Upda te s in Co ntra c e ptio n: Adva nc e s in T e c hnic a l a nd - - PDF document

Upda te s in Co ntra c e ptio n: Adva nc e s in T e c hnic a l a nd I nte rpe rso na l Ca re

Christine De hle ndo rf, MD MAS

De partme nt o f F amily and Co mmunity Me dic ine and Obste tric s, Gyne c o lo gy and Re pro duc tive S c ie nc e s

Disc lo sure s

• No fina nc ia l disc lo sure s to re po rt
• I

disc uss o ff-la b e l use o f so me c o ntra c e ptive me tho ds.

Are yo u fa milia r with the US Me dic a l E lig ib ility Crite ria fo r Co ntra c e ptio n?

a . Ye s b . No

Ca n my pa tie nt use this me tho d?

1 Can use the method No restrictions 2 Can use the method Advantages generally

• utweigh theoretical or

proven risks. 3 Should not use method unless no other method is appropriate or acceptable Theoretical or proven risks generally outweigh advantages 4 Should not use method Unacceptable health risk

US Medical Eligibility Criteria (MEC)

A 35 year-old woman comes to you for contraception counseling. She has a h/o of migraines without aura. Can she use an estrogen containing method?

Ca n a wo ma n with mig ra ine s witho ut a ura use e stro g e n- c o nta ining c o ntra c e ptive s?

a . Ye s b . No c . I t de pe nds

ME C a nd He a da c he s

Birth Control Methods

Medical Condition MEC Category

• Wo me n a t risk fo r se xua lly tra nsmitte d dise a se no

lo ng e r a se pa ra te c a te g o ry with mo re c o nc e rns with I UDs

• Sta te s “risk fo r PID with risk fa c to rs fo r ST

Ds is lo w”

• I

UDs no w a c a te g o ry 2 fo r wo me n with AI Ds (fro m 3)

2016 ME C Upda te s: I UDs 2016 ME C Upda te s

• Additio n o f re c o mme nda tio ns fo r wo me n with:
• Cystic fib ro sis (De po is c a te g o ry 2)
• Multiple sc le ro sis (CHCs a re c a te g o ry 2 with immo b ility)
• Use o f SSRIs a nd St. Jo hn’ s wo rt (CHC a nd impla nt a 2 fo r SJW)
• Re visio ns to the re c o mme nda tio ns fo r:
• Wo me n with:
• Dyslipide mia s (no w inc lude d in wo me n with multiple

c a rdio va sc ula r risks)

• Mig ra ine he a da c he s
• Wo me n who a re re c e iving a ntire tro vira l the ra py (CHCs no w

c a te g o ry 2 with Rito na vir-b o o ste d ARVs)

Co ntra c e ptio n a nd De pre ssio n

• Re c o mme nda tio ns b a se d o n syste ma tic re vie w o f six

studie s (1 RCT a nd 5 c o ho rt studie s) o f wo me n with b ipo la r diso rde r o r de pre ssio n

• Ove ra ll po o r to fa ir q ua lity studie s

Pagano, Contraception, 2016.

Ca n o ve r a millio n Da nish wo me n b e wro ng ?

• Pro spe c tive c o ho rt study o f 1,061,997 wo me n in

De nma rk

• Use rs (within the la st six mo nths) o f c o mb ine d

ho rmo na l c o ntra c e ptio n/ pro g e stin o nly c o ntra c e ptio n ha d:

• An RR o f 1.23 (95% CI 1.22-1.25)/ 1.34 (95% CI 1.27-1.40) fo r first use
• f a n a ntide pre ssa nt
• An RR o f 1.1 (95% CI 1.08-1.14)/ 1.2 (95% CI 1.04-1.31) fo r dia g no sis
• f de pre ssio n
• RR de c re a se d with a g e o f the use r

Skovlund, JAMA Psychiatry, 2016.

Do e s this ma ke se nse ?

