Women’s preferences for public versus private birth control services

Nearly 40 percent of women in developing countries seek birth control from the private sector. However, the reasons that women choose private or public providers are not well understood. In a new study, UCSF Bixby Center researchers examined women’s expectations and experiences when seeking family planning care from private and public facilities in Nairobi, Kenya. Through interviews and group discussions, the researchers explored women's decision-making about contraceptive use after giving birth. They found that women:

  • Preferred private over public facilities due to convenience and faster service. They avoided public facilities due to long wait times./li>
  • Believed that private facilities treated their customers with care and attention compared with public facilities, where participants experienced verbal harassment, inattention and rudeness.
  • Reported that they felt more confident about the quality of medical care in public facilities than in private, and believed that private providers prioritized profit over safe medical care.
  • Reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-making support.

As an increasing number of women in urban areas worldwide rely on private sector health providers, these private facilities can continue to attract clients with respectful care and efficient of service. However, private providers may need assistance with technical standards of care. Public facilities, on the other hand, can improve patient care by enhancing interpersonal relationships and efficiency. These findings are also relevant to the Family Planning 2020 goal of enabling 120 million more women and girls to use contraceptives by 2020.


Making a one-year supply of birth control a national standard

A group of federal lawmakers recently sent a letter to the Department of Health & Human Services (HHS) urging the agency to require health insurance plans to cover a 12-month supply of birth control without out-of-pocket costs. The letter cites a UCSF Bixby Center study that found a 12-month supply of birth control decreased unplanned pregnancies by 30 percent, compared with a supply of just one or three months. The study also found that giving women a one-year supply of birth control reduced the odds of an abortion by 46 percent.

Many insurance plans limit birth control prescriptions to one or three months. “If a woman is unable to refill her prescription at the time her insurance company requires, she may have a gap in her birth control use and her chanes of unintended pregnancy will increase,” the lawmakers wrote in the letter. "This is of particular concern for low- and middle-income women who may have unpredictable work hours, difficulty accessing transportation, or other barriers preventing them from getting to a pharmacy.”

The Centers for Disease Control and Prevention (CDC) and Office of Population Affairs (OPA) both advise health care providers to give women multiple cycles of birth control, ideally a year, to help reduce such gaps. Both Oregon and the District of Columbia recently passed laws ensuring residents have access to a one-year supply of birth control.


Postpartum birth control reduces subsequent preterm births

Preterm birth--or birth before 37 weeks’ gestation--is a significant cause of newborn illness and death around the world. Each year, more than one million infants die from complications of preterm birth, and those who survive often face long-term health effects. There are many causes of preterm birth, and preventing it is a major public health challenge.

UCSF Bixby Center researchers examined if contraceptive services can help reduce rates of preterm birth for women's subsequent pregnancies. They looked at public health records in California to see whether women received contraceptive services within 18 months after giving birth. Contraceptive services were provided by publicly funded programs, such as Medi-Cal and Family PACT. The researchers found that:

  • Of the more than 100,000 women in the study, 9.8% had a subsequent pregnancy with a preterm birth.
  • For every month a woman used postpartum contraception, her odds of a subsequent preterm birth decreased by 1.1%.

Providing women with access to contraceptive services reduces rates of preterm birth. Publicly funded contraceptive programs are key to improving maternal and newborn health. To help reduce preterm birth worldwide, increasing access to high-quality contraceptive services would be an effective primary prevention strategy.


New online training in IUDs and implants

UCSF Bixby Center has launched a free online training, An Update on Long-Acting Reversible Contraception. The training is a primer on IUDs and the contraceptive implant, and is suitable for all types of healthcare providers and support staff. This one-hour course is self-paced with videos, case studies and interactive quizzes.

The training features real world providers who guide learners through all steps of offering IUD and implant services, from the first phone call to follow-up. The course helps all clinic staff to integrate IUDs and implants into routine contraceptive care, and provides resources for many facets of this integration. Clinicians taking the course will receive continuing medical education credit from the the University of California, San Francisco.

Here is what people are saying about the course:

“I loved this training. We train health educators and this is an excellent resource for them.”
— Peer health education training coordinator, FL

“Very good overview and the information was accurate. I liked the approach of hearing from multiple health care providers.”
— Registered nurse, Washington, DC

To access the course, register at bixbycenter.digitalchalk.com, then go to the Catalog tab in the upper right. Select "An update on long-acting reversible contraception" and add it to your cart. Then click on the checkout icon at the top of the screen. Please contact the Online Training Coordinator with any questions.


How providers can help pregnant workers get medically necessary accommodations

When a woman needs to request medical leave or a change in her job duties due to a pregnancy, her obstetrician or other prenatal care provider can help her by writing a letter to her employer.  Yet there is little guidance for healthcare providers to write such notes, and some notes have been used to fire pregnant women. In a new commentary, a UCSF Bixby Center and UC Hastings working group offers guidance to help providers write work accommodation letters. The commentary also provides an overview of current federal and state laws meant to protect pregnant workers.

They note that a correctly written letter will help pregnant women protect their rights, keeping their jobs while maintaining a healthy pregnancy. “Writing a precise, informed and thoughtful note can help a patient continue to work during pregnancy as well as keep her job and health benefits after delivery.” Healthcare providers can also “advocate for more comprehensive laws that protect pregnant workers such as the Pregnant Worker's Fairness Act to ensure [women's] ability to both support their families and have healthy pregnancies.”