Does Contraceptive Use in the United States Meet Global Goals?

CONTEXT The United Nations Sustainable Development Goals (SDGs) seek to achieve health equity, and they apply to all countries. SDG contraceptive use estimates for the United States are needed to contextualize U.S. performance in relation to that of other countries. METHODS Data from the 2011–2013 and 2013–2015 waves of the National Survey of Family Growth were used to calculate three SDG indicators of contraceptive use for U.S. women aged 15–44: contraceptive prevalence, unmet need for family planning and demand for family planning satisfied by modern methods. These measures were calculated separately for married or cohabiting women and for unmarried, sexually active women; differences by sociodemographic characteristics were assessed using t tests from logistic regression analysis. Estimates for married women were compared with 2010–2015 estimates from 94 other countries, most of which were low- or middle-income. RESULTS For married or cohabiting women, U.S. estimates for contraceptive prevalence, unmet need and demand satisfied by modern methods were 74%, 9% and 80%, respectively; for unmarried, sexually active women, they were 85%, 11% and 82%, respectively. Estimates varied by sociodemographic characteristics, particularly among married or cohabiting women. Five countries performed better than the United States on contraceptive prevalence, 12 on unmet need and four on both measures; seven performed better on demand satisfied by modern methods. CONCLUSIONS There is a need to continue efforts to expand access to contraceptive care in the United States, and to monitor the SDG indicators so that improvement can be tracked over time

Reducing Unintended Pregnancies as a Strategy to Avert Zika-Related Microcephaly Births in the United States: A Simulation Study

Introduction There is increasing evidence that infection with the Zika virus (ZIKV) during pregnancy can lead to severe brain abnormalities in infants exposed in utero. The objective of our analysis was to estimate the contribution of enhanced contraception access to averting ZIKV-related microcephaly births in the United States, alone and in combination with another possible strategy, anti-ZIKV vaccination. Methods We used Monte Carlo sampling techniques (n = 100,000 simulations) to estimate the number of microcephaly births expected under strategies of enhanced contraception only, vaccination only, both enhanced contraception and vaccination, and status quo (no intervention). Enhanced contraceptive access was assumed to reduce unintended pregnancy rates by 46% and anti-ZIKV vaccination was assumed to be 90% effective. Plausible values for effectiveness of enhanced contraceptive access, ZIKV cumulative incidence, ZIKV-related microcephaly risk, and anti-ZIKV vaccination parameters were derived from the literature or best available knowledge. Results Enhanced contraceptive access alone reduced the median number of ZIKV-related microcephaly births by 16% (95% simulation interval: 5, 23), while the anti-ZIKV vaccine alone reduced these births by 9% (95% SI: 0, 18), 45% (95% SI: 36, 54), and 81% (95% SI: 71, 91), under conservative (10% vaccine uptake), moderate (50% vaccine uptake), and optimistic (90% vaccine uptake) scenarios, respectively. The reduction in ZIKV-related microcephaly births was always greater if both interventions were employed. Discussion Enhanced contraceptive access alone has the ability to produce a meaningful reduction in microcephaly births, and could provide an important adjuvant prevention strategy even following the development of a highly-effective anti-ZIKV vaccine

Future Directions in Performance Measures for Contraceptive Care: A Proposed Framework

In the United States, almost half (45%) of the approximately 6 million pregnancies each year are unintended. These statistics indicate that many women experience barriers to achieving their desired reproductive outcomes, which has potential adverse consequences for women, children and society at large, such as higher rates of preterm birth, lower rates of breastfeeding and lower educational attainment. Contraceptive care is a highly effective clinical intervention that can substantially reduce those adverse outcomes, help individuals and couples achieve their desired number and spacing of children, and save money. However, many women at risk of unintended pregnancy do not use contraception or use it incorrectly or inconsistently, and there are documented barriers in access to and quality of contraceptive care services available

Projecting the Unmet Need and Costs for Contraception Services After the Affordable Care Act.