• Pre vio us lite ra ture did no t sho w a de finitive

a sso c ia tio n fo r a ny me tho ds

• So me b io lo g ic a l e vide nc e suppo rting pro g e stin a nd

e stro g e n influe nc e o n mo o d

• HOWE

VE R, we kno w tha t so me wo me n re po rt mo o d c ha ng e s with me tho ds, a nd ma ny a re wo rrie d a b o ut e ffe c ts o n the ir mo o d

• Re se a rc h o n wo me n’ s e xpe rie nc e s during c o unse ling do c ume nts

tha t ma ny fe e l the ir c o nc e rns a re dismisse d witho ut due c o nside ra tio n

Hall, AJOG, 2015; Dehlendorf, Contraception, 2013 Schaffir, Eur J Contracept Reprod Health Care, 2016

Ho w do we put this a ll to g e the r?

• While hig h q ua lity study, no t ra ndo mize d
• Co nfo unding b y unme a sure d c ha ra c te ristic s o f individua ls?
• Co nfo unding b y re la tio nship c o nte xt? (No da ta o n no n-ho rmo na l

c o ntra c e p tive me tho d (e .g . c o ppe r IUD) pro vide d a s c o mpa riso n)

• T

he re fo re , c a nno t dra w de finitive c a usa l c o nc lusio n

• De finitive e vide nc e is unlike ly, g ive n diffic ulty (e thic s? ) o f

ra ndo mizing c o ntra c e p tio n

• If it is re a l, wha t is the ma g nitude ?
• 1.7% vs. 2.2% o ve ra ll – NNH o f 200
• We need to honor women’s concerns/experiences around mood

effects of contraception, acknowledging the lack of definitive data

• We can provide reassurance that at worst, few women are impacted

Whe re do yo u find the US ME C?

Yo u de te rmine a me tho d is sa fe . No w wha t?

• ME

C is NOT de sig ne d to pro vide insig ht into wha t me tho d is rig ht fo r a g ive n pa tie nt

• Co ntra c e ptive c o unse ling invo lve s e duc a tio n a nd

de c isio n suppo rt to he lp pa tie nts unde rsta nd the ir

• ptio ns a nd ma ke a se le c tio n
• Do c ume nte d impa c t o f c o ntra c e ptive c o unse ling
• n me tho d se le c tio n a nd c o ntinua tio n

De hle ndo rf: AJ OG, 2016 Harpe r: PE C, 2010

Wha t is the b e st a ppro a c h to c o ntra c e ptive de c isio n ma king ?

a . E nc o ura g e wo me n to c ho o se the mo st hig hly e ffe c tive me tho ds b . Give the m info rma tio n a b o ut a ll me tho ds a nd le t the m de c ide fo r the mse lve s c . Give the m whic he ve r me tho d the y sa y the y wa nt

• d. No ne o f the se

Co ntra c e ptive Co unse ling : L ARC F irst?

• I

nc re a sing e mpha sis o n/ pro mo tio n o f L ARC me tho ds in fa mily pla nning

• E

xa mple s:

• T

ie re d e ffe c tive ne ss: Pre se nt me tho ds in o rde r o f e ffe c tive ne ss

• Mo tiva tio na l inte rvie wing : Pa tie nt-c e nte re d a ppro a c h

to a c hie ving b e ha vio r c ha ng e

I s “L ARC F irst” c o unse ling pa tie nt-c e nte re d?

• Wo me n ha ve stro ng a nd va rie d pre fe re nc e s fo r

c o ntra c e ptive fe a ture s

• Re la te to diffe re nt a sse ssme nts o f po te ntia l
• utc o me s, suc h a s side e ffe c ts
• Also re la te s to diffe re nt a sse ssme nts o f the

impo rta nc e o f a vo iding a n uninte nde d pre g na nc y

L e ssa rd: PS RH, 2012 Ma dde n: AJ OG, 2015

I s a n uninte nde d pre g na nc y a lwa ys a b a d thing ?

a . Ye s b . No

Ho w do wo me n think a b o ut pre g na nc y?

