Celia Hubert

Unmet demand for highly effective postpartum contraception in Texas

OBJECTIVES We aimed to assess womens contraceptive preferences and use in the first 6 months after delivery. The postpartum period represents a key opportunity for women to learn about and obtain effective contraception, especially since 50% of unintended pregnancies to parous women occur within 2 years of a previous birth. METHODS We conducted a prospective cohort study of 800 postpartum women recruited from three hospitals in Austin and El Paso, TX. Women aged 18-44 who wanted to delay childbearing for at least 24 months were eligible for the study and completed interviews following delivery and at 3 and 6 months postpartum. Participants were asked about the contraceptive method they were currently using and the method they would prefer to use at 6 months after delivery. RESULTS At 6 months postpartum, 13% of women were using an intrauterine device or implant, and 17% were sterilized or had a partner who had had a vasectomy. Twenty-four percent were using hormonal methods, and 45% relied on less effective methods, mainly condoms and withdrawal. Yet 44% reported that they would prefer to be using sterilization, and 34% would prefer to be using long-acting reversible contraception (LARC). CONCLUSIONS This study shows a considerable preference for LARC and permanent methods at 6 months postpartum. However, there is a marked discordance between womens method preference and actual use, indicating substantial unmet demand for highly effective methods of contraception. IMPLICATIONS In two Texas cities, many more women preferred long-acting and permanent contraceptive methods (LAPM) than were able to access these methods at 6 months postpartum. Womens contraceptive needs could be better met by counseling about all methods, by reducing cost barriers and by making LAPM available at more sites.

The Impact of Reproductive Health Legislation on Family Planning Clinic Services in Texas

We examined the impact of legislation in Texas that dramatically cut and restricted participation in the states family planning program in 2011 using surveys and interviews with leaders at organizations that received family planning funding. Overall, 25% of family planning clinics in Texas closed. In 2011, 71% of organizations widely offered long-acting reversible contraception; in 2012-2013, only 46% did so. Organizations served 54% fewer clients than they had in the previous period. Specialized family planning providers, which were the targets of the legislation, experienced the largest reductions in services, but other agencies were also adversely affected. The Texas experience provides valuable insight into the potential effects that legislation proposed in other states may have on low-income womens access to family planning services.

Barriers to Postpartum Contraception in Texas and Pregnancy Within 2 Years of Delivery.

OBJECTIVE: To assess pregnancies that could have been averted through improved access to contraceptive methods in the 2 years after delivery. METHODS: In this cohort study, we interviewed 403 postpartum women in a hospital in Austin, Texas, who wanted to delay childbearing for at least 2 years. Follow-up interviews were completed at 3, 6, 9, 12, 18, and 24 months after delivery; retention at 24 months was 83%. At each interview, participants reported their pregnancy status and contraceptive method. At the 3- and 6-month interviews, participants were also asked about their preferred contraceptive method 3 months in the future. We identified types of barriers among women unable to access their preferred method and used Cox models to analyze the risk of pregnancy from 6 to 24 months after delivery. RESULTS: Among women interviewed 6 months postpartum (n=377), two thirds had experienced a barrier to accessing their preferred method of contraception. By 24 months postpartum, 89 women had reported a pregnancy; 71 were unintended. Between 6 and 24 months postpartum, 77 of 377 women became pregnant (20.4%), with 56 (14.9%) lost to follow-up. Women who encountered a barrier to obtaining their preferred method were more likely to become pregnant less than 24 months after delivery. They had a cumulative risk of pregnancy of 34% (95% confidence interval [CI] 0.25–0.43) as compared with 12% (95% CI 0.05–0.18) for women with no barrier. All but three of the women reporting an unintended pregnancy had earlier expressed interest in using long-acting reversible contraception or a permanent method. CONCLUSION: In this study, most unintended pregnancies less than 24 months after delivery could have been prevented or postponed had women been able to access their desired long-acting and permanent methods.

Desigualdades de oportunidades educacionais dos adolescentes no Brasil e no México

The aim of this paper is to examine recent trends in educational stratification for adolescents in Brazil and in Mexico in three distinct periods: the 1980s, years of severe recession, the 1990s, a period of structural adjustment, and the 2000s, a decade of growth. In addition to school enrollment and educational transitions, we also examined enrollment in private schools, an important aspect of educational inequality rarely addressed in studies on this topic. We used nationally representative data from the PNAD for Brazil and ENIGH for Mexico. Our findings confirm the significant benefits brought by recent improved conditions of universal primary education, but also identify increasing disadvantages associated with access to private schools, suggesting the importance of the EMI perspective (Effectively Maintained Inequality). The study emphasizes the importance of examining the quality in addition to the quantity of formal education for a deeper understanding of educational stratification in both Brazil and Mexico.

