Corinne D Sexsmith1, Jessica N Sanders1, Rebecca G Simmons1, Cristen Dalessandro2, David K Turok1. 1. Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah. 2. Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: cristen.dalessandro@hsc.utah.edu.
Abstract
BACKGROUND: The Title X family planning program previously supported contraception for Utah clients with low incomes, yet its contributions may not have been sufficient to allow clients to select their preferred methods, including long-acting reversible contraceptives (LARCs). In this study, we compare the contraceptive method choices of self-paying clients with low incomes at three participating Title X health centers in Salt Lake County, Utah, before and after the removal of additional cost barriers. METHODS: We used retrospective medical record review to assess clients' contraceptive choices during two 6-month periods: a control period with Title X-assisted sliding scale payment schedules (n = 2,776) and an intervention period offering no-cost contraceptive care (n = 2,065). We used logistic regression to identify the likelihood of selecting a LARC during the intervention period and multinomial regression to identify the selection probability of different types of available LARCs. RESULTS: During the control period, 16% of participants chose a LARC compared with 26% in the intervention period (p ≤ .001). During the intervention period, participants were 1.8 times more likely to select LARCs (95% confidence interval, 1.65-2.13) compared with non-LARC methods, holding covariates constant. In the multinomial regression, participants were three times more likely during the intervention period to select an implant than a pill, patch, or ring, holding all other covariates constant (odds ratio, 3.08; 95% confidence interval, 2.47-3.83). CONCLUSIONS: Title X clients offered contraceptive methods without cost more frequently selected a LARC method. Title X funding reductions may impede individuals' access to their contraceptive methods of choice.
BACKGROUND: The Title X family planning program previously supported contraception for Utah clients with low incomes, yet its contributions may not have been sufficient to allow clients to select their preferred methods, including long-acting reversible contraceptives (LARCs). In this study, we compare the contraceptive method choices of self-paying clients with low incomes at three participating Title X health centers in Salt Lake County, Utah, before and after the removal of additional cost barriers. METHODS: We used retrospective medical record review to assess clients' contraceptive choices during two 6-month periods: a control period with Title X-assisted sliding scale payment schedules (n = 2,776) and an intervention period offering no-cost contraceptive care (n = 2,065). We used logistic regression to identify the likelihood of selecting a LARC during the intervention period and multinomial regression to identify the selection probability of different types of available LARCs. RESULTS: During the control period, 16% of participants chose a LARC compared with 26% in the intervention period (p ≤ .001). During the intervention period, participants were 1.8 times more likely to select LARCs (95% confidence interval, 1.65-2.13) compared with non-LARC methods, holding covariates constant. In the multinomial regression, participants were three times more likely during the intervention period to select an implant than a pill, patch, or ring, holding all other covariates constant (odds ratio, 3.08; 95% confidence interval, 2.47-3.83). CONCLUSIONS: Title X clients offered contraceptive methods without cost more frequently selected a LARC method. Title X funding reductions may impede individuals' access to their contraceptive methods of choice.
Authors: Aletha Y Akers; Jennifer Harding; Lisa K Perriera; Courtney Schreiber; J Felipe Garcia-Espana; Sarita Sonalkar Journal: Obstet Gynecol Date: 2018-06 Impact factor: 7.661