• Intentions: T

iming -b a se d ide a s a b o ut if/ whe n to g e t pre g na nt

• Plans: De c isio ns a b o ut whe n to g e t pre g na nt a nd

fo rmula tio n o f a c tio ns

• Desires: Stre ng th o f inc lina tio n to g e t pre g na nt o r a vo id

pre g na nc y

• Feelings: E

mo tio na l o rie nta tio ns to wa rds pre g na nc y

Aike n: PS RH, 2016

A Multidime nsio na l Co nc e pt

Plans ≠ Intentions ≠ Desires ≠ Feelings

• All diffe re nt c o nc e pts
• Wo me n ma y find a ll o r o nly so me me a ning ful
• Ofte n a ppe a r inc o nsiste nt with e a c h o the r

Pla nning Ma y No t Be De sira b le

“I guess one of the reasons that I haven’t gotten an IUD yet is like, I don’t know, having

• ne kid already and being in a long-term

committed relationship, it takes the element of surprise out of when we would have our next kid, which I kind of want. I’m in that weird

• position. I just don’t want to put too much

thought and planning into when I have my next kid.”

Hig g ins e t a l. In Pre pa ra tio n

Uninte nde d Ma y b e We lc o me

Aike n: S

• c ial S

c ie nc e & Me dic ine , 2015

“I don’t want more kids...We can’t afford another one. But if it happened I’d still be

• happy. I’d be really excited. We’d rise to the
• ccasion…nothing would really change.”

Amb iva le nt a nd I ndiffe re nt De sire s

“I already got a kid so you know I’m not opposed to having children. If it happens, it happens…. I’d prefer we don’t have children right now but if it happens, okay.”

Go me z e t al. Yo ung Co uple s Study 2016

But sho uldn’ t we g e t wo me n to pla n “fo r the ir o wn g o o d”?

• I

s a n uninte nde d pre g na nc y a unive rsa lly ne g a tive he a lth o utc o me ?

• L

ittle da ta to suppo rt this a ssumptio n

• Ma ny studie s sho w no a sso c ia tio n with so c ia l o r he a lth
• utc o me s
• So me studie s sho w a sso c ia tio ns with lo w b irth we ig ht a nd

pre te rm b irth

• Ho we ve r, g e ne ra lly no t we ll-de sig ne d a nd we ll-c o ntro lle d
• Mo st e xa mine o nly re tro spe c tive inte ntio ns

Ha ll, Ma te rn Child He a lth J, 2017 Gipso n e t a l. Studie s in F a mily Pla nning , 2008 Sha h e t a l. Ma te rn Child He a lth J, 2011

Co nc e rns with dire c tive c o unse ling a ppro a c he s

• Assuming wo me n sho uld wa nt to use c e rta in

me tho ds:

• Ig no re s va ria b ility in pre fe re nc e s, inc luding a ro und

impo rta nc e o f a vo iding uninte nde d pre g na nc y

• Do e s no t prio ritize a uto no my
• Pre ssure to use spe c ific me tho ds c a n b e

c o unte rpro duc tive

• Pe rc e ive d pre ssure inc re a se s risk o f me tho d disc o ntinua tio n
• Pe rc e iving pro vide a s ha ving a pre fe re nc e a sso c ia te d with

lo we r sa tisfa c tio n with me tho d

K a lmuss: F am Plann Pe rspe c t, 1996 De hle ndo rf: Co ntrac e ptio n, 2017

Co ntra c e ptive de c isio n ma king

Directive Counseling Consumerist Counseling Consumerist Counseling Directive Counseling Sha re d de c isio n ma king Qua lity de c isio n b a se d o n pa tie nt pre fe re nc e s

Sha re d De c isio n Ma king in F a mily Pla nning

“I just think pro vide rs sho uld be ve ry info rmative abo ut it and no n- biase d…maybe no t try to pe rsuade the m to go o ne way o r the o the r, but maybe try to find o ut abo ut the ir bac kgro und a little bit and what the ir re latio nships are like and maybe sugge st what might wo rk be st fo r the m but ultimate ly le ave the de c isio n up to the patie nt.”

