Public Funding for Contraception, Provider Training, and Use of Highly Effective Contraceptives: A Cluster Randomized Trial

American Journal of Public Health
Kirsten Mj ThompsonCynthia C Harper

Abstract

We determined whether public funding for contraception was associated with long-acting reversible contraceptive (LARC) use when providers received training on these methods. We evaluated the impact of a clinic training intervention and public funding on LARC use in a cluster randomized trial at 40 randomly assigned clinics across the United States (2011-2013). Twenty intervention clinics received a 4-hour training. Women aged 18 to 25 were enrolled and followed for 1 year (n = 1500: 802 intervention, 698 control). We estimated the effects of the intervention and funding sources on LARC initiation with Cox proportional hazards models with shared frailty. Women at intervention sites had higher LARC initiation than those at control (22 vs 18 per 100 person-years; adjusted hazard ratio [AHR] = 1.43; 95% confidence interval [CI] = 1.04, 1.98). Participants receiving care at clinics with Medicaid family planning expansion programs had almost twice the initiation rate as those at clinics without (25 vs 13 per 100 person-years; AHR = 2.26; 95% CI = 1.59, 3.19). LARC initiation also increased among participants with public (AHR = 1.56; 95% CI = 1.09, 2.22) but not private health insurance. Public funding and provider training substantia...Continue Reading

References

Jun 3, 2008·Obstetrics and Gynecology·Cynthia C HarperEleanor A Drey
Feb 5, 2010·The Review of Economics and Statistics·Melissa S Kearney, Phillip B Levine
Feb 6, 2010·Obstetrics and Gynecology·UNKNOWN American College of Obstetricians and Gynecologists Committee on Gynecologic Practice, UNKNOWN Long-Acting Reversible Contraception Working Group
Sep 28, 2010·Patient Education and Counseling·Aileen M LangstonCarolyn L Westhoff
Mar 22, 2012·Obstetrics and Gynecology·Crystal P TylerPolly A Marchbanks
Jun 12, 2012·Perspectives on Sexual and Reproductive Health·Jessica MorseCynthia C Harper
Sep 7, 2012·BMJ : British Medical Journal·Marion K CampbellUNKNOWN CONSORT Group
Nov 22, 2012·Obstetrics and Gynecology·Jeffrey F PeipertGina M Secura
Dec 12, 2013·Perspectives on Sexual and Reproductive Health·Kirsten M J ThompsonCynthia C Harper
Dec 21, 2013·American Journal of Public Health·Lawrence B Finer, Mia R Zolna

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Citations

Dec 23, 2015·American Journal of Obstetrics and Gynecology·Corinne H RoccaCynthia C Harper
Sep 26, 2016·The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine·Susannah E GibbsCynthia C Harper
Feb 23, 2018·American Journal of Public Health·Frida GyllenbergOskari Heikinheimo
Jan 3, 2019·Maternal and Child Health Journal·Lindsey Rose Bullinger, Kosali Simon
May 22, 2019·Paediatrics & Child Health·Giuseppina Di Meglio, Elisabeth Yorke
Mar 27, 2021·Preventive Medicine Reports·Kate E BeattyGlory Okwori
Oct 13, 2021·Maternal and Child Health Journal·Nathan HaleAmal Khoury

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