The recent addition of NORPLANT implants to the set of contraceptive options available to women in the United States raises an umber of important health policy questions concerning low-income women and others who are at increased risk of unintended pregnancy. This study will address the following questions: (1) What sociodemographic, fertility, and health care delivery factors predict NORPLANT selection and retention among low-income women? (2) what are the satisfaction, removal and failure (i.e., pregnancy) rates among low-income NORPLANT users and the reasons for NORPLANT removal? (3) how does NORPLANT use affect the use of barrier methods of birth control among high risk black women such as those who are HIV positive or have other STDs? (4) what are the costs and potential cost-savings associated with NORPLANT use by low-income women? and (5) what are the health and economic policy implications of the answers to these questions? These questions will be addressed through the analysis of three years of longitudinal data on contraceptive use among a sample of low-income women in Florida. This project builds on a study initiated in 1991 to tract NORPLANT selection and use among clients of publicly-funded family planning clinics in four counties in Florida (funding for which terminates in April, 1993). The first year of the project will be spent collecting data (time points 3 & 4) on study subjects (N=1,539) through telephone interviews (two per year) concerning their current method of contraception, fertility status, and health care use. During this year, data from the State Health and Medicaid Offices on the utilization and costs of health care services by study subjects will also be obtained and linked with the subject data. During the latter part of year 1 and in year 2 the longitudinal interview and health care costs data will be analyzed using a variety of analytic techniques including logistic regression, event history analysis, semi-Markov models, and cost-effectiveness estimation. The implications of the findings for state and national public health policy will be addressed and included in a final report on the study findings. This study responds to the need for research on new contraceptive methods and the need for reductions in unintended pregnancies in the U.S. as set forth in Healthy People 2000.
