Contraceptive Choices Application (App) Development

Background. Improved access to contraception and reduction of unmet need for family planning are key components to improve reproductive health of women. Voluntary family planning is one of the great advances in public health during the last century, with the greatest advancements developed during the last 35 years (Department of Reproductive Health, World Health Organization [WHO], 2010). Family planning saves the lives of women by allowing self-determination in the limitation of the number of births, spacing pregnancies, and avoidance of pregnancies in the very young and older women of childbearing age (Global Health Learning Center, 2007). During the years 1985-2005, almost 4 million additional maternal deaths would have occurred if the use of family planning had not improved (Global Health Learning Center). The majority of saved lives is attributed to fewer births and reduced mortality during the birthing process.

 In 2012, the London Summit on Family Planning spurred international, national, and private organizations to expand access to voluntary family planning (Family Planning 2020). Despite advancements in reproductive health and voluntary family planning, over 200 million women who do not want to get pregnant do not have access to contraceptives and voluntary family planning knowledge and services (WHO, 2013). The lack of access results in over 75 million unintended pregnancies every year (Family Planning 2020). Approximately 40 percent of pregnancies in developing countries are unintended and, interestingly, 47 percent in developed countries (Engelman, 2011).

The cost of unintended pregnancies places the adolescent or woman at risk (U.S. Department of Health and Human Services [DHHS], 2014). These risks include delays in initiating prenatal care with untoward maternal and fetal outcomes. This population is less likely to breastfeed, with resultant risks on maternal-fetal bonding and childhood obesity and asthma, among others. These adolescents and women are more likely to develop depression and have an increased risk of physical abuse during pregnancy. 

Adolescents are particularly vulnerable to unintended pregnancies. Among females younger than 20 years, slightly more than 80% of pregnancies were unintended (DHHS, 2014).  And this proportion is even higher in those younger than 15 years, as this group has a 98% unintended pregnancy rate. Negative consequences are greater for adolescent mothers who are less likely to graduate high school (HS) or earn a General Education Development (GED) by age 30 years or earn a wage comparable to women who delay childbearing. Adolescent mothers are also twice as likely to receive Federal benefits and continue them twice as long.

Many barriers exist in having contraceptives more widely available and accessible. Barriers include cultural impediments as well as lack of funding, lack of products to meet women’s needs, and lack of knowledge. In addition to public benefits which support women with unintended pregnancies, there are publicly funded clinics that provide family planning care. These clinics prevent nearly 1.5 million unintended pregnancies, nearly 400,000 of which would occur with adolescents (Guttmacher Institute, 2012).  In the United States (U.S.), the Title X Family Planning program, enacted in 1970, is the Federal program that provides grants that ultimately provide individuals with “comprehensive family planning and related preventive health services” (DHHS, n.d.). Contraceptives, however, are one of the best investments a country can make for its future, delivering significant savings in healthcare costs. DHHS (n.d.) states that every dollar spent on contraceptive services in the U.S. saves approximately $3.74 in costs related to pregnancy and delivery care and care to infants during their first year of life.

In order to reduce the unintended pregnancy rate, family planning efforts should address access to effective contraceptives to those at greatest risk (Finer & Zolna, 2011). Underserved, low-income adolescents and women of one Midwestern U.S. County are the target population for this project and presentation. This population is at high risk for unintended pregnancies along with premature births and other untoward pregnancy outcomes.

Purpose. The purpose of this presentation is to describe the development of an application (app) using data that explores relationships among contraceptive choice and use with selected characteristics of clients from one Midwestern U.S. county health department’s family planning clinic who are at high-risk for unintended pregnancies. This clinic is supported by Title X funds. Data will be used to improve client care by actively involving clients in identifying contraceptive methods that are tailored to the client’s risk factors and needs using medically accurate information and education. This tailored choice of contraceptives, including knowledge and access to long-acting reversible contraceptives (LARC), is anticipated to reduce the unintended pregnancy rate, which is high in this Midwestern County.

Methods. Results of a related study on the Midwestern family planning clinic will be used to develop an evidence-based app that will allow tailoring information on contraceptive choices for each client. Because the app will be developed based on data obtained from the clinic’s client charts, the information in the evidence-based app will be applicable to this high-risk for pregnancy population. iPads with security and tamper protection will be available in the waiting room of the family planning clinic for client use for those without the ability to download the app on their portable device. The app will be available at no cost for the clinic and its clients, but will be available for purchase at the app store. The app development began using storyboarding for the algorithm that included contraceptive choices The content was drawn primarily from the United States Medical Eligibility Criteria for Contraceptive Use (USMEC) (Centers for Disease Control and Prevention, 2010) which was based upon the World Health Organization Medical Eligibility Criteria for Contraceptive Use (4^th ed.) (WHO, 2010). The app will be user-friendly, bilingual, and provide tailored education on contraceptive choices.

Results. As the client narrows her options via interactive questions, the easy-to-use app will highlight the most suitable types of birth control for her, but also explain potential side effects and risks associated with each of her options. Clients who use the app will be better informed and already have a baseline knowledge about what characteristics of contraceptives are important to them when they see their health care provider (HCP). The HCP can then can spend less time explaining birth control options and more time focused on a more narrow discussion tailored to the client’s particular options.