| Description |
Unintended pregnancy is a persistent public health problem that has seen a recent decline in prevalence. The decline in unintended pregnancy rates is largely due to the increased use of highly effective reversible contraception (HER-C) methods such as intrauterine devices (IUDs) and implants. With relatively few women selecting HER-C methods in the United States, research has focused on reducing cost barriers to accessing these methods. The Highly Effective Reversible Contraceptive Initiative (HER Salt Lake) is a prospective cohort study examining the social and economic impact of removing out-of-pocket costs for contraceptive methods provided at federally-funded Title X family planning clinics in Salt Lake County, Utah. This retrospective medical record review assesses changes in contraceptive method uptake between the control period, with standard of care payment schedules, and the intervention period, when all out-of-pocket contraceptive costs were removed for eligible patients. This analysis focuses on self-pay patients ages 16-45 initiating a new contraceptive method. Demographic information along with service descriptions and prescription information was obtained from the Planned Parenthood electronic medical record system. Contraceptive method distribution and demographics were compared, logistic regression models were used to identify associations with selecting a HER-C method during the intervention period, and multinomial regression models were used to find the selection probability of different types of HER-C methods available compared to non-HER-C methods. The unit of analysis is the number of new contraceptive visits (prescriptions refills were excluded). The sample included 6,021 clinic encounters, the control period accounted for 2,922 and the intervention period 3,099. In the control period, 16% chose a HER-C method compared to 26% in the intervention period. During the intervention period, the odds of selecting a HER-C method were 1.8 times more likely compared to non-HER-C methods holding covariates (age, race/ethnicity, pregnancy history, county of residence, and clinic location) constant. The implant saw the largest proportional increase in uptake from 4% to 11%. This study contributes to knowledge surrounding self-pay patients who present to Title X funded clinics. This analysis has effectively demonstrated a desire for HER-C methods. Continued efforts are needed to promote access to and increase awareness of HER-C methods. |
