Introduction

Choose Well (CW) is South Carolina’s statewide contraceptive access initiative implemented from 2017-2022 to promote equitable access to contraception without judgment or coercion. We examined CW’s impact on patients’ experiences with contraceptive counseling and subsequent contraceptive use.

Methods

A quasi-experimental design was employed to recruit patients from CW-participating clinics across SC, including health department and federally qualified health center clinics, and matched comparison clinics in a peer state. Patients visiting the clinics for a contraceptive appointment were recruited and followed over 24 months. Data were collected about contraceptive experiences (using the validated Person-Centered Contraceptive Counseling scale) and contraceptive use. Generalized estimating equations measured CW’s impact on 1) counseling experiences immediately post-appointment and 2) contraceptive use prior to the appointment and three months later.

Results

A total of 1,086 participants in CW clinics and 1,136 in comparison clinics aged 16-44 years were recruited. After adjusting for differences between the populations, significantly more CW clinic patients reported person-centered contraceptive counseling (60%) than comparison clinic patients (53%; p=0.04). The proportion of CW clinic patients using Intra-Uterine Devices (IUDs) increased from 7.6% at pre-counseling to 11.8% at 3-months post counseling. In contrast, the proportion of comparison clinic patients using IUDs increased from 4.4% to 4.8%. The resulting 3.8 percentage point difference was statistically significant (p=0.02).

Conclusion

CW clinic patients reported more person-centered counseling and higher rates of IUD use than comparison clinic patients. CW likely increased access to desired contraceptive methods without coercive counseling, highlighting the important role of statewide contraceptive access initiatives.

Online social networks provide avenues for sharing health information and have become increasingly popular, especially among adolescents and young adults (AYA). Reddit (a popular social networking site) posts are anonymous, providing a unique glimpse into sensitive subjects, including contraception experiences.

Posts with keywords related to AYA contraception published between 6/01/2022 - 09/01/2024 to nine subreddits were extracted using Python (n=607). Posts were screened and included if 1) they discussed contraception and 2) self-identifying information indicated the poster was aged <26 (n=265). A hybrid inductive-deductive thematic codebook was developed and refined. After five coders achieved consensus coding with 10% of posts, remaining posts were double coded. Final coded data are being analyzed with descriptive thematic analysis, utilizing the Socio-ecological Model and Upward-Downward contraceptive framework.

Results indicate AYA posters use Reddit to seek and share information related to contraception, particularly lived experiences. Posts often described influencing factors considered in their decision-making for reported contraception use. Sources of influence were described at every socio-ecological model level, including parents, partners, friends, clinicians, other online users, education systems, healthcare institutions, economic and insurance considerations, and specific policies and social norms. Across posts, we classified influences ranged in direction (to use versus to not use contraception) and in perceived impact (coercive versus empowering).

AYA-posted contraceptive content on Reddit provides insight into the complexities of social influence on AYA contraceptive decision-making and autonomy. Understanding this pivotal time in the reproductive life course offers the potential for interventions at multiple levels to empower person-centered contraceptive decision-making, particularly for AYA.

Introduction

In 2017, the Choose Well (CW) contraceptive access initiative launched in South Carolina (SC) among federally qualified health centers (FQHCs), aiming to increase equitable access to contraception free of judgment and coercion. The “A’s of Access” framework provides a blueprint for holistically assessing access via five dimensions: Availability, Accessibility, Affordability, Acceptability, and Accommodation.

This study utilized contraceptive access scales reflecting the A’s of Access to evaluate contraceptive access changes among CW-participating and non-participating clinics over time.

Methods

We surveyed FQHCs in SC and a comparison state regarding their clinic’s contraceptive services, policies and practices in 2016/ and 2022/endline. Survey items were mapped to the five dimensions of access. Changes in access scores between CW and non-CW clinics were analyzed with random intercept mixed effect models using a difference-in-differences approach adjusted for geography.

Results

In 2016, 23 CW clinics (response rate (RR)=62%) and 84 non-CW clinics (RR=48%) responded. In 2022, 40 CW clinics (RR=56%) and 63 non-CW clinics (RR=43%) responded. Compared to non-CW clinics, CW-clinics reported significantly higher proportional increases in contraceptive availability (17.3 percentage points, p=.02), accommodation (13.7 percentage points, p=.011) and accessibility (13.7 percentage points, p=.03) at endline relative to baseline. No significant differences in affordability and acceptability were found.

Discussion

We holistically assessed contraceptive access at FQHCs during the CW initiative. The initiative positively impacted key dimensions of accessibility at safety-net clinics.

This framework can assist evaluators, administrators policymakers, and program planners in determining strategic policies and practices to l enhance contraceptive access and advance reproductive autonomy.

Background: The South Carolina contraceptive access initiative launched in 2017 as the first initiative of its kind in the US southeast. This study compared contraceptive attitudes and beliefs among women recruited from intervention clinics in South Carolina and matched comparison clinics in a peer state including health departments and Federally Qualified Health Centers.

Methods: Participants were surveyed longitudinally over two years. A total of 1,086 participants in intervention clinics and 1,136 participants in comparison clinics answered questions about contraceptive attitudes and beliefs and were included in this analysis. Multivariate analysis accounted for longitudinal correlation, sociodemographic and clinic characteristics. Analyses were conducted using SAS 9.4.

