Increasing access to single-visit contraception in urban health care settings: Findings from a multi-site learning collaborative.

OBJECTIVES: Multiple barriers limit access to the full range of contraceptive options. The purpose of this quality improvement initiative was to increase single-visit access to the full range of contraceptive methods in primary care, postabortion, and immediate postpartum settings in New York City (NYC). STUDY DESIGN: From 2015 to 2018 we convened 2 learning collaboratives, named the Quality Improvement Network for Contraceptive Access, with 17 teams (representing 40 sites) from New York City-based hospitals and health centers using an adaptation of the Institute for Healthcare Improvement's Breakthrough Series Learning Collaborative model. Participating teams sought to implement evidence-informed recommendations to increase access. The goal was to increase the patient-centeredness of services by reducing barriers. In the absence of a way to directly measure access, we measured progress toward implementation of the 4 recommendations and contraceptive care utilization measures as proxies for access, and asked teams to describe facilitating factors. RESULTS: Learning collaborative teams successfully implemented all 4 of the recommendations in 95% of the participating sites. Patients who chose and received a most or moderately effective method increased from 22% to 38% in primary care, and from 0% to 17% in the immediate postpartum period. Patients who chose and received a long-acting-reversible contraceptive increased from 5% to 11% in primary care, and from 0% to 3% in immediate postpartum. Facilitating factors included the involvement of interdisciplinary teams, consideration of costs, utilization of peers to demonstrate change, and champions to drive change. CONCLUSIONS: The application of evidence-informed recommendations using a structured quality improvement initiative increases contraceptive access. IMPLICATIONS: This paper identifies key facilitators and factors that influenced the successful implementation of evidence-based recommendations for access to the full range of contraceptive methods in primary care, postabortion, and immediate postpartum settings. Findings can inform future initiatives that seek to increase contraceptive access at the service delivery level, as a component of reproductive autonomy, and contraceptive equity.

Early age of first sex and health risk in an urban adolescent population.

BACKGROUND: Early sex is associated with high-risk behaviors and outcomes, including sexual risk behaviors, forced sex, physical dating violence, and becoming pregnant or impregnating someone. METHODS: Using 2005 and 2007 data from the New York City Youth Risk Behavior Survey (N = 17,220), this study examined the prevalence of early sex among public high school students; associations between early sex and other sexual risk factors and violence indicators; and whether associations varied across 4 racial/ethnic groups. Bivariate and multiple logistic regression models estimated the relationship between sexual risk and violence outcomes and "early sex," defined as first having sexual intercourse before age 14. Separate models with an interaction term for early sex by race/ethnicity were also estimated. RESULTS: More than one third of students who ever had sex reported having early sex. Adolescents reporting early sex were significantly more likely than those reporting later sex to engage in most sexual risk behaviors and to experience violence. The magnitude of association varied significantly by race/ethnicity for sexual risk behaviors. CONCLUSIONS: The high prevalence of early sex, coupled with its associated high-risk behaviors and outcomes, underscores the necessity of implementing evidence-based interventions that have been found to positively impact these behaviors beginning in middle school.

Marketing breastfeeding--reversing corporate influence on infant feeding practices.

Breast milk is the gold standard for infant nutrition and the only necessary food for the first 6 months of an infant's life. Infant formula is deficient and inferior to breast milk in meeting infants' nutritional needs. The infant formula industry has contributed to low rates of breastfeeding through various methods of marketing and advertising infant formula. Today, in New York City, although the majority of mothers initiate breastfeeding (approximately 85%), a minority of infants is breastfed exclusively at 8 weeks postpartum (approximately 25%). The article reviews the practices of the formula industry and the impact of these practices. It then presents the strategic approach taken by the NYC Department of Health and Mental Hygiene and its partners to change hospital practices and educate health care providers and the public on the benefits of breast milk, and provides lessons learned from these efforts to make breastfeeding the normative and usual method of infant feeding in New York City.