Since few clinicians provide women information on highly effective (ie, intrauterine or subdermal) contraceptives, the iPLEDGE program increases anxiety about isotretinoin more than it helps women feel protected from the teratogenic risks of isotretinoin.

PURPOSE To compare rates of pelvic inflammatory disease (PID) among women who did and did not receive an intrauterine device (IUD) the day they sought emergency contraception (EC) or pregnancy testing. METHODS Women, 15–45 years of age, who sought EC or pregnancy testing from an urban family planning clinic completed surveys at the time of their clinic visit (August 22, 2011-May 30, 2013) and three months after their clinic visit. The surveys assessed contraceptive use and symptoms, testing, and treatment for sexually transmitted infections (STI) and pelvic inflammatory disease (PID). We reviewed the medical records of participants who reported IUD placement within 3 months of enrollment and abstracted de-identified electronic medical record (EMR) data on all women who sought EC or pregnancy testing from the study clinic during the study period. FINDINGS During the study period, 1,060 women visited the study clinic; 272 completed both enrollment and follow-up surveys. Among survey completers with same-day IUD placement, PID in the 3 months following enrollment was not more common [1/28; 3.6% (95% CI 0–10.4%)] than among women who did not have a same-day IUD placed [11/225; 4.9% (95% CI 2.7%-8.6%)], p=0.71. Chart review and EMR data similarly showed that rates of PID within 3 months of seeking EC or pregnancy testing were low whether women opted for same-day or delayed IUD placement. CONCLUSIONS Same-day IUD placement was not associated with higher rates of PID. Concern for asymptomatic STI should not delay IUD placement, and efforts to increase uptake of highly effective reversible contraception should not be limited to populations at low risk of STI.

Objectives To evaluate the impact of counseling regarding the maternal health effects of lactation on pregnant women's intentions to breastfeed. Methods Women seeking prenatal care at an urban university hospital completed surveys before and after receiving a 5-min counseling intervention regarding the maternal health effects of breastfeeding. The counseling was delivered by student volunteers using a script and one-page infographic. Participants were asked the likelihood that breastfeeding affects maternal risk of multiple chronic conditions using 7-point Likert scales. We compared pre/post changes in individual item responses and a summary score of knowledge of the maternal health benefits of lactation (MHBL) using paired t tests. Multivariable logistic regression was used to examine the impact of increases in knowledge of MHBL on participants' intentions to breastfeed. Results The average age of the 65 participants was 24 ± 6 years. Most (72 %) were African-American and few (9 %) had college degrees. Half (50 %) had previously given birth, but few (21 %) had previously breastfed. Before counseling, few were aware of any benefits of lactation for maternal health. After counseling, knowledge of MHBL increased (mean knowledge score improved from 19/35 to 26/35, p < 0.001). Improvement in MHBL knowledge score was associated with increased intention to try breastfeeding (aOR 1.20, 95 % CI 1.02-1.42), of wanting to breastfeed (aOR 1.45, 95 % CI 1.13-1.86), and feeling that breastfeeding is important (aOR 1.21, 95 % CI 1.03-1.42). Conclusions for Practice Brief structured counseling regarding the effects of lactation on maternal health can increase awareness of the maternal health benefits of breastfeeding and strengthen pregnant women's intentions to breastfeed.

A contraceptive information sheet can significantly improve patients' contraceptive knowledge and may be a useful addition to efforts to prevent isotretinoin-induced birth defects.

Objective To assess how a checklist reminding clinicians to deliver a bundled intervention affects contraceptive knowledge and use 3 months after women seek walk-in pregnancy testing. Methods Pre-intervention, an inner-city family planning clinic provided unstructured care; during the intervention period, clinic staff used a checklist to ensure women received needed services. Women seeking walk-in pregnancy testing who wished to avoid pregnancy for at least 6 months were asked to complete surveys about their contraceptive knowledge and use immediately after and 3-months after visiting the study clinic. To assess the significance of changes over time, we used logistic regression models. Results Between January 2011 and May 2013, over 1500 women sought pregnancy testing from the study clinic; 323 completed surveys (95 pre-intervention and 228 during the intervention period). With this checklist intervention, participants were more likely to receive emergency contraception (EC) (22% vs. 5%, aOR=4.64, 95% CI 1.77-12.17), have an intrauterine device or implant placed at the time of their clinic visit (5% vs. 0%, p=0.02), or receive a contraceptive prescription (23% vs. 10%, p<0.001). Three months after visiting the study clinic, participants from the intervention period were more knowledgeable about intrauterine and subdermal contraception and were more likely to be using intrauterine, subdermal or injectable contraception (aOR=2.18, 95% CI 1.09-4.35). Conclusions Women seeking walk-in pregnancy testing appear more likely to receive EC and to have switched to a more effective form of birth control in 3 months following their visit when clinic staff used a 3-item checklist and provided scripted counseling. Implications A checklist reminding clinic staff to assess pregnancy intentions, provide scripted counseling about both emergency and highly-effective reversible contraception, and offer same-day contraceptive initiation to women seeking walk-in pregnancy testing appears to increase use of more effective contraception.