascular risk factors. However, the number of studies on this subject is insufficient. This study aimed to assess the use of hormonal contraceptive methods and the knowledge levels of women with cardiological symptoms and diseases attending a cardiology outpatient clinic. Methods: A descriptive and cross-sectional study was conducted with cardiological problems (diagnosed or being treated at the Cardiology Polyclinic) of women between the ages of 18 and 45. Data were collected through face-to-face interviews using the Sociodemographic Characteristics Form and the Structured Contraception Knowledge Level Form. The study sample consisted of 190 women visiting a state hospital's Cardiology Polyclinic in Istanbul between October 2019 and January 2020. Results: Among the participants, 24.8% used hormonal contraceptives, and 15.8% reported facing problems while using them, most commonly experiencing constant headaches (53.3%) and iron deficiency (30%). The study revealed that 7.9% of the participants had cardiovascular disease, with 52.1% experiencing cardiological symptoms, such as palpitations and rapid heartbeat. A total of 24.7% had received family planning counseling, and 59.6% believed that counseling influenced their contraceptive choices. Those who received counseling showed greater knowledge regarding the safety of progesterone-only birth control pills for women with heart disease. Conclusion: Women with cardiovascular disease should be well informed about the risks associated with hormonal contraceptives. The study emphasizes the importance of counseling services provided by nurses in cardiology and obstetrics clinics to guide women toward safer contraceptive options. Continuous monitoring and education are essential to ensure women's health and safety in contraceptive choices. [ABSTRACT FROM AUTHOR]

BACKGROUND: Contraceptive care is a key element of reproductive health, yet only 12%-30% of women report being able to access and receive the information they need to make these complex, personal health care decisions. Current guidelines recommend implementing shared decision-making approaches; and tools such as patient decision aid (PtDA) applications have been proposed to improve patients access to information, contraceptive knowledge, decisional conflict, and engagement in decision-making and contraception use. To inform the design of meaningful, effective, elegant, and feasible PtDA applications, studies are needed of all users current experiences, needs, and barriers. While multiple studies have explored patients experiences, needs, and barriers, little is known about clinicians experiences, perspectives, and barriers to delivering contraceptive counseling. OBJECTIVE: This study focused on assessing clinicians experiences, including their perspectives of patients needs and barriers. It also explored clinicians suggestions for improving contraceptive counseling and the feasibility of a contraceptive PtDA. METHODS: Following the decisional needs assessment approach, we conducted semistructured interviews with clinicians recruited from the Society of Family Planning. The Ottawa Decision Support Framework informed the interview guide and initial codebook, with a specific focus on decision support and decisional needs as key elements that should be assessed from the clinicians perspective. An inductive content approach was used to analyze data and identify primary themes and suggestions for improvement. RESULTS: Fifteen clinicians (12 medical doctors and 3 nurse practitioners) participated, with an average of 19 years of experience in multiple regions of the United States. Analyses identified 3 primary barriers to the provision of quality contraceptive counseling: gaps in patients underlying sexual health knowledge, biases that impede decision-making, and time constraints. All clinicians supported the development of contraceptive PtDAs as a feasible solution to these main barriers. Multiple suggestions for improvement were provided, including clinician- and system-level training, tools, and changes that could support successful implementation. CONCLUSIONS: Clinicians and developers interested in improving contraceptive counseling and decision-making may wish to incorporate approaches that assess and address upstream factors, such as sexual health knowledge and existing heuristics and biases. Clinical leaders and administrators may also wish to prioritize solutions that improve equity and accessibility, including PtDAs designed to provide education and support in advance of the time-constrained consultations, and strategic training opportunities that support cultural awareness and shared decision-making skills. Future studies can then explore whether well-designed, user-centered shared decision-making programs lead to successful and sustainable uptake and improve patients reproductive health contraceptive decision-making.

OBJECTIVES: The CHARM2 (Counseling Husbands and wives to Achieve Reproductive Health and Marital Equity) intervention engages health care providers to deliver gender-equity and family planning sessions to couples using a person-centered shared decision-making approach for contraception counseling. We previously showed that the intervention improved contraceptive use at 9-month follow-up. We sought to assess whether the intervention was further associated with the quality of care reported by participants and whether the quality of care reported mediated the effect of the intervention on contraceptive use. STUDY DESIGN: This is a planned secondary analysis of the effect of the CHARM2 intervention on 1201 married couples in rural Maharashtra, India in a cluster randomized controlled trial completed between 2018 and 2020. We assessed the effect of CHARM2 on perceived quality of care as measured by the Interpersonal Quality of Family Planning (IQFP) scale using a difference-in-differences linear regression approach including a mixed-effects model with nested random effects to account for clustering. We assessed whether the association between CHARM2 and modern contraceptive use was mediated by quality of family planning care. RESULTS: Intervention participants had higher mean IQFP scores than control participants at 9-month follow-up (intervention 3.2, SD 0.6 vs. control 2.3 mean, SD 0.9, p < 0.001). The quality of care reported mediated the effect of the intervention on contraceptive use (indirect effect coefficient 0.29, 95% CI 0.07-0.50). CONCLUSION: Family planning interventions such as CHARM2, which utilize person-centered shared decision-making contraceptive counseling approaches improve womens perceived quality of care. Effects on quality of care mediate observed effects of the intervention on contraceptive use. IMPLICATIONS: Contraceptive interventions should focus on improving person-centered outcomes, such as quality of care, rather than contraceptive use targets. By focusing on improving person-centered care, interventions will improve contraceptive use among those who desire a method while meeting the holistic reproductive health needs of clients and couples.

The contraceptive needs of women for whom the benefits of menstrual bleeding may outweigh its disadvantages have largely been overlooked, especially outside high-income countries. Some providers and researchers have assumed that users of nonhormonal birth control (non-HBC) are misinformed about the positive and negative effects of HBC and/or the need for menstrual bleeding. This study takes the position that many of those rejecting HBC in favor of methods that do not alter bleeding are, in fact, making informed decisions. Using questionnaire data from 4,255 contraceptive users in three countries, we compared current HBC users explicitly open to hormone use ("H-receptive") and non-HBC users explicitly rejecting hormones ("H-averse"). To the extent that menstrual bleeding attitudes affect contraceptive choice, these two groups should have the greatest contrasts in those attitudes. This novel study design mitigates ambiguities arising from posing hypothetical scenarios to those ambivalent about using hormones or who are not currently using contraception. In all three countries, of those agreeing with the prompt, "I don't want to change my natural menstrual cycle," the fractions of H-averse and H-receptive users are disproportionally high and low, respectively (p ≤.0026). Responses to other prompts varied across populations, revealing complex juxtapositions of multiple criteria, including bleeding preferences, that likely influence contraceptive choices. These patterns, reflecting personal and culturally salient values, highlight the necessity of not assuming that menstrual bleeding is undesirable or relying on a single criterion to ascertain clients' contraceptive needs and preferences. Rather, acknowledging a client's personal hierarchy of preferences regarding contraceptive attributes best serves their goals. [ABSTRACT FROM AUTHOR]

Bariatric surgery is a common treatment for obesity, and about half of patients undergoing these procedures are patients of reproductive age. Following bariatric procedures, rapid weight loss and an increase in fertility occur. Guidelines recommend pregnancy delay for 12–24 months postoperatively. It is important that patients capable of pregnancy undergoing bariatric procedures receive preoperative contraceptive counseling. Studies surveying bariatric providers demonstrate that most providers understand the importance of delaying pregnancy and contraceptive counseling. However, deficiencies in bariatric provider knowledge, comfort, and practice with contraceptive counseling were identified. These gaps highlight opportunities for improvement in preoperative care to ensure patients are receiving appropriate contraception. [ABSTRACT FROM AUTHOR]