De hle ndo rf, Co ntra c e ptio n, 2013

Sha re d de c isio n-ma king in fa mily pla nning

• “I

nve sting in the b e g inning ” a nd “E lic iting the pa tie nt pe rspe c tive ” b o th a sso c ia te d with c o ntra c e ptive c o ntinua tio n (p<0.05)

• Pa tie nts who re po rt sha ring the ir de c isio n with the ir

pro vide r ha d hig he r sa tisfa c tio n with the ir fa mily pla nning e xpe rie nc e

• Co mpa re d to b o th pa tie nt- a nd pro vide r-drive n de c isio ns
• Ma y no t b e b e st fo r e ve ryo ne , b ut pro vide s sta rting

po int fo r c o unse ling

De hle ndo rf, AJOG, 2016 De hle ndo rf, Co ntra c e ptio n, 2017

Sha re d De c isio n Ma king a nd Dispa ritie s in F a mily Pla nning Ca re

Histo ry o f re pro duc tive injustic e s

• No nc o nse nsua l ste riliza tio n
• f po o r wo me n a nd wo me n
• f c o lo r thro ug ho ut the

1900s

• Une thic a l te sting o f o ra l

c o ntra c e ptive s in Pue rto Ric o

• 150 inc a rc e ra te d wo me n in

Ca lifo rnia we re ille g a lly ste rilize d fro m 2006-2010

Ro b e rts, K illing the Bla c k Bo dy, 1998 Ste rn, AJPH, 2005

Ra c e a nd trust in fa mily pla nning se rvic e s

• 35% o f Bla c k wo me n re po rte d “me dic a l a nd pub lic

he a lth institutio ns use po o r a nd mino rity pe o ple a s g uine a pig s to try o ut ne w b irth c o ntro l me tho ds.”

• Gre a te r tha n 40% o f Bla c ks a nd L

a tina s think g o ve rnme nt pro mo te s b irth c o ntro l to limit mino ritie s

• Bla c k wo me n mo re like ly to pre fe r a me tho d o ve r

whic h the y ha ve c o ntro l

Ja c kso n, Co ntra c e ptio n, 2015 Ro c c a , PSRH, 2012 T ho rb un a nd Bo g a rt, Wo me n’ s He a lth, 2005

Pro vide r b ia s in fa mily pla nning

• L
• w-inc o me wo me n o f c o lo r mo re like ly to re po rt

b e ing a dvise d to limit the ir c hildb e a ring tha n middle -c la ss white wo me n

• Bla c ks we re mo re like ly tha n white s to re po rt ha ving

b e e n pre ssure d b y a c linic ia n to use c o ntra c e ptio n

• 67% o f b la c k wo me n re po rte d ra c e -b a se d

disc rimina tio n whe n re c e iving fa mily pla nning c a re

Do wning : Am J Public He alth, 2007 Be c ke r: Pe rspe c t S e x Re pro d He alth, 2008 T ho rb urn: Wo me n He alth, 2005

• F

a mily pla nning pro vide rs ha ve lo we r le ve ls o f trust in the ir Bla c k pa tie nts

• Pro vide rs a re mo re like ly to a g re e to ste rilize wo me n
• f c o lo r a nd po o r wo me n
• Are the re a lso dispa ritie s in c o unse ling a b o ut the

I UD?

• RCT

using vide o s o f sta nda rdize d pa tie nts pre se nting fo r c o ntra c e ptive a dvic e

• Sho wn to pa rtic ipa nts a t na tio na l me e ting s o f ACOG a nd

AAF P

Ja c kso n, unpub lishe d da ta Ha rriso n, Ob ste t Gyne c o l 1988 De hle ndo rf, Ame ric a n Jo urna l o f Ob ste tric s a nd Gyne c o lo g y, 2010

Are wo me n o f c o lo r c o unse le d diffe re ntly?

Are pro vide rs mo re o r le ss like ly to re c o mme nd I UDs to Bla c k a nd L a tina wo me n?

• 1. Pro vide rs a re MORE

like ly to re c o mme nd I UDs to Bla c k a nd L a tina wo me n tha n to White wo me n

• 2. Pro vide rs a re L

E SS like ly to re c o mme nd I UDs to Bla c k a nd L a tina wo me n tha n to White wo me n

• 3. T

he re a re no diffe re nc e s b y ra c e / e thnic ity in re c o mme nda tio ns fo r I UDs

42% 63% 67%

10 20 30 40 50 60 70 80 90

Whites Blacks Latinas

% Recommending IUC

Percent of Providers Recommending IUC to Low SES Women, by Race/Ethnicity (n=173)

