Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use.
Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use.
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DOI：
10.1007/s10995-022-03433-2
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发表时间：
2022-08
影响因子：
2.3
通讯作者：
Boudreaux M
中科院分区：
文献类型：
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作者：
Caudillo ML;Hurtado-Acuna C;Rendall MS;Boudreaux M
虽然多组成部分的政策干预措施可以是增加避孕药具获得的重要工具，但我们对它们如何改变产后妇女的避孕药具使用情况知之甚少。我们评估了特拉华州避孕现在访问（DelCAN）倡议与产后长效可逆避孕（LARC）的使用之间的关联。DelCAN包括产后立即使用LARC的医疗补助支付改革、LARC提供方面的提供者培训和技术援助，以及一场公众宣传运动。我们使用了差异设计和2012年至2017年妊娠风险评估监测系统的数据，比较了特拉华州与15个比较州产后LARC使用的变化，以及女性医疗补助登记的变化差异。相对于比较州，在2015-2017年DelCAN实施期间，特拉华州的产后LARC使用增加了5.26个百分点（95% CI 2.90-7.61，P < 0.001）。这一增幅在接受医疗补助的妇女中最大，并且在实施的头三年中有所增长。到DelCAN倡议的第三年（2017年），医疗补助妇女产后LARC使用的相对增加超过非医疗补助妇女7.24个百分点（95% CI 0.12-14.37，P = 0.046）。DelCAN倡议与特拉华州产后妇女使用LARC的增加有关。在头3年的倡议，LARC的使用逐步增加，并在更大程度上在医疗补助登记women. Comprehensive倡议，结合联合收割机医疗补助支付改革，提供者培训，免费避孕服务，并提高公众认识的努力，可以减少产后几个月的高效避孕药具的未满足的需求。在线版本包含补充材料，可通过10.1007/s10995-022-03433-2获得。
Although multi-component policy interventions can be important tools to increase access to contraception, we know little about how they may change contraceptive use among postpartum women. We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign. We used a difference-in-differences design and data from the 2012 to 2017 pregnancy risk assessment monitoring system to compare changes in postpartum LARC use in Delaware versus 15 comparison states, and differences in such changes by women’s Medicaid enrollment. Relative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90–7.61, P < 0.001) during the 2015–2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12–14.37, P = 0.046). The DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months. The online version contains supplementary material available at 10.1007/s10995-022-03433-2.