Call from Anonymous Foundation Remove financial barriers to most effective long-term reversible methods –Promote LARC use Provide no-cost contraception.

Slides:

Advertisements

Similar presentations

Integrating Family Planning Services into an STD Clinic Setting Judith Shlay, MD, MSPH Denver Public Health Denver, CO.

Advertisements

Integrating Family Planning Services into an STD Clinic Setting J. Shlay, D. Bell, M. Maravi, C. Urbina, and the entire Denver Metro Health Clinic Staff.

What Is the Take Control Initiative? The Take Control Initiative (TCI) empowers women with the choice of when to bear children through the through education,

Integration: Intersection for Reproductive Health and HIV Programs: the Kenyan Experience Family Health International Sponsored Satellite Session World.

{ Bedsider for Postpartum Contraception Counseling Jennifer Bromley, MD ACOG Junior Fellow Resident,Ob/Gyn Karen Gerancher, MD Principal Investigator ACOG.

Brenda Dawley M.D.. Why high –risk? Unplanned Unwanted Substance abuse Lack prenatal care Increased risk certain pregnancy complications.

Contraception/Pregnancies MTN 020. Why do we care? Participants must come off product during pregnancy and breastfeeding – Studies of dapivirine in pregnant.

The Contraceptive CHOICE Project Enter Presenter’s Name Enter Presenter’s Organization Enter Presentation Date.

Concerns about the future of LARC provision in primary care Dr Anne Connolly GP Clinical Specialty Lead for maternity, women’s and sexual health; Bradford.

Medication Abortion In Early Pregnancy Induced termination of early intrauterine pregnancy using medications.

Britt Lunde, MD MPH The Mount Sinai School of Medicine.

The importance of contraception across the lifecourse Alison Hadley, Director, Teenage Pregnancy Knowledge Exchange, University of Bedfordshire.

LARC: What Is It and Why Is It Important for Teens?

Session I, Slide #1 Female Condom Session I: Characteristics Female Condoms.

1 Milwaukee Alliance for Sexual Health (MASH) Community Mobilization Initiative Addressing Disparities in STDs and Unintended Pregnancies Community Voices.

Contraceptive Choices 8.ICR.3.2 Evaluate methods of FDA-approved contraceptives in terms of their safety and their effectiveness in preventing unintended.

Dr. Helen Roberts Senior Lecturer Women’s Health University of Auckland, New Zealand Research Manager Family Planning Sex and the Teenager LARCS.

Effective Contraception for Teenagers Dr Louise Cook Associate Specialist Sexual and Reproductive Health.

The Secretary’s Advisory Committee on Infant Mortality November 14, 2012 Marilyn J. Keefe, MPH, MPP Deputy Assistant Secretary for Population Affairs U.S.

Applying Your Knowledge of Contraception in the Clinical Setting Jan Shepherd, MD, FACOG Florida State University College of Medicine.

Long Acting Reversible Contraceptive Options for College Women

Session I: Characteristics of IUDs

Prevention of Preterm Births: The Role of Family Planning

LARCs and YOUTH Let’s Talk Effectiveness, Safety, and Satisfaction Candace Lew, MD, MPH May 27, 2014.

Amita Toprani, MD, MPH New York City Department of Health & Mental Hygiene EIS Field Assignments Branch Centers for Disease Control and Prevention CSTE.

Focus Area 9 Family Planning Progress Review December 8, 2004.

INSERT LOGO HERE Unintended Pregnancy (UP) at a Glance in our Region Presenter’s Name Presentation Date.

Debbie Postlethwaite RNP, MPH Adekemi Ogultala, MD Maqdooda Merchant MSc, MA.

Cuyahoga Cleveland Partnership Ohio Equity Institute to Improve Birth Outcomes Does the data support the notion that we promote family planning within.

Taking a new look: Expanding Contraceptive Method Choice and Access through Improved Programming for Long-acting and Permanent Methods (LA/PMs)/Global.

SAF-PAC/SRMH/CARE Kamlesh Giri April 23rd, 2013

Session I, Slide #11 Contraceptive Implants Session I: Characteristics of Implants.

Healthy People 2010 Focus Area 9: Family Planning Richard J. Klein Progress Review November 6, 2008.

Family Planning Women’s Health Training Day 2014.

Contraception Choices Adolescent Clinic NNMC Objective   Discuss the different options   Important counseling points   Review by playing a game.

