The Colorado Initiative to Reduce Unintended Pregnancy: Contraceptive Access and Impact on Reproductive Health.

The Colorado Initiative to Reduce Unintended Pregnancy, including its largest subproject, the Colorado Family Planning Initiative, had a significant impact on contraceptive access during and after the project period. This coordinated and multilevel initiative improved reproductive health outcomes by driving change in public health systems, advancing statewide policies, building capacity through training and technical assistance, and increasing public awareness and education. Lessons learned from the implementation and outcomes of the Colorado Initiative to Reduce Unintended Pregnancy continue to inform contraceptive access efforts. (Am J Public Health. 2022;112(S5):S532-S536. https://doi.org/10.2105/AJPH.2022.306891).

Insertion characteristics of intrauterine devices in adolescents and young women: success, ancillary measures, and complications.

OBJECTIVE: The objective of the study was to evaluate success and safety of intrauterine device (IUD) placement in a large cohort of adolescents. STUDY DESIGN: We examined the medical records of patients aged 13-24 years at the Children's Hospital Colorado Adolescent Family Planning Clinic with at least 1 attempt at IUD placement. We abstracted demographic, reproductive, and procedural variables. The primary outcome was successful placement at first IUD insertion visit. We compared nulliparous with parous adolescents and patients younger than 18 years with those 18 years of age and older. RESULTS: Between April 2009 and December 2011, 1177 adolescent women aged 13-24 years (mean age 20.8 ± 2.5 years) had an attempted IUD placement, 1012 (86%) of which were with an advanced practice clinician. The first attempt was successful for 1132 women (96.2%). The first-attempt success rate was 95.8% for nulliparous women and 96.7% for parous women (P = .45). The first-attempt success rate was 95.5% (n = 169) for women aged 13-17 years compared with 96.3% (n = 963) for women aged 18-24 years (P = .6). Only 1.8% (n = 21) of all first-attempt successful insertions required ancillary measures. Of the 45 patients with a failed first insertion attempt, 40% (n = 18) had a second attempt with a physician, of which 78% (n = 14) were successful. Within the first 6 months of IUD placement, no perforations were identified and 24 patients (3.0%) expelled the IUD. Insertion failures and IUD expulsions were not related to IUD type, age, or parity. CONCLUSION: Intrauterine devices can be inserted in nulliparous adolescents of any age with similar success to parous adolescents, by both physicians and advanced practice clinicians. Inability to provide ancillary measures such as paracervical block or cervical dilation should not limit access to this first-line contraceptive method.