Objectives. We estimated the number of women of reproductive age in need who would gain coverage for contraceptive services after implementation of the Affordable Care Act, the extent to which there would remain a need for publicly funded programs that provide contraceptive services, and how that need would vary on the basis of state Medicaid expansion decisions. Methods. We used nationally representative American Community Survey data (2009), to estimate the insurance status for women in Massachusetts and derived the numbers of adult women at or below 250% of the federal poverty level and adolescents in need of confidential services. We extrapolated findings to simulate the impact of the Affordable Care Act nationally and by state, adjusting for current Medicaid expansion and state Medicaid Family Planning Expansion Programs. Results. The number of low-income women at risk for unintended pregnancy is expected to decrease from 5.2 million in 2009 to 2.5 million in 2016, based on states’ current Medicaid expansion plans. Conclusions. The Affordable Care Act increases women’s insurance coverage and improves access to contraceptive services. However, for women who remain uninsured, publicly funded family planning programs may still be needed

Client Preferences for Contraceptive Counseling: A Systematic Review

ContextProviders can help clients achieve their personal reproductive goals by providing high-quality, client-centered contraceptive counseling. Given the individualized nature of contraceptive decision making, provider attention to clients' preferences for counseling interactions can enhance client centeredness. The objective of this systematic review was to summarize the evidence on what preferences clients have for the contraceptive counseling they receive.Evidence acquisitionThis systematic review is part of an update to a prior review series to inform contraceptive counseling in clinical settings. Sixteen electronic bibliographic databases were searched for studies related to client preferences for contraceptive counseling published in the U.S. or similar settings from March 2011 through November 2016. Because studies on client preferences were not included in the prior review series, a limited search was conducted for earlier research published from October 1992 through February 2011.Evidence synthesisIn total, 26 articles met inclusion criteria, including 17 from the search of literature published March 2011 or later and nine from the search of literature from October 1992 through February 2011. Nineteen articles included results about client preferences for information received during counseling, 13 articles included results about preferences for the decision-making process, 13 articles included results about preferences for the relationship between providers and clients, and 11 articles included results about preferences for the context in which contraceptive counseling is delivered.ConclusionsEvidence from the mostly small, qualitative studies included in this review describes preferences for the contraceptive counseling interaction. Provider attention to these preferences may improve the quality of family planning care; future research is needed to explore interventions designed to meet preferences.Theme informationThis article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services

Patterns and Trends in Contraceptive Use Among Women Attending Title X Clinics and a National Sample of Low-Income Women

Objectives To describe the types of contraception used by women attending Title X-funded clinics and a comparable group of low-income reproductive-age women at risk of unintended pregnancy. Study design We estimated the percentage of reproductive aged (15–44 years) women using contraception, by method type and level of effectiveness in preventing pregnancy (i.e., most, moderately, and less effective), using Title X Family Planning Annual Report (2006–2016) and National Survey of Family Growth (2006–2015) data. We divided most effective methods into permanent (female and male sterilization) and reversible (long-acting reversible contraceptives [LARCs]) methods. Results Among Title X clients during 2006–2016, use of LARCs increased (3–14%); use of moderately effective methods decreased (64–54%); and use of sterilization (~ 2%), less effective methods (21–20%), and no method (8–7%) was unchanged. These same trends in contraceptive use were observed in a comparable group of women nationally during 2006–2015, during which LARC use increased (5–19%, p \u3c .001); moderately effective method use decreased (60–48%, p \u3c .001); and use of sterilization (~5%), less effective methods (19%), and no method (11–10%) was unchanged. Conclusions The contraceptive method mix among Title X clients differs from that of low-income women at risk of unintended pregnancy nationally, but general patterns and trends are similar in the two populations. Research is needed to understand whether method use patterns among low-income women reflect their preferences, access, or the conditions of the supply environment. Implications This study contributes to our understanding of patterns and trends in contraceptive use among two groups of reproductive-age women — Title X clients and low-income women nationally who are at risk of unintended pregnancy. The findings highlight areas for further researc

Unintended Pregnancy and Interpregnancy Interval by Maternal Age, National Survey of Family Growth

Background: The relationship between unintended pregnancy and interpregnancy interval (IPI) across maternal age is not clear. Methods: Using data from the National Survey of Family Growth, we estimated the percentages of pregnancies that were unintended among IPI groups (\u3c6, 6-11, 12-17, 18-23, 24+ months) by maternal age at last live birth (15-19, 20-24, 25-29, 30-44 years). Results: Approximately 40% of pregnancies were unintended and 36% followed an IPI\u3c18 months. Within each maternal age group, the percentage of pregnancies that were unintended decreased as IPI increased. Conclusion: Unintended pregnancies are associated with shorter IPI across the reproductive age spectrum