Family Planning as a Cost-Saving Preventive Health Service

Cleland, Kelly; Peipert, Jeffrey F.; Westhoff, Carolyn; Spear, Scott

doi:10.1056/nejmp1104373

Cited by 91 publications

(63 citation statements)

References 4 publications

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“…17 Thus, increased utilization of LARC methods is an important strategy to reduce unintended pregnancies, which would both improve women's health and save health care dollars. 22 The CHOICE Project provided a model of contraceptive provision that was unique but adaptable. All women received tiered contraceptive counseling by a trained counselor and were informed that LARC methods are the most effective reversible methods of contraception.…”

Section: Discussionmentioning

confidence: 99%

Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review

Birgisson

Zhao

Secura

et al. 2015

Journal of Women's Health

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174

127

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The Contraceptive CHOICE Project (CHOICE) sought to reduce unintended pregnancies in the St. Louis Region by removing cost, education, and access barriers to highly effective contraception. CHOICE was a prospective cohort study of over 9,000 women 14-45 years of age who received tiered contraceptive counseling to increase awareness of all reversible methods available, particularly long-acting reversible contraceptive (LARC) methods. Participants were provided with contraception of their choice at no cost for 2-3 years. We studied contraceptive method choice, continuation, and population outcomes of repeat abortion and teen pregnancy. Seventy-five percent of study participants chose one of the three LARC methods (46% levonorgestrel intrauterine system, 12% copper intrauterine device, and 17% subdermal implant). LARC users reported greater continuation than non-LARC users at 12 months (87% versus 57%) and 24 months (77% versus 41%). In our cohort, LARC methods were 20 times more effective than non-LARC methods. As a result, we observed a reduction in the percent of repeat abortions from 2006 to 2010 in St. Louis compared with Kansas City and nonmetropolitan Missouri and found substantial reductions in teen pregnancy, birth, and abortion (34.0, 19.4, and 9.7 per 1000 teens, respectively) compared with national rates among sexually experienced teens (158.5, 94.0, and 41.5 per 1000, respectively). Improved access to LARC methods can result in fewer unintended pregnancies and abortions and considerable cost savings to the health care system.

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Section: Discussionmentioning

confidence: 99%

Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review

Birgisson

Zhao

Secura

et al. 2015

Journal of Women's Health

Self Cite

174

127

View full text Add to dashboard Cite

show abstract

“…A substantial body of research has highlighted the potential of LARC methods to reduce unintended pregnancy, 37-39 yet these methods are still beyond the reach of many women in the United States. 40 Use is particularly low among Latina women, 41 who tend to have higher rates of unintended pregnancy than their nonHispanic white peers. 1 At the individual level, if providers do not accurately assess women's childbearing intentions and successfully identify women with a strong motivation to avoid pregnancy, they are likely to miss opportunities to help women obtain the methods they desire.…”

Section: Discussionmentioning

confidence: 99%

Happiness About Unintended Pregnancy And Its Relationship to Contraceptive Desires Among a Predominantly Latina Cohort

Aiken

2015

Perspect Sex Repro H

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CONTEXT-Women frequently profess happiness about unintended pregnancies; such incongruence is associated with use of less effective contraceptive methods and inconsistent or incorrect method use. Yet, the methods women use may differ from those they desire.METHODS-Data on 578 women were drawn from a prospective survey of postpartum women aged 18-44 recruited from three hospitals in Texas between 2012 and 2014. Jonckheere-Terpstra tests were used to compare women's feelings about a future pregnancy with their childbearing intentions. Fisher-Freeman-Halton tests compared distributions of contraceptive methods currently used and desired by women who professed happiness about a future unintended pregnancy, as well as distributions of desired methods by women's reported feelings. RESULTS-The proportion of women who reported happiness about a future pregnancy was 59% among those intending to wait two or three years for another child, 46% among those intending to wait four or more years, and 36% among those intending to have no more children. Among women who professed happiness, a greater proportion desired to use a highly effective contraceptive method than were currently using one (72% vs. 15% among those intending no more children; 55% vs. 23% among those intending to wait at least four years; and 36% vs. 10% among those intending to wait two or three years). Across intention categories, the types of methods desired did not differ by whether women professed happiness or unhappiness.CONCLUSIONS-Women who profess happiness about a future unintended pregnancy may nonetheless desire highly effective contraceptive methods.Unintended pregnancy is a persistent public health issue in the United States: An estimated 51% of pregnancies each year are unintended-a figure that has changed little since 1994. 1 Unintended pregnancies are associated with an increased risk of adverse maternal and neonatal outcomes. 2 Yet, much debate still surrounds the measurement and interpretation of women's pregnancy intentions, particularly in relation to their feelings about pregnancy. 3,4 According to Trussell et al.'s examination of contraceptive failures reported in the 1995 National Survey of Family Growth (NSFG), women frequently professed happiness about pregnancies that they classified as unintended. 5 The NSFG relies on women's retrospective reports of their pregnancy intentions and feelings (i.e., reports made after the pregnancy or birth has already occurred), which are susceptible to recall bias. 6 However, the same incongruence between intentions and feelings has been demonstrated with data measured prospectively (i.e., based on a hypothetical future pregnancy or birth). 7 This incongruence has been found to be more common among Latina women than among non-Hispanic whites. 8,9 In the current literature, happiness about pregnancies that would be or were unintended is commonly interpreted as a reflection of ambivalence about avoiding conception. [10][11][12] Yet, an alternative explanation is that intentions and feelings are ...

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“…Few studies have examined whether the increase in repeat abortion has occurred evenly between socioeconomic groups, although such studies would help create interventions aimed at avoiding such procedures. Avoiding unintended pregnancy would reduce public expenditures compared with the cost of repeat abortion (Cleland et al, 2011;Frost et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Educational Inequalities in Repeat Abortion: A Longitudinal Register Study in Finland 1975–2010

Väisänen

2016

J. Biosoc. Sci.

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Summary. The proportion of repeat abortions among all abortions has increased over the last decades in Finland. This study examined the association of education with the likelihood of repeat abortion, and the change in this association over time using reliable longitudinal data. A unique set of register data from three birth cohorts were followed from age 20 to 45, including about 22,000 cases of repeat abortion, and analysed using discretetime event-history models. Low education was found to be associated with a higher likelihood of repeat abortion. Women with low education had abortions sooner after the preceding abortion, and were more often single, younger and had larger families at the time of abortion than more highly educated women. The educational differences were more significant for later than earlier cohorts. The results show a lack of appropriate contraceptive use, possibly due to lack of knowledge of, or access to, services. There is a need to improve access to family planning services, and contraceptives should be provided free of charge. Register data overcome the common problems of under-reporting of abortion and attrition ensuring the results are reliable, unique and of interest internationally.

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Family Planning as a Cost-Saving Preventive Health Service

Cited by 91 publications

References 4 publications

Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review

Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review

Happiness About Unintended Pregnancy And Its Relationship to Contraceptive Desires Among a Predominantly Latina Cohort

Educational Inequalities in Repeat Abortion: A Longitudinal Register Study in Finland 1975–2010

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