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The COVID-19 pandemic increased the provision of contraception through telemedicine. This qualitative study describes provider perceptions of how telemedicine provision of contraception has impacted patient care.We interviewed 40 obstetrics-gynecology and family medicine physicians, midwives, nurse practitioners, and support staff providing contraception via telemedicine in practices across Illinois, including Planned Parenthood of Illinois (PPIL) health centers. We analyzed interview content to identify themes around the perceived impact of telemedicine implementation on contraception access, contraceptive counseling, patient privacy, and provision of long-acting reversible contraception (LARC).Participants perceived that telemedicine implementation improved care by increasing contraception access, increasing focus on counseling while reducing bias, and allowing easier method switching. Participants thought disparities in telemedicine usage and limitations to the technological interface presented barriers to patient care. Participants' perceptions of how telemedicine implementation impacts patient privacy and LARC provision were mixed. Some participants found telemedicine implementation enhanced privacy, while others felt unable to ensure privacy in a virtual space. Participants found telemedicine modalities useful for counseling patients considering methods of LARC, but they sometimes presented an unnecessary extra step for those sure about receiving one at a practice offering same day insertion.Providers felt telemedicine provision of contraception positively impacted patient care. Improvements to counseling and easier access to method switching suggest that telemedicine implementation may help reduce contraceptive coercion. Our findings highlight the need to integrate LARC care with telemedicine workflows, improve patient privacy protections, and promote equitable access to all telemedicine modalities.

To determine the proportion of complete abortion without surgical intervention for patients who chose medication abortion with vaginal compared to buccal misoprostol following oral mifepristone through 70 days of gestation.We performed a retrospective cohort study. We reviewed charts via electronic medical record data abstraction of patients receiving medication abortion with mifepristone and buccal or vaginal misoprostol between September 1, 2017 and August 1, 2019. Primary outcome was complete abortion without surgical intervention for any indication. Secondary outcomes were ongoing pregnancy and uterine aspiration for indications other than ongoing pregnancy.There were 14,504 encounters included in the data set. Of the 4814 patients who took vaginal misoprostol and the 4011 patients who took buccal misoprostol for whom follow up data is available, 4640 (96.4%) and 3917 (97.7%) had a complete abortion without surgical intervention, respectively (p = 0.002). At64 days of gestation, complete abortion was 96.6% for vaginal administration compared to 98.0% for buccal (p = 0.001). At 64 to 70 days of gestation, complete abortion was 92.7% for vaginal administration compared to 93.2% for buccal (p = 0.08). Of the 1128 patients who took vaginal misoprostol at less than 6 hours after mifepristone, 95.3% experienced a complete abortion.Buccal administration of misoprostol is associated with a higher proportion of complete abortion before 64 days of gestation compared to vaginal misoprostol. Clinically, vaginal misoprostol is an effective route of administration through 70 days of gestation.Medication abortion with vaginal misoprostol is effective when administered through 70 days of gestation and with shorter intervals between mifepristone and misoprostol. Prospective research to better estimate effectiveness is warranted. Expanding medication abortion options promotes patient autonomy amid increasing restrictions and bans on abortion.

Introduction. Although pre-exposure prophylaxis (PrEP) is recommended by the Centers for Disease Control and Prevention, there is a practice gap in treatment at Planned Parenthood of Illinois. This project evaluated a clinical practice alert and evidence-based patient education script to determine if the intervention increased the number of appointments to discuss or initiate PrEP in patients at risk for acquiring HIV. Method. From October to December 2018, a clinical practice alert and evidence-based patient education script were implemented at one Planned Parenthood of Illinois health center. Aggregate data collected included the number of times the clinical alert was generated, the number of times staff read the script, the number of scheduled appointments to discuss PrEP, and the number of times PrEP was prescribed. Qualitative data were collected from clinic staff to further evaluate the intervention. Results. Eleven patients triggered the alert and staff read the education script nine times during the 8-week implementation period. One patient scheduled an appointment to discuss PrEP; no new prescriptions were initiated. One identified patient scheduled an appointment with a provider to initiate PrEP on a date after the implementation period ended. Staff found the alert and script helpful to initiate conversations with patients. Conclusions. This intervention established a system for clinic staff to identify patients at risk for acquiring HIV in order to discuss accurate, evidence-based PrEP information. Findings are limited to this particular setting due to a small sample size, which eliminated the possibility for statistical analysis.

Objective To evaluate the effect of miPlan, a waiting-room contraceptive counseling mobile application (app), on interest in discussing long-acting reversible contraception (LARC) during the clinical encounter and LARC uptake. Study design This randomized controlled trial evaluated the miPlan contraceptive counseling app. African American and Latina young women ages 15–29 years attending four family planning clinics in a large Midwestern city were randomized to either: (1) use miPlan (intervention) prior to the contraceptive clinic visit or (2) contraceptive clinic visit alone (control). Groups were compared on knowledge of contraceptive effectiveness, interest in discussing LARC, behavioral intentions to use LARC, and LARC uptake. Results From February 2015 to January 2016, 207 young women were randomized to intervention (n=104) or control (n=103) group. Immediately following app use, the intervention group had an increase in knowledge and interest in learning about the implant. Immediate post visit, there was no significant difference in uptake of LARC between the two groups (p>.05). At three months post intervention, app users reported more knowledge of IUD effectiveness (52.3% vs 30.8%, p=.001) compared to controls. There was no significant difference in LARC use. Conclusion App use was not associated with an increase in using LARC methods. It was associated with increased knowledge of contraceptive effectiveness, an interest in learning about the implant, and behavioral intentions to use LARC methods. Implications The miPlan app is a feasible clinic adjunct for increasing contraceptive knowledge and intentions, however, it is not associated with increased LARC use. Mobile applications can offer an accessible complement to the contraceptive counseling visit.