BACKGROUND: High-quality contraceptive counseling is critical to support Veterans reproductive autonomy and promote healthy outcomes. OBJECTIVE: To describe perceived quality of contraceptive counseling in Veterans Health Administration (VA) primary care and assess factors associated with perceived high- and low-quality contraceptive counseling. DESIGN: Cross-sectional study using data from the Examining Contraceptive Use and Unmet Need in women Veterans (ECUUN) national telephone survey. PARTICIPANTS: Veterans aged 18-44 who received contraceptive services from a VA primary care clinic in the past year (N=506). MAIN MEASURES: Perceived quality of contraceptive counseling was captured by assessing Veterans agreement with 6 statements regarding provider counseling adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. High-quality counseling was defined as a top score of strongly agreeing on all 6 items; low-quality counseling was defined as not agreeing (neutral, disagreeing, or strongly disagreeing) with >3 items. We constructed two multivariable models to assess associations between patient-, provider-, and system-level factors and perceived high-quality (Model 1) and perceived low-quality counseling (Model 2). KEY RESULTS: Most participants strongly agreed that their providers listened carefully (74%), explained things clearly (77%), and spent enough time discussing things (71%). Lower proportions strongly agreed that their provider discussed more than one option (54%), discussed pros/cons of various methods (44%), or asked which choice they thought was best for them (62%). In Model 1, Veterans who received care in a Womens Health Clinic (WHC) had twice the odds of perceiving high-quality counseling (aOR=1.99; 95%CI=1.24-3.22). In Model 2, Veterans who received care in a WHC (aOR=0.49; 95%CI=0.25-0.97) or from clinicians who provide cervical cancer screening (aOR=0.49; 95%CI=0.26-0.95) had half the odds of perceiving low-quality counseling. CONCLUSIONS: Opportunities exist to improve the quality of contraceptive counseling within VA primary care settings, including more consistent efforts to seek patients perspectives with respect to contraceptive decisions.

ObjectiveTo describe changes in contraceptive method plans pre-appointment, after counseling, and post-procedure in patients having an abortion.Study designWe reviewed electronic medical records of University of California, Davis Health patients who had an operating room abortion from January 2015 to December 2016. We excluded persons with procedures for fetal anomaly or demise. We extracted patient demographics and contraceptive plans reported at each encounter (telephone intake, pre-operative appointment, and day of abortion). We evaluated individual contraceptive plans across the encounters, identified patient characteristics that contributed to plan change, and created a multivariable logistic regression model for predictors of contraception method plan change from telephone intake to post-procedure.ResultsThe 747 patients had a mean gestational age of 16 4/7 ± 5 0/7 weeks with 244 (32.7%)

BackgroundMonitoring clients' experiences with contraceptive care is vital to inform quality improvement efforts and ensure fulfillment of individuals' human rights. The Quality of Contraceptive Counseling (QCC) Scale is a previously validated scale that comprehensively measures individuals' experiences receiving counseling in three subscales: Information Exchange, Interpersonal Relationship, and Disrespect and Abuse. We sought to better understand the correlation of client, provider, and visit factors with client-reported quality of contraceptive counseling in the public sector in two Mexican states using the QCC Scale.MethodsThis cross-sectional survey study used the QCC Scale total score and subscale scores as outcome variables. Explanatory variables included clients' age, LGBTTTIQ status, relationship status, number of children, education, and occupation; providers' gender and type of provider; and the reason for visit. Linear and logistic regression models assessed bivariate associations. Multivariable, multilevel mixed-effects models with clinic as a random effect were fit. All models used complete cases (n = 470).ResultsIn the multilevel mixed-effects analyses, patients aged 35+ years reported worse Information Exchange (coefficient - 0.29, p = 0.01). Clients receiving care post-partum reported worse Information Exchange (coefficient - 0.25, p = 0.02) and worse total scores (coefficient - 0.15, p = 0.04) compared to clients seeking contraceptive information or methods. Clients who had 1+ children reported better Information Exchange (coefficient 0.21, p = 0.01) than those with no children. Though Disrespect and Abuse subscale scores were overall high (indicating high quality of care), we found a significant association between age and report of such negative experiences: clients in increasing age categories had increasingly higher adjusted odds of reporting no disrespect and abuse (aORs compared to the youngest group were 2.50 for those aged 19-24 years, p = 0.04; 4.53 for those 25-34 years, p = 0.01; and 6.11 for those 35+ years, p = 0.01.) CONCLUSIONS: Our findings align with previous results that younger clients have lower adjusted odds of reporting high-quality services in Mexico. There is a need for continued work supporting youth-friendly services in Mexico, and efforts should aim to ensure zero tolerance for disrespectful or coercive provider behaviors, such as pressuring or scolding clients. Improvements are also needed to ensure quality in counseling for post-partum clients, those aged 35+ years, and those without children.

Experiences of contraceptive counseling and obtaining contraceptives vary for women of childbearing age based on education level, race, ethnicity, and health insurance. Community pharmacists are an important resource for improving access to contraceptive care in states with over-the-counter access to and pharmacist prescribing of contraceptives. We first aimed to determine how patient education level, race, ethnicity, insurance, and patient-provider race concordance influenced the likelihood of receiving contraceptive counseling. The second aim was to determine how receiving contraceptive counseling influenced the likelihood of being dispensed contraceptives by a pharmacist. Pearson chi-square tests and logistic regression were used to address study aims. Older women and those with Medicaid were less likely to receive contraceptive counseling. Race concordance had no influence on counseling. Counseling and education level were strong predictors of being dispensed contraceptives. Race, ethnicity, Medicaid, and marital status were negatively associated with being dispensed contraceptives. Inequities exist in access to contraceptive care for women of diverse backgrounds as well as those insured through Medicaid. State-level policy advancements and over the counter access to oral contraceptives may provide pharmacists a unique opportunity to provide contraceptive care for women without access to a primary care provider. [ABSTRACT FROM AUTHOR]

Objectives: To explore clinician perspectives on the development, utility, and feasibility of a provider-facing point-of-care tool to assist in provision of patient-centered contraceptive care for Latina/x patients in Baltimore, MD. Methods: We conducted 25 semi-structured qualitative interviews with a sample of clinicians who provide contraceptive care to Latina/x patients. An interview guide was developed based on prior research related to patient-centered care and extant point-of-care tools. Transcripts were independently coded by two study team members and analyzed using a directed content analysis approach. Results: Four themes emerged from the data: (1) clinician perception of a need for a tool to facilitate patient-centered contraceptive care, (2) concern for tool burden and burnout, (3) desire for tool ease of use, and (4) a need for cultural awareness during tool development to avoid bias and typecasting. Conclusions: A provider-facing, point-of-care tool to facilitate patient-centered contraceptive counseling was acceptable among providers, provided the tool is easy to use and promotes cultural awareness. Innovation: In the current era of more limited reproductive choice across the U.S., the need and support for non-coercive, patient-centered contraceptive care is timely. A provider-facing, point-of-care tool can facilitate the provision of patient-centered care among clinicians proving contraceptive counseling to Latina/s.

