Source of care and variation in long acting reversible contraception use

Capsule:
In a national cross-sectional study, women receiving care from family-planning clinics had lower odds of long-acting reversible contraception use compared with those receiving care from a private doctor’s office or health maintenance organization.

Authors:
Lauren Groskaufmanis, M.P.H., Saba W. Masho, M.D.

Volume 105, Issue 2, Pages 401-409

Abstract:

Objective:
To examine variation in long acting reversible contraception (LARC) use by source of birth control services.

Design:
Cross-sectional study.

Setting:
Not applicable.

Patient(s):
Sexually active women who received contraceptive services in the past 12 months, who were neither pregnant nor trying to become pregnant and who were not sterilized and nor were their partners sterilized.

Intervention(s):
Three multinomial logistic regression models assessed the relationship between source of services and LARC use, controlling for covariates. The odds of LARC use were compared with LARC nonuse, high-efficacy use, and low-efficacy use.

Main Outcome Measure(s):
Reported LARC method use.

Result(s):
There was no statistically significant difference in LARC use between women receiving services from community or public health clinics and women receiving services from private clinics. Women receiving care at a family-planning clinics had lower odds of LARC use versus LARC nonuse (odds ratio [OR] = 0.27; 95% confidence interval [CI], 0.10–0.74), versus high-efficacy method use (OR = 0.32; 95% CI, 0.11–0.88) and versus low-efficacy method use (OR = 0.13; 95% CI, 0.02–0.87) compared with those receiving services at private clinics.

Conclusion(s):
Women receiving care from family-planning clinics had lower odds of LARC use compared with those receiving care from a private doctor’s office or HMO facility.

  • Jason M. Franasiak

    A very interesting and important study. The fact that increased availability and/or likelihood of offering LARC (i.e. in family planning clinics) does not necessarily translate to their use is of concern. Do the authors propose possible solutions in the regard? It is simply due to patient population and/or provider counseling/training? Are there other issues potentially at hand?

    • Lauren Groskaufmanis

      We hypothesized that staffing differences between types of clinics could contribute our findings, due to the different educational backgrounds of providers. Our adjusted model did control for differences in the patient populations. However, ultimately, the data source that we used (NSFG) did not include any information that provided any particular insights into the underlying causality of differences in LARC use by source of care. We hope that future research will explore this question more comprehensively. As for solutions, findings of the contraceptive CHOICE project, have shown that women utilize LARC methods at much higher rate when they are accessible and affordable.

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