Survey: OBGYNs Report That the Affordable Care Act Has Increased Use of Contraceptives Among Patients, but the Cost of Reproductive Health Care Still a Burden for Their Low-Income Patients

As the nation awaits the Supreme Court ruling on the future of the Affordable Care Act (ACA), a 2020 KFF survey of obstetrician-gynecologists (OBGYNs) finds that since implementation of the ACA’s contraceptive coverage requirement, nearly two-thirds of OBGYNs (63%) reported an increase in contraceptive uptake from their patients and 69% reported an increase in their patients use of their desired contraceptive method. However, nearly all OBGYNs (92%) reported the cost of reproductive health care services still presents a challenge for low-income patients.

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Some key findings include:

• Nearly all OBGYNs offered their patients some forms of contraceptive care, but just 18% of OBGYNs offered their patients all methods of non-permanent contraception that must be either prescribed or provided by a clinician. These methods include the pill, patch, ring, diaphragm or cervical cap, intrauterine devices (IUDs), contraceptive implants (Nexplanon), contraceptive injections (Depo-Provera) and emergency contraception (Copper IUD and Ulipristal Acetate/Ella). Those that offered all methods tended to be younger and work in large practices, with more than 10 clinicians.
• Most OBGYNs (75%) reported their practices did not provide abortions for pregnancy termination, but over one in five (23%) worked in practices that do. Abortion provision was more common among OBGYNs in urban and suburban locations compared to rural, and in the Northeast and West compared to the Midwest and South.
• A sizeable minority said they had encountered at least one Medicaid restriction regarding contraceptive care, including needing to obtain prior authorization (45%), being limited to an initial contraceptive supply of 30 days (33%), requiring “step-therapy” (15%) or being denied immediate replacement of expelled or removed LARCs (15%).
• Over six in ten OBGYNs reported an increase in the share of their patients who were using any contraceptive method (63%) as well as their desired contraceptive method (69%) since implementation of the ACA’s contraceptive coverage requirement in 2012.

Journal of the American Academy of Physician Assistants | Webb, Lauren DMSc, PA-C

Multiple studies have shown that oral or vaginal probiotics can effectively treat and prevent recurrent bacterial vaginosis. The dose, route, and treatment protocols vary greatly between studies, but many have shown a statistically significant reduction in the rate of recurrence of bacterial vaginosis. Further research is needed to determine the adequate dose, specific probiotic, optimal duration, and route of administration, with or without antibiotics.

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If you want to increase your exposure to PAs who practice in women's health, this opportunity is for you. Our premium and supporting partner options provide a range of benefits at great 2021 prices.

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Join us on National #WearRedDay to raise awareness about #HeartDisease, a leading cause of death in the US. Devoting a little time every day to care for yourself can go a long way toward protecting your heart health. 

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ACOG | Clinical 

All pregnant individuals who choose to receive the COVID-19 vaccine must be allowed to do so in alignment with their state and local vaccination allocation plan. This includes the estimated 330,000 health care workers who are pregnant and should be allowed to receive the vaccine as part of the first phase of vaccine distribution plans.  Reports of pregnant individuals being refused vaccination are concerning.

Pregnant individuals who otherwise meet the criteria for COVID-19 vaccines should not be denied the opportunity to be vaccinated, should they choose to do so. Although a conversation with a clinician may be helpful for patients to aid in their decision-making, it should not be required prior to vaccination. 

As the COVID-19 vaccine rollout continues, use must reflect the vaccines’ federal regulatory authorization as well as information and recommendations from the U.S. Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, and expert healthcare organizations.

Currently, available data demonstrate that pregnant individuals are at increased risk of more severe illness and death due to COVID-19 than their non-pregnant counterparts1. Providing pregnant individuals with the opportunity to be vaccinated can be critical to allowing them to protect themselves, particularly if their occupation puts them at increased risk of contracting the virus or if they have underlying and comorbid conditions. 