Background: Providing quality contraceptive counseling services is essential to support mothers in using modern contraceptives that meet their needs. However, the quality of service provision has not been evaluated in a study setting. Objective: This study aimed to assess the quality of contraceptive counseling using a service quality model in southern Ethiopia. Design: A facility-based cross-section study was conducted. Methods: The study was conducted from 15 May to 15 June 2021 at the public health facilities of Boloso Bombe Woreda in southern Ethiopia. In total, 391 clients were included using systematic sampling techniques. Data were collected using a structured service quality questionnaire, entered into EPI data version 3.1, and analyzed using SPSS version 25 for data analysis. The significant difference and correlation between the mean of a client's perception and expectation were determined using the Wilcoxon's sign test. The correlation between sociodemographic characteristics and the quality of counseling was tested using the Friedman's test. A p value of <0.05 was taken as the criterion for statistical significance. Finally, the result was presented in a table and pie chart. Results: The study participants included 391 women of childbearing age attending family planning clinics, with a 96.6% response rate. Overall, the quality of advice was found to be low. Respondents' ages (p < 0.001, χ2 = 385.00), number of living children (p < 0.001, χ2 = 381.04), marital status (p < 0.001, χ2 = 359.60), type of contraceptive method (p < 0.001, χ2 = 379.61), user type (p < 0.001, χ2 = 368.59), occupations (p < 0.001, χ2 = 379.00), and educational status (p < 0.001, χ2 = 371), 20) were statistically associated with the quality of counseling service. Conclusion: In all health facilities, the quality of contraceptive counseling services was low. Family planning users had high expectations of the contraceptive counseling service compared to that which they received. Plain Language Summary: Maternal and neonatal mortality are current global problems, although there have been improvements over the last few decades. Providing quality family planning is among the most important approaches to preventing maternal and neonatal mortality. To achieve quality family planning services, we should provide quality counseling services. Improper counseling causes fear of side effects as well as rumors and misconceptions about contraceptive use. Most women have stopped using contraceptives. To address this problem, the quality of counseling services should be evaluated regularly. However, the quality of the counseling service had not been evaluated in the study area. For this reason, we evaluated the quality of advice among family planning users, which we found to be low. In the study area, substandard contraceptive counseling leads to discontinuation of contraceptive services; change in methods, from the most effective to the least effective; unwanted pregnancies; and unsafe abortions. We suggest that all stakeholders should take effective and immediate action in this study area. This, in turn, would greatly improve contraceptive use, prevent unsafe abortions and unwanted pregnancies, prevent high fertility rates, and promote the health of mothers and their children. [ABSTRACT FROM AUTHOR]

Background: Women with disabilities are less likely to receive reproductive health counseling than women without disabilities. Yet, little is known about reproductive health counseling and concerns among women with congenital heart defects (CHD) and disabilities. Methods: We used population-based survey data from 778 women aged 19 to 38 years with CHD to examine contraceptive and pregnancy counseling and pregnancy concerns and experiences by disability status, based on six validated questions on vision, hearing, mobility, cognition, self-care, and living independently. Multivariable Poisson regression was used to examine adjusted prevalence ratios between disability status and each outcome, adjusted for CHD severity, age, race/ethnicity, place of birth (Arkansas, Arizona, Georgia), and insurance type. Results: Women with disabilities (n = 323) were 1.4 and 2.3 times more likely than women without disabilities (n = 455) to receive clinician counseling on safe contraceptive methods and avoiding pregnancy because of their CHD. Women with CHD and disabilities, compared to those without disabilities, were more likely to be concerned about their ability to have children (aPR = 1.2) and to have delayed or avoided pregnancy (aPR = 2.2); they were less likely to have ever been pregnant (aPR = 0.7). Associations differed slightly across specific disability types. All associations remained after excluding 71 women with chromosomal anomalies. Conclusion: Among women with CHD, reproductive counseling, concerns, and experiences differ by disability status. [ABSTRACT FROM AUTHOR]

In the last decade-plus, there has been growing enthusiasm for long-acting reversible contraceptive methods as the solution to unintended pregnancy in the United States. Contraceptive access efforts have primarily focused on addressing provider and policy barriers to long-acting reversible contraception and have promoted long-acting reversible contraception as first-line methods through marketing and tiered-effectiveness counseling. A next generation of contraceptive access efforts has the opportunity to move beyond this siloed focus on long-acting reversible contraception toward a focus on equity and person-centeredness. Here we define a new framework for increasing equitable access to high-quality, person-centered contraceptive care that includes programmatic elements necessary to provide information and services to address the barriers to accessing quality care, organized into a four-part continuum. The continuum is contextualized within structural, systematic, and social factors that influence experience of contraceptive care. We aim to provide a practical framework for researchers, program implementers, and policy makers to develop and evaluate efforts to improve equitable access to and quality of contraceptive care. Initiatives can intentionally be cognizant of broader structural and social factors that will influence their success and the likelihood of negative unintended consequences for marginalized groups and thus deliberately work to design programs that meet all people's contraceptive needs and support reproductive autonomy.

ObjectivesAbortions are common health experiences in the United States, yet they are siloed from mainstream health care. To provide guidance on how clinicians could break down these silos, normalize conversations about abortion, and potentially improve patient experience and contraceptive decision-making, we sought to understand patient attitudes regarding discussing abortion during contraceptive counseling.Study designIn 2018, we completed in-depth semi-structured interviews with reproductive-aged women recruited from primary care clinics of two politically disparate regions within California. We elicited acceptability, preferences, and implications of clinicians mentioning abortion during contraceptive counseling. Using directed content analysis, we coded transcripts for inductive and deductive themes.ResultsWe achieved thematic saturation after 49 interviews. Interviewees were diverse in reproductive history, race/ethnicity, religiosity, and abortion attitudes. Participants with diverse attitudes about abortion reported that having abortion mentioned during contraceptive counseling was generally viewed as acceptable, and even helpful, when delivered in a non-directive manner focused on information provision. For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making. Careful attention to a non-judgmental communication style is critical to safeguard against potential contraceptive coercion.ConclusionsDiscussing abortion during contraceptive counseling was acceptable among this diverse population, and our findings suggest ways to best structure such counseling. Coupled with research on clinician perspectives, our findings can inform development of patient-centered contraceptive counseling approaches that integrate abortion in an attempt to facilitate patient care and reduce stigma.ImplicationsMentioning abortion during contraceptive counseling can be acceptable, and even helpful, to patients when delivered in a non-directive manner focused on information provision, even among patients who believed abortion should be illegal in all or most cases. For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making.

ObjectivesThe provision of high-quality family planning (FP) counseling can both enhance clients' experience of care and improve their ability to make and act on their contraceptive decisions. The Interpersonal Quality of Family Planning (IQFP) scale measures FP counseling quality and has been validated in the United States. We aimed to explore whether it remains appropriate for use in a low-/middle-income country (LMIC).Study designWe surveyed 1201 nonsterilized married women ages 18-29 in Maharashtra, India, between September 2018 and June 2019. Respondents rated their FP provider from "poor" (1) to "excellent" (5) across 11 IQFP items. We assessed scale reliability via Cronbach's α test and used exploratory factor analysis to evaluate unidimensionality and regression models of plausibly related outcomes to assess construct validity.ResultsFive hundred four women (42%) had seen an FP provider within the past year, 491 (97%) of whom answered all items. Mean IQFP score was 2.62 out of 5 (SD 0.94, range 1-5). Scale reliability was high (α = 0.97). Exploratory factor analyses support unidimensionality (all factor loadings > 0.4). A 1-point increase in average IQFP score was associated with nearly double the odds of current modern contraceptive use (adjusted odds ratio = 1.73, 95% confidence interval = 1.36-2.19).ConclusionsThe IQFP scale shows good reliability and construct validity in this context, and its use in LMIC settings should be broadly considered. A higher IQFP score was associated with greater odds of contraceptive use. The reported FP counseling quality was low, so future public health efforts should aim to increase counseling quality to better meet the needs of women in low-resource settings like rural India. Measurement tools like IQFP can support success evaluation of the quality of care provided by family planning programs.ImplicationsThe Interpersonal Quality of Family Planning scale is a useful tool in rural India, a different context than the one in which it was developed. Use of the IQFP scale should be considered in other low-/middle-income countries to better measure the quality of family planning care provided.

