Recommendations for policies enabling pharmacist-prescribed contraceptive services.

Community perspectives on pharmacist-prescribed hormonal contraception in rural California

A new metric was developed to estimate the numbers of women who likely need contraceptive services and supplies using a more person-centered perspective than the conventional metric. The measure classifies self-defined need based on reported recent use of contraception or contraceptive services or reporting a desire to use contraception if financial barriers were not an issue. Need for contraceptive services can be for any reason and is no longer focused solely on the prevention of unintended pregnancy. Using the new metric, in 2023, nearly 52 million US women aged 15–49 were estimated to have a self-defined need for contraceptive services and supplies. More than 40% of these women (21.5 million) were likely in need of public support for contraceptive services because of their low family income (16.6 million women aged 20–49 living below 250% of the federal poverty level) or being younger than 20 with an increased likelihood of needing confidential care independent of their families’ resources (4.9 million women aged 15–19). The proportion of all women with a self-defined need who likely needed public support for contraceptive care varied widely across states; the highest proportions were found in states with higher-than-average numbers of low-income households (those with likely need exceeded 50% in three states: Arkansas, Louisiana and Mississippi). Compared with prior reports, estimates of self-defined need reported for 2023 are somewhat higher, both because of differing age ranges (13–44 vs. 15–49) and because the new metric counts those with reported need for contraceptive services for any reason, not solely pregnancy prevention, and among women who previously were assumed not to need contraceptive care (e.g., those who are sterile or have a partner who is sterile).

The implementation of payment for grassland ecosystem services (PGES) is the result of cooperative games between farmers and the local government. However, there are currently many studies on the willingness behavior of farmers to participate in payment for grassland ecosystem services, although there is a lack of research on the impact of the willingness behavior of local governments on the implementation of payment for grassland ecosystem services. Based on the theory of planned behavior, in this study, the impact of government policy instruments on PGES implementation outcomes was taken as the primary research objective, and the following findings were derived from the three secondary objectives of constructing a model, using structural equations to measure and quantitatively decompose the policy instruments: (1) policy instruments have a significant impact on policy implementation; (2) policy instruments play an important guiding role in farmers’ participation in PGES; and (3) the amount of ecological compensation and the degree of policy implementation have a significant impact on policy instruments. Reasonable adjustments can effectively improve the effect of policy implementation. This study incorporated the implementation willingness and interaction of farmers and local governments into the analysis model of the implementation of payment for grassland ecosystem services, providing a theoretical basis for improving the performance of payment for grassland ecosystem services from the perspective of government policy instruments.

How commonly do US abortion clinics offer contraceptive services?

BackgroundGrowing evidence shows that social accountability contributes to improving health care services, with much promise for addressing women’s barriers in contraceptive care. Yet little is known about how social accountability works in the often-complex context of sexual and reproductive health, particularly as sex and reproduction can be sensitive topics in the open and public formats typical of social accountability. This paper explores how social accountability operates in the highly gendered and complex context of contraceptive care.MethodsThis exploratory research uses a case study approach to provide a more grounded understanding of how social accountability processes operate in the context of contraceptive information and services. We observed two social accountability projects that predominantly focused on contraceptive care in Uganda over a year. Five instruments were used to capture information from different source materials and multiple respondents. In total, one hundred and twenty-eight interviews were conducted and over 1000 pages of project documents were collected. Data were analyzed and compiled into four case studies that provide a thick description of how these two projects operated.ResultsThe case studies show the critical role of information, dialogue and negotiation in social accountability in the context of contraceptive care. Improved community and health system relationships, community empowerment, provider and health system responsiveness and enhanced availability and access to services were reported in both projects. There were also changes in how different actors related to themselves and to each other, and contraceptive care, a previously taboo topic, became a legitimate area for public dialogue.ConclusionThe study found that while social accountability in the context of contraceptive services is indeed sensitive, it can be a powerful tool to dissolving resistance to family planning and facilitating a more productive discourse on the topic.

