263929 Birth control use and reasons for discontinuation in incarcerated women

Sunday, October 28, 2012

Hannah Watson, BA , Center for Primary Care and Prevention, Warren Alpert Medical School of Brown University, Pawtucket, RI
Jennifer Clarke, MD, MPH , Department of Medicine and OB/GYN, The Warren Alpert Medical School of Brown University, Pawtucket, RI
BACKGROUND: Unintended pregnancy is an important public health issue, and incarcerated women are at especially high risk upon release. We assessed the contraceptive choices among a sample of incarcerated women to identify factors associated with contraceptive method discontinuation and nonuse. METHODS: Women from Rhode Island's only jail were invited to participate in a study about family planning and STDs. Women age 18-35 were eligible if they were sexually active with men prior to incarceration, were not planning a pregnancy and were not using permanent or long acting reversible contraception (LARC). RESULTS: Of 219 women surveyed, 86.3% had used at least one birth control method (BCM). The most common method was the oral contraceptive pill (OCP: 73.5%), followed by Depo-Provera (52.2%), the patch (20.5%) and spermicide (9.6%). Only 8.7% had ever used a LARC. Reasons for discontinuation included forgetting (70/161 OCPs; 14/115 Depo; 4/45 patch), side effects (56/161 OCPs; 61/115 Depo; 21/45 patch) and unintended pregnancy (15/161 OCPs; 3/115 Depo; 5/45 patch). Only 1.8% of users attributed discontinuation to cost. CONCLUSIONS: Preventing unintended pregnancy, especially in the high-risk incarcerated population, is an important public health issue. In our sample, most women had used at least one BCM in the past. There were high rates of discontinuation due to side effects. Despite high rates of uninsurance and low socioeconomic status in the sample population, cost was not commonly cited as a reason for discontinuation. Possible side effects and reminders for consistent use should be explored when discussing contraceptive methods in this population.

Learning Areas:
Assessment of individual and community needs for health education
Clinical medicine applied in public health
Provision of health care to the public
Public health or related research

Learning Objectives:
Analyze the past contraceptive choices of a sample of incarcerated women and identify reasons for discontinuation of birth control methods in this population.

Keywords: Prisoners Health Care, Reproductive Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a fourth year medical student at Brown University. I have focused my research on the family planning needs of incarcerated women through research with Dr. Jennifer Clarke, including work with this current NIH-funded grant Contraceptive Awareness and Reproductive Education. My research interests include developing primary care strategies for health behavior change in underserved populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.