Increase Access to Contraception
Return to Opioid Top-Level Strategy Map or ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use
Table of Contents
Background
Family planning and preconception care for women who use opioids is considered an important strategy to reduce the incidence of NAS.[1] "CDC and the Office of Population Affairs of the U.S. Department of Health and Human Services recommend that health care providers support family planning services, which include preconception services, pregnancy intention screening, and contraceptive counseling to prevent unintended pregnancy by increasing access to the full range of contraceptive methods, including long-acting reversible contraception (e.g., intrauterine devices and implants)."[2]
Current Status
- 31% to 47% of US pregnancies are unintended, research suggests that, for women with opioid use disorder, the proportion of unintended pregnancies was higher than 85%.[3]
- The statistics of a study in Eastern Tennessee were alarming:
- Half of the 320,000 women in Medicaid in Tennessee received an opioid prescription in 2016[4]
- Only 3% of them use a reliable birth control method[5]
- Their general knowledge of birth control is very low[6]
Improving Education about Contraception
While there is often disagreement on what type of sex education is appropriate, communities should make it a priority to improve understanding of birth control as a way to avoid unintended pregnancies.
Research on Birth Control Options
See this article on preferences and effectiveness of different birth control options.
LARCs
Increasing access to Long Acting Reversible Contraceptives (LARCs) could be a key part of a strategy. Since 2007, researchers have seen a sharp rise in LARCs, such as intrauterine devices and implants. These forms of birth control last for years once inserted and prevent pregnancy for more than 99 percent of users. That helps explain why they're a big part of the story behind America's plummeting unintended pregnancy rate. [7] One of the biggest obstacles to LARC use, historically, has been price. Planned Parenthood has estimated that IUDs can cost between $500 and $900 out of pocket. Insurance plans tended to charge patients more for IUDs than for birth control pills, just because the devices have such high upfront costs.[8]This article makes some interesting points and has information on the relative effectiveness of different types of contraceptives.
Hormone-releasing Implants
NEXPLANON is a hormone-releasing birth control implant for use by women to prevent pregnancy for up to 3 years.
Non-Hormone IUDs
Paragard is an IUD that can prevent pregnancy for up to 10 years. Paragard is a hormone-free IUD. It may be 100% covered by insurance. See Paragardbvsp.com to learn if benefits cover Paraguard. .
Overcoming Cost Barriers to Access
Healthcare providers or clinics can join a Group Purchasing Organization (GPO) to get lower costs on birth control
Afaxys is a pharma company that produces birth control pills, but they also have a Group Purchasing Organization that provides discount pricing on Bayer IUDs.
Other Barriers to Access
Approximately 1 in 7 ob/gyns believe pelvic inflammatory disease is a significant risk of IUD use, despite substantial research to the contrary.[9]
Preconception Services
Pregnancy Intention Screening
Contraceptive Counseling
EmpowerHealth USA provides a telehealth option for contraception counseling.[1]
Statistics
- A study of 946 women who were using opioids who gave birth revealed that 86% reported that the pregnacy was unintended.[10]
Potential Barriers
"For example, the ACOG supports placement of LARC devices during the immediate postpartum period to improve the use of LARC among postpartum women13; however, bundled payments for delivery create a relative financial disincentive to place LARC devices at the time of delivery.[11] State Medicaid programs play a critical role in ensuring access to highly effective contraception at the time when it is desired, including the time of delivery. However, recent research suggests that states are variable in aligning financial incentives to ensure access to LARC methods if elected at the time of delivery.14"[12]
Patient contraceptive selection is sensitive to copayment. A 2010 analysis confirmed that employer-based plans display significant variation in copayments by contraceptive method, with LARC methods being the most expensive in terms of upfront costs to patients.[13] The Medicaid program has always required that family planning services be fully covered for patients without cost sharing.[14] The Patient Protection and Affordable Care Act (ACA) similarly required new private health plans to provide no-cost coverage for all FDA-approved contraceptives.[15]
Promising Programs
NAS Primary Prevention InitiativeEast Tennessee Primary Prevention Initiative - Tennessee Department of Health
Contact: Erica Wilson, MPH, Community Services Director, [[2]]
Overview of program
- Partnership with local jails
- Health education sessions
- focus on NAS prevention
- information on effective contraceptives and LARCs
- Partnerships with jails to refer inmates to local health department for family planning
- Among 442 referrals (2014-15), 94% received a contraceptive method, 84% chose a voluntary LARC
Resources:
- PowerPoint presentation - to educate community partners [contacted for resource]
- Pamphlet - to educate community partners [contacted for resource]
- Presentation - conducted to inmates on NAS and how it can be prevented [contacted for resource]
emPOWERhealthUSA
emPOWERhealthUSA has a program that provides telehealth coaching on birth control (among other things) to help more women get LARCs or make other informed decisions on birth control, with a focus on women who are using opioids.
Access and Resources in Contraceptive Health (ARCH) Patient Assistance Program
This patient assistance program provides Bayer IUDs (intrauterine devices), Kyleena, Mirena and Skyla, at no cost to eligible women.[16] Eligible women include those who do not have either private health insurance or Medicaid coverage for Bayer IUDs and who meet all other program eligibility requirements. Kyleena and Mirena can help prevent pregnancy for up to 5 years and Skyla up to 3 years.[17]
Tools & Resources
TR - Improve Access to Contraception
Scorecard Building
Potential Objective Details
Potential Measures and Data Sources
Potential Actions and Partners
Resources to Investigate
More RTI on Access to Contraception
PAGE MANAGER: [insert name here]
SUBJECT MATTER EXPERT: [fill out table below]
| Reviewer | Date | Comments |
Sources
- [3]
- Gavin L, Moskosky S, Carter M, et al. Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep 2014;63(No. RR-4).
- [4]
- [5]
- [6]
- [7]
- [8]
- [9]
- Luchowski, A.T., et al. (2014). Obstetrician-Gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations. Contraception 89.
- [10]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052960/
[11]
Pace, L.E., Dusetzina, S.B., Fendrick, A.M., Keating, N.L., and Dalton, V.K. The impact of out-of-pocket costs on the use of intrauterine contraception among women with employer-sponsored insurance. Medical Care. 2013; 51: 959–963
- Dusetzina, S.B., Dalton, V.K., Chernew, M.E., Pace, L.E., Bowden, G., and Fendrick, A.M. Cost of contraceptive methods to privately insured women in the United States. Women's Health Issues. 2013; 23: e69–71
- National Women's Law Center. (2015). Fact sheet: Contraceptive coverage in the health care law: Frequently asked questions. Accessed August 24, 2015.
[12]
- [13]