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Highly Effective Reversible Contraception Initiative - Salt Lake: A prospective cohort examining the social and economic impact of removing cost barriers to intrauterine devices and contraceptive implants

David Turok, MD, University of Utah

Project abstract

Although popularity of highly effective reversible contraception (HERC) in the U.S. is steadily increasing, less than 10% of contracepting women use intrauterine devices (IUDs) or implants. Supporting use of HERC methods through contraceptive counseling and removing cost barriers can reduce community-wide rates of unintended pregnancy.

The main objectives of this large-scale project are:

  1. to assess changes HERC uptake from baseline in Salt Lake County, Utah (an environment with limited Medicaid coverage and no family planning waiver) at four participating clinics and in the community overall during three time periods: #1–the introduction of shared decision making; #2–removal of financial barriers to all contraception; and #3–a targeted media campaign to increase awareness and positive regard for IUDs and implants that directs women to clinics offering free contraception; and
  2. to prospectively assess educational attainment and economic advancement to create a model of projected earning potential among women initiating highly effective vs. other methods of contraception.

Novel aspects of this proposal include:

  1. using clinics that provide same day HERC device insertion, have a known historical baseline for HERC use, and have experience in conducting research;
  2. utilizing a shared decision making model of contraceptive counseling rather than relying on effectiveness approaches alone; and
  3. the unique ability to link study participants to administrative data on long-term economic information.

SFP support for this proposal is requested only for the project’s 18-month period to establish the prospective cohort.


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