The first-ever over-the-counter (OTC) birth control pill is now available in the US after 20 years of research and advocacy by the Free the Pill coalition, a group of over 200 reproductive justice advocates, researchers, providers, and youth activists. Decades of research show that birth control pills, including progestin-only birth control pills (POPs) like the one now available OTC, are safe, effective, and of interest to people of all ages. Barriers to accessing birth control pills are rooted in systemic inequities and disproportionately affect people of color, Indigenous peoples, young people, immigrants, LGBTQ+ folks, people living in rural communities, those working to make ends meet, and people with disabilities. The first-ever OTC birth control pill has the potential to bridge gaps in access, advance health equity, and give people greater control over their health. Now that an OTC POP is available, innovative and evidence-based educational campaigns are key to ensuring the communities who could benefit the most from OTC access have accessible information about this option. This presentation will provide information on the communications strategies that Free the Pill is implementing to spread the word about this new contraceptive option, creatively disseminate research, and combat misinformation. Such strategies include social media campaigns, digital days of action, and collaboration with coalition partners and health care providers to disseminate accurate information about this product and POPs broadly. This work builds upon Free the Pill’s history of success in disseminating the research and evidence necessary to bring the first birth control pill OTC.

Introduction

Emergency Contraception (EC) plays an important role in preventing unintended pregnancies and is particularly crucial in regions facing restrictive reproductive health legislation. Safety-net clinics, such as health departments (HDs) and Federally-Qualified Health Centers (FQHCs), can facilitate access to EC, especially for patients who are under-resourced. This study examines the provision and utilization of EC in Alabama (AL) and South Carolina (SC), two states with significant abortion restrictions.

Methods

Data from three sources; a safety-net clinic survey, key informant interviews with safety-net clinic staff, and a survey of safety-net clinic patients, were analyzed to assess patterns of EC provision and use in 2019 and 2022.

Results

Clinic surveys reveal that HDs provided EC more often than FQHCs. HDs were more likely to provide EC on-site, in advance, and via telehealth during the COVID-19 pandemic according to survey and interview data. Less than 20% of patients at safety-net clinics utilized EC, with the majority using it in combination with other contraceptive methods.

Discussion

Clinic administrators indicated that HDs retained EC on-site and provided it in advance, while FQHC clinic administrators identified not having EC onsite as a key barrier to provision. HDs may be providing EC at higher rates due to Title X funding and having a centralized organizational structure. It is critical, as reproductive health legislation continues to restrict access, that EC be readily accessible in order to provide patients with a full range of contraceptive options and safeguard patient reproductive autonomy.

Objective: To explore perspectives regarding obtaining out-of-state abortion training (OSAT) among OB-GYN residents residing in abortion-banned or restricted states post the Dobbs decision.

Methods: We conducted semi-structured interviews with 19 OB-GYN residents living in abortion-banned or restricted states. Grounded theory analysis revealed themes related to current abortion training availability, barriers to obtaining OSAT, and long-term impacts of training restrictions on professional goals.

Results: Eight themes emerged during interviews: 1) State’s current laws regarding abortion training; 2) Barriers related to financial expenses (e.g., housing, transportation) incurred due to OSAT; 3) Disruptions in daily life (e.g., separation from family) created by OSAT; 4) Social and emotional challenges (e.g. loneliness, lack of support) experienced during OSAT; 5) Concerns regarding inadequate training impacting career preparedness; 6) Concerns about licensing and liability relating to abortion-related training or career plans; 7) Future employment placement; and 8) Concerns about evolving abortions policies.

Conclusions: Along with challenges related to financial expenses, disruptions in daily life, and social and emotional factors, participants expressed concerns about inadequate training affecting their and their colleagues’ performance, unclear licensing and liability as residents obtaining OSAT and as future OB-GYNs, and ongoing changes in abortion policies. Factors influencing location of future employment included distance from loved ones, familiarity with the location, and grappling with staying in an abortion-restricted state to care for patients with little access versus moving to be able to provide abortions. These findings inform the development of strategies to address the challenges OB-GYN residents pursuing OSAT experience.

Objectives: Partners in Contraceptive Choice and Knowledge (PICCK) was a time-limited contraceptive access and quality improvement initiative for Massachusetts birth hospitals (2018-2023). Participant hospitals received a customized multicomponent intervention focused on patient-centered contraceptive counseling, emergency contraception access, provision of inpatient postpartum contraception, and same-day ambulatory provision of long-acting reversible contraception (LARC). We assessed the impact of PICCK participation on inpatient postpartum contraception.

Methods: Using electronic medical record data from six geographically diverse PICCK participant hospitals, we fit a multilevel logistic regression model for the binary individual-level outcomes of 1) LARC received (Y/N) and 2) any moderately or highly effective contraception method received (Y/N), for the follow-up (6 months post-intervention) vs. baseline (6 months pre-intervention) periods. Models accounted for patient age, race/ethnicity, preferred language, insurance type, median neighborhood income, and hospital size, as well as an indicator term for the acute COVID period.

Results: Our analytic sample included 18,450 patient records. Patients had higher odds of receiving inpatient postpartum LARC in the follow-up period vs. baseline (aOR 1.18, 95% CI 1.04, 1.34). The higher odds of receiving any moderately or highly effective method in the follow-up vs. baseline period was not statistically significant (aOR 1.02, 95% CI 0.94, 1.11).

Conclusions: A hospital’s participation in PICCK was associated with an increased likelihood of inpatient postpartum patients there receiving LARC specifically, but not contraception overall. These differences may be due to a shift of individuals who would have otherwise chosen moderately effective methods instead receiving LARC, as has been documented in other settings.