De hle nd o rf, e t a l. AJOG, 2010

P<0.05

Co unse ling a nd F a mily Pla nning Dispa ritie s

• Pro vide rs ne e d to b e a wa re o f b o th histo ric a l

c o nte xt a nd do c ume nte d dispa ritie s in c o unse ling

• E

sse ntia l to e nsure tha t pro vide rs fo c us o n individua l pre fe re nc e s whe n c a ring fo r wo me n o f c o lo r

• Sha re d de c isio n ma king pro vide s e xplic it fra me wo rk

fo r do ing this, witho ut swing ing to o fa r to o the r side

T he pro c e ss o f sha re d de c isio n ma king

• E

sta b lish ra ppo rt

• E

lic it info rme d pre fe re nc e s fo r me tho d c ha ra c te ristic s:

• E

ffe c tive ne ss

• Side e ffe c ts
• F

re q ue nc y o f using me tho d

• Diffe re nt wa ys o f ta king me tho ds
• F

a c ilita te de c isio n g ro unde d in pa tie nt pre fe re nc e s

E xa mple s o f fa c ilita tio n

“I a m he a ring yo u sa y tha t a vo iding pre g na nc y is the mo st impo rta nt thing to yo u rig ht no w. I n tha t c a se , yo u ma y wa nt to c o nside r e ithe r a n I UD o r impla nt. Ca n I te ll yo u mo re a b o ut tho se me tho ds? ” “Yo u me ntio ne d tha t it is re a lly impo rta nt to yo u to no t ha ve irre g ula r b le e ding . T he pill, pa tc h, ring a nd c o ppe r I UD a re g o o d o ptio ns, if yo u wa nt to he a r mo re a b o ut tho se .”

Co ntra c e ptive Upda te s

Insertion tube of 4.4 mm

• 20 mc g / da y (5 yr) - Mire na
• 19 mc g / da y (3 yr) - L

ile tta

• Curre nt a ppro va l fo r 3 yrs
• L
• we r c o st
• Bo th ha ve b e tte r b le e ding pro file s

tha n sma lle r I UDs Insertion tube of 3.8 mm

• 14 mc g / da y (3 yr) – Skyla
• 17.5 mc g / da y (5 yr) - K

yle e na

Wha t’ s with a ll the ne w L e vo no rg e stre l I UDs?

Ho w lo ng sho uld we te ll wo me n a Mire na I UD is e ffe c tive fo r?

a . 5 ye a rs b . 6 ye a rs c . 7 ye a rs

• d. 12 ye a rs

T he L a te st o n I UDs….

• Ho w ma ny ye a rs c a n a wo ma n le a ve a n IUD in pla c e ?
• Da ta fro m the CHOICE

study sho ws Mire na is e ffe c tive a t le a st fo r 7 ye a rs.

• L
• ng sta nding da ta a b o ut the c o ppe r IUD indic a te s it is e ffe c tive

fo r a t le a st 12 ye a rs

• (Co ntra c e p tive impla nt e ffe c tive fo r a t le a st 5 ye a rs)
• Do I ne e d to g e t re sults o f ST

I te sts b a c k b e fo re inse rting a n IUD?

• NO! T

e sting a c c o rding to sc re e ning g uide line s c a n b e pe rfo rme d the da y o f the pro c e dure a s ne c e ssa ry

• Sho uld we put b a rrie rs in pla c e a ro und IUD re mo va l?
• NO!

Sufrin, Ob ste t Gyne c o l, 2012 Mc Nic ho la s, AJOG, 2017 Hig g ins, AJPH, 2016

Re sista nc e to I UD Re mo va ls

I was telling the nurse how I been on my period for like 3 weeks now, and I’m having bad cramps, and I’m even having them in my back, which I never had before. And she was saying, “Just give it another month or so and see how it goes.” . . . I was mad. I told them that I wanted it out and they said that it’s really expensive and that the IUD’s the best option. I got some resistance there. . . . I was a little emotional at the time and she [the provider] didn’t even care, it seemed.