Objective: To compare the prevalence of contraception in breast cancer (BC) patients at risk of unintentional pregnancy (i.e. not currently pregnant or trying to get pregnant) and matched controls. Study design: The FEERIC study (Fertility, Pregnancy, Contraception after BC in France) is a prospective, multicenter case-control study, including localized BC patients aged 18–43 years, matched for age and parity to cancer-free volunteer controls in a 1:2 ratio. Data were collected through online questionnaires completed on the Seintinelles research platform. Results: In a population of 1278 women at risk of unintentional pregnancy, the prevalence of contraception at study inclusion did not differ significantly between cases (340/431, 78.9%) and controls (666/847, 78.6%, p = 0.97). Contrarily, the contraceptive methods used were significantly different, with a higher proportion of copper IUD use in BC survivors (59.5% versus 25.0% in controls p

Abstract The availability of a variety of modern contraceptive methods is necessary but insufficient to provide a high-quality contraceptive service to postabortion clients. Women, especially young women, must be empowered to make informed choices about which methods they receive, including whether to use contraception following an abortion service. In this study, we conducted 2,488 client exit interviews with abortion clients after their induced abortion service or postabortion care visit in Ipas-supported health facilities in eight countries: Argentina, Bolivia, Ethiopia, Kenya, Mexico, Nepal, Nigeria, and Uganda. We evaluated the quality of postabortion contraceptive counseling across two domains of contraceptive counseling: information exchange and interpersonal communication. We measured the association between these quality elements and two outcomes: 1) client-perceived choice of contraceptive method and 2) whether or not the client received a modern contraceptive method. We examined these relationships while adjusting for sociodemographic and confounding variables, such as the client feeling pressure from the provider to accept a particular method. Finally, we determined whether associations identified differ by age group: under 25 and 25+. Information exchange and interpersonal communication both emerged as important counseling domains for ensuring that clients felt they had the ability to choose a contraceptive method. The domain of information exchange was associated with having received a contraceptive method for all abortion clients, including young abortion clients under 25. Nearly 14% of clients interviewed reported pressure from the provider to accept a particular contraceptive method; and pressure from the provider was significantly associated with a client’s perception of not having a choice in selecting and receiving a contraceptive method during her visit to the facility. Improving interpersonal communication, strengthening contraceptive information exchange, and ensuring clients are not pressured by a provider to accept a contraceptive method, must all be prioritized in postabortion contraceptive counseling in health facilities to ensure postabortion contraceptive services are woman-centered and rights-based for abortion clients.

This study examined the experience of contraceptive counseling and care in a Federally Qualified Health Center in Maryland. Patients attending medical visits in 2021 were surveyed using the Interpersonal Quality of Family Planning scale to assess the quality of contraceptive counseling. Medical chart reviews were performed to identify alignment between contraceptive care received, and preferences patients had expressed. Primary care providers, reproductive health providers, and a subgroup of patients were interviewed to further contextualize survey and chart review findings. The average item score for the 94 survey participants was 4.39 (SD: 0.9) out of 5. Factor analysis showed high internal consistency reliability (alpha = 0.96). Eighty percent of patients received contraceptive care that aligned with their preferences, 4% did not, and 16% lacked clear contraceptive preferences. Qualitative analysis revealed that patients desired more guidance from providers in selecting a contraceptive method, while providers noted logistical and insurance-related barriers to care. While the quality of contraceptive counseling was high, patient experience of care may be improved by implementing team-based care. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the study was to determine the current status of contraceptive education and counseling provided by midwives. Methods The anonymous web-based questionnaire survey was administered to midwives working in medical institutions and in the community. The survey included: the implementation (within 3 years) of individual counseling and group education on contraception, the target population, the place of implementation, the content of implementation, and the facilitating and inhibiting factors in the implementation of individual counseling and group education. Descriptive statistics were calculated for quantitative data, and content analysis was conducted for qualitative data. Results Responding were 708 midwives. Individual counseling on contraception was provided by 278 (39.3%) and group education by 274 (38.7%). Respondents (55.8%) provided individual consultations with 155 women who were hospitalized after childbirth and 21.9% provided for 61 women who were hospitalized before or after abortion. A majority of consultations (n=206, 74.1%), took place at hospitals, clinics, and midwifery centers. There were 107 (39.1%) mid-wives providing group education for women hospitalized after childbirth, 104 (37.8%) junior high school students, and 95 (34.7%) high school students. The most common place of implementation for group education was school or university 164 (59.9%). The most common content of implementation was "general information on contraceptive methods" for both individual counseling and group education, by 246 (88.5%) and 263 (96.0%) respondents, respectively. The most common factor promoting individual counseling and group education was the improvement of midwives' knowledge and skills. The inhibiting factors included difficulties in accessing women's partners and limited educational content in schools. Conclusion The implementation rate of both contraceptive counseling and education by midwives was about 40%. The issues for promoting the implementation of contraceptive education and counseling were identified. Midwives as a profession need to acquire not only general knowledge about contraception, but also in-depth knowledge and support skills regarding contraception to assist women. [ABSTRACT FROM AUTHOR]

ObjectiveIn this study we aimed to investigate the content and process of contraceptive counseling surrounding combined hormonal contraceptive (CHC) methods (combined oral contraceptives, the ring, and the patch).Study designWe performed a mixed methods analysis of data collected as part of the Patient-Provider Communication about Contraception study, in which reproductive age women and their providers were recruited at several San Francisco Bay Area clinics from 2009-2012. Participants completed pre- and post-visit surveys, and had their visits audio recorded and transcribed. We performed descriptive and bivariate analyses of the entire cohort to examine associations between demographic characteristics and pre-existing method preferences with method selection and counseling content, and coded transcripts of a subset of the sample for salient themes related to content and process of counseling about combined hormonal contraceptive methods using a directed content analysis approach.ResultsThe overall sample included 342 women, with 152 women (44%) having a preference for a specific CHC prior to their visit, 127 women (37%) had a preference for a non-CHC method, and 63 (18%) having no existing method preference. Of the women who reported preferring a CHC in their pre-visit survey, the majority (72%) chose that method. We found that women were inconsistently counseled about the range of CHC methods. For example, women who had no pre-visit method preference (52%) or who preferred the ring (54%) or the patch (73%) were more likely to receive comprehensive counseling about the three CHC methods than were women who preferred combined oral contraceptives (35%) or non-CHC methods (33%). Providers mentioned the patch the least often, and in qualitative analysis indicated discomfort with prescribing this method. Side effects and benefits of methods, as well as strategies to enhance successful use of the chosen method, were inconsistently discussed. In only 73% of visits in which a woman chose a CHC did the provider assess the patient's ability to use the chosen method correctly, and in 66% of all visits in which women chose a CHC method, providers discussed what to do if she was dissatisfied with the method.ConclusionsCounseling about combined hormonal contraceptive methods often does not include information about all available methods, or comprehensive information about side effects, benefits, or logistics of use. As this counseling can impact patient's satisfaction with and continuation of their chosen method of contraception, future work should focus on designing interventions to improve providers' ability to meet patients' needs.ImplicationsShort acting hormonal contraception is widely used, but counseling for these methods often neglects key features. Comprehensive counseling about all methods and their individual features can improve contraceptive selection and use.

