Oral Emergency Contraception Provision in the Veterans Health Administration: a Retrospective Cohort Study

• Published in: Journal of general internal medicine : JGIM Vol. 37; no. Suppl 3; pp. 685 - 689
• Main Authors: Gawron, Lori M., He, Tao, Lewis, Lacey, Fudin, Hannah, Callegari, Lisa S., Turok, David K., Stevens, Vanessa
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-09-2022; Springer Nature B.V
• Subjects: Acetic acid; Birth control; Cohort analysis; Contraception; Effectiveness; Health care facilities; Internal Medicine; Medicine; Medicine & Public Health; Military personnel; Minority & ethnic groups; Original Research; Pregnancy; Prescriptions; Regression analysis; Regression models; Veterans; unintended pregnancy; Female veterans; Emergency contraception
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-022-07596-0

ABSTRACT
Background
In the USA, oral emergency contraception (EC) use to prevent unintended pregnancy is increasing. Oral EC methods include levonorgestrel (LNG) and ulipristal acetate (UPA), with increased UPA efficacy over LNG in high BMI users and those beyond 3 days post intercourse. The Veterans Health Administration (VHA) provides oral EC at low or no cost, yet prescription-level Veteran data are lacking.
Objective
To describe oral EC provision in VHA, including method type and Veteran user and prescriber characteristics.
Design
A retrospective cohort study using VHA administrative data.
Participants
All VHA oral EC prescriptions from January 1, 2016, to December 31, 2020.
Main Measures
We linked Veteran-level sociodemographic and military characteristics and provider-level data with each prescription to identify variables associated with oral EC method.
Key Results
A total of 4280 EC prescriptions (85% LNG) occurred for 3120 unique Veterans over 5 years. While prescriptions remained low annually, the proportion of UPA prescriptions increased from 12 to 19%. Compared to LNG users, UPA users were older (34% vs 25% over age 35 years,
p
<0.001); more likely to identify as white (57% vs 46%) and non-Hispanic (84% vs 79%) (
p
<0.001); and more likely to have a BMI ≥ 25 (76% vs 67%,
p
<0.001). UPA prescriptions originated most frequently from VA Medical Centers (87%) and women’s health clinics (76%) compared to community-based or other clinic types. In multivariable regression models, race, ethnicity, BMI ≥30, and prescriber facility type of a VA Medical Center or a women’s clinic location were predictive of UPA prescription.
Conclusions
Oral EC provision in VHA remains low, but UPA use is increasing. LNG prescription occurs frequently in high BMI Veterans who would benefit from increased efficacy of UPA. Interventions to expand oral EC access in VHA are essential to ensure Veterans’ ability to avert unwanted pregnancies.