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IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-11-22 DOI: 10.1016/S0010-7824(24)00453-0

引用次数: 0

IMPROVING CARE FOR INDIVIDUALS WITH HIGHER BODY MASS INDEX (BMI) UNDERGOING INDUCTION TERMINATION 改善对体重指数（BMI）较高的接受引产终止妊娠者的护理

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110584

M Fuerst, K Prewitt, B Garg, S Ramanadhan, L Han

Objectives

We aimed to examine the association of body mass index (BMI) with time to delivery for those undergoing induction of labor for pregnancy termination in the second or third trimester.

Methods

This is a retrospective cohort study including all patients with a singleton pregnancy undergoing induction termination at a single academic medical center over a 14-year period (1/2020-2/2024). Our primary outcome was time to fetal expulsion from the first medication given. BMI was categorized into four groups (<18.5, 18.5-25, 25-30, and >30). Kruskal-Wallis tests were used to compare median time to delivery among the BMI groups; and multivariable logistic regression models were used to assess the association of BMI with time to delivery ≥24 hours.

Results

Of the 428 charts reviewed, 393 patients met inclusion criteria. Of these, 290 (73.7%) had a BMI greater than 25. The median time to expulsion was significantly different among BMI categories (9 hours for BMI < 18.5, 12 hours for BMI 18.5-25, 14 hours for BMI 25-30, and 20 hours for individuals with BMI >30, p<0.001). After adjusting for maternal age, gestational age, history of cesarean section and prior vaginal deliveries, individuals with a BMI >30 had 6.74 times the odds (95%CI 3.24-14.00) of having a time to expulsion ≥24 hours compared to BMI 18.5-25.

Conclusions

We found individuals had a significantly longer time to delivery in second and third trimester induction terminations for patients with BMI >30. Induction protocols may need to be adjusted to provide equitable care for individuals with higher BMI.

方法这是一项回顾性队列研究，包括 14 年间（2020 年 1 月至 2024 年 2 月）在一家学术医疗中心接受引产终止妊娠的所有单胎妊娠患者。我们的主要结果是从首次用药到胎儿排出的时间。体重指数分为四组（18.5、18.5-25、25-30 和 30）。采用 Kruskal-Wallis 检验比较各 BMI 组的中位分娩时间；采用多变量逻辑回归模型评估 BMI 与分娩时间≥24 小时的关系。其中，290 人（73.7%）的体重指数大于 25。不同体重指数类别的产妇排出胎儿的中位时间有显著差异（体重指数为 18.5 的产妇排出胎儿的时间为 9 小时，体重指数为 18.5-25 的产妇排出胎儿的时间为 12 小时，体重指数为 25-30 的产妇排出胎儿的时间为 14 小时，体重指数为 30 的产妇排出胎儿的时间为 20 小时，p<0.001）。在对产妇年龄、胎龄、剖宫产史和既往阴道分娩史进行调整后，与 BMI 值为 18.5-25 的产妇相比，BMI 值为 30 的产妇的排出时间≥24 小时的几率是后者的 6.74 倍（95%CI 为 3.24-14.00）。可能需要调整引产方案，以便为体重指数较高的患者提供公平的护理。

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引用次数: 0

RACE AND ETHNICITY REPORTING AND REPRESENTATION IN US CONTRACEPTIVE CLINICAL TRIALS FROM 2007-2024 2007-2024 年美国避孕药具临床试验中的种族和民族报告及代表性

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110578

N Fang, J Sheeder

Objectives

Contraceptive clinical trials inform policy and practice changes, yet participants are often non-representative of the US population. We aimed to characterize race and ethnicity reporting among completed contraceptive trials.

Methods

We queried ClinicalTrials.gov for all completed trials (2007–2024) with keywords “contraception” or “contraceptive.” We extracted all race and ethnicity participant data. If this was not reported, we manually reviewed linked publications. We categorized trials as “representative” or “non-representative” of the US population if the proportion of non-White participants were within 30% of the 2020 Census estimates. We described and compared trial characteristics for reporting and representation using chi-squared tests (IBM SPSS Version 29). The study included only publicly available data and was deemed exempt by the Colorado Multiple Institutional Review Board.