Perceived Interest in Vasectomy among Latina Women and their Partners in a Community with Limited Access to Female Sterilization

The low prevalence of vasectomy among Latino men in the United States is often attributed to cultural characteristics despite limited evidence supporting this hypothesis. We assessed male partners’ perceived willingness to undergo vasectomy through surveys with 470 Mexican-origin women who did not want more children in El Paso, Texas. Overall, 32% of women reported that their partner would be interested in getting a vasectomy. In multivariable analysis, completing high school (OR=2.03 [1.05, 3.95]), having some college education (OR=2.97 [1.36, 6.48]) or receiving US government assistance (OR=1.95 [1.1, 3.45]) was associated with partners’ perceived interest. Additionally, we conducted two focus groups on men’s knowledge and attitudes about vasectomy with partners of a subsample of these women. Despite some misperceptions, male partners were willing to get a vasectomy, but were concerned about cost and taking time off work to recover. Health education and affordable vasectomy services could increase vasectomy use among Mexican-origin men.

Community College Students Want to Use More Effective Birth Control Methods But Can’t Always Get What They Want

Female community college students who have a child while in college are 65% more likely to drop out than those who don’t. This brief, from researchers with the Texas Policy Evaluation Project, shows that a large percentage of community college students want to use more effective contraceptive methods, but many aren’t using them, often due to access barriers. Several strategies are recommended to help community college students have children when they are ready for them, thus improving their chances of successfully completing college.

Unmet Demand for Short-Acting Hormonal and Long-Acting Reversible Contraception among Community College Students in Texas.

ABSTRACT Objective: To identify preferences for and use of short-acting hormonal (e.g., oral contraceptives, injectable contraception) or long-acting reversible contraception (LARC) among community college students in Texas. Participants: Female community college students, ages 18 to 24, at risk of pregnancy, sampled in Fall 2014 or Spring 2015 (N = 966). Methods: We assessed characteristics associated with preference for and use of short-acting hormonal or LARC methods (i.e., more-effective contraception). Results: 47% preferred short-acting hormonal methods and 21% preferred LARC, compared to 21% and 9%, respectively, who used these methods. A total of 63% of condom and withdrawal users and 78% of nonusers preferred a more effective method. Many noted cost and insurance barriers as reasons for not using their preferred more-effective method. Conclusions: Many young women in this sample who relied on less-effective methods preferred to use more-effective contraception. Reducing barriers could lead to higher uptake in this population at high risk of unintended pregnancy.

Desigualdad en las oportunidades educacionales de los adolescentes en Brasil y México

The aim of this paper is to examine recent trends in educational stratification for adolescents in Brazil and in Mexico in three distinct periods: the 1980s, years of severe recession, the 1990s, a period of structural adjustment, and the 2000s, a decade of growth. In addition to school enrollment and educational transitions, we also examined enrollment in private schools, an important aspect of educational inequality rarely addressed in studies on this topic. We used nationally representative data from the PNAD for Brazil and ENIGH for Mexico. Our findings confirm the significant benefits brought by recent improved conditions of universal primary education, but also identify increasing disadvantages associated with access to private schools, suggesting the importance of the EMI perspective (Effectively Maintained Inequality). The study emphasizes the importance of examining the quality in addition to the quantity of formal education for a deeper understanding of educational stratification in both Brazil and Mexico.

Inequalities in educational opportunities of adolescents in Brazil and Mexico

The aim of this paper is to examine recent trends in educational stratification for adolescents in Brazil and in Mexico in three distinct periods: the 1980s, years of severe recession, the 1990s, a period of structural adjustment, and the 2000s, a decade of growth. In addition to school enrollment and educational transitions, we also examined enrollment in private schools, an important aspect of educational inequality rarely addressed in studies on this topic. We used nationally representative data from the PNAD for Brazil and ENIGH for Mexico. Our findings confirm the significant benefits brought by recent improved conditions of universal primary education, but also identify increasing disadvantages associated with access to private schools, suggesting the importance of the EMI perspective (Effectively Maintained Inequality). The study emphasizes the importance of examining the quality in addition to the quantity of formal education for a deeper understanding of educational stratification in both Brazil and Mexico.