Objectives To determine the prevalence and correlates of having a regular physician among women presenting for induced abortion. Methods We conducted a retrospective review of women presenting to an urban, university-based family planning clinic for abortion between January 2008 and September 2011. We conducted bivariate analyses, comparing women with and without a regular physician, and multivariable regression modeling, to identify factors associated with not having a regular physician. Results Of 834 women, 521 (62.5%) had a regular physician and 313 (37.5%) did not. Women with a prior pregnancy, live birth, or spontaneous abortion were more likely than women without these experiences to have a regular physician. Women with a prior induced abortion were not more likely than women who had never had a prior induced abortion to have a regular physician. Compared with women younger than 18 years, women aged 18 to 26 years were less likely to have a physician (adjusted odds ratio [aOR], 0.25; 95% confidence interval [CI], 0.10–0.62). Women with a prior live birth had increased odds of having a regular physician compared with women without a prior pregnancy (aOR, 1.89; 95% CI, 1.13–3.16). Women without medical/fetal indications and who had not been victims of sexual assault (self-indicated) were less likely to report having a regular physician compared with women with medical/fetal indications (aOR, 0.55; 95% CI, 0.17–0.82). Conclusions The abortion visit is a point of contact with a large number of women without a regular physician and therefore provides an opportunity to integrate women into health care.

Objectives We explored how negative stories about long-acting reversible contraception (LARC) — defined as a firsthand negative experience with LARC shared directly with the study participant — were involved in participants’ decisions about whether to use LARC following abortion, and how counseling affected the influence of negative LARC stories on contraceptive choices. Study design We performed a multi-methods study, embedded within a trial examining the impact of a theory-based counseling intervention on LARC uptake post-abortion. Participants completed a baseline survey to determine the influence of negative LARC stories. We subsequently invited respondents who reported having heard negative LARC stories to participate in a semi-structured qualitative interview. We analyzed quantitative data with univariate statistics. We analyzed qualitative data using thematic content analysis. Results Among the 60 participants, 16 (27%) reported having heard negative LARC stories. Two of the 16 (13%) planned to initiate LARC prior to counseling, compared to 18 of 44 women (41%) who had not heard negative LARC stories (p=0.06). Prior to counseling, 69% of participants with negative LARC stories reported that these stories made them less likely to use LARC. In qualitative interviews with 9 women, we identified several key themes: (1) negative LARC stories deterred LARC use; (2) friends and family were valued informants; (3) potential side effects were important to LARC decision-making; and (4) positive and negative features of the counseling encounter influenced the effect of negative LARC stories. Conclusions Negative LARC stories are common among women presenting for abortion at our institution and may influence patient uptake of these methods. Implications This study uses a multi-methods approach to examine the influence of negative stories about long-acting reversible contraception (LARC) on decision-making about LARC. These findings can help providers elicit patients’ needs in contraception counseling and generate hypotheses for future counseling research.

Objective The objective was to describe infection rates after intrauterine device (IUD) placement at an urban teaching hospital that did not restrict IUD eligibility based on risk factors for sexually transmitted infections (STIs). Methods We reviewed charts of patients undergoing IUD placement at the University of Chicago obstetrics and gynecology resident clinic from July 2007 to June 2008 ( n =283). The primary outcome was diagnosis of pelvic inflammatory disease (PID) within 12 months. Results Almost half (49.5%) of patients reported a history of any STI. Two patients (0.7%) were diagnosed with PID. Conclusion Postplacement infection in this unrestricted population was infrequent and comparable to reported rates in previous studies.

Introduction Heterosexual anal intercourse (HAI) is common among U.S. women. Receptive anal intercourse is a known risk factor for HIV, yet there is a paucity of data on HAI frequency and distribution in the United States. Condom use is lower with HAI vs. vaginal intercourse, but little is known regarding of correlates of HAI with and without condoms. Aims The aims of this study were to describe recent (past 12 months) and lifetime HAI among sexually active reproductive-aged U.S. women, and to characterize women who engage in HAI with and without condoms. Methods We analyzed a sample of 10,463 heterosexually active women aged 15–44 years for whom anal intercourse data were available in the 2006–2010 National Survey of Family Growth. Main Outcome Measures Weighted bivariate and multivariable analyses were used to determine HAI prevalence and correlates. Primary outcomes were lifetime HAI, recent (last 12 months) HAI, and condom use at last HAI. Results In our sample, 13.2% of women had engaged in recent HAI and 36.3% in lifetime HAI. Women of all racial and ethnic backgrounds and religions reported recent anal intercourse. Condom use was more common at last vaginal intercourse than at last anal intercourse (28% vs. 16.4%, P < 0.001). In multivariable analysis, correlates of recent HAI included: less frequent church attendance, younger age at first intercourse, multiple sexual partners, history of oral intercourse, history of unintended pregnancy, and treatment for sexually transmitted infections (all P < 0.05). Correlates of lifetime HAI were similar, with the addition of older age, higher education, higher income, and history of drug use (all P < 0.05). Conclusion Women of all ages and ethnicities engage in HAI, at rates higher than providers might realize. Condom use is significantly lower for HAI vs. vaginal intercourse, putting these women at risk for acquisition of sexually transmitted infections.