Results

We reviewed 129 trials meeting initial inclusion criteria; 55 were excluded for including non-US sites or the study was not related to contraception, leaving 74 for the final analysis. Most reported race or ethnicity (85.1%) and occurred in the West region (32.4%); 43.2% evaluated pharmacokinetics, safety, or efficacy. 68.9% were non-representative of the US population. Of those, 82.4% had overrepresentation of non-White participants. Trial phase, funder type, completion year, contraceptive method, and study type did not differ between “representative” and “non-representative” studies.

Conclusions

Race and ethnicity of participants in contraceptive trials are not representative of the US. Deliberate and thoughtful recruitment strategies are needed to ensure that contraceptive trials are diverse, inclusive, have adequate representation, and are not unintentionally over-recruiting populations with historical mistreatment within the research community.

目的避孕药临床试验为政策和实践变革提供信息，但参与者往往不代表美国人口。方法我们在 ClinicalTrials.gov 中以关键词 "避孕 "或 "避孕药 "查询了所有已完成的试验（2007-2024 年）。我们提取了所有种族和民族的参与者数据。如果未报告种族和民族数据，我们将人工审核链接的出版物。如果非白人参与者的比例在 2020 年人口普查估计值的 30% 以内，我们将试验归类为 "代表 "或 "不代表 "美国人口。我们使用卡方检验（IBM SPSS Version 29）描述并比较了报告和代表性的试验特征。结果我们审查了 129 项符合初始纳入标准的试验；其中 55 项因包括非美国研究机构或研究与避孕无关而被排除，剩下 74 项用于最终分析。大多数试验报告了种族或民族（85.1%），并且发生在西部地区（32.4%）；43.2%的试验评估了药代动力学、安全性或有效性。68.9%的研究不代表美国人口。其中，82.4%的非白人参与者比例过高。试验阶段、资助者类型、完成年份、避孕方法和研究类型在 "有代表性 "和 "无代表性 "研究之间没有差异。要确保避孕试验具有多样性、包容性和充分的代表性，并且不会无意中过度招募在研究界历来受到虐待的人群，就需要采取深思熟虑的招募策略。

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引用次数: 0

URGENT, EMERGENT, OR JUST MISSED? GEOPOLITICAL VARIATIONS IN THE MANAGEMENT OF EARLY PREGNANCY LOSS IN US EMERGENCY DEPARTMENTS 紧急、急诊还是错过？美国急诊科在处理早孕损失方面的地缘政治差异

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110626

ED Lantos, LS Benson, R Sangara, P Garza, M Pearlman Shapiro, BT Nguyen

Objectives

We aimed to describe geopolitical variations in Emergency Medicine (EM) providers’ treatment of early pregnancy loss (EPL) and evaluated their attitudes toward directly managing EPL, with attention to the influence of post-Dobbs v Jackson Women’s Health Organization restrictions.

Methods

We distributed a nationwide anonymous survey to emergency medicine clinicians using specialty-specific listservs and social media platforms, exploring experience and comfort with EPL diagnosis and management, as well as relevant institutional and structural barriers, inclusive of state abortion restrictions. We examined associations between state restrictions and emergency medicine resources via bivariate analysis.

Results

Most participants (n=203) identified as female (56.6%), non-Hispanic White (69.0%), attendings (73.6%), in urban settings (82.7%) and abortion-permissive states (60.8%). Most reported comfort diagnosing (93.0%) and counseling (86%) about EPL. However, only 39.7% consistently counseled on all management options--expectant, medication, procedural. Participants in abortion-permissive states were significantly more likely to consistently offer comprehensive counseling (44.2% vs. 32.7%, p=0.02) and reported increased access to on-site Ob-Gyn consultation (49.6% vs. 27.5%, p=0.002). Regardless of restrictions, only 16.2% consistently prescribed mifepristone-misoprostol; fewer (3.5%) performed manual uterine aspiration. 49.7% felt stable patients experiencing EPL should not receive treatment in the ED; 48.7% felt Ob-Gyns should manage EPL; 44.0% reported that arranging follow-up was a barrier to management. The majority (78.1%) endorsed the importance of more training on medication management of EPL.