As a continent with 54 independent states Africa’s diversity is often highlighted but frequently forgotten when fertility is discussed. Fifty and more years ago to consider that all African countries and societies had a single fertility pattern (large numbers of children) and single trend (unchanging over time) was a valid characterization. Since the 1960s however that uniformity has disappeared replaced by substantial inter- and intra-country differences in fertility patterns and trends that render previous perceptions of continent-wide homogeneity obsolete. In this chapter we consider two African countries—Ghana and Kenya—whose fertility patterns and trends and their determinants have been well documented (Bongaarts 2008; Garenne 2008; Machiyama 2010; Shapiro and Gebreselassie 2008; Sneeringer 2009). Both countries have benefited from regularWorld Fertility Surveys (WFS) and Demographic and Health Surveys (DHS) that record trends in fertility family planning (FP) and other relevant indicators. The recently introduced Performance Monitoring and Accountability 2020 (PMA2020) surveys monitor progress since 2012 for the FP2020 initiative and occasional Situation Analysis and Service Provision Assessment surveys have also detailed the readiness of the health system in both countries to make quality FP services available. Ghana and Kenya share some common history: both have relatively strong health system legacies from the period of British colonialization; both were among the earliest countries to achieve independence; they were the first two African countries that developed policies to address population growth in the 1960s; and both have received substantial and sustained resources over several decades from many external donors and technical assistance organizations explicitly intended to increase the availability and quality of family planning services. However they are composed of cultures that are both diverse within each country and markedly different in many ways between the two countries. The two countries demonstrate remarkably different pathways in fertility and family planning patterns and trends from the 1970s to the present. We highlight some of the key differences and similarities explain why they have occurred and identify insights that could inform a wider understanding of fertility transitions and the role of family planning in other African countries. (excerpt)

Background: Medicaid family planning programs provide coverage for contraceptive services to low-income women who otherwise do not meet eligibility criteria for Medicaid. In some states that expanded Medicaid eligibility following the Affordable Care Act (ACA), women who were previously eligible only for family planning services became eligible for full-scope Medicaid. The objective of this study was to provide context for the impact of the ACA Medicaid expansion on contraceptive service provision to women in Oregon who were newly enrolled in Medicaid following the expansion. Materials and Methods: We used Medicaid eligibility data to identify women ages 15-44 years who were newly enrolled in Oregon's Medicaid program following the ACA expansion (n = 305,042). Using Medicaid claims data, we described contraceptive services and other preventive reproductive care received in 2014-2017. Results: Overall, 20% of women newly enrolled in Medicaid received contraceptive counseling and 31% received at least one method. The most frequently received methods were the pill (38% of women who received any method), intrauterine device (28%), implant (15%), and injectable (12%). Community health centers played a significant role in contraceptive service provision, particularly for the implant and injectable. Nine of 10 women (89%) who received contraceptive services also received other preventive reproductive services. Conclusions: This study provides insight regarding receipt of contraceptive services and preventive reproductive care following Medicaid expansion in a state with a Medicaid family planning program. These findings underscore the importance of Medicaid expansion for reproductive health even in states with preexisting Medicaid family planning.