IMPORTANCE: The United States continues to have one of the highest teen pregnancy rates of all the industrialized nations. Evidence shows that adolescents are using contraceptive methods but they are using less effective methods and have high rates of discontinuation and providers may not be identifying adolescents as candidates for long-term methods. OBJECTIVE: This review sought to dispel contraceptive myths. By providing adolescents with accurate information about all contraception options and by focusing on the most effective methods providers can better counsel their adolescent patients and facilitate choosing the best method for each individual patient. EVIDENCE ACQUISITION: The US Medical Eligibility Criteria for Contraceptive Use released in 2010 by the Centers for Disease Control and Prevention is an invaluable resource when considering contraception for any patient. RESULTS: Age alone is not a contraindication for any method of contraception. Adolescents are less likely to experience an unintended pregnancy when they use long-acting methods. CONCLUSIONS AND RELEVANCE: Most adolescents are healthy and have no contraindications to any of the available contraceptive methods. Although it is essential to ask the correct screening questions to identify adolescents who have medical illnesses it is just as important to make sure that as providers we do not limit an adolescents choice because of misconceptions.

The intrauterine device (IUD) is a safe, long-acting, highly effective method of birth control. Two-visit protocols for IUD insertion may represent a barrier to IUD uptake.This study is a retrospective database review. We identified Medicaid-insured women who requested IUDs in our urban university-based clinic, which employed a two-visit protocol for IUD insertion. The number of women who returned for IUD insertion was determined. To compare women who underwent insertion to those who did not, bivariate and multivariable analyses were used.Of the 708 women who requested IUDs at the initial visit, only 385 had an IUD inserted (54.4%). Single women were less likely to return for IUD placement compared to women who had ever been married (52.4% vs. 70.3%; p.01). Patients who ordered IUDs at gynecologic visits were more likely to return as opposed to those who had them ordered at obstetrics-related visits (60.5% vs. 50.2%; p.01). Women who lived10 miles away from the clinic were less likely to return for IUD insertion than women who lived10 miles away from the clinic (45.3% vs. 56.2%; p=.03). Race, age and type of IUD ordered were not significantly associated with probability of insertion.Almost half of women who ordered IUDs did not return for insertion, suggesting that two-visit protocols hinder a woman's ability to have an IUD placed. We must eliminate barriers to IUD insertion.

OBJECTIVES To systematically review the literature to determine which interventions improve the screening, diagnosis or treatment of cervical cancer for racial and/or ethnic minorities. DATA SOURCES Medline on OVID, Cochrane Register of Controlled Trials, CINAHL, PsycINFO and Cochrane Systematic Reviews. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS We searched the above databases for original articles published in English with at least one intervention designed to improve cervical cancer prevention, screening, diagnosis or treatment that linked participants to the healthcare system; that focused on US racial and/or ethnic minority populations; and that measured health outcomes. Articles were reviewed to determine the population, intervention(s), and outcomes. Articles published through August 2010 were included. STUDY APPRAISAL AND SYNTHESIS METHODS One author rated the methodological quality of each of the included articles. The strength of evidence was assessed using the criteria developed by the GRADE Working Group.45,46 RESULTS Thirty-one studies were included. The strength of evidence is moderate that telephone support with navigation increases the rate of screening for cervical cancer in Spanish- and English-speaking populations; low that education delivered by lay health educators with navigation increases the rate of screening for cervical cancer for Latinas, Chinese Americans and Vietnamese Americans; low that a single visit for screening for cervical cancer and follow up of an abnormal result improves the diagnosis and treatment of premalignant disease of the cervix for Latinas; and low that telephone counseling increases the diagnosis and treatment of premalignant lesions of the cervix for African Americans. LIMITATIONS Studies that did not focus on racial and/or ethnic minority populations may have been excluded. In addition, this review excluded interventions that did not link racial and ethnic minorities to the health care system. While inclusion of these studies may have altered our findings, they were outside the scope of our review. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Patient navigation with telephone support or education may be effective at improving screening, diagnosis, and treatment among racial and ethnic minorities. Research is needed to determine the applicability of the findings beyond the populations studied.

