Public funding for contraception, provider training, and use of highly effective contraceptives: A cluster randomized trial

K.M.J. Thompson, C.H. Rocca, J.E. Kohn, S. Goodman, L. Stern, M. Blum, J.J. Speidel, P.D. Darney and C.C. Harper

American Journal of Public Health, 2016, vol. 106, issue 3, 541-546

Abstract: Objectives. We determined whether public funding for contraception was associated with long-acting reversible contraceptive (LARC) use when providers received training on these methods. Methods. We evaluated the impact of a clinic training intervention and public funding on LARC use in a cluster randomized trial at 40 randomly assigned clinics across the United States (2011-2013). Twenty intervention clinics received a 4-hour training.Women aged 18 to 25 were enrolled and followed for 1 year (n = 1500: 802 intervention, 698 control). We estimated the effects of the intervention and funding sources on LARC initiation with Cox proportional hazards models with shared frailty. Results. Women at intervention sites had higher LARC initiation than those at control (22 vs 18 per 100 person-years; adjusted hazard ratio [AHR] = 1.43; 95% confidence interval [CI] = 1.04, 1.98). Participants receiving care at clinics with Medicaid family planning expansion programs had almost twice the initiation rate as those at clinics without (25 vs 13 per 100 person-years; AHR = 2.26; 95% CI = 1.59, 3.19). LARC initiation also increased among participants with public (AHR = 1.56; 95% CI = 1.09, 2.22) but not private health insurance. Conclusions. Public funding and provider training substantially improve LARC access.

Keywords: contraceptive agent; delayed release formulation; drug implant, adolescent; adult; attitude to health; continuing education; contraception; controlled study; delayed release formulation; drug implant; economics; education; family planning; female; health care personnel; human; intrauterine contraceptive device; medicaid; randomized controlled trial; statistics and numerical data; United States; utilization; young adult, Adolescent; Adult; Contraception; Contraceptive Agents, Female; Delayed-Action Preparations; Drug Implants; Education, Continuing; Family Planning Services; Female; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Intrauterine Devices; Medicaid; United States; Young Adult (search for similar items in EconPapers)
Date: 2016
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Citations: View citations in EconPapers (2)

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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2015.303001_8

DOI: 10.2105/AJPH.2015.303001

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