Conclusions

Less than 20% of emergency medicine clinicians consistently offer EPL treatment. On-site Ob-Gyn consultations remain an essential resource, though less accessible in abortion-restrictive states. Training emergency medicine providers to treat EPL and improving access to follow-up could improve care.

方法我们通过特定专业的列表服务器和社交媒体平台向急诊科临床医生分发了一份全国范围的匿名调查，调查内容包括对早孕损失（EPL）诊断和管理的经验和舒适度，以及相关的制度和结构性障碍，包括各州的堕胎限制。我们通过双变量分析研究了州限制与急诊医学资源之间的关联。结果大多数参与者（n=203）认为自己是女性（56.6%）、非西班牙裔白人（69.0%）、主治医师（73.6%）、城市环境（82.7%）和允许堕胎的州（60.8%）。大多数人表示对 EPL 的诊断（93.0%）和咨询（86%）感到满意。然而，只有 39.7% 的人始终如一地就所有处理方案提供咨询，包括期待治疗、药物治疗和手术治疗。允许堕胎州的参与者更有可能持续提供全面咨询（44.2% 对 32.7%，P=0.02），并报告有更多机会获得现场妇产科咨询（49.6% 对 27.5%，P=0.002）。无论限制条件如何，只有 16.2% 的人坚持处方米非司酮-米索前列醇；较少的人（3.5%）进行了人工子宫吸引术。49.7%的人认为病情稳定的宫缩患者不应在急诊室接受治疗；48.7%的人认为妇产科医生应处理宫缩；44.0%的人表示安排随访是处理宫缩的障碍。大多数人（78.1%）都认为必须加强对急诊室急症室药物管理的培训。结论只有不到 20% 的急诊科临床医生持续提供急诊室急症室治疗。尽管在限制堕胎的州，现场妇产科会诊仍是一项重要资源。对急诊医疗服务提供者进行 EPL 治疗培训并改善随访服务可改善医疗服务。

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引用次数: 0

WHERE’S THE SPACE FOR JOY? A CALL FOR EXPANDED MEASUREMENT OF POSITIVE EMOTIONS AND ATTITUDES ASSOCIATED WITH ABORTION 快乐的空间在哪里？呼吁扩大与堕胎有关的积极情绪和态度的测量范围

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110625

A Bell, J Williams, S Banks, K Giles, A Gubrium

Objectives

The study explored Black women’s abortion experiences and their responses to an existing abortion stigma scale.

Methods

Following a six-week virtual digital storytelling workshop that aimed to reduce internalized abortion stigma, 14 self-identified Black women aged 19–66, from California and Indiana participated in a one-hour interview and in four 90-minute focus group discussions (FGDs) conducted via Zoom. During the FGDs, participants completed the Individual Level Abortion Stigma (ILAS) scale and reflected on its contents. The interviews and FGDs were audio-recorded, transcribed, and analyzed thematically using Dedoose.

Results

Participants reported that receiving the ILAS scale prior to starting the digital storytelling workshop would have negatively affected their participation. More specifically, participants said that it would have led to feeling unsafe, lack of trust, and emotional guardedness. Respondents described positive emotions related to their abortion that are not captured in the ILAS or other validated measures, including feelings of relief, joy, pride, and gratitude. Participants also reported positive outcomes of terminating the pregnancy, such as finishing post-secondary school, ending harmful romantic relationships, and family planning for the future. Participants noted the need for a measure to better capture these positive aspects. At least one participant believed that the measure should be specific to Black women.

Conclusions

Use of scales such as the ILAS, while important, focus on the negative aspects associated with abortion and may actually introduce stigma. Our findings highlight the need for robust measures that are culturally responsive and capture both positive and negative impacts of abortion.