STUDY OBJECTIVE: The intrauterine device (IUD) is underused by young women who are at high risk for unintended pregnancy. We aimed to assess the impact of a brief educational intervention on the attitudes of young women toward intrauterine contraception and to assess characteristics associated with a change in attitude. DESIGN SETTING AND PARTICIPANTS: This is a planned secondary analysis of a survey of 144 women aged 14-24 years which assessed attitudes toward the IUD. INTERVENTION: The analysis was planned to fully examine the impact of a 3-minute educational intervention about the IUD given during administration of the survey which included risks and benefits of IUD use costs side effects and a demonstration of the IUD insertion and removal process. MAIN OUTCOME MEASURE: Proportions of participants with a positive attitude toward the IUD before and after the intervention were compared using McNemars chi-square test for paired proportions. Factors associated with a change in attitude toward the IUD were evaluated using multivariable analysis. RESULTS: Before the educational intervention 14.7% (21/143) had both heard of the IUD and expressed a positive attitude toward it. After the intervention this proportion increased to 53.8% (77/143) (P < .01). The increase in proportion with a positive attitude was consistent for all subpopulations. In multivariable analysis the only significant predictor of a positive change in attitude toward the IUD was a history of voluntary sexual activity (adjusted odds ratio 10.3 95% confidence interval 2.0-53.1). CONCLUSIONS: A brief educational intervention significantly improves the attitude of young sexually active women toward the IUD. Copyright 2010 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Objective To determine if a counseling intervention using the principles of motivational interviewing (MI) would impact uptake of long-acting reversible contraception (LARC) after abortion. Methods We conducted a pilot randomized controlled trial comparing an MI-based contraception counseling intervention to only non-standardized counseling. Sixty women 15–29 years-old were randomized. Primary outcome: uptake of LARC within four weeks of abortion. Secondary outcomes: uptake of any effective contraceptive, contraceptive use three months after abortion and satisfaction with counseling. Bivariate analysis was used to compare outcomes. Results In the intervention arm, 65.5% of participants received a long-acting method within four weeks compared to 32.3% in the control arm (p = 0.01). Three months after the abortion, differences in LARC use endured (60.0% vs. 30.8%, p = 0.05). Uptake and use of any effective method were not statistically different. More women in the intervention arm reported satisfaction with their counseling than women in the control arm (92.0% vs. 65.4%, p = 0.04). Conclusion Twice as many women in the MI-based contraception counseling intervention initiated and continued to use LARC compared to women who received only non-standardized counseling. Practice implications A contraception counseling session using the principles and skills of motivational interviewing has the potential to impact LARC use after abortion.

OBJECTIVE: The objective was to develop and test a postabortal contraception counseling intervention using motivational interviewing (MI) and to determine the feasibility impact and patient acceptability of the intervention when integrated into an urban academic abortion clinic. STUDY DESIGN: A single-session postabortal contraception counseling intervention for young women aged 15-24 years incorporating principles skills and style of MI was developed. Medical and social work professionals were trained to deliver the intervention their competency was assessed and the intervention was integrated into the clinical setting. Feasibility was determined by assessing ability to approach and recruit participants ability to complete the full intervention without interruption and participant satisfaction with the counseling. RESULTS: We approached 90% of eligible patients and 71% agreed to participate (n=20). All participants received the full counseling intervention. The median duration of the intervention was 29 min. Immediately after the intervention and at the 1-month follow-up contact 95% and 77% of participants reported that the session was helpful respectively. CONCLUSIONS: MI counseling can be tailored to the abortion setting. It is feasible to train professionals to use MI principles skills and style and to implement an MI-based contraception counseling intervention in an urban academic abortion clinic. The sessions are acceptable to participants. IMPLICATIONS: The use of motivational interviewing in contraception counseling may be an appropriate and effective strategy for increasing use of contraception after abortion. This study demonstrates that this patient-centered directive and collaborative approach can be developed into a counseling intervention that can be integrated into an abortion clinic. Copyright (c) 2015. Published by Elsevier Inc.

To quantify and compare serum levels and uterine effects following vaginal (dry), vaginal (moistened), buccal, and rectal misoprostol administration.Forty women seeking elective abortion between 6 and 12 6/7 weeks were randomly assigned to receive 400 mug of misoprostol by one of four routes. A 2.5-mm pressure monitoring catheter was placed through the cervix to the uterine fundus to record uterine tone and activity during the 5-hour observation period. Serum levels of misoprostol acid were measured at 15 and 30 minutes, then every 30 minutes.The four groups were similar in age, race or ethnicity, body mass index, parity, and gestation. Serum levels after vaginal, vaginal moistened and buccal administration rose gradually, peaked between 15 and 120 minutes and fell slowly. Vaginal and vaginal moistened routes produced higher peak serum levels than buccal and rectal (445.9 and 427.1 compared with 264.8 and 202.2 pg/mL; P = .03) and higher serum concentration area under the curve at 5 hours (1,025.0 and 1279.4 compared with 519.6 and 312.5 pg-hr/mL; P.001). Uterine tone and activity, however, were similar for buccal and the two vaginal routes. After rectal administration, serum levels peaked earlier (P.001) then dropped more abruptly, and peak uterine tone (P.001) and total activity (P = .04) were lower than after the other routes.Although serum levels were lower for buccal compared with the vaginal routes, the three routes produced similar uterine tone and activity. Rectal administration produced lower uterine tone and activity. Vaginal serum levels were two to three and a half times higher than those observed in prior misoprostol pharmacokinetic studies.