Brooke W Bullington,1,2 Asha Sata,3 Kavita Shah Arora3 1Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27516, USA; 2Carolina Population Center, University of North Carolina, Chapel Hill, NC, 27516, USA; 3Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, 27516, USACorrespondence: Kavita Shah Arora, Department of Obstetrics and Gynecology, University of North Carolina, 3031 Old Clinic Building, CB 7570, Chapel Hill, NC, 27599-7570, USA, Email kavita_arora@med.unc.eduAbstract: There are multi-level barriers that impact uptake of postpartum contraception and result in disparities, including clinical barriers such as provider bias. Fortunately, clinicians have direct control over their contraceptive counseling practices, and thus reducing structural barriers is actionable through high quality contraceptive counseling that equips patients with the knowledge and guidance they need to fulfill their reproductive desires. Yet, many commonly employed contraceptive counseling strategies, like One Key Question and WHO tiered contraceptive counseling, are not patient-driven, do not account for the important nuances of contraceptive choices, and are not focused specifically on the postpartum period. Given the history of eugenics and reproductive coercion in the US, supporting patient through their contraceptive decision-making process is especially vital. Additionally, contraceptive preferences vary based on patient-level factors and fluctuate over time and counseling should account for such differences. Shared contraceptive decision-making occurs when patients provide input on their values, desires, and preferences and clinicians share medical knowledge and evidence-based information without judgement. This approach is considered the most ethically sound form of counseling, as it maximizes patient autonomy. Shared decision-making also has clinical benefits, including increased patient satisfaction. In sum, shared contraceptive decision-making should be universally adopted to promote ethical, high-quality care and reproductive autonomy.Keywords: postpartum contraception, shared decision-making, contraceptive counseling

To compare the prevalence of contraception in breast cancer (BC) patients at risk of unintentional pregnancy (i.e. not currently pregnant or trying to get pregnant) and matched controls. The FEERIC study (Fertility, Pregnancy, Contraception after BC in France) is a prospective, multicenter case-control study, including localized BC patients aged 18–43 years, matched for age and parity to cancer-free volunteer controls in a 1:2 ratio. Data were collected through online questionnaires completed on the Seintinelles research platform. In a population of 1278 women at risk of unintentional pregnancy, the prevalence of contraception at study inclusion did not differ significantly between cases (340/431, 78.9%) and controls (666/847, 78.6%, p = 0.97). Contrarily, the contraceptive methods used were significantly different, with a higher proportion of copper IUD use in BC survivors (59.5% versus 25.0% in controls p < 0.001). For patients at risk of unintentional pregnancy, receiving information about chemotherapy-induced ovary damage at BC diagnosis (OR = 2.47 95%CI [ 1.39–4.37] and anti- HER2 treatment (OR = 2.46, 95% CI [ 1.14–6.16]) were significantly associated with the use of a contraception in multivariate analysis. In this large French study, BC survivors had a prevalence of contraception use similar to that for matched controls, though almost one in five women at risk of unintentional pregnancy did not use contraception. Dedicated consultations at cancer care centers could further improve access to information and contraception counseling. [ABSTRACT FROM AUTHOR]

Unplanned pregnancies in women with maternal cardiac disease (MCD) are associated with increased morbidity and mortality, but the majority of these individuals do not use highly reliable contraception on postpartum hospital discharge. Contraceptive counseling in this population outside of pregnancy is incomplete and counseling during pregnancy remains poorly characterized. Our objective was to evaluate the provision and quality of contraceptive counseling for individuals with MCD during pregnancy. All individuals with MCD who delivered between 2008 and 2021 at a tertiary care institution with a multidisciplinary cardio-obstetrics team were sent a 27-question survey. A subset of questions were derived from the validated Interpersonal Quality in Family Planning (IQFP) survey, which emphasizes interpersonal connection, adequate information, and decision support for the individual. Each participant received a $15 gift card for survey completion. We performed chart review for clinical and demographic details, including cardiac risk score. Of 522 individuals to whom the survey was sent, 133 responded and met inclusion criteria. Overall, 67% discussed contraception with their general obstetrician, 36% with their maternal-fetal medicine (MFM) specialist, and 24% with their cardiologist. Compared to individuals with low cardiac risk scores, those with high cardiac risk scores had a nonsignificant trend toward being more likely to discuss contraception with a MFM provider (52% vs 33%, p =.08). 65% reported that their provider was 'excellent' or 'good' in all IQFP domains. Respondents valued providers who respected their autonomy and offered thorough counseling. Respondents disliked feeling pressured or uninformed about the safety of contraceptive options. Most individuals with MCD reported excellent contraceptive counseling during pregnancy. Additional work is needed to understand barriers to and enablers for effective, patient-centered contraceptive counseling and use in this population. [ABSTRACT FROM AUTHOR]

Objectives: This qualitative study examined how patient-related factors influence providers' contraceptive counseling for persons with substance use disorders (SUDs). Specifically, we explored individual behavior and social factors that contribute to providers modifying their contraceptive counseling approaches and described how providers alter their counseling recommendations and communication strategies in the presence of such factors. Methods: In 2019, we purposively recruited a national sample of contraceptive providers (N = 24) and conducted semistructured phone interviews to inquire about their contraceptive counseling practices for women with SUDs. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis with inductive codes. Results: Participants included 10 medical doctors, 8 nurse practitioners, and 6 certified nurse-midwives. We found that providers modify their contraceptive counseling provision when their patients are actively using substances or have unstable living conditions, such as intimate partner violence or homelessness. With patients experiencing these instabilities, providers reported postponing contraceptive discussions until patients are stabilized in treatment, recommending long-active reversible contraceptive methods, and varying communication styles according to their own perceptions of patients' communication needs. Providers perceived that individuals in long-term recovery have increased stability and fewer barriers to contraceptive access and adherence and therefore reported increased willingness to provide greater autonomy during contraceptive decision making and shift the counseling focus to short-acting contraceptive methods. Conclusions: This study highlights that substance use and social "stability" of patients contributes to how providers approach their contraceptive counseling and make methods recommendations for their patients with SUDs. More research is needed to understand strategies that individuals with SUDs use to overcome barriers to contraceptive access and adherence in the context of active substance use and social instability. [ABSTRACT FROM AUTHOR]

Background: One Key Question? (OKQ) is a tool that embeds a patient-centered screening into routine visits with the goal of making pregnancy intention screening universal, but widespread implementation has not yet been adopted. We aimed to explore the barriers and facilitators of OKQ implementation to better understand how to best implement the tool across different settings. Methods: We invited staff and clinicians from one obstetrics and gynecology clinic and one family medicine clinic, which previously implemented OKQ, to complete surveys and qualitative interviews about their experiences with the tool. The interview guide and thematic analysis of the interview transcripts were informed by the Consolidated Framework for Implementation Research (CFIR). Main Findings: Major facilitators of OKQ implementation are the simplicity of the tool, engagement of clinic leadership, and compatibility between the perceived goals of the tool and those of practice staff and clinicians. Although participants indicated that OKQ had a minimal impact on clinic workflow during its implementation, preimplementation time concerns were a major barrier to implementation in both clinics. Barriers seen in the family medicine practice included OKQ distracting from the visit agenda, and concerns about the OKQ gold standard protocol of screening each patient at every visit. Participants even suggested asking OKQ only during annual check-up appointments. Conclusions: The perceived alignment between the tool's goals and those of clinic stakeholders was an important facilitator of OKQ implementation success. However, characteristics of the clinic setting, such as competing medical priorities and time constraints, influenced initial attitudes toward the feasibility of the intervention. Clinical Trial Registration Number: NCT03947788