该研究探讨了黑人女性的堕胎经历及其对现有堕胎耻辱感量表的反应。方法在为期六周的旨在减少内化堕胎耻辱感的虚拟数字故事研讨会之后，来自加利福尼亚州和印第安纳州的 14 名自我认同的 19-66 岁黑人女性参加了一小时的访谈和四次 90 分钟的焦点小组讨论 (FGD)，讨论是通过 Zoom 进行的。在 FGD 中，参与者填写了个人堕胎羞辱量表 (ILAS) 并对其内容进行了反思。对访谈和 FGD 进行了录音、转录，并使用 Dedoose 进行了主题分析。结果参与者表示，在开始数字故事研讨会之前收到 ILAS 量表会对他们的参与产生负面影响。更具体地说，受试者表示这将导致他们感到不安全、缺乏信任和情绪戒备。受访者描述了与堕胎有关的积极情绪，这些情绪在 ILAS 或其他有效的测量方法中均未体现，包括如释重负、喜悦、自豪和感激之情。受试者还报告了终止妊娠的积极结果，如完成中学后学业、结束有害的恋爱关系以及为未来做好家庭计划。与会者指出，有必要制定一项措施来更好地反映这些积极方面。结论 ILAS 等量表的使用虽然很重要，但其重点在于与堕胎相关的消极方面，实际上可能会带来耻辱感。我们的研究结果突出表明，我们需要能够反映文化背景并同时捕捉堕胎的积极和消极影响的可靠测量方法。

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引用次数: 0

DISTANCE TRAVELED TO OBTAIN ABORTION CARE IN SOUTHERN ILLINOIS BEFORE AND AFTER THE DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION DECISION 多布斯诉杰克逊妇女健康组织案判决前后伊利诺伊州南部地区为获得堕胎护理所走的路程

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110569

J Trevino, R Paul, E King, J Reeves, D Eisenberg, T Madden

Objectives

We aimed to examine changes in one-way driving distance for people seeking abortion care at a single site before and after the Dobbs v Jackson Women’s Health Organization decision, and to identify factors associated with traveling ≥250 miles.

Methods

We conducted a retrospective cohort study of abortions performed at a single abortion clinic in Southern Illinois for 12 months pre- and post-Dobbs using electronic scheduling data. We compared patient characteristics and one-way driving distance using chi-square. We used a multivariable logistic regression to identify factors associated with a one-way driving distance ≥250 miles.

Results

In total, 12,920 abortions occurred from June 2021 to June 2023: 4,666 pre-Dobbs and 8,254 post-Dobbs. The median one-way driving distance increased from 20 miles (IQR 14-118) to 142 miles (IQR 17-312) (p<0.001). Post-Dobbs, a smaller proportion of patients traveled <25 miles, while the absolute number remained stable: 2,617 (56.1%) vs. 2,891 (35.0%). Post-Dobbs, the number of patients traveling ≥250 miles increased by 701% (488 to 3,469). The proportion of out-of-state patients receiving abortions increased from 66.6% to 83.0% (p<0.001). Post-Dobbs, patients traveling≥250 miles for an abortion were more likely to be ≥12 weeks gestational duration (adjusted OR (aOR) 2.94, 95%CI 2.63-3.29), of Hispanic origin (aOR 2.78, 95%CI 2.20-3.51), and self-pay for their procedure (aOR 9.59, 95%CI 8.00-11.48).

Conclusions

Post-Dobbs, we observed a seven-fold increase in patients traveling≥250 miles for care at a single independent abortion clinic in Southern Illinois. These findings highlight the increased barriers to abortion access caused by restrictive legislation in the US.