Results: Intervention clinic participants were more likely than comparison clinic participants to express positive feelings toward the contraceptive implant (AOR = 1.62, 95% CI: 1.34-1.96) and Intra-Uterine Device (IUD) (AOR = 1.70, 95% CI: 1.39-2.07); report stronger alignment between birth control and self-perception (implant: AOR = 1.61, 95% CI: 1.32-1.96; IUD: AOR = 1.57, 95% CI: 1.26-1.95); and exhibit greater confidence in correctly using the implant (AOR = 1.44, 95% CI: 1.24-1.66) and IUD (AOR = 1.41, 95% CI: 1.21-1.64). Conversely, intervention clinic participants reported lower approval from important people for the contraceptive shot (AOR = 0.87, 95% CI: 0.75-1.00).

Conclusion: Women at intervention clinics exhibited more positive contraceptive attitudes and beliefs than those at comparison clinics. The initiative likely contributed to these favorable attitudes by addressing cost barriers, enhancing clinical capacity, and increasing awareness. These findings highlight the potential effectiveness of statewide contraceptive access initiatives.

Background: New Jersey passed a law in January 2023 allowing pharmacists to directly prescribe self-administered hormonal birth control, including pills, patches, rings, and shots. Regulations were finalized in May 2024 and pharmacists who were trained could start prescribing. This is the first study of pharmacists’ perceived comfortability with prescribing self-administered birth control methods. Comparisons between those with and without the required four hour training mandated by the state to expand their practice are examined. Method: All pharmacists listed on the NJ Consumer Affairs website were emailed to participate in an online questionnaire in July 2024; 169 agreed to participate. Results: Fourteen pharmacists received the required training to directly prescribe birth control. Twelve of the fourteen trained indicated they were somewhat (50%) or very (35.7%) comfortable directly prescribing contraceptives. Two responded they were not comfortable at all despite receiving training. Among those who did not receive training, there was less comfortability with directly prescribing. Over half of those not trained indicated they were not too comfortable or not at all comfortable directly prescribing. With additional training, the majority of participants indicated they would be very (51.0%) or somewhat comfortable (61.5%) directly prescribing. Current comfortability prescribing varied by type of self- administered contraceptive, with pills having higher levels of comfortability than shots, patches, or rings. Among trained individuals, comfortability prescribing shots was the lowest. Conclusions: Though pharmacists indicate generally low current comfortability directly prescribing hormonal birth control to patients, they indicate optimism in the ability to do so with additional training.

Background: Family planning (FP) services are essential for ensuring the health and wellbeing of women of reproductive age. However, in conflict-affected settings, access to and utilization of these services can be severely compromised. This study assessed the unmet need for family planning before, during, and after the Tigray conflict among women of reproductive age in Samre District, Southeastern Tigray, Ethiopia.

Methods: Community-based cross-sectional study design was employed using a multi-stage sampling procedure among 629 women aged 15–49 years. Data were collected from January 1-31, 2025, using a structured, pre-tested questionnaire administered through face-to-face interviews. Descriptive statistics were used to characterize the respondents’ socio-demographic profile, family planning usage, knowledge, and barriers. The study period included 2 years of prewar, 2 years of war time, and 2 years of postwar. Data were analyzed using SPSS v-27.

Results: The mean age of respondents was 29.6 (SD = 6.8) years. Prewar, wartime, and postwar contraceptive usage were 72.5%, 23.5%, and 64.5%, respectively (p-value <0.001). Injectables were commonly used both prewar (73.5%) and postwar (66.3%). Reliance on traditional methods accounted for 44.6% during the war. Lack of access to services (66.9%), disruption to health facilities, and shortages of preferred methods, emerged as significant barriers during the conflict. Cultural beliefs and partner support played roles in FP uptake across all periods.

Conclusion: The Tigray conflict disrupted contraception service availability and utilization. Post-conflict strategies should focus on rebuilding health facilities, ensuring a consistent supply of contraceptives, offering mobile or outreach FP services, and involving me in decision-making.

---

Female sterilization is highly effective contraceptive method that is widely used and sought after. At the same time, sterilization has a problematic history linked to racism and coercion. Interestingly, use of female sterilization is more common in rural areas than urban. High rates of sterilization are not inherently concerning; however, unlike other methods, sterilization is permanent and requires surgical intervention if users later decide they no longer want it. We assessed whether desire for sterilization reversal also differs by rural/urban residence and examined whether it differs by salient aspects of the sterilization care visit (method of payment and type of facility). We used data from 473 female 2015-2019 National Survey of Family Growth (NSFG) respondents who received a tubal ligation in the last five years. We used multivariate logistic regression to examine associations between wanting a sterilization reversal and rural/urban residence, method of payment (Medicaid/free vs private insurance/copay/other), and facility type (public vs private). We found no differences between rural and urban women in the desire for sterilization reversal, but did find differences by facility type, prior unwanted pregnancy, reason for receiving sterilization, and race and ethnicity. We will present the results of our analyses and engage participants in a discussion about proposed policy changes to address issues in sterilization care delivery in the US.