Biomedical Sciences ETDs

Publication Date

Summer 9-25-2017


The Institute of Medicine defines six important domains of health care quality: safety, efficacy, timeliness, efficiency, equitable delivery and patient-centeredness. Quality family planning care aims to provide individuals with the tools needed to engage in healthy and satisfying sex lives while planning and spacing pregnancies to achieve desired family size. The field of family planning strongly relies on the domain of patient-centeredness as individual values and preferences guide clinical care. Yet large gaps in knowledge exist in understanding how to improve patients’ clinical experience. This hybrid thesis posits avenues for improving the quality and patient-centeredness of clinical care.

Quality care is meaningless if the public cannot access care. Numerous barriers to health care exist in the US for many. Education about our bodies, confusing media messaging about sex, cultural attitudes about sex and young parenting, conflation of contraception with abortion in politics and Catholic hospital mergers create barriers to access to care.

On the other hand, a facilitator of access is an increase in comfort among providers and patients with long acting reversible contraceptives or LARC. Encompassing intrauterine devices (IUDs) and implants, LARC methods are highly effective contraceptives that do not require ongoing adherence. These methods are exploding in popularity, but can be difficult to obtain due to cost or difficulty obtaining an appointment with a trained provider.

Extended duration of contraceptive implants may allow better contraceptive coverage as women navigate access barriers. Additionally, IUDs can be painful to place in the office setting. An anesthetic medication allowing an IUD to be placed with less discomfort may empower women who might not otherwise feel comfortable with placement of this method. Nitrous oxide is an inhaled gas that has been used in a number of settings in medicine. As a novel agent for painful outpatient gynecologic procedures, it provides the unique benefit of rapid clearance, potentially allowing a woman to obtain an IUD under this rapidly reversible anesthesia and return to her daily activities. Nitrous oxide may also preserve privacy, as other anesthetic options often require that a woman have a driver following the appointment. Privacy is particularly important in provision of abortion care.

These included chapters identify opportunities for the health care community to improve quality per the Institute of Medicine’s domains.


family planning, contraception, abortion, patient centered, quality

Document Type




Degree Name

Clinical Research

Level of Degree


Department Name

Biomedical Sciences Graduate Program

First Committee Member (Chair)

Rameet Singh

Second Committee Member

Eve Espey

Third Committee Member

Shiraz Mishra