我们旨在研究在多布斯诉杰克逊妇女健康组织案判决前后，在单个地点寻求人工流产护理的人的单程驾驶距离的变化，并确定与旅行≥250 英里相关的因素。方法我们使用电子排班数据对南伊利诺伊州单个人工流产诊所在多布斯案前后 12 个月内进行的人工流产手术进行了回顾性队列研究。我们使用卡方检验比较了患者特征和单向行车距离。结果在 2021 年 6 月至 2023 年 6 月期间，共有 12920 例人工流产：多布斯之前 4666 例，多布斯之后 8254 例。单程驾驶距离的中位数从 20 英里（IQR 14-118）增加到 142 英里（IQR 17-312）（p<0.001）。多布斯手术后，行驶<25英里的患者比例降低，但绝对人数保持稳定：2617人（56.1%）对2891人（35.0%）。多布斯事件后，行程≥250 英里的患者人数增加了 701%（从 488 人增至 3469 人）。州外患者接受人工流产的比例从 66.6% 增加到 83.0% (p<0.001)。多布斯案后，妊娠期≥250 英里的流产患者更有可能妊娠期≥12 周（调整 OR (aOR) 2.94，95%CI 2.63-3.29）、西班牙裔（aOR 2.78，95%CI 2.20-3.51）和自费流产。结论在多布斯事件后，我们观察到在南伊利诺伊州的一家独立堕胎诊所就诊的患者中，旅行里程≥250 英里的患者增加了七倍。这些发现凸显了美国限制性立法对堕胎造成的更多障碍。

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引用次数: 0

LIMITS OF PUBLIC POLICY TO CHANGE INDIVIDUALS’ CONSIDERATION OF ABORTION IN THE US SOUTHWEST 在美国西南部，公共政策在改变个人堕胎考虑方面的局限性

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110591

DG Foster, E Gonzalez, LJ Ralph, CH Rocca

Objectives

We aimed to understand abortion decision making and the extent to which unsupportive social/economic policies might contribute to people having abortions who might otherwise choose childbearing

Methods

As part of a longitudinal cohort study in the US Southwest, we prospectively followed 2,015 participants aged 15-34 years, recruited between 2019-2022 from 23 healthcare facilities, for one year until incident pregnancy (n=382) and through pregnancy decision-making. Participants having abortions reported the circumstances under which they might have decided to continue the pregnancy and raise the child.

Results

Among the 95 people who had an abortion, only 15% said nothing would have led them to decide to carry the pregnancy to term. About 71% indicated at least one circumstance related to social/economic status. For instance, 58% might have chosen to give birth if they had more money, of whom 1 in 5 said they would need less than $5,000. Housing was a major consideration, with 47% of women reconsidering abortion if they had their own or a better place to live. However, the vast majority (90%) also indicated circumstances that are immutable to social/economic policy such as if they were older (39%), finished with school (28%), married (27%), in better health (26%), or if their other children did not need their attention (21%). Only one participant exclusively indicated circumstances that could be addressed with economic policies, such as housing, childcare, and financial support.

Conclusions

Results suggest that more supportive social/economic policies could help improve reproductive autonomy but would unlikely significantly reduce need for abortion.

方法作为美国西南部纵向队列研究的一部分，我们对 2019-2022 年间从 23 家医疗机构招募的 2,015 名 15-34 岁的参与者进行了为期一年的前瞻性跟踪调查，直至发生妊娠事件（人数=382）并完成妊娠决策。结果在 95 名人工流产者中，只有 15%的人表示没有任何情况会导致他们决定继续妊娠。约 71% 的人表示至少有一种情况与社会/经济地位有关。例如，如果她们有更多的钱，58%的人可能会选择分娩，其中五分之一的人表示她们需要的钱少于 5000 美元。住房也是一个重要的考虑因素，47% 的妇女如果有自己的住房或更好的住房，会重新考虑堕胎。然而，绝大多数人（90%）也表示了社会/经济政策不可改变的情况，如年龄较大（39%）、完成学业（28%）、已婚（27%）、健康状况较好（26%）或其他孩子不需要她们照顾（21%）。结果表明，更加支持性的社会/经济政策有助于提高生育自主权，但不太可能显著减少堕胎需求。

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引用次数: 0

ENHANCING CARE FOR LACTATION AFTER A SECOND-TRIMESTER ABORTION OR FETAL LOSS: A QUALITATIVE STUDY 加强对第二胎流产或胎儿死亡后哺乳的护理：一项定性研究

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110597

E Shindo, AE Paris

Objectives

Encountering breastmilk secretion following abortion or fetal loss in the second trimester can be physically and emotionally challenging. Options for lactation in this setting are to expectantly manage, suppress using behavioral modifications, pharmacologically suppress, and to express and discard or donate milk. Little is known about the lactation preferences among second-trimester abortion and fetal loss patients. This study sought to explore lactation preferences of these patients via the experiences and practices of their healthcare providers, and to enhance support around lactation options counseling for this population.

