Jatlaoui Tara C, Zapata Lauren B, Curtis Kathryn M, Folger Suzanne G, Marchbanks Polly A, Mandel Michele G, Jamieson Denise J
Division of Reproductive Health, Centers for Disease Control and Prevention , Atlanta, Georgia .
J Womens Health (Larchmt). 2017 Aug;26(8):870-877. doi: 10.1089/jwh.2016.5930. Epub 2017 Jan 31.
Whether providers who regularly provide family planning services consider contraceptive methods as unsafe for women with obesity is unknown.
We analyzed questionnaire responses received from December 2009 to March 2010 from 635 office-based physicians and 1323 Title X clinic providers delivering family planning services, who were randomly sampled (response rate 65%) before the release of national evidence-based contraception guidelines. We examined provider and clinical setting characteristics and clinic patient demographics for association with provider misconceptions about safety of combined oral contraceptives (COCs), depot medroxyprogesterone acetate (DMPA), or intrauterine devices (IUDs) for women with obesity. If providers considered methods as unsafe or do not know, we categorized those responses as misconceptions. We used multivariable logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
A substantial proportion of respondents had misconceptions about the safety of COCs (31%), DMPA (24%), copper (Cu) (18%), and levonorgestrel (LNG)-IUDs (16%) for women with obesity. Provider type was associated with increased odds of misconceptions for all four methods compared with office-based obstetrician/gynecologists. Not having the method available onsite was associated with safety misconceptions of DMPA (aOR 1.90, 95% CI 1.07-3.36), Cu-IUD (aOR 4.19, 95% CI 1.51-11.61), and LNG-IUD (aOR 5.25, 95% CI 1.67-16.49).
While the majority of providers considered all four contraceptive methods safe for women with obesity, substantial proportions had misconceptions about safety of COCs, DMPA, and IUDs. Provider education, particularly among certain specialties, is needed to increase knowledge regarding moderate and highly effective contraceptive methods among this patient population.
定期提供计划生育服务的医疗服务提供者是否认为避孕方法对肥胖女性不安全尚不清楚。
我们分析了2009年12月至2010年3月期间从635名提供计划生育服务的门诊医生和1323名第十类诊所提供者收到的问卷回复，这些提供者是在国家循证避孕指南发布之前随机抽样的（回复率65%）。我们研究了医疗服务提供者和临床环境特征以及诊所患者人口统计学特征，以确定与医疗服务提供者对肥胖女性使用复方口服避孕药（COC）、醋酸甲羟孕酮长效避孕针（DMPA）或宫内节育器（IUD）安全性的误解之间的关联。如果医疗服务提供者认为这些方法不安全或表示不知道，我们将这些回复归类为误解。我们使用多变量逻辑回归来估计调整后的优势比（aOR）和95%置信区间（CI）。
很大一部分受访者对肥胖女性使用COC（31%）、DMPA（24%）、铜（Cu）（18%）和左炔诺孕酮（LNG）-IUD（16%）的安全性存在误解。与门诊妇产科医生相比，医疗服务提供者类型与所有四种方法的误解几率增加有关。现场没有某种方法与DMPA（aOR 1.90，95%CI 1.07-3.36）、Cu-IUD（aOR 4.19，95%CI 1.51-11.61）和LNG-IUD（aOR 5.25，95%CI 1.67-16.49）的安全性误解有关。
虽然大多数医疗服务提供者认为所有四种避孕方法对肥胖女性都是安全的，但仍有很大比例的人对COC、DMPA和IUD的安全性存在误解。需要对医疗服务提供者进行教育，特别是在某些专业领域，以增加该患者群体对中度和高效避孕方法的了解。
