Counseling for Long-Acting Reversible Contraception in the U.S. South: Findings from Statewide Surveys of Family Physicians
Location
Culp Center Rm. 366
Start Date
4-25-2023 1:00 PM
End Date
4-25-2023 1:20 PM
Faculty Sponsor’s Department
Health Services Management & Policy
Name of Project's Faculty Sponsor
Amal Khoury
Competition Type
Competitive
Type
Oral Presentation
Project's Category
Health Services Delivery, Public Health, Womens Health
Abstract or Artist's Statement
Introduction
The U.S. South has higher rates of unintended pregnancy than other regions of the nation. Rurality and limited supply of medical providers and reproductive health services contribute to these disparities. Layered on this are restrictive reproductive health policies that are changing rapidly. Many rural areas in the South are "maternity care deserts” with no OB/GYNs, midwives, or obstetric care. In these areas, family physicians are often the only providers of reproductive health services. While family physicians commonly counsel about and prescribe oral contraceptives, little is known about their counseling practices for long-acting reversible contraception (LARC), including intrauterine devices (IUDs) and contraceptive implants. This study examines attitudes and practices of family physicians in two Southern states related to counseling for IUDs and implants.
Methods
Statewide representative surveys of family physicians (FPs) were administered in South Carolina and Alabama in 2018. The survey questionnaire, informed by in-depth interviews with providers and a systematic literature review, collected data about providers’ knowledge, attitudes and practices related to contraceptive counseling and provision. The questionnaire was pilot tested, revised and finalized. Random samples of FPs from each state were selected, with oversampling of rural providers. Sampled providers were web traced and phone screened to verify eligibility and contact information. The IRB-approved survey protocol involved mixed-mode administration (electronic and mail surveys), participation incentives for providers and office managers, and extensive follow-up with non-respondents. Survey data were weighted to account for the sampling design and to generate robust estimates. Data were cleaned and analyzed in STATA using t-tests and chi-square tests for independence.
Results
Five hundred and ten (510) FPs responded to the survey. The majority of FPs (70%) were in private medical practice and one-fourth in rural areas. Among FPs in Alabama, 39.3% reported not counseling any of their reproductive-aged female patients in the past year about IUDs, and 53.1% reported not counseling about the implant. Prevalence of counseling did not differ significantly between AL and SC providers. While a majority of FPs in both states (88.7%) reported general training in contraceptive counseling during their formal education, fewer reported training specific to IUDs (61.7%) and implants (43.9%), and only 28% had received recent training in contraceptive counseling in the past 2 years. Risk perceptions of providers varied. Contrary to medical eligibility criteria, the majority of FPs considered IUDs unsafe for women who had an STI (sexually transmitted infection) in the past 2 years (62.4%) and unsafe immediately post-partum (69.4%). Contraceptive training was positively associated with counseling provision, whereas risk perceptions were negatively associated with counseling provision.
Conclusion
Substantial training gaps and needs were noted among FPs. While the scope of practice of FPs is broad and demanding, their engagement in comprehensive contraceptive counseling is essential for their patients’ health and well-being. This is particularly true in the U.S. south where contraceptive services are not always available or accessible. FPs must be supported through evidence-based training programs and clinic-level interventions that facilitate their contraceptive counseling and, ultimately, their patients’ contraceptive choices and outcomes.
Counseling for Long-Acting Reversible Contraception in the U.S. South: Findings from Statewide Surveys of Family Physicians
Culp Center Rm. 366
Introduction
The U.S. South has higher rates of unintended pregnancy than other regions of the nation. Rurality and limited supply of medical providers and reproductive health services contribute to these disparities. Layered on this are restrictive reproductive health policies that are changing rapidly. Many rural areas in the South are "maternity care deserts” with no OB/GYNs, midwives, or obstetric care. In these areas, family physicians are often the only providers of reproductive health services. While family physicians commonly counsel about and prescribe oral contraceptives, little is known about their counseling practices for long-acting reversible contraception (LARC), including intrauterine devices (IUDs) and contraceptive implants. This study examines attitudes and practices of family physicians in two Southern states related to counseling for IUDs and implants.
Methods
Statewide representative surveys of family physicians (FPs) were administered in South Carolina and Alabama in 2018. The survey questionnaire, informed by in-depth interviews with providers and a systematic literature review, collected data about providers’ knowledge, attitudes and practices related to contraceptive counseling and provision. The questionnaire was pilot tested, revised and finalized. Random samples of FPs from each state were selected, with oversampling of rural providers. Sampled providers were web traced and phone screened to verify eligibility and contact information. The IRB-approved survey protocol involved mixed-mode administration (electronic and mail surveys), participation incentives for providers and office managers, and extensive follow-up with non-respondents. Survey data were weighted to account for the sampling design and to generate robust estimates. Data were cleaned and analyzed in STATA using t-tests and chi-square tests for independence.
Results
Five hundred and ten (510) FPs responded to the survey. The majority of FPs (70%) were in private medical practice and one-fourth in rural areas. Among FPs in Alabama, 39.3% reported not counseling any of their reproductive-aged female patients in the past year about IUDs, and 53.1% reported not counseling about the implant. Prevalence of counseling did not differ significantly between AL and SC providers. While a majority of FPs in both states (88.7%) reported general training in contraceptive counseling during their formal education, fewer reported training specific to IUDs (61.7%) and implants (43.9%), and only 28% had received recent training in contraceptive counseling in the past 2 years. Risk perceptions of providers varied. Contrary to medical eligibility criteria, the majority of FPs considered IUDs unsafe for women who had an STI (sexually transmitted infection) in the past 2 years (62.4%) and unsafe immediately post-partum (69.4%). Contraceptive training was positively associated with counseling provision, whereas risk perceptions were negatively associated with counseling provision.
Conclusion
Substantial training gaps and needs were noted among FPs. While the scope of practice of FPs is broad and demanding, their engagement in comprehensive contraceptive counseling is essential for their patients’ health and well-being. This is particularly true in the U.S. south where contraceptive services are not always available or accessible. FPs must be supported through evidence-based training programs and clinic-level interventions that facilitate their contraceptive counseling and, ultimately, their patients’ contraceptive choices and outcomes.