Methods

This was a qualitative study involving semi-structured interviews with a purposively recruited sample of nine providers and community partners who interact with second-trimester abortion/fetal loss patients. Thematic analysis was used to identify and interpret meaningful patterns across the dataset.

Results

Three key themes were identified: (1) lactation guidance in the second trimester should be tailored to varying patient situations, (2) more provider education on lactation specific to the second-trimester population is desired, and (3) while milk donation by second trimester patients was rare, stakeholders perceived the experience as being positive for those who chose to donate.

Conclusions

Providers are encouraged to seek ways to communicate all lactation options to patients that may be interested. Provision of an informational brochure, enhanced coordination with lactation consultants, and increased educational opportunities for providers around second trimester lactation can help advance such efforts.

目标在妊娠后三个月流产或胎儿夭折后，母乳分泌在生理和情感上都是一种挑战。在这种情况下，泌乳的选择包括期待管理、通过行为调整抑制、药物抑制、挤出并丢弃或捐赠乳汁。人们对第二胎流产和胎儿丢失患者的哺乳偏好知之甚少。本研究旨在通过这些患者的医疗服务提供者的经验和实践来探索他们的哺乳偏好，并加强对这一人群的哺乳选择咨询支持。方法这是一项定性研究，对有目的性地招募的九名医疗服务提供者和社区合作伙伴进行了半结构化访谈，这些医疗服务提供者和社区合作伙伴与二次妊娠流产/胎儿损失患者有互动。研究采用主题分析法来确定和解释整个数据集中有意义的模式。结果确定了三个关键主题：(1) 第二孕期的哺乳指导应根据患者的不同情况量身定制；(2) 希望提供者针对第二孕期人群开展更多的哺乳教育；(3) 虽然第二孕期患者捐献牛奶的情况很少见，但利益相关者认为选择捐献牛奶的患者的经历是积极的。提供信息手册、加强与泌乳顾问的协调，以及为医疗服务提供者提供更多有关第二孕期泌乳的教育机会，都有助于推进这些工作。

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引用次数: 0

INTIMATE PARTNER VIOLENCE AND DELAYS IN SCHEDULING ABORTION SERVICES 亲密伴侣间的暴力行为与人工流产服务排期的延误

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110600

SS Nayak, AAJ Scoglio, T Sanni-Ojikutu

Objectives

Intimate partner violence (IPV), the experience of physical and sexual violence, stalking, and/or psychological aggression within an intimate relationship, may influence reproductive autonomy and abortion access. We examined the relationship between IPV victimization and delays in scheduling abortion services for pregnant people in the US.

Methods

Data come from the Guttmacher Institute’s Abortion Patient Survey, a nationally representative non-hospital sample of women seeking abortions in 2014 (n=8,380). We estimated complex survey-weighted logistic regression to model the association between IPV victimization and two-week delays in scheduling a desired abortion after the decision to terminate a pregnancy, controlling for sociodemographic variables. We chose two weeks based on the earliest plausible time of pregnancy awareness (four weeks) and the shortest gestation bans (six weeks). A delay of more than two weeks could result in a denied abortion.

Results

In bivariate models (n=6,996), experiencing IPV was associated with greater abortion scheduling delays compared to those not experiencing IPV (OR = 1.64, 95% CI 1.27, 2.11, p=0.0002). In multivariable models (n=6,197), experiencing IPV was associated with greater abortion scheduling delays compared to those not experiencing IPV (OR= 1.36, 95% CI 1.01, 1.83, p = 0.0430), controlling for covariates.