OBJECTIVE To compare the efficacy and acceptability of same-day misoprostol and overnight laminaria for cervical ripening before early second-trimester surgical abortion. METHODS We performed a randomized, double-blinded, controlled trial comparing 400 microg of vaginal misoprostol, given 3-4 hours preoperatively, with overnight laminaria before early second-trimester surgical abortion among women at 13.0-16.0 weeks of gestation (n = 84). The primary outcome was procedure time, and the sample size was based on 95% power to detect a difference of 4.5 minutes between groups. Secondary outcomes included completion of the procedure on the first attempt, procedural difficulty, and patients' pain scores and preferences. RESULTS The average gestational duration was 14 weeks 6 days. Procedures performed after laminaria were significantly faster than those after misoprostol (median 3.4 versus 7.2 minutes, respectively, P = .01). Laminaria patients had significantly greater dilation than misoprostol patients at abortion (mean 43 versus 33 French, P < .001), and more misoprostol patients required additional dilation (85% versus 21%, P < .001). Physicians rated 27% of the misoprostol procedures as moderate-markedly difficult versus 5% of laminaria procedures (P = .01). Differences in efficacy were pronounced among nulliparous patients. There were no significant differences in ability to complete the procedure on the first attempt or patients' intraoperative pain scores. More women in the misoprostol group would choose their assigned method again (93% versus 62%, P < .01), and 82% of all subjects preferred a 1-day procedure. CONCLUSION Early second-trimester abortions take longer and are technically more challenging after cervical ripening with same-day misoprostol than with overnight laminaria, but patients prefer same-day misoprostol.

OBJECTIVE: To compare pregnancy risk factors and outcomes between females in the United States with pregnancy occurring before age 15 years and between ages 15 and 19 years. METHODS: We analyzed data from the 2006 to 2010 National Survey of Family Growth. Our sample included women aged 20 to 44 years at the time of interview who reported first pregnancy before age 20 years (n=3095). Using weighted multivariable logistic regression we compared demographics family characteristics sexual debut circumstances and pregnancy intendedness and outcome among females with pregnancy occurring before age 15 years and between the ages of 15 and 19 years. RESULTS: Overall 3.4% (n=289) of women reported their first pregnancy occurring before age 15 years and 39.5% (n=3095) of women reported their first pregnancy between ages 15 and 19 years. Women with pregnancies before age 15 years were more likely to be Hispanic (23.5% compared with 22.4%; adjusted odds ratio [OR] 1.84; 95% confidence interval [CI] 1.07-3.20) to be black (31.7% compared with 19.4% adjusted OR 2.24; 95% CI 1.47-3.42) to report their first sexual partner was at least 6 years older (35.9% compared with 17.0%; adjusted OR 3.34; 95% CI 1.71-6.51) and to report that the index pregnancy was unintended (88.9% compared with 74.9%; adjusted OR 2.57; 95% CI 1.27-5.17). They were less likely to report being raised within a religion (Catholic: 22.8% compared with 33%; adjusted OR 0.32; 95% CI 0.17-0.59; Protestant: 54.6% compared with 51.3%; adjusted OR 0.52; 95% CI 0.27-0.98) living with both biological parents at age 14 years (33.3% compared with 53.4%; adjusted OR 0.49; 95% CI 0.33-0.71) and using contraception at sexual debut (25.3% compared with 56.0%; adjusted OR 0.29; 95% CI 0.18-0.46). CONCLUSION: Understanding risk factors for pregnancy before age 15 years may help clinicians address the social family planning and reproductive health needs of this population.

Objective: The objective of this study was to measure HIV prevalence, HIV incidence, and risk factors for infection among women seeking elective pregnancy termination in San Francisco. Study: The authors conducted a cross-sectional survey comprising a consecutive sample of women seeking elective pregnancy termination in San Francisco's county hospital from August 2002 to July 2003. Demographic and risk behavior information was abstracted from routine clinic records. HIV testing was conducted on blood specimens collected for other purposes after removing identifying information. Results: Based on 11 HIV-positives among 1,992 tested, HIV prevalence among women seeking pregnancy termination was 0.55% (95% confidence interval [CI], 0.28-0.99). One recent HIV seroconversion was detected for an annual incidence of 0.11% per year (95% CI, 0.23-0.88). In addition, risk factors significantly associated with HIV infection included sex with a known HIV-positive man, history of an abnormal Pap smear, history of genital herpes infection, history of trichomoniasis, and age 25 to 29 years. Conclusions: Women electing pregnancy termination can serve as a sentinel population to track trends in the HIV epidemic. However, barriers remain to wider implementation of the approach as a surveillance tool.

