US “Safety Net” Clinics Provide Access to Effective Contraception for Adolescents and Young Women, 2017–2019

Objectives. To describe patterns of providing moderately effective versus the most effective contraception and of providing implants versus intrauterine devices in US community health centers. Methods. We conducted a historical cohort study (2017–2019). Outcomes were woman-level receipt of most effe...

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Published inAmerican journal of public health (1971) Vol. 112; no. S5; pp. S555 - S562
Main Authors Darney, Blair G., Biel, Frances M., Oakley, Jee, Rodriguez, Maria I., Cottrell, Erika K.
Format Journal Article
LanguageEnglish
Published Washington American Public Health Association 01.06.2022
Subjects
Adolescents
Age groups
Birth control
Clinics
Codes
Cohort analysis
Community centers
Contraception
Electronic health records
Ethnicity
Health care access
Health facilities
Implants
Indigent care
Intrauterine devices
IUD
Medicaid
Methods
Patients
Planning
Population
Public health
Specialists
Statistical analysis
Teenagers
Transplants & implants
Women
Womens health
United States > US
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Summary:Objectives. To describe patterns of providing moderately effective versus the most effective contraception and of providing implants versus intrauterine devices in US community health centers. Methods. We conducted a historical cohort study (2017–2019). Outcomes were woman-level receipt of most effective contraception (long-acting reversible contraception; implants and intrauterine devices) or moderately effective contraception. We used logistic regression to identify patient and clinic factors associated with providing (1) most versus moderately effective methods, and (2) implants versus intrauterine devices. We calculated adjusted probabilities for both outcomes by age group. Results. We included 199 652 events of providing contraception to 114 280 women in 410 community health centers. Adjusted probabilities were similar across age groups for moderately versus most effective methods. However, the adjusted marginal means for receiving an implant compared with an intrauterine device were highest for adolescents (15–17 years: 78.2% [95% confidence interval (CI) = 75.6%, 80.6%]; 18–19 years: 69.5% [95% CI = 66.7%, 72.3%]). Women’s health specialists were more likely to provide most versus moderately effective contraception. Conclusions. Community health centers are an important access point for most effective contraception for women of all ages. Adolescents are more likely to use implants than intrauterine devices. (Am J Public Health. 2022;112(S5):S555–S562. https://doi.org/10.2105/AJPH.2022.306913 )
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Contributor Statement: BGD, FB conceived of the study and conducted the analysis. BGD, FB, JO drafted the manuscript; all authors participated in data interpretation and revised the manuscript for intellectual content.
About the Authors: Blair G. Darney and Maria I. Rodriguez are Associate Professors of Obstetrics and Gynecology at Oregon Health & Science University. Blair G. Darney is also with the Health Systems & Policy in the OHSU-Portland State University joint School of Public Health and holds appointment at the National Institute of Public Health (INSP), Center for Population Health (CISP) in Cuernavaca, Morelos, Mexico. Frances M. Biel, Jee Oakley and Erika Cottrell are with OCHIN, Inc, in Portland, Oregon. Erika K. Cottrell is also a Associate Professor of Family Medicine, School of Medicine at Oregon Health & Science University.
ISSN:0090-0036
1541-0048
DOI:10.2105/AJPH.2022.306913