Changes to Contraceptive Method Use at Title X Clinics Following Delaware Contraceptive Access Now, 2008–2017

Boudreaux, Michel; Xie, Liyang; Choi, Yong Eui; Roby, Dylan H.; Rendall, Michael S.

doi:10.2105/ajph.2020.305666

Cited by 27 publications

(29 citation statements)

References 20 publications

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“…Previous studies have underscored the importance of providing training for healthcare providers and technical assistance to support the implementation of payment reforms (Fuerst et al, 2021 ; Lacy et al, 2020 ; Okoroh et al, 2018 ). And state-wide comprehensive family planning interventions encompassing information campaigns, no-cost contraceptive services, and/or provider training have been found to reduce barriers to contraceptive access among women of reproductive age (Biggs et al, 2015 ; Birgisson et al, 2015 ; Boudreaux et al, 2020 ; Lindo & Packham, 2017 ; Ricketts et al, 2014 ; Secura et al, 2014 ). Nonetheless, we know little about how such a comprehensive initiative may change contraceptive use among postpartum women.…”

Section: Introductionmentioning

confidence: 99%

Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use

Caudillo

Hurtado-Acuna

Rendall

et al. 2022

Matern Child Health J

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Objectives Although multi-component policy interventions can be important tools to increase access to contraception, we know little about how they may change contraceptive use among postpartum women. We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign. Methods We used a difference-in-differences design and data from the 2012 to 2017 pregnancy risk assessment monitoring system to compare changes in postpartum LARC use in Delaware versus 15 comparison states, and differences in such changes by women’s Medicaid enrollment. Results Relative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90–7.61, P < 0.001) during the 2015–2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12–14.37, P = 0.046). Conclusions for Practice The DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months.

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Section: Introductionmentioning

confidence: 99%

Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use

Caudillo

Hurtado-Acuna

Rendall

et al. 2022

Matern Child Health J

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“…Contraceptive access efforts have long prioritized LARC uptake and contraceptive use, with the goal of preventing teen and unintended pregnancy and abortion [12][13][14][15][16] . However, despite an increasing recognition of the importance of person-centeredness and equity in improving contraceptive access, effort s to address racism in contraceptive care and to develop a trustworthy health care workforce as part of efforts to expand contraceptive access, have been limited.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the historical and ongoing injustices committed by health care institutions have led to understandable mistrust among Black women toward providers and the health care system [ 2 , 10 , 11 ]. Attempts to improve contraceptive care and access have prioritized the promotion of LARC and increased contraceptive use, using the reduction of teen and unintended pregnancy, and abortion, as signals of improved reproductive health outcomes [12][13][14][15][16] . However, research indicates that perceived pressure to use contraception further perpetuates mistrust in health care and that the focus on LARC promotion may be exacerbating this problem [ 9 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Contraceptive care experiences and preferences among Black women in Mississippi: A qualitative study

et al. 2022

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“…This study evaluated an information intervention—a digital media campaign that accompanied a comprehensive state‐based contraceptive access program. Delaware Contraceptive Access Now (DelCAN) was a public–private initiative that aimed to reduce unintended pregnancy in Delaware by increasing access to the full range of contraceptives and particularly to long‐acting reversible contraceptives 11,12 …”

Section: Introductionmentioning

confidence: 99%

An evaluation of the Be Your Own Baby public awareness campaign

Marthey

Rashid

Xie

et al. 2021

Health Services Research

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Objective Assess the impact of the Be Your Own Baby (BYOB) public awareness campaign including population‐level exposure, the effectiveness of ad platforms, and the effect of the campaign on family planning clinic attendance, the campaign's primary goal. Data Sources The study relied on administrative data on traffic and engagement from the campaign's website, population survey data measuring campaign exposure, and clinic attendance volumes from state‐by‐year restricted‐use versions of the Office of Population Affairs' Family Planning Annual Reports (2006–2018). Study Design Bivariate analyses were used to assess website traffic and engagement and population‐level exposure across key subgroups. We then used the synthetic control method to examine the impact of the BYOB campaign on per capita Title X clinic attendance among the target demographic, women 18–29 years of age. Data Collection/Extraction Methods Not applicable. We relied on secondary sources. Principal Findings Primary media platforms used by the campaign included social media, digital display, streaming audio, YouTube, and search. Website traffic was driven primarily by digital display ads, but engagement was highest for search. Our results suggest nearly 12% of Delaware women 18–29 years of age were exposed to the campaign. However, exposure was measured at the end of the campaign and was likely much larger during its peak. Our results indicated that the campaign was associated with between 13 and 23 additional Title X clinic visits per 1000 women compared with 110 users per 1000 at baseline in 2014. Conclusions Our findings suggest the BYOB campaign was successful at increasing clinic attendance among the target demographic. These results have important implications for other programs seeking to use public awareness messaging to increase participation in the health care system and are especially important for Title X administrators who have faced declining patient volumes for over 10 years.

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Changes to Contraceptive Method Use at Title X Clinics Following Delaware Contraceptive Access Now, 2008–2017

Cited by 27 publications

References 20 publications

Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use

Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use

Contraceptive care experiences and preferences among Black women in Mississippi: A qualitative study

An evaluation of the Be Your Own Baby public awareness campaign

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