Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-74, Chamblee, Georgia 30341-3717.
Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-74, Chamblee, Georgia 30341-3717; Oak Ridge Institute for Science and Education (ORISE), 1299 Bethel Valley Road, Oak Ridge, TN 37830.
Contraception. 2019 Nov;100(5):413-419. doi: 10.1016/j.contraception.2019.07.142. Epub 2019 Jul 29.
The US Medical Eligibility Criteria for Contraceptive Use (USMEC) is the first national guidance containing evidence-based recommendations for contraception. We describe provider attitudes about contraceptive safety before and after the 2010 USMEC release.
We conducted two cross-sectional mailed surveys using different nationwide samples of office-based physicians and Title X clinic providers before (2009-2010) and after (2013-2014) the USMEC release. We compared the proportion of providers reporting select contraceptive methods as safe for women with specific characteristics or medical conditions before and after the USMEC release and conducted multivariable logistic regression to adjust for provider characteristics.
For the following select characteristics for which the USMEC classifies specific contraceptive methods as safe (Category 1 or 2), a significantly (p<.05) higher proportion of providers reported the method safe after versus before the USMEC release: intrauterine devices (IUDs) for adolescents (79.8% versus 60.2%), IUDs for women with HIV (72.4% versus 50.6%), depot medroxyprogesterone acetate (DMPA) for women with obesity (89.5% versus 76.1%), and DMPA for women with history of bariatric surgery (87.6% versus 73.9%). These differences remained significant after adjustment for provider characteristics.
While we observed many positive changes in health care provider attitudes related to contraception safety after the USMEC release, gaps remain. Continuing education and evidence-based training for providers, and ensuring office and health center protocols address medical eligibility for contraception for the full range of characteristics included in the USMEC might bridge remaining gaps and increase delivery of high-quality contraception care.
Gaps between evidence and provider attitudes remain that can inform future efforts to improve contraceptive service delivery.
美国生育控制合格标准（USMEC）是首个包含避孕循证建议的全国性指导。我们描述了在 2010 年 USMEC 发布前后，提供者对避孕安全性的态度。
我们在 USMEC 发布前后（2009-2010 年和 2013-2014 年）使用不同的全国性医生和 Title X 诊所提供者的两个横断面邮寄调查，比较了在 USMEC 发布前后报告特定特征或医疗条件下特定避孕方法安全的提供者比例，并进行多变量逻辑回归以调整提供者特征。
对于 USMEC 将特定避孕方法分类为安全的以下特定特征（类别 1 或 2），提供者报告该方法安全的比例在 USMEC 发布后显著（p<.05）高于发布前：青少年宫内节育器（IUD）（79.8% 对 60.2%），HIV 女性的 IUD（72.4% 对 50.6%），肥胖女性的 depot 醋酸甲羟孕酮（DMPA）（89.5% 对 76.1%）和有减重手术史的女性的 DMPA（87.6% 对 73.9%）。在调整提供者特征后，这些差异仍然显著。
虽然我们在 USMEC 发布后观察到与避孕安全性相关的医疗保健提供者态度发生了许多积极变化，但差距仍然存在。继续为提供者提供继续教育和基于证据的培训，并确保办公室和健康中心的协议涵盖 USMEC 中包含的所有特征的生育控制合格标准，可能会缩小剩余差距并增加高质量避孕护理的提供。
证据与提供者态度之间仍然存在差距，可以为未来改善避孕服务提供信息。
