Health Care Provider Practices around Emergency Contraception: An Analysis of a Nationwide Provider Survey

Document Type

Presentation

Presentation Date

11-7-2017

Abstract or Description

Background: Emergency contraception (EC) can play an important role in decreasing risk for unintended pregnancy, yet there are barriers to EC access in the United States. We conducted a nationwide survey to examine health care provider EC practices and related factors.

Methods: We analyzed weighted data from a mailed survey of family planning providers (n=406 office-based physicians; n=1649 public-sector health center providers). We estimated adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the associations between select factors and EC practices.

Results: The overall prevalence of frequently providing an advanced EC prescription was 16.3%, frequently providing an advanced EC supply was 8.6%, and frequently providing a copper intrauterine device (Cu-IUD) as EC was 2.7%. Factors associated with increased odds of frequent provision of an advanced EC prescription included: being an office-based adolescent medicine physician (AOR=6.64; 95% CI=3.35, 13.15) or a public-sector provider at a Planned Parenthood clinic (AOR=11.70; 95% CI=6.23, 22.00), compared with office-based obstetrician-gynecologists; and having >50% (AOR=2.92; 95% CI=1.30, 6.57) or 25-49% racial/ethnic minority female patients (AOR=2.56; 95% CI=1.25, 5.24) versus <25%. Factors associated with increased odds of frequent provision of an advanced EC supply included: being an office-based adolescent medicine physician (AOR=4.18; 95% CI=2.18, 8.01), a public-sector provider at a Planned Parenthood clinic (AOR=15.10; 95% CI=7.82, 29.14) or health department (AOR=2.24; 95% CI=1.01, 5.06), compared with office-based obstetrician-gynecologists; and being female (AOR=4.54; 95% CI=1.40, 14.70). The prevalence of frequently providing or prescribing regular contraception when EC was provided was 30.8%. Factors associated with increased odds of frequent provision of regular contraception with EC included: being an office-based adolescent medicine physician (AOR=8.53; 95% CI=3.95, 18.43) or a public-sector provider at a Planned Parenthood clinic (AOR=25.69;95% CI=12.53, 52.69), health department (AOR=4.45; 95% CI=2.74, 7.24), or hospital (AOR=2.27; 95% CI=1.18, 4.34), compared with office-based obstetrician-gynecologists.

Conclusions: Frequent provision of EC in the form of an advanced prescription, an advanced supply, or a Cu-IUD was not common among this sample of healthcare providers and varied by provider characteristics and setting. Understanding provider- and system-level barriers to EC provision is important to improve access.

Sponsorship/Conference/Institution

American Public Health Association Annual Meeting (APHA)

Location

Atlanta, GA

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