Contraceptive Options for Women and Couples with HIV.

Strategic assessment of policy, quality and access to contraception and abortion services in Macedonia Main findings 2007/08.

Back to the Future: A Call to Action for FP and LAPMs Scott Radloff Director Office of Population and Reproductive Health USAID ACQUIRE End-of-Project.

Division of Reproductive Health Office of the Director CDC’s Winnable Battle CDC Health Officer Orientation May 13, 2015 Lisa M. Romero, DrPH, MPH Health.

Case Study of a Preconception Health Campaign in Southern Oregon Maggie Sullivan, Aubra Johnson, Martha Rivera.

Predicting Pregnancy Risk among Women Attending an STD Clinic Judith Shlay MD, MSPH Denver Public Health September 21, 2008 CityMatCH Conference.

Contraception/Pregnancies. Why do we care? Participants must come off product during pregnancy and breastfeeding Time off product results in dilution.

Family Planning In Jordan

Prepared by: Program Inventory / Assessment: Summary of Findings Adapted from AMCHP Birth Outcomes Compendium Tools.

Trviai SHE SAID…WHAT? COUNSELING RULES YOU GOTTA KNOW THIS… YEP…LARC IS JUST THAT AWESOME.

FACT OR MYTH. A history of gonorrhea or chlamydia is a contraindication to an IUD MYTH.

Paying for Sexual and Reproductive Health Services for PLWHA Jennifer Marshall Pepper Program & Quality Manager, Ryan White Part A Program Shelby County.

A Comprehensive Understanding of Contraceptives July 8, 2015.

Long Acting Reversible Contraceptives Lessons from the CHOICE Project Amna Dermish MD MSc Associate Medical Director, Planned Parenthood of Greater Texas.

S UCCESSES IN A DOLESCENT H EALTH : Improving Outcomes with Teens and LARC (Long-Acting Reversible Contraceptives) T HURSDAY, M AY 26, 2016.

Adesina OA*, Awolude O, Oladokun A, Roberts A, Adewole IF, Department of Obstetrics & Gynaecology, College of Medicine, University of Ibadan. *Corresponding.

Adolescent Contraception

Outline  Background  Research questions  Methods and measures  Results  Implications.

The Effect of Continuous Combination Oral Contraceptive use on Subsequent Fertility The Effect of Continuous Combination Oral Contraceptive use on Subsequent.

LARC at different stages of reproductive life

Family PACT Program Report FY09-10: Overview of Contraceptive Services and Practical Applications for Practice Improvement February 8, 2012 Family PACT.

Improving Contraceptive Care Assessing and Promoting “Bedsider” in Women’s Health Practice Preliminary Findings From Baseline Presenter: Janine M. Talis.

LAKE COUNTY Group 2 Elaine Yeiter, Alisha Gross, Colette Pelky, and Lauren Zink.

Improving postpartum contraceptive uptake: A targeted prenatal counseling intervention to facilitate resident-patient shared decision-making Liza Straub1,

Ally Roy, MD Instructor Marshall University School of Medicine

Optimizing Outcomes.

A RETROSPECTIVE CHART REVIEW: LONG-ACTING REVERSIBLE CONTRACEPTION UTILIZATION AT UNIVERSITY MEDICAL CENTER Cheree Melton, D.O., Ashley Wambolt, M.D.,

INTRAUTERINE DEVICES (IUDS)

Intrauterine Devices (IUDs)

Making the Case: Ending Silos Once and For All with Evidence

Post Abortion Contraception

CONTRACEPTION POST ABORTION

Presentation transcript:

Call from Anonymous Foundation Remove financial barriers to most effective long-term reversible methods –Promote LARC use Provide no-cost contraception & make a population impact: –Teen pregnancy –Repeat abortion procedures

MYTHS Regarding IUCs Survey of St. Louis Women (N=1,665) 50% of women surveyed believe IUC is SAFE –Common safety concerns: Pelvic Pain36% Infertility30% Cancer14% STDs 11% 61% underestimate the effectiveness Hladky, et al. Obstet Gynecol 2011

Contraceptive Cohort Study Recruit 10,000 participants over 4 years –Remove cost barriers to long-term methods Copper IUD (ParaGard) LNG IUD (Mirena) Implant (Implanon) –Participant choice 2-3 years follow-up Assess continuation, satisfaction –Population outcomes