Higgins, AJPH, 2016

E me rg e nc y Co ntra c e ptio n E me rg e nc y Co ntra c e ptio n: E ffic a c y

• E

ffe c tive ne ss:1,2 Uliprista l Ac e ta te (UPA) mo re e ffe c tive tha n L NG E C

• T

a ke n a t 120 hrs: OR = .55 (.32-.93)

• T

a ke n a t 24 hrs: OR = .35 (.11-.93)

• Ob e se wo me n ha ve lo we r E

C e ffic a c y

• L

NG: No e ffic a c y >70-75 kg (>154-165lb )

• L

a rg e dro p in e ffic a c y a t BMI >26

• PK

da ta : Do ub ling the L NG do se ma y inc re a se e ffic a c y5

• UPA: L

e ss e ffic a c y in o b e se wo me n b ut still e ffe c tive

• Ma y lo se e ffic a c y a t we ig ht o f 90 kg (198 lb ) o r BMI >35

1Glasier, Lancet, 2010. 2Creinin, Obstet Gynecol, 2006. 3Kapp, Contraception, 2015. 4Moreau, Contraception, 2012. 5Edelman, Contraception, 2016.

% cycles with

• vulation within 5

days UPA + placebo 3% UPA + desogestrel OC 45%

Brache V et al. Hum Reprod 2015; 30:2785‐93

Quickstarting Contraception After UPA

p=0.0054

I nitia tio n o f Co ntra c e ptio n Afte r UPA

• Sta rt o r re sume HC no so o ne r tha n 5 da ys a fte r UPA
• DMPA, impla nts, a nd IUDs a t the time o f UPA ma y b e

c o nside re d

• T

he risk tha t the me tho d mig ht de c re a se the e ffe c tive ne ss o f UPA must b e we ig he d a g a inst risk o f no t sta rting a me tho d

• Ab sta in o r use a b a rrie r fo r 7 da ys afte r sta rting o r

re suming HC, o r until ne xt me nse s, whic he ve r c o me s first

• Any no n-ho rmo na l me tho d c a n b e sta rte d imme dia te ly
• Advise a pre g na nc y te st if no withdra wa l b le e d within 3

we e ks

Do yo u a sk wo me n o f re pro duc tive a g e a b o ut tra ve l to a re a s with Zika ?

a . Ye s b . No

Wha t sho uld I a sk a b o ut Zika ?

• Ask wo me n a b o ut tra ve l in

pa st 8 we e ks

• Ask me n a b o ut tra ve l in

pa st six mo nths

• Ask a b o ut pla nne d tra ve l
• Ask a b o ut pre g na nc y g o a ls

Co ntra c e ptive Pe rfo rma nc e Me a sure s

• Me a sure s fo r a ll wo me n:
• 1. T

he pe rc e nta g e o f wo me n a t risk pro vide d a mo st e ffe c tive o r mo de ra te ly e ffe c tive c o ntra c e p tive me tho d

• 2. T

he pe rc e nta g e o f wo me n a t risk tha t is pro vide d a lo ng -a c ting re ve rsib le c o ntra c e ptive (L ARC) me tho d

• Me a sure s fo r po stpa rtum wo me n:
• 1. T

he pe rc e nta g e tha t is pro vide d a mo st e ffe c tive o r mo de ra te ly e ffe c tive c o ntra c e ptive me tho d within 3 a nd 60 da ys o f de live ry

• 2. T

he pe rc e nta g e tha t is pro vide d a L ARC me tho d within 3 a nd 60 da ys o f de live ry

Appro pria te Use o f the Me a sure s

Pub lic Co mme nts During NQF Pro c e ss

“T he Na tio na l Pa rtne rship fo r Wo me n & F a milie s stro ng ly suppo rts the c o mmitte e ’ s re c o mme nda tio n to e ndo rse this me a sure ….It is e xtre me ly impo rta nt to ke e p in mind tha t re pro duc tive c o e rc io n ha s a tro ub ling histo ry, a nd re ma ins a n

• ng o ing re a lity fo r ma ny, inc luding lo w-inc o me wo me n, wo me n
• f c o lo r, yo ung wo me n, immig ra nt wo me n, L

GBT pe o ple , a nd inc a rc e ra te d wo me n. We ho pe this me a sure will b e pa ire d with a wo ma n-re po rte d “b a la nc ing me a sure ” o f e xpe rie nc e o f re c e iving c o ntra c e ptive c a re . Suc h a me a sure c a n b e e xpe c te d to he lp ide ntify a nd/ o r c he c k ina ppro pria te pre ssure fro m the he a lth c a re syste m.“

