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

Published byEdwina Shelton Modified over 9 years ago

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Presentation on theme: "Call from Anonymous Foundation Remove financial barriers to most effective long-term reversible methods –Promote LARC use Provide no-cost contraception."— Presentation transcript:

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2 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

3 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

4 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

5 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

6 CHOICE: Recruitment Sites

7 CHOICE: Inclusion Criteria 14-45 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

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

10 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

11 Baseline Characteristics 11 Age (years)N% 14-174855.2 18-20154816.7 21-25355938.5 26-35302932.7 36-456356.9 Racen% Black466050.6 White386141.9 Other6937.5 2,033

12 Baseline Characteristics (N=9,256) 12 SESn% Public assistance344237.2 Trouble meeting basic needs363939.3 Insurancen% None378241.1 Private395743.1 Public145515.8

13 Baseline Characteristics 13 ParityN% 0437547.3 1-2388550.0 3+99610.7 Unintended pregnancy585763.2 History of STI374640.5

14 LARC Acceptance % LNG-IUS46.0 CuT380A11.9 Implant16.9 DMPA6.9 Pills9.4 Ring7.0 Patch1.8 Other<1.0 14 75%

15 Choice of LARC Methods in Adolescents

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

17 NEJM CHOICE Publication

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

19 Unintended Pregnancy by Contraceptive Method Winner, et al. NEJM 2012. HR adj = 22.3 (95% CI 14.0, 35.4) TWENTY-FOLD DIFFERENCE!

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

21 12- & 24-Month Continuation: Overall Cohort Method12-Month (%)24-Month (%) LNG-IUS87.578.9 Copper IUD84.177.3 Implant83.368.5 Any LARC86.276.6 DMPA56.238.0 OCPs55.043.5 Ring54.241.1 Patch49.539.9 Non-LARC54.740.9 Peipert, et al. Obstet Gynecol 2011; O’Neil, et al. Obstet Gynecol In Press

22 Contraceptive CHOICE Project Population Outcomes

23 Abortion Data: RHS

24 P-value KC:STL 0.32 0.93 0.31 0.02 Repeat Abortion 2006 - 2009 24

25 Percentage of Abortions that are Repeat Abortions P-value KC:STL 0.32 0.93 0.31 0.02 <0.001

26 Pregnancy Outcomes: CHOICE Compared to U.S. CHOICE Data: Unpublished; U.S. Data: Finer 2011, Jones 2011 CHOICE Annual RateU.S. RateReduction Pregnancy39.4 108 * 63% Unintended pregnancy 29.6 52 * 43% Abortion10.4 19.6 ^ 47% All rates per 1,000 women 15-44 years * 2006 data ^ 2008 data

27 NEJM CHOICE Publication

28 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 34.0158.564% Birth19.494.063% Abortion9.741.565% *All rates per 1,000 teens 15-19 years Secura et al. NEJM 2014.

29 Pregnancy Rates: Sexually Experienced U.S. Teens Compared to CHOICE Stratified by Race White White Black Black Secura et al. NEJM 2014. U.S.CHOICE

30 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

31 Thank you

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33 LARC First Resource Center

34 Can CHOICE Help Shape Policy?

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

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

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