Aliza Adler, M Antonia Biggs, Shelly Kaller, Rosalyn Schroeder, Ndola Prata, Karen Scott, Lauren Ralph
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引用次数: 0
Abstract
Objective: To assess the prevalence of ever considering self-managing an abortion (SMA) and its associations with experiences of medical mistrust and mistreatment in a nationally representative sample.
Study design: In 2021-22, we conducted a national, cross-sectional, online probability-based survey of US people assigned female at birth ages 15-49. Among those who had ever been pregnant, we ran weighted multivariable logistic regressions to examine whether having had difficulty trusting medical providers and/or experiencing medical mistreatment was associated with SMA consideration.
Results: Of 4260 participants who had ever been pregnant, 5.2% (95% CI, 4.3%-6.3%) ever considered SMA. Additionally, 38.8% (95% CI, 36.8%-40.9%) reported prior moderate medical mistrust; 17.0% (15.4%-18.6%) experienced neglect of symptoms only, and 22.2% (20.6%-24.0%) experienced ridicule or humiliation in a previous healthcare encounter. In multivariable analyses, those who reported prior high medical mistrust had increased odds of considering SMA (aOR=5.2, [95% CI, 2.9-9.2]), compared to those who had no prior medical mistrust. Those who had experienced ridicule or humiliation by healthcare providers had increased odds of considering SMA (aOR=3.8, [95% CI, 2.3-6.1]), compared to those without such experiences. Participants who believed others perceived them as Black or Arab/Middle Eastern, were poor in their youth, or identified as Lesbian, Gay, Bisexual, Transgender, Queer, and other had higher proportions of considering SMA (p-values<0.01).
Conclusions: Experiences of medical mistrust and mistreatment are common and are associated with increased likelihood of considering SMA. Those who identified with a structurally minoritized group were more likely to consider SMA, and those whose "street race" was Arab/Middle Eastern had the highest likelihood.
Implications: If restrictions on abortion continue to increase, individuals may further consider SMA. Our findings suggest a need to create healthcare environments that foster trust and respect, as well as to ensure people have access to safe options for SMA.
目的:在全国具有代表性的样本中,评估曾经考虑自我管理人工流产(SMA)的发生率及其与医疗不信任和虐待经历的关联:在一个具有全国代表性的样本中,评估曾经考虑自我管理人工流产(SMA)的流行率及其与医疗不信任和虐待经历的关联:研究设计:2021-22 年,我们对 15-49 岁出生时即被指定为女性的美国人进行了一次全国性、横断面、在线概率调查。在曾经怀孕的人群中,我们进行了加权多变量逻辑回归,以研究难以信任医疗服务提供者和/或遭受医疗虐待是否与考虑 SMA 有关:在 4260 名曾经怀孕的参与者中,5.2%(95% CI,4.3%-6.3%)曾经考虑过 SMA。此外,38.8%(95% CI,36.8%-40.9%)的受试者表示曾有过中度的医疗不信任;17.0%(15.4%-18.6%)的受试者仅有过忽视症状的经历,22.2%(20.6%-24.0%)的受试者在之前的医疗经历中受到过嘲笑或羞辱。在多变量分析中,与之前没有医疗不信任经历的人相比,之前报告过高度医疗不信任经历的人考虑 SMA 的几率更高(aOR=5.2,[95% CI,2.9-9.2])。经历过医疗服务提供者嘲笑或羞辱的参与者与无此类经历者相比,考虑 SMA 的几率增加(aOR=3.8,[95% CI,2.3-6.1])。认为他人认为自己是黑人或阿拉伯/中东人、年轻时贫穷或被认定为 LGBTQ+ 的参与者考虑 SMA 的比例更高(p 值 < 0.01):医疗不信任和虐待的经历很常见,与考虑接受 SMA 的可能性增加有关。那些被认定为结构上属于少数群体的人更有可能考虑 SMA,而那些 "街头种族 "为阿拉伯/中东人的人考虑 SMA 的可能性最大:如果对堕胎的限制继续增加,人们可能会进一步考虑 SMA。我们的研究结果表明,有必要营造一种促进信任和尊重的医疗环境,并确保人们能够获得安全的 SMA 选择。