Pub lic Co mme nts During NQF Pro c e ss

“T he Na tio na l Pa rtne rship fo r Wo me n & F a milie s stro ng ly suppo rts the c o mmitte e ’ s re c o mme nda tio n to e ndo rse this me a sure ….It is e xtre me ly impo rta nt to ke e p in mind tha t re pro duc tive c o e rc io n ha s a tro ub ling histo ry, a nd re ma ins a n

• ng o ing re a lity fo r ma ny, inc luding lo w-inc o me wo me n, wo me n
• f c o lo r, yo ung wo me n, immig ra nt wo me n, L

GBT pe o ple , a nd inc a rc e ra te d wo me n. We ho pe this me a sure will b e pa ire d with a wo ma n-re po rte d “b a la nc ing me a sure ” o f e xpe rie nc e o f re c e iving c o ntra c e ptive c a re . Suc h a me a sure c a n b e e xpe c te d to he lp ide ntify a nd/ o r c he c k ina ppro pria te pre ssure fro m the he a lth c a re syste m.“

Me a sure in De ve lo pme nt a t UCSF

Think about your visit with [provider] at [site] on [date of visit]. How do you think they did? Please rate them on each of the following by circling a number. Poor Fair Good Very good Excelle nt Respecting me as a person 1 2 3 4 5 Letting me say what mattered to me about my birth control method 1 2 3 4 5 Taking my preferences about my birth control seriously 1 2 3 4 5 Giving me enough information to make the best decision about my birth control method 1 2 3 4 5

https:/ / Be dside r.o rg T a ke ho me po ints

• Use o f the CDC Me dic a l E

lig ib ility Crite ria a nd SPR c a n he lp e nsure sa fe a nd e vide nc e -b a se d pre sc rib ing

• Sha re d de c isio n ma king is a va lua b le a ppro a c h to

pro viding pa tie nt-c e nte re d c o ntra c e ptive c a re

• While IUDs a nd impla nts a re g o o d, hig hly e ffe c tive

me tho ds, pro vide rs sho uld no t a ssume the y a re b e st fo r e ve ryo ne

• Appro a c he s to o ptimize wo me n’ s re pro duc tive he a lth

c a re inc lude using Be dside r.o rg , e duc a ting a b o ut Zika , a nd e nsuring a ppro pria te use o f pe rfo rma nc e me a sure s

Re fe re nc e s

• Aike n AR, Bo rre ro S, Ca lle g a ri L

S, De hle ndo rf C. Re thinking the Pre g na nc y Pla nning Pa ra dig m: Uninte nde d Co nc e ptio ns o r Unre pre se nta tive Co nc e pts? Pe rspe c t Se x Re pro d He a lth 2016;48:147-51

• Curtis K

M, T e ppe r NK , Ja tla o ui T C, e t a l. U.S. Me dic a l E lig ibility Crite ria fo r Co ntra c e ptive Use , 2016. MMWR Re c o mm Re p 2016;65:1-103.

• De hle ndo rf C, Ga vin L

, Mo sko sky S. Pro viding fa mily pla nning c a re in the c o nte xt o f Zika : a to o lkit fo r pro vide rs fro m the US Offic e o f Po pula tio n Affa irs. Co ntra c e ptio n 2017;95:1-4.

• De hle ndo rf C, K

ra je wski C, Bo rre ro S. Co ntra c e ptive c o unse ling : b e st pra c tic e s to e nsure q ua lity c o mmunic a tio n a nd e na b le e ffe c tive c o ntra c e ptive use . Clin Ob ste t Gyne c o l 2014;57:659-73.

• De hle ndo rf C, He nde rso n JT

, Vitting ho ff E , e t a l. Asso c ia tio n o f the q ua lity o f inte rpe rso na l c a re during fa mily pla nning c o unse ling with c o ntra c e ptive use . Am J Ob ste t Gyne c o l 2016;215:78 e 1-9.

• Hig g ins JA. Ce le b ra tio n me e ts c a utio n: L

ARC's b o o ns, po te ntia l b usts, a nd the b e ne fits o f a re pro duc tive justic e a ppro a c h. Co ntra c e ptio n 2014;89:237-41.

• www.fpntc .o rg fo r the Zika to o lkit