Public and Private Providers’ Involvement in Improving their Patients’ Contraceptive Use

Guttmacher Institute, New York, NY 10038, USA.
Contraception (Impact Factor: 2.34). 08/2008; 78(1):42-51. DOI: 10.1016/j.contraception.2008.03.009
Source: PubMed


This study measured differences in the provision of care between public and private providers of contraceptive services, what problems using contraception these providers perceived their patients to have and providers' views on how to improve their patients' method use.
A nationally representative mixed-mode survey (mail, Internet and fax) of private family practice and obstetrician/gynecologist physicians who provided contraceptive care in 2005 was conducted. A parallel survey was administered to public contraceptive care providers in community health centers, hospitals, Planned Parenthood clinics and other sites during the same period. Descriptive and multivariate analyses were conducted across both surveys.
A total of 1256 questionnaires were completed for a response rate of 62%. A majority of providers surveyed believed that over 10% of their contraceptive clients experienced ambivalence about avoiding pregnancy, underestimated the risk of pregnancy and failed to use contraception for one or more months when at risk for unintended pregnancy. Implementation of protocols to promote contraceptive use ranged widely among provider types: a full 78% of Panned Parenthood clinics offered quick-start pill initiation, as did 47% of public health departments. However, 38% of obstetrician-gynecologists, 27% of "other public" clinics and only 13% of family physicians did so. Both public and private providers reported that one of the most important things they could do to improve patients' contraceptive method use was to provide more and better counseling. At least 46% of private providers and at least 21% of public providers reported that changing insurance reimbursement to allow more time for counseling was very important.
Strategies to improve contraceptive use for all persons in need in the United States have the potential to be more effective if the challenges contraceptive providers face and the differences between public and private providers are taken into account.

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    • "While almost all contraceptive providers currently offer women oral contraceptives and condoms (Landry et al., 2008), these methods have high discontinuation and typical-use failure rates, especially among underserved populations, where failure of oral contraceptives can be as high as 16 pregnancies per 100 person-years (Kost et al., 2008; Raine et al., 2011; Vaughan et al., 2008). LARC methods have extremely low typical use failure rates (b1%), similar to perfect use failure rates from clinical trials, because the methods require no user action for effectiveness (Trussell, 2011). "
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    • "Women also reported that mood change was the most important side effects they have experienced during pill use. Unfortunately most warning notes on the pill packages do not address or acknowledge about mood changes adequately while this is an important issue for ensuring that women will continue to use pills in order to prevent at least unwanted pregnancies [16,17]. In fact, discontinuity of oral contraceptive pills might jeopardize women’s health in general and reproductive health in particular [18,19]. "
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    • "Our analysis of the factors associated with contraceptive effectiveness among women who wish to delay pregnancy revealed that adult women with less education were more likely to report less effective practices, a finding that is consistent with a large body of research literature linking contraceptive practices to various measures of SES (Ahluwalia, Whitehead, & Bensyl, 2007; Melvin et al., 2000). In general this literature confirms the notion that lack of access to health services related to geographic location, costs, un-or underinsurance, and lack of knowledge lead to relatively poor contraceptive practices among low-income and other disadvantaged populations (Bednash, Worthington, & Wysocki, 2009; Landry, Wei, & Frost, 2008; Melvin et al.; Shields, 2009). "
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