Author ORCID Identifier
https://orcid.org/0000-0001-7612-1587
Date Available
12-15-2026
Year of Publication
2024
Document Type
Doctoral Dissertation
Degree Name
Doctor of Philosophy (PhD)
College
Pharmacy
Department/School/Program
Pharmaceutical Sciences
Advisor
Dr. Patricia R. Freeman
Abstract
Unintended pregnancies constitute nearly half of all US pregnancies and are associated with significant negative impacts, including delayed prenatal care, preterm deliveries, low birth weights, higher levels of maternal depression, and increased levels of smoking, drinking, and illicit drug use during pregnancy. As nearly half of unintended pregnancies occur in sexually active individuals not using contraception, increasing contraceptive access and understanding barriers to access are key components to mitigating unintended pregnancies. Additionally, because contractive access is not universal across all populations, developing an understanding of the existing disparities in contraceptive use is crucial to providing the foundation for targeted interventions aimed at increasing contraceptive access. Unfortunately, the literature surrounding disparities in contraceptive use is sparse and nonexistent for some populations, including Kentucky residents. Further barriers to contraceptive access include major disruptions, such as the SARS-CoV-2 (COVID-19) pandemic, which severely impacted society and resulted in many lasting changes to healthcare delivery. While existing data has detailed an initial increase in contraceptive days’ supply following the COVID-19 national emergency, questions remain regarding potential differential impacts seen among residents living in rural vs. urban locations and changes in overall dispensing rates. Answering these questions is critical to assessing long-term changes in contraceptive access and use following the COVID-19 emergency. Additionally, services such as extended contraceptive days supplies (i.e., dispensing of a 6 or 12-month supply in a single fill) have been shown to increase contraceptive continuity and decrease unintended pregnancies; however, data regarding the population-level impacts of these policies are limited.
In this work, we aimed to describe impacts of major barriers to contraceptive use, including both disparities and the COVID-19 pandemic. We also set out to assess the impacts of a policy aimed at increasing contraceptive continuity and decreasing unintended pregnancy – extended oral contraceptive days’ supply mandates. Given the importance of mitigating unintended pregnancies, this work will lay the foundation for future policies aimed at mitigating contraceptive use disparities, adjusting contraceptive healthcare efforts in light of major disruptions, and increasing contraceptive continuity, with the ultimate goal of reducing unintended pregnancies.
Chapter 1 will provide historical context to unintended pregnancy, disparities in contraceptive use, and efforts in mitigating these disparities.
Chapter 2 utilizes segmented regression analysis for statistical modeling of an interrupted time series to evaluate the impact of the COVID-19 national emergency on contraceptive dispensing trends among commercially-insured Kentuckyfemales and assess for differential impact among rural-urban classification and age group.
Chapter 3 explores contraceptive care measures in the Kentucky Medicaid Population and assesses for differences in these measures among various demographic and geographic factors, shedding light on critical disparities that exist in this population.
Chapter 4 utilizes generalize estimating equation Poisson modeling to evaluate the population-level impacts of extended oral contraceptive days’ supply legislation on rates of extended days’ supply provision and risk of gaps in oral contraceptive therapy.
Finally, Chapter 5 will discuss how the findings of this work may be used to improve clinical practice, inform future research efforts, and develop policies aimed at mitigating unintended pregnancies.
Digital Object Identifier (DOI)
https://doi.org/10.13023/etd.2024.473
Funding Information
Additional support was provided by the National Institutes of Health (NIH) National Center for Advancing Translational Sciences through grant number UL1TR001998. The content is solely the responsibility of the author and does not necessarily represent the official views of the CHFS DMS/ODA or NIH.
Recommended Citation
Miracle, Dustin, "Contraceptive Continuity and Access: An Assessment of Recent Utilization Trends, Disparities, and Extended Days' Supply Policies" (2024). Theses and Dissertations--Pharmacy. 163.
https://uknowledge.uky.edu/pharmacy_etds/163
Included in
Community Health and Preventive Medicine Commons, COVID-19 Commons, Obstetrics and Gynecology Commons, Pharmacy Administration, Policy and Regulation Commons, Women's Health Commons