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he 2021 AAPA Salary Survey is now open – please participate! Results provide the data you need to negotiate the compensation and benefits you deserve. If the pandemic has impacted your earnings or job status, we also want to hear from you so we can understand COVID-19’s effect on the profession. Complete the survey by February 28 -- members will receive a copy of the national summary report, and you’ll be entered to win one of 20 $50 gift cards.

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February is International Prenatal Infection Prevention Month and we are sharing information with you to check out this month. Click here for more information on preventing infection before and during pregnancy. 

Practice Advisories

• Vaccinating Pregnant and Lactating Patients Against COVID-19 (December 2020)
• Novel Coronavirus 2019 (COVID-19) (Updated December 2020)
• Updated Guidance Regarding Fetal Growth Restriction (September 2020)
• See all Practice Advisories

New Committee Opinions

• NEW 821 Barriers to Breastfeeding: Supporting Initiation and Continuation of Breastfeeding (February 2021)
• NEW 820 Breastfeeding Challenges (February 2021) 
• NEW 819 Informed Consent and Shared Decision Making in Obstetrics and Gynecology (February 2021)
• NEW 818 Medically Indicated Late-Preterm and Early-Term Deliveries (February 2021)
• 817 Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment (January 2021)
• 816 Consumer Testing for Disease Risk (January 2021)
• 815 Increasing Access to Abortion (December 2020)
• 814 Delayed Umbilical Cord Clamping After Birth (December 2020)
• 813 Gynecologic Considerations for Adolescents and Young Women With Cardiac Conditions (November 2020)
• See all Committee Opinions

New Practice Bulletins

• NEW 227 Fetal Growth Restriction (February 2021) 
• 226 Screening for Fetal Chromosomal Abnormalities (October 2020) Published Ahead of Print
• 225 Medication Abortion Up to 70 Days’ Gestation (October 2020) Published Ahead of Print
• See all Practice Bulletins

More from ACOG

• Clinical Updates: Seizures (January 2021)
• Clinical Updates: Travel Medicine (November 2020)
• Clinical Updates: Anorectal Disorders (September 2020)

ACOG

The New York Times (1/31, Caron) reported researchers found that pregnant women transfer SARS-CoV-2 antibodies to their fetuses and transfer “more antibodies to their babies if they are infected earlier in their pregnancies.” The findings (1/29) were published in JAMA Pediatrics. Dr. Denise Jamieson, an obstetrician at Emory University and a member of ACOG’s Covid expert group, said the placenta is a complex organ that has been understudied and “What we really want to know is, do antibodies from the vaccine efficiently cross the placenta and protect the baby, the way we know happens in influenza and pertussis.” Dr. Mark Turrentine, a member of ACOG’s Covid expert group, said: “It’s plausible that the Covid vaccine will offer protection to both pregnant mothers and their infants. To me, this study highlights that inclusion of pregnant women in clinical trials such as the Covid-19 vaccine is essential, particularly when the benefit of vaccination is greater than the potential risk of a life-threatening disease.”

Washington, DC – The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) are aware of the World Health Organization’s (WHO) recommendation to withhold COVID-19 vaccines from pregnant individuals unless they are at high risk of exposure. ACOG and SMFM continue to stress that both COVID-19 vaccines currently authorized by the U.S. Food and Drug Administration should not be withheld from pregnant individuals who choose to receive the vaccine. ACOG’s and SMFM’s current guidance on the COVID-19 vaccine in pregnant patients remains in place.

Despite efforts by ACOG and SMFM to advocate for their inclusion, clinical trials that informed the emergency use authorization (EUA) of the vaccines did not include pregnant individuals. However, preliminary developmental and reproductive toxicity (DART) studies for both the Pfizer-BioNtech and Moderna vaccines are encouraging, with no safety signals reported. DART animal studies provide the first safety data to help inform the use of these vaccines in pregnancy until there are more data in this specific population. These studies do not indicate any adverse effects on female reproduction or fetal/embryonal development. ACOG and SMFM strongly urge manufacturers and federal agencies to collect and report data regarding the use of these vaccines in pregnancy.

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