A clinical workforce providing contraceptive and abortion care is critical for access to contraception and may include women's health, primary care, and other clinicians. A confluence of crises faced by clinicians may be associated with their loss from the workforce. Such crises include COVID-19 and policies penalizing abortion care, which culminated in the 2022 Dobbs v Jackson decision overturning Roe v Wade. This study used a national-level claims data set to examine changes in the contraception and abortion workforce from January 2019 to December 2021. IQVIA preadjudicated medical claims were derived from clinician offices and insurance clearinghouses. Data were obtained on contraceptive methods (intrauterine devices, contraceptive implants, injectable contraception), abortion (ie, misoprostol and mifepristone, dilation and curettage, dilation and evacuation, and surgical procedures), or both. Outcome variables examined included counts of contraceptive and abortion clinicians by year and service type and monthly volume changes in services. During the study period, 141,837 clinicians provided at least 1 in-person contraception or abortion service, and 5804 provided both. In 2020, the number of physicians in the workforce decreased for all services except medical abortion, and the number of physicians providing contraceptive care was not reestablished to prepandemic levels in 2021. Abortion services did not distinctly decrease in early 2020. Instead, procedural abortion steadily decreased (from 8315 services in January 2019 to 5665 services in December 2021), and use of medication abortions steadily increased (from 14,347 services in January 2019 to 16,074 services in December 2021). In contrast, the number of advanced practice clinicians (physician assistants, nurse practitioners) was identical from 2019 to 2020 and increased above prepandemic levels in 2021. Abortion services did not distinctly decrease in early 2020. Instead, procedural abortion steadily decreased (from 8315 services in January 2019 to 5665 services in December 2021), and medication abortions steadily increased (from 14,347 services in January 2019 to 16,074 services in December 2021). The incredible strain on the health workforce by COVID-19 resulted in practice closures and physicians leaving practice. Although these physicians may reenter the workforce, the data suggest ongoing loss of physicians providing contraception services. Access to contraception requires that primary care clinicians offer the full scope of care, including family planning services. State-level expanded scope of practice policies may strengthen this segment of the workforce. These data show that the overall number of clinicians providing contraception and abortion services decreased in 2020 and was restored in 2021. The number of physicians providing contraception services did not reach prepandemic levels, whereas the number of advanced practice clinicians providing contraception services continued to increase, which mirrored the increasing numbers of advanced practice clinicians in primary care and other settings. Many individuals reported fertility plans for fewer children or later pregnancies, suggesting that demand for contraceptive services remained even as services were unavailable. In addition, this study did not capture outcomes associated with the 2022 Supreme Court decision overturning Roe v Wade, a watershed event that will shape the provision of abortion and contraception for the foreseeable future.

The purpose of this study to analysis the effect of training service toward performance of managerial, to analysis the effect of training service toward organization governance, and analysis indirect effect the training service through performance of managerial toward organization governance on BPSDM South Sulawesi Province. The research applied on BPSDM South Sulawesi Province with population as amount 583 employees and samples as amount 237 respondent through Slovin formulation. Data from questioner to analysis with path analysis. The result of research with path analysis obtained: the first, implementation of training service have effected toward organization governance in BPSDM. The second, the practice performance of managerial not yet to support the implementation of training service in effect toward organization governance in BPSDM. The result of test showed that the training service have positive and significant toward organization governance. That meaning the implementation of training service, so can to increase the organization governance. better of implementation the training service so the organization governance in BPSDM South Sulawesi Province more increase it.

The role of doulas and community birth workers in abortion and contraception care: An international scoping review

Key Points Key Points In 2016, 20.6 million U.S. women were likely in need of public support for contraceptive services and supplies. Between 2010 and 2016, the number of women likely in need of public support for contraceptive services and supplies rose 8% overall. Among women below 250% of federal poverty guidelines, there was a 12% increase; among adolescents, there was a 5% decline. Between 2013 and 2016, the number of women likely in need of public support for contraceptive services who had neither public nor private health insurance fell more than one-third (36%), from 5.6 million to 3.6 million. States that implemented the Affordable Care Act’s Medicaid expansion experienced particularly large declines. Between 2010 and 2016, the overall number of women receiving publicly supported contraceptive services remained stable at about nine million women. However, the number of women served by different types of providers shifted dramatically over this period. While Title X–funded sites continued to serve the largest segment of women receiving publicly supported care, their patient load fell by 25%, from 4.7 million in 2010 to 3.5 million in 2016. The number of contraceptive patients served by other public clinics that do not receive Title X funding rose by 29% and the number of women receiving Medicaid-funded contraceptive services from private providers rose by 19%. In 2016, women who obtained contraceptive services from all publicly supported providers were able to postpone or avoid two million pregnancies that they would have been unable to prevent without access to publicly supported care. Women who obtained contraceptives from Title X–funded clinics avoided 755,000 pregnancies. Screening and vaccination services provided at family planning visits with all publicly supported providers helped patients avoid more than 12,000 cases of pelvic inflammatory disease and nearly 2,000 cases of cervical cancer in 2016. More than 100,000 chlamydia infections, 18,000 gonorrhea infections and 800 cases of HIV were prevented among the partners of women obtaining publicly funded contraceptive care.