Long-Acting Reversible Contraception LNG-IUS 99% effective 20 mcg levonorgestrel/day Up to 5 years Copper T IUD 99% effective Copper ions Up to 10 years Subdermal Implant 99% effective 60 mcg etonogestrel/day Up to 3 years

CHOICE: Recruitment Sites

CHOICE: Inclusion Criteria years Primary residency in STL City or Country Sexually active with male partner (or soon to be) Does not desire pregnancy during next 12 months –Desires reversible contraception Willing to try a new contraceptive method

Study Recruitment Location9,256 2 Abortion clinics17% 8 Community clinics14% University-based research clinic Word-of-mouth Provider referrals 69%

Contraceptive CHOICE Project: Study Details 10 ELIGIBLE Tiered Contraceptive Counseling LNG-IUS Cu-IUD Implant DMPA Pills Patch Ring Other 94% 87% 81% Secura G, Am J Obstet & Gynecol 2010 Madden T, Contraception 2012

Baseline Characteristics 11 Age (years)N% Racen% Black White Other ,033

Baseline Characteristics (N=9,256) 12 SESn% Public assistance Trouble meeting basic needs Insurancen% None Private Public

Baseline Characteristics 13 ParityN% Unintended pregnancy History of STI

LARC Acceptance % LNG-IUS46.0 CuT380A11.9 Implant16.9 DMPA6.9 Pills9.4 Ring7.0 Patch1.8 Other< %

Choice of LARC Methods in Adolescents

Evaluation of CHOICE Outcomes –Short term: Effectiveness Continuation & satisfaction –Long-term Population-based outcomes –Unplanned pregnancies: »Repeat abortions »Teen births

NEJM CHOICE Publication

Unintended Pregnancy Rates in CHOICE Cohort August 2007 through July 2011 –615 reported pregnancies –459 (75%) unintended –334 contraceptive failures

Unintended Pregnancy by Contraceptive Method Winner, et al. NEJM HR adj = 22.3 (95% CI 14.0, 35.4) TWENTY-FOLD DIFFERENCE!

Method Failure by Age Winner NEJM 2012 HR adj = 1.9; 95% CI 1.2, 2.8

12- & 24-Month Continuation: Overall Cohort Method12-Month (%)24-Month (%) LNG-IUS Copper IUD Implant Any LARC DMPA OCPs Ring Patch Non-LARC Peipert, et al. Obstet Gynecol 2011; O’Neil, et al. Obstet Gynecol In Press

Contraceptive CHOICE Project Population Outcomes

Abortion Data: RHS

P-value KC:STL Repeat Abortion

Percentage of Abortions that are Repeat Abortions P-value KC:STL <0.001

Pregnancy Outcomes: CHOICE Compared to U.S. CHOICE Data: Unpublished; U.S. Data: Finer 2011, Jones 2011 CHOICE Annual RateU.S. RateReduction Pregnancy * 63% Unintended pregnancy * 43% Abortion ^ 47% All rates per 1,000 women years * 2006 data ^ 2008 data

NEJM CHOICE Publication

Teen Outcomes: CHOICE Compared to U.S. CHOICE Data: Unpublished; U.S. Data: Kost 2012 CHOICE Annual Rate* 2008 U.S. Rate*Reduction Pregnancy among sexually active teens % Birth % Abortion % *All rates per 1,000 teens years Secura et al. NEJM 2014.

Pregnancy Rates: Sexually Experienced U.S. Teens Compared to CHOICE Stratified by Race White White Black Black Secura et al. NEJM U.S.CHOICE

The Secret: 3 Key Ingredients Education regarding all methods, especially LARC –Reframe the conversation: start with the most effective methods Access to providers who will offer & provide LARC –Dispel myths and increase the practice of evidence- based medicine Affordable contraception –Institute of Medicine recommendation, Affordable Care Act, Medicaid Expansion, local funders

Thank you

LARC First Resource Center

Can CHOICE Help Shape Policy?

Take-Home Messages CHOICE Methods: –Education, Access, Cost Evidence-based counseling –LARC-friendly providers IUDs rarely contraindicated Same-day insertion

Take-Home Messages LARC Methods are THE most effective –Increased use of LARC will Decrease abortions and unintended pregnancies Decrease racial/SES disparities