University of Kansas Medical School, Kansas City, Kansas.
Department of Preventive Medicine and Public Health, University of Kansas Medical School, Kansas City, Kansas.
J Rural Health. 2018 Mar;34(2):132-137. doi: 10.1111/jrh.12243. Epub 2017 Apr 11.
Unintended pregnancy persists as a public health problem in the United States. Local health departments (LHDs) could play an important role in preventing unintended pregnancy by promoting and providing long-acting reversible contraception (LARC, intrauterine devices [IUDs] and implants), particularly in rural states that may lack robust family planning service infrastructure. The objective of this study was to determine availability of LARC in LHDs in Kansas.
From October 2015 to January 2016, LHD administrators in Kansas were contacted to participate in a structured, cross-sectional phone survey assessing LARC availability, staff trained to place LARC, the process for obtaining LARC, and barriers to offering LARC. The main outcome measure was the proportion of Kansas LHDs offering LARC.
Of 101 eligible LHDs, staff from 98 agreed to be interviewed (97.0%). Of 69.4% providing family planning services, 20.6% provided LARC (20.6% provided IUDs, 11.8% provided implants and IUDs, and none provided implants only). Overall, only 29.4% of LHDs reported discussing contraception routinely regardless of reason for visit. Rural health departments were less likely to offer testing for sexually transmitted infections and LARCs and less likely to have trained staff on site to insert LARCs when compared to nonrural LHDs.
LARC methods are not commonly available in Kansas LHDs. Small LHDs in a rural state like Kansas could benefit from increased capacity to provide LARC to populations with limited access to health care. An increase in funding to prevent unintended pregnancy through expanded LARC access could result in substantial state savings and lead to fewer unintended pregnancies.
在美国，意外怀孕仍是一个公共卫生问题。地方卫生部门（LHD）可以通过推广和提供长效可逆避孕措施（LARC，宫内节育器[IUD]和植入物），在预防意外怀孕方面发挥重要作用，特别是在可能缺乏健全计划生育服务基础设施的农村州。本研究的目的是确定堪萨斯州 LHD 提供 LARC 的情况。
从 2015 年 10 月到 2016 年 1 月，联系堪萨斯州的 LHD 管理人员参加一项结构化的横断面电话调查，评估 LARC 的可用性、培训放置 LARC 的工作人员、获得 LARC 的流程以及提供 LARC 的障碍。主要结局指标是提供 LARC 的堪萨斯州 LHD 的比例。
在 101 个符合条件的 LHD 中，有 98 个 LHD 的工作人员同意接受采访（97.0%）。在提供计划生育服务的 69.4%中，有 20.6%提供 LARC（20.6%提供 IUD，11.8%提供植入物和 IUD，没有提供植入物）。总体而言，只有 29.4%的 LHD 报告无论就诊原因如何，都会常规讨论避孕措施。与非农村 LHD 相比，农村卫生部门提供性传播感染和 LARC 检测的可能性较低，现场有培训人员插入 LARC 的可能性也较低。
堪萨斯州的 LHD 中通常不提供 LARC 方法。堪萨斯州等农村小州的 LHD 可以从增加向医疗服务有限的人群提供 LARC 的能力中受益。通过扩大 LARC 获得途径增加资金以防止意外怀孕，可以为各州节省大量资金，并减少意外怀孕。
