Estimates of use of preferred contraceptive method in the United States: a population-based study.

Background: In the U.S. and globally, dominant metrics of contraceptive access focus on the use of certain contraceptive methods and do not address self-defined need for contraception; therefore, these metrics fail to attend to person-centeredness, a key component of healthcare quality. This study addresses this gap by presenting new data from the U.S. on preferred contraceptive method use, a person-centered contraceptive access indicator. Additionally, we examine the association between key aspects of person-centered healthcare access and preferred contraceptive method use. Methods: We fielded a nationally representative survey in the U.S. in English and Spanish in 2022, surveying non-sterile 15-44-year-olds assigned female sex at birth. Among current and prospective contraceptive users (unweighted n = 2119), we describe preferred method use, reasons for non-use, and differences in preferred method use by sociodemographic characteristics. We conduct logistic regression analyses examining the association between four aspects of person-centered healthcare access and preferred contraceptive method use. Findings: A quarter (25.2%) of current and prospective users reported there was another method they would like to use, with oral contraception and vasectomy most selected. Reasons for non-use of preferred contraception included side effects (28.8%), sex-related reasons (25.1%), logistics/knowledge barriers (18.6%), safety concerns (18.3%), and cost (17.6%). In adjusted logistic regression analyses, respondents who felt they had enough information to choose appropriate contraception (Adjusted Odds Ratio [AOR] 3.31; 95% CI 2.10, 5.21), were very (AOR 9.24; 95% CI 4.29, 19.91) or somewhat confident (AOR 3.78; 95% CI 1.76, 8.12) they could obtain desired contraception, had received person-centered contraceptive counseling (AOR 1.72; 95% CI 1.33, 2.23), and had not experienced discrimination in family planning settings (AOR 1.58; 95% CI 1.13, 2.20) had increased odds of preferred contraceptive method use. Interpretation: An estimated 8.1 million individuals in the U.S. are not using a preferred contraceptive method. Interventions should focus on holistic, person-centered contraceptive access, given the implications of information, self-efficacy, and discriminatory care for preferred method use. Funding: Arnold Ventures.

Patient Satisfaction with IUD Services in a School-Based Health Center: A Pilot Study.

STUDY OBJECTIVE: We aimed to determine the acceptability to and satisfaction of high school students receiving an intrauterine device (IUD) at a school-based health center (SBHC). DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: In this prospective pilot study at a Bronx SBHC, adolescent patients who had an IUD inserted in the SBHC between November 2010 and June 2013 completed a self-administered survey on the day of IUD insertion and a follow-up survey within 6 months. The initial survey addressed patient sexual and contraceptive history, reasons for choosing the IUD, and the insertion experience, whereas the follow-up survey addressed IUD continuation and side effects. RESULTS: In all, 104 of 139 (75%) eligible patients agreed to participate, and 75 (72%) of those completed the follow-up survey. Respondents chose IUDs because they were long-lasting, effective, private, and easy to remember, and chose the SBHC for services because it was convenient, recommended, free, and a trusted setting. Participants rated their interactions with SBHC staff highly, and almost all described their procedure experience as somewhat or very acceptable. Of the respondents, 92% were still using the IUD at the time of the follow-up survey, with 32% stating that they were somewhat satisfied and 65% stating they were very satisfied with this method of contraception. CONCLUSION: Our research demonstrates that IUD services can be integrated into the SBHC setting with high rates of acceptability and satisfaction. Furthermore, SBHCs provide a unique and acceptable option for providing these services and have the potential to increase adolescents' contraceptive access and choice.

Integration of Onsite Long-Acting Reversible Contraception Services Into School-Based Health Centers.

BACKGROUND: With recent recommendations from professional organizations, long-acting reversible contraception (LARC) methods are considered appropriate first-line contraception for adolescents. Many school-based health centers (SBHCs) in New York City (NYC) have recently added onsite LARC insertion and management to their contraceptive options. We aimed to explore key elements needed to implement LARC training and services into the SBHC setting and to identify successful factors for program implementation. METHODS: Semistructured qualitative interviews were conducted with 19 providers and staff at 7 SBHCs in high schools in the Bronx and analyzed using Dedoose. RESULTS: Support and leadership from administration; comprehensive onsite training of providers and staff; developing an effective staffing model for procedure sessions; and patient-centered contraceptive counseling were 4 key themes named by respondents as crucial to the program implementation process. CONCLUSIONS: Integrating LARC services onsite at SBHCs is feasible and positively received by providers and staff. With good leadership, staffing, training, and appropriate contraceptive counseling, both SBHCs and other primary clinics that serve adolescents can integrate LARC insertion, removal, and management into routine contraceptive care. This in turn can increase youth access to these methods.