Conclusions

IPV is associated with delays in scheduling a desired abortion. In the increasingly restrictive US policy climate, IPV-related delays in scheduling services may make abortions functionally inaccessible. Comprehensive IPV screening is critical in obstetrics. Providers working with patients who are seeking abortions and experiencing IPV should provide prompt resources and education to ensure rapid access to abortion services.

目的亲密伴侣暴力（IPV），即亲密关系中的身体暴力、性暴力、跟踪骚扰和/或心理攻击，可能会影响生育自主权和堕胎机会。方法数据来自古特马赫研究所（Guttmacher Institute）的堕胎患者调查，这是一项具有全国代表性的非医院样本调查，调查对象为 2014 年寻求堕胎的女性（n=8380）。我们估算了复杂的调查加权逻辑回归，以模拟 IPV 受害与决定终止妊娠后两周才安排所需的人工流产之间的关联，同时控制了社会人口变量。我们选择两周的依据是最早的妊娠意识时间（四周）和最短的妊娠禁止时间（六周）。结果在双变量模型中（n=6,996），与未经历过 IPV 的人相比，经历过 IPV 的人流产计划延迟程度更高（OR = 1.64，95% CI 1.27，2.11，p=0.0002）。在多变量模型中（n=6,197），与未经历过 IPV 的人相比，经历过 IPV 的人流产排期延迟程度更高（OR=1.36，95% CI 1.01，1.83，p=0.0430），控制协变量。在美国日益严格的政策环境下，与 IPV 相关的预约服务延迟可能会使人工流产在功能上无法实现。全面的 IPV 筛查对产科至关重要。为寻求人工流产且遭遇 IPV 的患者提供服务的医疗人员应及时提供资源和教育，以确保患者能快速获得人工流产服务。

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引用次数: 0

REAL-WORLD CONTRACEPTIVE FAILURE RATES OF MULTIPLE METHODS OVER THREE YEARS: FINDINGS FROM THE HER SALT LAKE CONTRACEPTIVE INITIATIVE — A PROSPECTIVE COHORT STUDY 三年内多种方法的实际避孕失败率：她的盐湖避孕倡议的发现--一项前瞻性队列研究

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110560

JN Sanders, G Carter, B Bullington, A Gero, R Simmons, DK Turok

Objectives

The HER Salt Lake Contraceptive Initiative provided no-cost contraceptive options for up to three years at four family planning clinics in Salt Lake County, UT. In this analysis, we assess real-world contraceptive failure rates as reported by HER Salt Lake participants.

Methods

Survey data were collected at nine time points over 36 months to assess user experiences, including switching, discontinuation, and pregnancy experiences among individuals using the implant, copper IUD, hormonal IUD, pills, ring, injectable, and nonhormonal behavioral methods. We calculated incidence ratios and 95% confidence intervals for contraceptive failures at 1, 2, and 3 years, as well as cumulative incidence failure rates based on reported person-years among continuers for each of these methods.

Results

Among 4,278 individuals, there were 91 unintended pregnancies that occurred while contracepting. Hormonal IUDs had the overall lowest cumulative incidence failure rate (incidence rate (IR), 0.006/person-year; 95% CI, 0.004–0.011), followed by the implant (IR, 0.008/person-year; 95% CI, 0.005–0.016), copper IUD (IR, 0.011/person-year; 95% CI, 0.006–0.019), injectable (IR, 0.014/person-year; 95% CI, 0.006–0.025), ring (IR, 0.019/person-year; 95% CI, 0.007–0.044), pills (IR, 0.022/person-year; 95% CI, 0.016–0.031) and nonhormonal behavioral methods (IR, 0.05/person-year; 95% CI, 0.016–0.148).

Conclusions

Three-year failure rates in real-world settings are rarely published. The HER participants received their preferred methods and reported lower typical-use failure rates across methods compared to currently published information. While participation in research may influence behaviors, data from contraceptive initiatives that prioritize patient preference add important context when discussing contraceptive effectiveness over time. Our findings provide encouraging data for contraceptive access initiatives committed to offering the full range of contraceptive options and support the effectiveness of all methods.

