Kim Taehyun, Steinberg Julia R, Boudreaux Michel
University of Wisconsin-Madison, School of Medicine and Public Health, Collaborative of Reproductive Equity, Madison, WI, United States.
University of Maryland School of Public Health, Department of Family Science, College Park, MD, United States.
Contraception. 2025 Apr;144:110814. doi: 10.1016/j.contraception.2025.110814. Epub 2025 Jan 16.
To examine changes in contraceptive use, access, and care experiences during a statewide contraceptive access initiative, Delaware Contraceptive Access Now.
We used responses from the Delaware/Maryland Survey of Women at the early wave (November, 2016-March, 2017) and late wave (February, 2021-October, 2021). Our cross-sectional sample included 6467 respondents at risk of unintended pregnancy. We used logistic regression to examine changes in contraceptive outcomes, controlling for age, race/ethnicity, income, education, marital status, and employment. Using interaction terms between state and survey wave, we compared population-level changes in outcomes in Delaware to changes in Maryland, which did not implement a similar contraceptive initiative.
The change in long-acting reversible contraceptive (LARC) use in Delaware compared to Maryland was estimated as a 2.8% point increase, but was not statistically significant (95% CI: -2.8, 8.3). Knowing where to get free LARC increased by 6.2% points (95% CI: 0.4, 12.1; p < 0.05) in Delaware compared to Maryland. Both Delaware and Maryland indicated substantial within-state decreases in reporting their doctor asked about plans for pregnancy (Delaware: -8.9% points; Maryland: -15.1% points), but the decrease in Delaware was significantly smaller: 5.6% points (95% CI: -0.9, 12.1; p < 0.1). Delaware also had a net decrease of 4.7% points (95% CI: -9.9, 0.5; p < 0.1), compared to Maryland, among those very or somewhat satisfied with their current method.
We observed a mixed picture of changes in contraceptive use, access, and care experiences during the program. Our findings will be useful to Delaware program administrators and others, including the federal government, as they adopt similar reforms.
We found that the Delaware contraceptive access initiative substantially increased knowledge of free LARC access and led to a relative increase in respondents reporting they had been asked about their pregnancy plans, compared to Maryland, but was not associated with other outcomes.
研究在全州范围内开展的一项避孕服务可及性倡议活动——“特拉华州立即实现避孕服务可及性”期间，避孕措施的使用、获取情况及护理体验的变化。
我们采用了特拉华州/马里兰州女性调查早期阶段（2016年11月至2017年3月）和后期阶段（2021年2月至2021年10月）的回复。我们的横断面样本包括6467名有意外怀孕风险的受访者。我们使用逻辑回归分析来研究避孕结果的变化，并对年龄、种族/族裔、收入、教育程度、婚姻状况和就业情况进行了控制。通过州与调查阶段之间的交互项，我们将特拉华州的结果变化与未实施类似避孕倡议的马里兰州的变化进行了比较。
与马里兰州相比，特拉华州长效可逆避孕法（LARC）使用的变化估计增加了2.8个百分点，但无统计学意义（95%置信区间：-2.8，8.3）。与马里兰州相比，特拉华州知道何处可免费获取LARC的比例增加了6.2个百分点（95%置信区间：0.4，12.1；p<0.05）。特拉华州和马里兰州都表示，报告医生询问其怀孕计划的比例在州内均大幅下降（特拉华州：-8.9个百分点；马里兰州：-15.1个百分点），但特拉华州的下降幅度明显较小：5.6个百分点（95%置信区间：-0.9，12.1；p<0.1）。与马里兰州相比，特拉华州对当前避孕方法非常或有点满意的人群中，净下降了4.7个百分点（95%置信区间：-9.9，0.5；p<0.1）。
我们观察到该项目期间避孕措施的使用、获取情况及护理体验的变化情况喜忧参半。我们的研究结果对特拉华州项目管理人员及其他方面（包括联邦政府）在采用类似改革措施时将有所帮助。
我们发现，与马里兰州相比，特拉华州的避孕服务可及性倡议大幅提高了对免费获取LARC的知晓率，并导致报告被询问怀孕计划的受访者相对增加，但与其他结果无关。