Objective: This trial was designed to compare levonorgestrel intrauterine device (LNG-IUD) use at 1 year after delivery between women randomized to postplacental insertion at the time of cesarean delivery and delayed insertion 4-8 weeks after delivery. Study design: This randomized controlled trial was conducted at two urban medical centers. Eligible pregnant women with planned cesarean deliveries were randomized to immediate postplacental insertion during cesarean or delayed insertion after 4-8 weeks. We used intention-to-treat analysis for the primary outcome of LNG-IUD use 12 months after delivery. Results: Forty-two women were randomized 20 into the postplacental group and 22 in the delayed group. Although confirmed use of the LNG-IUD 12 months after delivery was higher in the postplacental group (60.0% vs. 40.9% p=.35) this difference was not statistically significance. Expulsion was significantly more common in the postplacental group (20.0% vs. 0% p=.04). There were significant differences between the two sites in baseline population characteristics follow-up and expulsion. The trial did not answer the intended question as it was halted early due to slow enrollment. Conclusions: Our results show higher expulsion after postplacental insertion compared to delayed insertion but suggest similar IUD use at 12 months. Moreover it provides valuable lessons regarding a randomized controlled trial of postplacental LNG-IUD placement due to the challenges of estimating effect size and the nature of the population who might benefit from immediate insertion. Implications: Postplacental insertion of an IUD may improve use of highly effective contraception during the postpartum period. While our results suggest higher expulsion after postplacental insertion compared to delayed insertion and similar IUD use at 12 months our trial was insufficient to definitively test our hypothesis. Copyright © 2014 Elsevier Inc. All rights reserved.

Long-acting contraceptives, such as the intrauterine device (IUD), show potential for decreasing the incidence of unintended pregnancy. However, use among adolescent and young adult women remains low. We determined factors associated with IUD use among young women.We conducted an analysis of nationally representative, cross-sectional data from the 2002 and 2006-2010 National Surveys of Family Growth. We included sexually active women 15-24 years old. We used bivariate analysis to compare proportions of ever-use of any type of IUD in 2002 and in 2006-2010 and multivariable logistic regression to identify correlates of ever-use in 2006-2010.We found an increase in IUD use in teens 15-19 years old, from .2% to 2.5% (p.001), and among women 20-24 years old, 2.0% to 5.4% (p.001). Use increased among nearly all subgroups of respondents. Compared with nulliparous young women, those with one prior delivery and with two or more deliveries were substantially more likely to have used an IUD (adjusted OR 11.43, 95% CI 3.61-36.16, and adjusted OR 13.60, 95% CI 4-46.48, respectively). Young black women were less likely to report IUD use (adjusted OR .32, 95% CI .16-.66), and women whose mothers received at least a high school education were more likely to report use (adjusted OR 2.56, 95% CI 1.22-5.43).IUD use is increasing among adolescent and young adult women overall and among almost all sociodemographic subgroups. Nonetheless, use remains low, and nulliparous young women are highly unlikely to use the IUD.

Background The purpose of this study was to explore intrauterine device (IUD) awareness and knowledge in a diverse, multiethnic population. Methods We conducted a self-administered, anonymous survey addressing awareness of the IUD as a contraceptive method and knowledge about aspects of IUD use in a group of women aged 14 to 19 years. Demographic and medical information was obtained to compare awareness and knowledge between demographic groups. Chi-square, Fisher exact test, and t tests were used for analysis. Multiple logistic regression was utilized to confirm relationships. Results Of the 106 respondents, 76.4% (81/106) were sexually active and 56.6% (60/106) reported a history of ever being pregnant. There were 21.1% (33/106) of respondents who had heard of the IUD as a contraceptive method. Of the subjects who had heard of the IUD, 39.4 % (13/33) were able to identify key features of the IUD. Although a history of pregnancy was predictive of having heard of the IUD, age, insurance status, education, and all other demographic factors were not associated with IUD awareness. Conclusion Over 70% of the adolescents had not heard of the IUD and less than half of adolescents who had heard of the IUD were able to identify key features about this contraceptive method. The lack of knowledge of this effective and safe contraceptive option is concerning given that most participants were at high risk for unintended pregnancy.

To compare culturally relevant factors associated with ever having used an effective method of contraception among a cohort of predominantly Mexican American females.Face to face interviews were conducted in either English or Spanish. The survey used was developed directly for this study based on qualitative research with this population as well as the existing literature. Women were grouped as either adolescents (ages 13-20) or young adults (ages 21-25) for study purposes.Two community-based outpatient clinics on Chicago's West Side.Non-pregnant Latina females between 13-25 years of age.Comparison of familial, cultural and psychosocial factors associated with use of effective contraception using bivariate and multivariable analyses.Final analysis included 267 participants. Multivariable models yielded three factors found to be statistically significant predictors of effective contraception use, but only one was significant for both age groups. Number of children was a strong predictor of effective contraceptive use among both Latina adolescents and young adults (P0.001 for adolescents and P = 0.049 for young adults). Partner communication predicted effective contraceptive use among Latina adolescents (P = 0.001). Acculturation level strongly predicted effective contraceptive use among Latina young adults (P0.001).Findings demonstrate the need to tailor messages to Latina adolescent and young adults to reduce unintended pregnancy. Interventions to improve effective contraceptive use among Latina adolescents should promote effective forms of contraception in conjunction with communication with their partners about birth control. In contrast, efforts to address unintended pregnancy among Latina young adults should be sensitive to degree of acculturation.

