- Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
What is the comparative effectiveness of medical and surgical methods to prevent unintended pregnancy in women?
- Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)
yes
- If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
-Long-acting reversible contraception (LARC), such as intrauterine devices, implantable devices, injectables -Other forms of pharmacologic contraception, such as oral contraceptives, rings, patches -Surgical contraception, such as tubal ligation, Essure, vasectomy -Barrier methods, such as condom, diaphragm
- What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)
Women of reproductive age
- Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)
Female adolescents Women >35
- Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)
- improved family planning and decisionmaking
- decrease health risks to women
- improved resource utilization
- reducing unintended or mistimed pregnancy
- improvements in contraceptive adherence
- reduce late entry into prenatal care
- Describe any health-related risks, side effects, or harms that you are concerned about.
Risks of using birth control methods:
- Surgical – such as surgical complications, irreversibility
- Medical – such as thrombolic events, weight gain, irregular bleeding, bone loss, depression and mood disorders
Appropriateness for EHC Program
- Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?
yes
- Which priority area(s) and population(s) does this topic apply to? (check all that apply)
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- EHC Priority Conditions (updated in 2008)
- Pregnancy, including preterm birth
- AHRQ Priority Populations
- Women
- Federal Health Care Program
- Medicaid
Importance
- Describe why this topic is important.
- Unintended pregnancies account for nearly 50% of all pregnancies in the US including mistimed, unplanned, unintended and unwanted pregnancy (burden of disease)
- In 2011, the Institute of Medicine recommended: a fuller range of contraceptive education, counseling, methods, and services so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes
- Uncertainty regarding the most effective approach to reducing the number of unintended pregnancies
- To increase the proportion of pregnancies that are intended
- What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)
This question was prioritized by stakeholders engaged in the Topic Identification project conducted by the Oregon Evidence-based Practice Center on “Prevention in Women’s Health.”
- Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)
yes
- If yes, please explain:
Clarifying the most effective approach to preventing unintended pregnancy in women
Potential Impact
- How will an answer to your research question be used or help inform decisions for you or your group?
This report would help women in their decisionmaking as well as the clinicians and health organizations who care for them
- Describe the timeframe in which an answer to your question is needed.
Not aware of a specific timing issue
- Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.
Women, minorities, teens, low-income, populations disproportionately affected by poor birth outcomes
Nominator Information
- Other Information About You: (optional)
-
- Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
This report would help women in their decisionmaking as well as the clinicians and health organizations who care for them
- Are you making a suggestion as an individual or on behalf of an organization?
Organization
- Please tell us how you heard about the Effective Health Care Program