While recent national discussions of the Affordable Care Act (ACA) made the introduction of mandated contraceptive coverage within health insurance policies seem like a novel idea, it is not new at all. Since the late 1990s, 29 states have mandated that insurance providers include prescription contraceptive supplies and, in some instances, associated contraceptive services in their coverage. We use state-level policy variation to generate both difference-in-differences and triple difference estimates to determine if women in states with state-level contraception supply or contraception supply and services insurance mandates experienced changes in their utilization of contraception and preventive health care services. We find a positive relationship between these policies and prescription contraception use for those with low educational attainment, but the results are not robust to a variety of specifications. Our results also show an increase in the consumption of preventive health services for women with low educational attainment as a result of these health insurance mandates. We conclude by discussing the implications for the ACA.

P043Southern health providers’ perspectives on policy considerations for implementation of telehealth medication abortion services

BackgroundTelehealth use rapidly increased during the COVID-19 pandemic, including for contraceptive care (e.g., counseling and method provision). This study explored providers’ experiences with contraceptive care via telehealth.MethodsWe conducted a survey with open-ended responses among contraceptive providers across the United States. The study population included physicians, nurse practitioners, health educators, and other health professionals (n = 546). Data were collected from April 10, 2020, to January 29, 2021. We conducted qualitative content analysis of the open-ended responses.ResultsProviders highlighted the benefits of telehealth, including continuing access to contraceptive services and accommodating patients who faced challenges attending in-person contraceptive visits. Providers at school-based health centers reported telehealth allowed them to reach young people while schools were closed. However, many providers noted a lack of patient awareness about the availability of telehealth services and disparities in access to technology. Providers felt there was less personal connection in virtual contraceptive counseling, noted challenges with confidentiality, and expressed concern about the inability to provide the full range of contraceptive methods through telehealth alone.ConclusionsThe pandemic significantly impacted contraceptive health care delivery. Telehealth has sustained access to contraception in important ways, but has been accompanied by various challenges, including technological access and confidentiality. As hybrid models of care evolve, it is important to assess how telehealth can play a role in providing contraceptive care while addressing its barriers.

Implementation of Aceh Qanun Number 11 of 2013 in Handling Beggars in Banda Sakti District, Lhokseumawe City is one of the efforts in handling the problem of beggars. This study aims to determine how the implementation of Aceh Qanun Number 11 of 2013 in handling beggars in Banda Sakti District, Lhokseumawe City and to find out what are the obstacles to the implementation of Aceh Qanun Number 11 of 2013 in Banda Sakti District, Lhokseumawe City has not been running effectively. The method used in this study is descriptive qualitative with data collection techniques through observation, interviews and documentation. The results of this study are that the implementation of Aceh Qanun Number 11 of 2013 in handling beggars in Banda Sakti District, Lhokseumawe City has not been running effectively, because the Social Service has not implemented the provision of training services, employment opportunities and business opportunities for beggars. This is because there is no budget and special facilities to handle beggars, lack of funding sources, human resources and infrastructure resources to support the implementation of education and training services as well as employment and business opportunities for beggars. Communication between agencies is also one of the obstacles to the implementation of Aceh Qanun Number 11 of 2013 in handling beggars in Banda Sakti District, Lhokseumawe City. The social service can provide education and training services to beggars as well as employment and business opportunities. The social service can also establish relationships with other agencies in the context of implementing Aceh Qanun Number 11 of 2013 with other agencies such as BLK and DISPERINDAGKOP.