This editorial focuses upon the issue of parental involvement (PI) laws required in some states for a daughter to obtain an abortion. It discusses a conducted review of literature to determine if there is evidence that legally mandated communication in the form of PI laws benefit of harm parent-daughter communication. It reviews and assesses the strengths and weaknesses of the literature and makes recommendations to clinicians researchers and advocates regarding areas for future research and policymaking. Copyright © 2010 Elsevier Inc. All rights reserved.

Background Most pregnancies among adolescent and young adult women are unintended, and adolescent birth rates have risen. Use of long-acting reversible contraception may be an effective strategy to reduce the rate of unintended pregnancy. Study Design We conducted a secondary data analysis of nationally representative, cross-sectional data from the 2002 National Survey of Family Growth. Our sample included 1722 sexually active women aged 15–24 years. We used multivariable logistic regression to identify correlates of ever-use of depot-medroxyprogesterone acetate (DMPA) or the intrauterine device (IUD). Results One-quarter of our sample had ever used DMPA, and less than 2% had ever used the IUD. In multivariable analysis, increasing parity was associated with ever-use of DMPA (OR 2.07, 95% CI 1.55–2.77) and ever-use of the IUD (OR 4.57, 95% CI 1.60–13.03), but age and measures of socioeconomic status were not. Having ever been married (OR 5.54, 95% CI 1.23–24.82) and current cohabitation (OR 4.89, 95% CI 1.10–21.71) were associated with ever-use of the IUD. A history of an adolescent pregnancy was associated with ever-use of DMPA (OR 1.79, 95% CI 1.19–2.70) but not of the IUD. Conclusions While similarities exist between the correlates of use of DMPA and the IUD, we discovered important differences, some of which may reflect provider biases regarding IUD provision.

Adolescents have a high rate of unintended pregnancy: 82% of pregnancies for women aged 15 to 19 years are unintended. The large majority of sexually active adolescent women are using some method of contraception, but few are using long-acting highly effective methods, that is, intrauterine devices and implants. Most adolescent women are relying on oral contraceptive pills and/or condoms as their most effective method, with the third most common method being depot medroxyprogesterone acetate. None of the long-acting highly effective methods are contraindicated in adolescents, and they should be considered for use and offered to young women as contraceptive options.

Background This study aimed to assess adolescent (aged 14–18 years) and young adult (aged 19–24 years) women's knowledge of and attitudes toward intrauterine devices (IUDs) before and after a brief educational intervention. Study design We administered a 43-item survey to 144 women aged 14–24 years, with half in each age category. The survey assessed knowledge of and attitudes toward IUDs, and incorporated a 3-min educational intervention about IUDs. Predictors for knowledge of and attitudes toward the IUD were examined using logistic regression. Results Forty percent of participants had heard of the IUD. Having ever heard of the IUD was associated with age >18 years [adjusted odds ratio (OR)=5.7; 95% confidence interval (95% CI)=2.1–15.7], a higher level of maternal education (adjusted OR=4.5; 95% CI=1.5–13.3) and a history of voluntary sexual intercourse (adjusted OR=4.9; 95% CI=1.0–23.5). Of those who had heard of the IUD previously, 37.5% reported a positive attitude toward the IUD before the intervention. After the educational intervention, 53.5% of all participants reported a positive attitude toward the IUD, with both adolescent and young adult women having similarly positive attitudes (51.4% vs. 55.6%, p=.62). This positive attitude was associated only with a history of voluntary sexual intercourse (adjusted OR=5.2; 95% CI=1.3–21.1). The characteristics of the IUD that the participants strongly liked and disliked were rated similarly by the two age groups. However, more adolescent women considered the privacy of the IUD and the ability to use the copper IUD for 10 years as positive characteristics. Conclusion Most young women were unaware of IUDs but were likely to think positively about IUDs after being educated about them. Demographic and reproductive health history did not predict attitude; thus, all young women should be offered education about IUDs.

Objective Adoption of long-acting reversible contraception (LARC) (ie, the intrauterine device or the contraceptive implant) immediately after abortion is associated with high contraceptive satisfaction and reduced rates of repeat abortion. Theory-based counseling interventions have been demonstrated to improve a variety of health behaviors; data on theory-based counseling interventions for postabortion contraception are lacking. Study Design Informed by the transtheoretical model of behavioral change, a video intervention was developed to increase awareness of, and dispel misconceptions about, LARC methods. The intervention was evaluated in a randomized controlled trial among women aged 18-29 years undergoing surgical abortion at a clinic in Chicago, IL. Participants were randomized 1:1 to watch the intervention video or to watch a stress management video (control), both 7 minutes in duration. Contraceptive methods were supplied to all participants free of charge. Rates of LARC initiation immediately after abortion were compared. Results Rates of LARC initiation immediately after abortion were not significantly different between the 2 study arms; 59.6% in the intervention and 51.6% in the control arm chose a LARC method ( P = .27). Conclusion This study resulted in an unexpectedly high rate of LARC initiation immediately after abortion. High rates of LARC initiation could not be attributed to a theory-based counseling intervention.

