Barriers and Pathways to Providing Long‐Acting Reversible Contraceptives in Massachusetts Community Health Centers: A Qualitative Exploration

Janiak, Elizabeth; Clark, James G.; Bartz, Deborah; Langer, Ana; Gottlieb, Barbara

doi:10.1363/psrh.12071

Cited by 11 publications

(3 citation statements)

References 24 publications

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“…Moreover, alongside ACA implementation, complex state policies, social and political environments, and clinic factors will continue to shape the availability and utilisation of reproductive health services in CHCs [21, 77, 78, 80, 81]. Within these contexts, individual and community-level preferences and behaviours and differences in knowledge and attitudes about pregnancy and healthcare also contribute to patterns of reproductive healthcare utilisation and disparities in outcomes [6, 82, 83]. Ultimately, the ACA will have the biggest impact on reproductive healthcare if women not only have access to the benefits, but are also aware of the benefits and act upon them.…”

Section: Discussionmentioning

confidence: 99%

Study protocol: a mixed-methods study of women’s healthcare in the safety net after Affordable Care Act implementation – EVERYWOMAN

Cottrell¹,

Darney²,

Templeton³

et al. 2019

Health Res Policy Sys

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Background Evidence-based reproductive care reduces morbidity and mortality for women and their children, decreases health disparities and saves money. Community health centres (CHCs) are a key point of access to reproductive and primary care services for women who are publicly insured, uninsured or unable to pay for care. Women of reproductive age (15–44 years) comprise just of a quarter (26%) of the total CHC patient population, with higher than average proportions of women of colour, women with lower income and educational status and social challenges (e.g. housing). Such factors are associated with poorer reproductive health outcomes across contraceptive, preventive and pregnancy-related services. The Affordable Care Act (ACA) prioritised reproductive health as an essential component of women’s preventive services to counter these barriers and increase women’s access to care. In 2012, the United States Supreme Court ruled ACA implementation through Medicaid expansion as optional, creating a natural experiment to measure the ACA’s impact on women’s reproductive care delivery and health outcomes. Methods This paper describes a 5-year, mixed-methods study comparing women’s contraceptive, preventive, prenatal and postpartum care before and after ACA implementation and between Medicaid expansion and non-expansion states. Quantitative assessment will leverage electronic health record data from the ADVANCE Clinical Research Network, a network of over 130 CHCs in 24 states, to describe care and identify patient, practice and state-level factors associated with provision of recommended evidence-based care. Qualitative assessment will include patient, provider and practice level interviews to understand perceptions and utilisation of reproductive healthcare in CHC settings. Discussion To our knowledge, this will be the first study using patient level electronic health record data from multiple states to assess the impact of ACA implementation in conjunction with other practice and policy level factors such as Title X funding or 1115 Medicaid waivers. Findings will be relevant to policy and practice, informing efforts to enhance the provision of timely, evidence-based reproductive care, improve health outcomes and reduce disparities among women. Patient, provider and practice-level interviews will serve to contextualise our findings and develop subsequent studies and interventions to support women’s healthcare provision in CHC settings.

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Section: Discussionmentioning

confidence: 99%

Study protocol: a mixed-methods study of women’s healthcare in the safety net after Affordable Care Act implementation – EVERYWOMAN

Cottrell¹,

Darney²,

Templeton³

et al. 2019

Health Res Policy Sys

View full text Add to dashboard Cite

show abstract

“…For many women, they are not a realistic option because they require medical services, are not easily accessible, and can be costly. [5][6][7][8] Furthermore, these systemically absorbed hormones can cause uncomfortable and potentially life-threatening side effects. 9 Consequently, many women distrust hormone-based methods while others do not want continuous protection.…”

Section: Introductionmentioning

confidence: 99%

“…Hormonal and long‐acting reversible contraceptive (LARC) methods are highly effective, but do not protect against sexually transmitted infections (STIs). For many women, they are not a realistic option because they require medical services, are not easily accessible, and can be costly 5–8 . Furthermore, these systemically absorbed hormones can cause uncomfortable and potentially life‐threatening side effects 9 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the novel vaginal contraceptive agent PPCM in preclinical studies using sperm hyaluronan binding and acrosome status assays

et al. 2021

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Background: Polyphenylene carboxymethylene (PPCM) sodium salt is a promising multipurpose technology for prevention of both sexually transmitted infections (STIs) and pregnancy. In preclinical studies, PPCM has demonstrated significant (1) antimicrobial activity against several important viral and bacterial pathogens and (2) contraceptive activity associated with premature acrosome loss.Objective: To further evaluate a vaginal antimicrobial compound as a contraceptive agent in preclinical studies utilizing a repurposed hyaluronan binding assay (HBA). Materials and methods:Semen samples containing either neat semen or washed spermatozoa were treated with increasing concentrations of PPCM or calcium ionophore A23187 (positive control). Sperm inactivation was measured by two methods: (1) double acrosome staining (AS), and (2) a hyaluronan binding assay (HBA ® ). Percentage of inactivated sperm was compared between untreated control sperm and those treated with PPCM or A23187.Results: PPCM had a significant (p < 0.05) and dose-dependent effect on sperm inactivation in both assays, with HBA detecting a higher proportion of inactivated sperm than AS. PPCM did not affect sperm motility and exhibited equivalent responses in the neat and washed samples.Discussion: Both HBA and AS confirmed that spermatozoa were rapidly inactivated at PPCM concentrations likely present in the vagina under actual use conditions and in a time-frame comparable to in vivo migration of spermatozoa out of seminal plasma into cervical mucus. Conclusion: PPCM vaginal gel may provide contraceptive protection as well as helpwith STI prevention. HBA may be a sensitive and much needed biomarker for sperm activity in future contraceptive development.

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The Teen Access and Quality Initiative: Improving Adolescent Reproductive Health Best Practices in Publicly Funded Health Centers

et al. 2019

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Barriers and Pathways to Providing Long‐Acting Reversible Contraceptives in Massachusetts Community Health Centers: A Qualitative Exploration

Cited by 11 publications

References 24 publications

Study protocol: a mixed-methods study of women’s healthcare in the safety net after Affordable Care Act implementation – EVERYWOMAN

Study protocol: a mixed-methods study of women’s healthcare in the safety net after Affordable Care Act implementation – EVERYWOMAN

Evaluation of the novel vaginal contraceptive agent PPCM in preclinical studies using sperm hyaluronan binding and acrosome status assays

The Teen Access and Quality Initiative: Improving Adolescent Reproductive Health Best Practices in Publicly Funded Health Centers

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