In developed countries, women bear the primary, and sometimes exclusive, responsibility for preventing pregnancy in heterosexual sexual relations. This unequal burden is not an intrinsic fact; it is the consequence of broad social narratives and interpersonal negotiations. The contraceptive counseling visit is increasingly recognized as a site of the discursive production of normative ideas about reproduction, suggesting that clinicians themselves may contribute to the assignment of responsibility for contraceptive labor to women (i.e. the feminization of contraception). Scholars have not yet considered how providers talk to patients about methods that are male body-based (i.e. condoms, withdrawal, and vasectomy) and, as such, may disrupt the feminization of responsibility for contraception. Using transcripts of 101 contraceptive counseling visits recorded between 2009 and 2012 in the San Francisco Bay Area, I investigate how clinicians discuss male body-based methods with female patients. Drawing on a constructivist approach, I find that clinicians generally devalued male body-based methods in their counseling. They did so by, first, failing to discuss them as options for long-term contraception. Second, when they did discuss them, clinicians tended to emphasize aspects of the methods that were presumed "negative" (e.g. the lower efficacy of withdrawal and condoms) but not features that patients might view positively (e.g. the high efficacy of vasectomy or the lack of side effects with condoms and withdrawal). In aggregate, these discursive practices marginalize male body-based methods as contraceptive choices. As a practical effect, this may encourage women to choose a method that does not best meet their preferences. At a structural level, by devaluing methods that could undercut the unequal division of fertility work, these discursive patterns contribute to the feminization of responsibility for contraception and the retrenchment of the unequal gendered division of fertility work.

The availability of a variety of modern contraceptive methods is necessary but insufficient to provide a high-quality contraceptive service to postabortion clients. Women, especially young women, must be empowered to make informed choices about which methods they receive, including whether to use contraception following an abortion service. In this study, we conducted 2,488 client exit interviews with abortion clients after their induced abortion service or postabortion care visit in Ipas-supported health facilities in eight countries: Argentina, Bolivia, Ethiopia, Kenya, Mexico, Nepal, Nigeria, and Uganda. We evaluated the quality of postabortion contraceptive counseling across two domains of contraceptive counseling: information exchange and interpersonal communication. We measured the association between these quality elements and two outcomes: 1) client-perceived choice of contraceptive method and 2) whether or not the client received a modern contraceptive method. We examined these relationships while adjusting for sociodemographic and confounding variables, such as the client feeling pressure from the provider to accept a particular method. Finally, we determined whether associations identified differ by age group: under 25 and 25+. Information exchange and interpersonal communication both emerged as important counseling domains for ensuring that clients felt they had the ability to choose a contraceptive method. The domain of information exchange was associated with having received a contraceptive method for all abortion clients, including young abortion clients under 25. Nearly 14% of clients interviewed reported pressure from the provider to accept a particular contraceptive method; and pressure from the provider was significantly associated with a client's perception of not having a choice in selecting and receiving a contraceptive method during her visit to the facility. Improving interpersonal communication, strengthening contraceptive information exchange, and ensuring clients are not pressured by a provider to accept a contraceptive method, must all be prioritized in postabortion contraceptive counseling in health facilities to ensure postabortion contraceptive services are woman-centered and rights-based for abortion clients. [ABSTRACT FROM AUTHOR]

Objectives: Men who accompany their female partners at the time of an abortion represent a unique population who may be amenable to receiving postabortion contraceptive services. We sought to examine their interest in receiving both counseling and contraception when available.Study Design: We analyzed a subset of survey data on the experience of accompanying male partners at the time of an abortion at two urban family planning clinics. We examined their beliefs about shared contraceptive responsibility, attitudes towards participating in contraceptive counseling, and willingness to use novel male contraceptives. We conducted bivariate analyses and logistic regressions for sociodemographic and reproductive factors linked to these outcomes.Results: Of 210 male partners surveyed at the time of an abortion, nearly three-quarters characterized preventing unwanted pregnancy as a shared responsibility, believed in the importance of attending contraceptive counseling with their female partner, and reported willingness to use novel male contraceptives. Contraceptive method used when discovering the pregnancy was neither linked to men's attitudes towards counseling nor interest in using novel male contraceptives. Individuals between the ages of 25 to 34 (aOR: 2.69; 95%CI: 1.32-5.48), those with a college education (aOR: 5.49; 95%CI: 1.31-22.94), and those who had never experienced abortion (aOR: 2.21; 95%CI: 1.08-4.55) exhibited greater interest in using novel male contraceptives. Black respondents (aOR: 2.33; 95%CI: 1.01-5.38) exhibited greater interest in receiving contraceptive counseling with their partner and a counselor following the abortion.Conclusion: For male partners, abortion may be an opportunity to engage men in contraceptive counseling and when available, offer new male contraceptives.Implications: As few men receive comprehensive contraceptive counseling, engaging men when they accompany their female partners to family planning clinics may be an additional strategy to prevent unwanted pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To describe receipt of person-centered contraceptive counseling among reproductive-aged women in the United States who sought contraceptive care at Title X clinics, non-Title X public clinics, and private clinics.Study Design: We conducted a secondary analysis of the 2017-2019 wave of the National Survey of Family Growth (NSFG). The sample included female respondents ages 15-49 who received contraceptive services in the past year and completed the Person-Centered Contraceptive Counseling (PCCC) measure, a quality metric evaluating interpersonal quality of the care received. We used multivariable logistic regression to estimate the predicted probability of receiving person-centered contraceptive counseling by source of care, adjusted for individual-level characteristics.Results: Of 2225 (weighted n = 26,599,620) eligible respondents, 6.9% received care at a Title X clinic, 8.2% at a non-Title X public clinic, and 84.9% at a private clinic. The adjusted predicted probability of receiving person-centered contraceptive counseling among respondents attending private clinics was 50.6% (95% CI 46.3%-54.8%) compared with 51.3% (95% CI 40.4%-62.3%) at Title X clinics and 52.4% (95% CI 44.0%-60.7%) at other public clinics. Respondents with incomes ≥300% above the federal poverty level (FPL) had higher odds of reporting receipt of person-centered counseling compared to those with incomes below 100% of the FPL (aOR = 2.12; 95% CI 1.47-3.06). Non-Latina Black respondents had lower odds of receiving person-centered contraceptive counseling (aOR = 0.69; 95% CI 0.51-0.94), compared to non-Latina white respondents.Conclusion: Title X clinics perform as well as the private sector in delivering person-centered contraceptive counseling.Implications: Title X clinics provide quality person-centered contraceptive counseling on par with the private sector, despite serving populations that are often less likely to report high quality care. Broad implementation of the PCCC measure will permit tracking person-centered contraceptive care across diverse practice settings and populations. [ABSTRACT FROM AUTHOR]