Objectives: The contraceptive prevalence in Ethiopia is one of the lowest and is highly skewed to short acting methods. Intrauterine devices (IUDs) are the most underutilized method in Ethiopia, accounting only for 0.2% of the 29% contraceptive prevalence rate. With the objective of improving IUD uptake, Ipas piloted an IUD scale-up initiative in 76 facilities in Ethiopia. These facilities were provided with supports that included engaging health extension workers on demand creation and establishing community-facility referral linkage. The remaining 305 facilities received the standard Ipas support for comprehensive contraceptive services. The aim of this study is to see if IUCD uptake differed between the facilities included in the IUCD scale-up initiative and those that were not. Methods: Data were collected from the registration books of all 381 Ipassupported facilities. Data were disaggregated into IUCD scale-up and nonscale-up facilities and analyzed. Results: Among women who obtained an IUD, 52.3% received their method from the 76 IUD scale-up facilities, while only 47.7% received one from the 305 non-scale up facilities (pb.001). The LARC and IUD caseload per facility was significantly high among the IUD scale-up sites. The proportion of IUDs provided versus all LARC methods was also higher in the intervention sites (17%) than in the other sites (9%) (pb.001). Conclusions: Engaging the health extension workers in demand creation and linking them to facilities helped improve IUD uptake. Health extension workers are key partners to improve family planning method choice and IUD/LARC uptake.

P = 0.07 Introduction • Risk of repeat unintended pregnancy is high after abortion.1 • Long-acting reversible contraception (LARC) reduce risk.2, 3 • Current education-focused contraception counseling has limited effectiveness in the setting of induced abortion.4 • Motivational Interviewing (MI) offers a promising approach. • Theory-based, directive, and patient-centered.5 • Successful in addressing many health behavior issues.6, 7

Introduction Heterosexual anal intercourse (HAI) is common among U.S. women. Receptive anal intercourse is a known risk factor for HIV, yet there is a paucity of data on HAI frequency and distribution in the United States. Condom use is lower with HAI vs. vaginal intercourse, but little is known regarding of correlates of HAI with and without condoms. Aims The aims of this study were to describe recent (past 12 months) and lifetime HAI among sexually active reproductive‐aged U.S. women, and to characterize women who engage in HAI with and without condoms. Methods We analyzed a sample of 10,463 heterosexually active women aged 15–44 years for whom anal intercourse data were available in the 2006–2010 National Survey of Family Growth. Main Outcome Measures Weighted bivariate and multivariable analyses were used to determine HAI prevalence and correlates. Primary outcomes were lifetime HAI, recent (last 12 months) HAI, and condom use at last HAI. Results In our sample, 13.2% of women had engaged in recent HAI and 36.3% in lifetime HAI. Women of all racial and ethnic backgrounds and religions reported recent anal intercourse. Condom use was more common at last vaginal intercourse than at last anal intercourse (28% vs. 16.4%, P P P Conclusion Women of all ages and ethnicities engage in HAI, at rates higher than providers might realize. Condom use is significantly lower for HAI vs. vaginal intercourse, putting these women at risk for acquisition of sexually transmitted infections. Benson LS, Martins SL, and Whitaker AK. Correlates of heterosexual anal intercourse among women in the 2006–2010 National Survey of Family Growth. J Sex Med 2015;12:1746–1752.

Objectives: Scant quantitative data exist on contraceptive knowledge among women obtaining an abortion. We sought to determine contraceptive knowledge in this population. Methods: We surveyed women presenting for induced abortion to an urban academic medical center, using a 15–30-min self-administered written survey. We reviewed medical records to determine choice of contraceptive method postabortion.Inadditiontodescriptivestatistics,weperformedbivariateanalysis to determine correlates of awareness of long-acting reversible (LARC) methods. Results: We surveyed 167 women from March 2012 to March 2013. The median age was 27 years (range 15–42), 73.9% were black and 71.1% were parous. Although 71.9% (120/167) had heard of the IUD and 64.2% (106/165) had heard of the implant, only 13.2% and 1.8% had used them, respectively. Parous women were more likely to have heard of the IUD than nulliparous women (83.1% vs. 43.8%, pb.001), and there was a similar trend for the implant (68.1% vs. 54.2%, p=.09). Of those who had heard of the IUD, only 49.2% (59/ 120) and 36.7% (44/120) perceived the levonorgestrel IUD and copper IUD to be effective, respectively. Assessment of the implant was even poorer, with only 34.0% (36/106) of those who had heard of it perceiving it to be effective. Approximately half (51.5%) of the participants planned to use a LARC method after their abortion. Conclusions: Although the majority of women had heard of LARC methods, knowledge about their efficacy was low, and a minority had used them. By learning women's current knowledge about contraceptive methods, contraceptive counseling interventions can be better directed.

Sexually active adolescents, including young women with lupus, are at high risk for unplanned pregnancy. Unplanned pregnancy among teens with lupus is associated with an elevated risk of poor maternal and fetal outcomes. The provision of effective contraception is a crucial element of care for a sexually-active young woman with lupus. Unfortunately, providers may be hesitant to prescribe contraception to this group due to concerns about increasing the risk of lupus complications. This article reviews the risks and benefits of currently-available contraceptives for young women with lupus. Providers are encouraged to consider long-term, highly-effective contraception, such as implantables and intrauterine devices, for appropriately selected adolescents with lupus.