Operationalizing 17α-Hydroxyprogesterone Caproate to Prevent Recurrent Preterm Birth: Definitions, Barriers, and Next Steps

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We appreciate the systems-based view on barriers to 17α-hydroxyprogesterone caproate in Stringer et al's December article.1 However, within Table 1's outline of barriers to 17α-hydroxyprogesterone use, no solution accompanies the barrier of unintended pregnancy. We suggest editing Table 1 to add the following solution to the barrier of unintended pregnancy: “Access to safe and affordable contraception and abortion services.”
Consider the relationship of contraceptive access to unintended pregnancy and preterm birth. A Colorado initiative increasing access to long-acting reversible contraception at Title X clinics was associated with 15% decreased odds of preterm birth for women living in counties with those clinics. The proportion of women using long-acting reversible contraception at these clinics increased from 0.8% to 8.6% over the study period.2 In 2008, 95% of unintended pregnancies in the United States occurred among the 32% of women not using contraceptives or using contraceptives inconsistently.3 In 2011, 42% of unintended pregnancies ended in abortion.4
Ensuring access to contraception is key to preventing unintended pregnancy. Access to contraception and abortion has a role in decreasing preterm birth. This may be clear to many of this journal's readers, but in today's political climate, we cannot afford to assume others appreciate these links. Anticipating the Affordable Care Act's repeal and replacement, we need to advocate for our patients' continued access to contraception and abortion.

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