Current literature suggests that emergency contraception, defined as a therapy aimed at preventing an unwanted pregnancy after unprotected or insufficiently protected intercourse, is used more by cancer survivors than by the general population. This may be related to reduced use of contraception in women after cancer diagnosis and, when it is used, to a choice of less effective methods, even in the absence of contraindications to hormonal options. The purpose of this review is to analyze the use of contraception in these patients, its predictors and the preferred methods, as well as to try to define timing and characteristics of an effective contraception counseling. Factors identified as predictors of contraception usage were younger age, having a partner and better sexual function, having children, past use and having received contraception counseling by a gynecologist, especially in the previous year. Contraception counseling should start before oncological therapies, together with information regarding fertility and sexual health, preferably by the gynecologist of the oncofertility unit, with a specific expertise in dealing with cancer patients. Increased awareness of oncologists and family medicine doctors is fundamental to optimize contraception use and compliance with the prescribed method. Major guidelines regarding oncological care in women of fertile age already recommend contraception counseling, but optimal timing and mode of the consultation(s) options should be further researched, to be better detailed in all relevant documents., Competing Interests: Matteo Lambertini reports advisory role for Roche, Lilly, Novartis, AstraZeneca, Pfizer, Seagen, Gilead, MSD, Exact Sciences, Pierre Fabre, Menarini; speaker honoraria from Roche, Lilly, Novartis, Pfizer, Sandoz, Libbs, Daiichi Sankyo, Takeda, Menarini, Ipsen, Knight, Gilead, AstraZeneca; travel Grants from Gilead, Daiichi Sankyo, Roche; research funding (to the Institution) from Gilead all outside the submitted work. The other authors report no conflicts of interest related to this work., (© 2024 Asinaro et al.)

The adolescent care provider has a unique opportunity to provide young patients with appropriate counseling about sexual health and prevention of pregnancy and sexually transmitted infections. To provide high-quality sexual and reproductive health care for the adolescent, providers must be familiar with the breadth of contraceptive options and their characteristics. The purpose of this review is to discuss recent developments in contraception and to review commonly used contraceptive methods as they apply to adolescents., Competing Interests: Disclosure The authors have no conflicts of interest or funding sources to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: The objective of this study is to understand whether clinicians who provide contraceptive counseling to adolescent patients perceive that the Dobbs decision has influenced their counseling., Study Design: We conducted in-depth interviews with a convenience sample of 16 clinicians who provide contraceptive counseling to adolescents at the American Academy of Pediatrics annual conference in October 2022. We used thematic content analysis and an iterative process of constant comparison to identify themes inductively. This analysis focused on participants' perception of if and how the Dobbs decision has or will influence their contraceptive counseling with adolescents., Results: Most clinicians in our study reported that the Dobbs decision influenced their contraceptive counseling. This included promoting long-acting reversible methods more so than pre-Dobbs, and explicitly considering changing state-level abortion laws and restrictions. Many clinicians openly noted that their personal preferences influence their counseling, such as prioritizing pregnancy prevention and encouraging patients to use particular methods., Conclusion: We found that most clinicians in our sample acknowledged that the Dobbs decision has influenced their contraceptive counseling practices with adolescents. Clinicians' responses demonstrate that, in many instances, the Dobbs decision motivated them to focus on method effectiveness, leading to tiered and directive contraceptive counseling. We recommend practice changes to support comprehensive contraceptive care provision, provider trainings in unbiased counseling, and developmentally tailored decision aids are needed to ensure that adolescent patients' autonomy is prioritized over a singular focus on pregnancy prevention., Competing Interests: Conflicts of Interest The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article., (Copyright © 2024. Published by Elsevier Inc.)

Abstract Background Immediate postpartum family planning (IPPFP) helps prevent unintended and closely spaced pregnancies. Despite Ethiopia’s rising facility-based delivery rate and supportive IPPFP policies, the prevalence of postpartum contraceptive use remains low, with little known about disparities in access to IPPFP counseling. We sought to understand if women’s receipt of IPPFP counseling varied by individual and facility characteristics. Methods We used weighted linked household and facility data from the national Performance Monitoring for Action Ethiopia (PMA-Ethiopia) study. Altogether, 936 women 5–9 weeks postpartum who delivered at a government facility were matched to the nearest facility offering labor and delivery care, corresponding to the facility type in which each woman reported delivering (n = 224 facilities). We explored women’s receipt of IPPFP counseling and individual and facility-level characteristics utilizing descriptive statistics. The relationship between women’s receipt of IPPFP counseling and individual and facility factors were assessed through multivariate, multilevel models. Results Approximately one-quarter of postpartum women received IPPFP counseling (27%) and most women delivered government health centers (59%). Nearly all facilities provided IPPFP services (94%); most had short- and long-acting methods available (71 and 87%, respectively) and no recent stockouts (60%). Multivariate analyses revealed significant disparities in IPPFP counseling with lower odds of counseling among primiparous women, those who delivered vaginally, and women who did not receive delivery care from a doctor or health officer (all p

Resumen Simple Monitorear las experiencias de las usuarias con los servicios anticonceptivos es vital para visibilizar los esfuerzos orientados a mejorar la calidad de la atención y garantizar sus derechos humanos. La Escala para Medir la Calidad de la Consejería Anticonceptiva (QCC) es una encuesta que evalúa las experiencias individuales de las usuarias con los servicios anticonceptivos. Está fundamentada en perspectivas centrada en la persona y de derechos humanos, e indaga explícitamente sobre posibles experiencias negativas. Este artículo describe el análisis de los datos recabados de la implementación de la Escala QCC, explorando asociaciones estadísticas entre las puntuaciones de las características de las usuarias, personal de salud y visita. En este estudio, también se analizaron los puntajes de las tres subescalas que conforman la Escala QCC (Intercambio de Información, Relaciones Interpersonales y Maltrato y Abuso). Los resultados del análisis revelan que, aunque no es reportado comúnmente, las usuarias más jóvenes tienen más probabilidades de reportar Abuso y Maltrato. Las usuarias de 35 o más años reportaron peor Intercambio de Información; las usuarias que recibieron atención postparto reportaron peor Intercambio de Información y peores puntuaciones totales; y las usuarias que tenían uno o más hijos, reportaron tener mejor Intercambio de Información. Estos hallazgos coinciden con resultados previos que indican que las usuarias más jóvenes tienen menores razones de probabilidad ajustada de reportar valores altos de calidad de los servicios anticonceptivos en México. Es necesario seguir apoyando a los servicios amigables para adolescentes en México, y los esfuerzos deberían apuntar a eliminar conductas irrespetuosas o coercitivas del personal de salud, tales como presionar o regañar a las usuarias. También es necesario mejorar y garantizar la calidad de la orientación consejería para usuarias en postparto, aquellas que tienen 35 o más años, y aquellas que no tienen hijos.

Efforts to reduce the incidence of unintended pregnancy by expanding access to and use of a new generation of long-acting reversible contraception (LARC) in recent years led to the wide-spread adoption of a tiered effectiveness (i.e., LARC-first) approach to contraceptive counseling in clinical practice. While reproductive justice scholar-advocates have critiqued this approach for how it may limit pregnancy-capable people's reproductive decision-making, less work in this area has examined efforts to prevent unintended pregnancy via contraceptive counseling as an interactional process shaped by social norms and inequities. Using individual interviews with clinicians working in obstetrics and gynecology that examined their approaches to contraceptive care delivery, this article draws on the sociological theory of interactional accountability to argue that clinicians hold their women patients accountable to social norms about pregnancy prevention in their attempts to persuade them to use LARC. Qualitative data analysis reveals that clinicians center their own contraceptive preferences and behaviors, prioritize pregnancy prevention via LARC use above other priorities patients may have, and communicate that contraceptive use is compulsory for women of reproductive age. By mobilizing their medical authority under the guise of achieving seemingly value-neutral public health goals, clinicians obscure the role that normative assumptions about reproductive behavior play in their practices of contraceptive counseling. By highlighting the strategies clinicians use to enact LARC-first contraceptive counseling as a normative accountability structure, this article demonstrates how these practices curtail women's reproductive autonomy and undermine ongoing efforts to achieve reproductive justice.