目标 "HER 盐湖避孕倡议 "在犹他州盐湖县的四家计划生育诊所提供了长达三年的免费避孕选择。方法在 36 个月内的 9 个时间点收集调查数据，以评估用户体验，包括使用皮下埋植、铜宫内节育器、荷尔蒙宫内节育器、药片、环、注射和非荷尔蒙行为方法的个人的转换、中止和怀孕体验。我们计算了 1 年、2 年和 3 年的避孕失败发生率和 95% 的置信区间，并根据报告的每种避孕方法持续使用者的人年计算了累计失败发生率。激素宫内节育器的累计失败率最低（发生率 (IR)，0.006/人-年；95% CI，0.004-0.011），其次是皮下埋植避孕法（IR，0.008/人-年；95% CI，0.005-0.016）、铜宫内节育器（IR，0.011/人-年；95% CI，0.006-0.019）、注射避孕法（IR，0.结论现实世界中的三年失败率很少公布。与目前公布的信息相比，HER 参与者获得了他们喜欢的方法，并报告了较低的各种方法的典型使用失败率。虽然参与研究可能会影响行为，但在讨论避孕药具的长期有效性时，优先考虑患者偏好的避孕措施所提供的数据会增加重要的背景信息。我们的研究结果为致力于提供全套避孕选择的避孕措施提供了令人鼓舞的数据，并支持所有避孕方法的有效性。

{"title":"REAL-WORLD CONTRACEPTIVE FAILURE RATES OF MULTIPLE METHODS OVER THREE YEARS: FINDINGS FROM THE HER SALT LAKE CONTRACEPTIVE INITIATIVE — A PROSPECTIVE COHORT STUDY","authors":"JN Sanders, G Carter, B Bullington, A Gero, R Simmons, DK Turok","doi":"10.1016/j.contraception.2024.110560","DOIUrl":"10.1016/j.contraception.2024.110560","url":null,"abstract":"<div><h3>Objectives</h3><div>The HER Salt Lake Contraceptive Initiative provided no-cost contraceptive options for up to three years at four family planning clinics in Salt Lake County, UT. In this analysis, we assess real-world contraceptive failure rates as reported by HER Salt Lake participants.</div></div><div><h3>Methods</h3><div>Survey data were collected at nine time points over 36 months to assess user experiences, including switching, discontinuation, and pregnancy experiences among individuals using the implant, copper IUD, hormonal IUD, pills, ring, injectable, and nonhormonal behavioral methods. We calculated incidence ratios and 95% confidence intervals for contraceptive failures at 1, 2, and 3 years, as well as cumulative incidence failure rates based on reported person-years among continuers for each of these methods.</div></div><div><h3>Results</h3><div>Among 4,278 individuals, there were 91 unintended pregnancies that occurred while contracepting. Hormonal IUDs had the overall lowest cumulative incidence failure rate (incidence rate (IR), 0.006/person-year; 95% CI, 0.004–0.011), followed by the implant (IR, 0.008/person-year; 95% CI, 0.005–0.016), copper IUD (IR, 0.011/person-year; 95% CI, 0.006–0.019), injectable (IR, 0.014/person-year; 95% CI, 0.006–0.025), ring (IR, 0.019/person-year; 95% CI, 0.007–0.044), pills (IR, 0.022/person-year; 95% CI, 0.016–0.031) and nonhormonal behavioral methods (IR, 0.05/person-year; 95% CI, 0.016–0.148).</div></div><div><h3>Conclusions</h3><div>Three-year failure rates in real-world settings are rarely published. The HER participants received their preferred methods and reported lower typical-use failure rates across methods compared to currently published information. While participation in research may influence behaviors, data from contraceptive initiatives that prioritize patient preference add important context when discussing contraceptive effectiveness over time. Our findings provide encouraging data for contraceptive access initiatives committed to offering the full range of contraceptive options and support the effectiveness of all methods.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110560"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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