Background: High-quality contraceptive counseling is critical to support Veterans' reproductive autonomy and promote healthy outcomes.Objective: To describe perceived quality of contraceptive counseling in Veterans Health Administration (VA) primary care and assess factors associated with perceived high- and low-quality contraceptive counseling.Design: Cross-sectional study using data from the Examining Contraceptive Use and Unmet Need in women Veterans (ECUUN) national telephone survey.Participants: Veterans aged 18-44 who received contraceptive services from a VA primary care clinic in the past year (N=506).Main Measures: Perceived quality of contraceptive counseling was captured by assessing Veterans' agreement with 6 statements regarding provider counseling adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. High-quality counseling was defined as a top score of strongly agreeing on all 6 items; low-quality counseling was defined as not agreeing (neutral, disagreeing, or strongly disagreeing) with >3 items. We constructed two multivariable models to assess associations between patient-, provider-, and system-level factors and perceived high-quality (Model 1) and perceived low-quality counseling (Model 2).Key Results: Most participants strongly agreed that their providers listened carefully (74%), explained things clearly (77%), and spent enough time discussing things (71%). Lower proportions strongly agreed that their provider discussed more than one option (54%), discussed pros/cons of various methods (44%), or asked which choice they thought was best for them (62%). In Model 1, Veterans who received care in a Women's Health Clinic (WHC) had twice the odds of perceiving high-quality counseling (aOR=1.99; 95%CI=1.24-3.22). In Model 2, Veterans who received care in a WHC (aOR=0.49; 95%CI=0.25-0.97) or from clinicians who provide cervical cancer screening (aOR=0.49; 95%CI=0.26-0.95) had half the odds of perceiving low-quality counseling.Conclusions: Opportunities exist to improve the quality of contraceptive counseling within VA primary care settings, including more consistent efforts to seek patients' perspectives with respect to contraceptive decisions. [ABSTRACT FROM AUTHOR]

Objective: We aimed to examine how peripartum contraceptive care quality improvement efforts address or perpetuate reproductive health injustices.Study Design: We conducted a comparative case study of inpatient postpartum contraceptive care implementation in 2017 to 2018, using key informant interviews at 11 United States hospitals. After our primary analysis revealed tensions between enhancing access to contraceptive care and patient-centeredness, we conducted the current inductive content analysis guided by 4 questions developed post-hoc: (1) What are healthcare workers' aspirations for contraceptive quality improvement programs? (2) What are healthcare workers' biases regarding peripartum contraceptive care delivery? (3) Do care delivery processes center patients' needs? (4) Do healthcare workers recognize and engage with structural inequities?Results: Seventy-eight key informants (i.e., clinicians, operations staff, administrators) participated. In nine study sites, we observed evidence of interviewees both mitigating and perpetuating reproductive injustice. Many aspired to provide compassionate, patient-centered care, avoid paternalism, and foster patient autonomy. Simultaneously, interviewees demonstrated biases, including implicit subscription to an ideology of stratified reproduction, stereotyping, and "othering." Even when interviewees endorsed goals of patient-centeredness, care delivery processes sometimes prioritized healthcare systems' needs, and patients were not included on quality improvement teams. Many interviewees recognized structural inequities as driving health outcome disparities, yet relied on individual-level solutions like long-acting reversible contraception, and not structural-level interventions, to address them.Conclusion: Alongside enthusiasm for delivering compassionate care exist biases, missed opportunities to center patients, and lack of curiosity about the appropriateness of solving structural-level problems with individual-level solutions.Implications: Our findings call for individual and institutional self-reflection, partnership with patients and communities, and other intentional efforts to mitigate potential for harm in initiatives enhancing access to contraceptive care. [ABSTRACT FROM AUTHOR]

Objective: Telemedicine for contraceptive services is purported to improve contraceptive access, yet few studies assess the quality of contraceptive counseling provided remotely. We assessed the quality of contraceptive counseling during telemedicine and office visits.Study Design: We conducted a cross-sectional study at Cleveland Clinic Women's Health Institute to compare contraceptive counseling quality between telemedicine (synchronous video) and office visits. We identified eligible patients through ambulatory encounters with primary contraceptive management or counseling ICD-10 codes. Respondents completed a survey assessing demographics, quality of contraceptive counseling, contraceptive method choice, an affinity for technology, and attitudes toward telemedicine. We used the validated Interpersonal Quality of Family Planning (IQFP) scale to assess counseling quality. We used the Wilcoxon rank-sum test, Pearson's chi-square test and Fisher's exact test to compare baseline characteristics.Results: Of all eligible patients, 110 of 380 (29%) completed the survey. Of those who were successfully contacted by phone or mail, 110 of 201 (55%) completed the survey. The IQFP scores were 'high quality' for 28 of 52 (54%) of telemedicine-visit respondents vs 37 of 58 (64%) of office-visit respondents (p = 0.29). The birth control pill was the most popular method, chosen by 27 of 52 (52%) of telemedicine-visit respondents and 24 of 58 (41%) of office-visit respondents (p = 0.27). Telemedicine respondents identified ease of communication and less scheduling difficulty as factors that promote telemedicine use. Office-visit respondents identified privacy and communication concerns as factors that deter telemedicine use.Conclusion: When patients self-select the encounter type, their assessment of the quality of contraceptive counseling among telemedicine and office visits is similar, with no statistically significant differences in the contraceptive method chosen. Results from this single-center study support the integration of telemedicine in contraceptive service provision.Implications: The quality of contraceptive counseling is similar among telemedicine and office visits. Telemedicine visits for contraceptive counseling should be routinely offered, and existing services should be expanded. [ABSTRACT FROM AUTHOR]

Objectives Mental disorders in reproductive-aged women have significant implications for the risk of unintended pregnancies. The objective of this study is to assess the professional counseling in clinical practice based on motivational interview in women with serious mental illness (SMI) in order to achieve a change to a more effective contraceptive method. Study design A prospective observational cohort study (2012–2017) was conducted in a convenience sample of women with severe–moderate psychiatric disorders (n = 91). Information related to psychiatric health, contraceptive use, sexual and reproductive health and socio-demographics was collected. To assess the variation in the contraceptive method, follow-up visits were planned before and after medical counseling. All participants underwent an evidence-based individual motivational interview for contraception counseling. A multivariate logistic model was carried out to identify the factors involved in changing to a more effective contraceptive method. Results After evidence-based counseling, 51.6% of participants changed their contraceptive method to a more effective one. This change was associated with gender violence (β coefficient = 1.58, p value = .006). The relation between changing to a more effective contraceptive method and both previous abortions and having children was also positive, although the coefficients did not reach statistical significance. Conclusions Evidence-based contraception counseling in clinical practice, based on an adapted protocol to patients with SMI, has shown, in this study, to be adequate to promote the shift to more effective contraceptive methods, avoiding the need of daily compliance in this population. Gender violence has been significantly associated with the shift to very high effectiveness methods as well as previous abortions and having children, not significantly.