Contraception最新文献_第10页

“I CONTROL MY BODY”: REPRODUCTIVE JUSTICE AMONG BLACK WOMEN ENGAGED IN THE CRIMINAL LEGAL SYSTEM IN NEW YORK CITY "我控制我的身体"：纽约市刑事法律系统中黑人妇女的生殖正义

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110615

A Dasgupta, J Meyer, D Goddard-Eckrich, N El-Bassel, L Gilbert

Objectives

This study aims to understand how rights to reproductive justice (RJ) are infringed upon or supported among Black women engaged in the criminal legal system in New York City.

Methods

Between October 2018 and January 2019, we conducted 43 semi-structured interviews with Black women in community supervision programs with histories of drug use who reported risks for HIV or being HIV-positive in New York City. Thematic analyses of the data were conducted using the RJ framework, with findings categorized based on each key RJ principle.

Results

Key themes related to the right to have a child included (1) forced abortion, (2) unexplained fertility not being followed up by doctors (and subsequent medical mistrust of providers), and (3) misinformation related to abortion and fertility. Themes related to the right to not have a child included (1) use of birth control, (2) primarily positive experiences with abortion access, (3) and having bodily autonomy. Themes related to the right to raise a child in a safe and healthy environment included (1) housing instability, (2) engagement with child protective services, and (3) the role of criminal legal systems in isolating mothers.

Conclusions

Findings highlight both major infringements to women’s RJ rights, as well as women describing facilitators to maintaining their RJ rights among this sample of Black women. Results also highlight the importance of access of equitable sexual and reproductive health services for women engaged in the criminal legal system, who may have competing priorities and needs to maintain their sexual and reproductive health.

目标本研究旨在了解纽约市参与刑事法律系统的黑人妇女的生殖正义（RJ）权利是如何受到侵害或支持的。方法在 2018 年 10 月至 2019 年 1 月期间，我们对纽约市社区监督计划中报告有 HIV 风险或 HIV 阳性的有吸毒史的黑人妇女进行了 43 次半结构式访谈。我们使用 RJ 框架对数据进行了专题分析，并根据每个关键 RJ 原则对分析结果进行了分类。结果与生育权有关的关键主题包括：（1）强迫堕胎；（2）医生没有对不明原因的生育进行跟踪（以及随后医疗人员对提供者的不信任）；以及（3）与堕胎和生育有关的错误信息。与不生育权有关的主题包括：(1) 使用节育措施；(2) 在获得堕胎服务方面的主要正面经历；(3) 拥有身体自主权。与在安全健康的环境中抚养孩子的权利有关的主题包括：（1）住房不稳定；（2）与儿童保护服务机构接触；（3）刑事法律系统在孤立母亲方面的作用。研究结果还强调了参与刑事法律系统的妇女获得公平的性健康和生殖健康服务的重要性，因为她们在维护自身的性健康和生殖健康方面可能有相互竞争的优先事项和需求。

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引用次数: 0

OHIO ABORTION SEEKERS CHALLENGED BY TWO-VISIT REQUIREMENT ARE LIKELY TO REPORT MORE CHALLENGES OVERALL 俄亥俄州寻求堕胎者受到两次探视要求的挑战，可能报告总体上面临更多挑战

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110607

A Kirkendall, M Bornstein, K Rivlin, A Norris Turner, M Davoodifar, T Odum, D Bessett

Objectives

Ohio, like many restrictive states, requires abortion patients to present in-person for two appointments 24-hours apart. This study seeks to understand which, if any, patient-reported challenges are associated with the two-visit requirement.

Methods

1,361 participants seeking abortion care in Ohio completed an online survey between April 2020 and July 2021. Survey questions addressed challenges experienced, delayed expenses, and actions taken to cover costs. Responses of those who indicated making multiple trips for their abortion care was a challenge were compared to those who did not experience this challenge.

Results

29.4% of participants were challenged by the multiple trips requirement. Participants reporting this challenge were demographically similar by race, sexuality, and gender to those not reporting this challenge. Participants challenged by multiple visits reported twice as many challenges overall than those who were not challenged by multiple trips (mean=4.0 vs. 2.1, p<0.01). Participants challenged by multiple trips took more actions to cover costs (mean=1.1 vs. 0.8 for those not challenged by multiple visits, p<0.01). Overall, 28.5% of participants delayed expenses to cover costs, including 37.8% of those challenged by multiple visits and 24.7% of those not challenged by multiple visits (p<0.01). The number of delayed expenses was greater for those challenged by multiple visits (mean=0.7 vs. 0.4, p<0.01).

Conclusions

Many Ohioans seeking abortion identified the two-visit requirement as a challenge. The two-visit requirement occurs in conjunction with, and likely exacerbates, other challenges, especially financial stressors. Patients should be allowed to work with their care providers to determine the right number of visits for them.

目标俄亥俄州与许多限制性州一样，要求堕胎患者必须在 24 小时内亲自赴约两次。本研究旨在了解患者报告的挑战（如果有的话）与两次就诊要求有哪些关联。方法在 2020 年 4 月至 2021 年 7 月期间，1361 名在俄亥俄州寻求堕胎护理的参与者完成了一项在线调查。调查问题涉及所经历的挑战、延迟支出以及为支付费用所采取的行动。我们将那些表示多次往返接受人工流产护理是一项挑战的参与者的回答与那些没有遇到这一挑战的参与者的回答进行了比较。在种族、性取向和性别方面，报告这一挑战的参与者与未报告这一挑战的参与者在人口统计学上相似。因多次旅行而受到挑战的参与者所报告的挑战数量是未受到多次旅行挑战的参与者的两倍（平均值=4.0 vs. 2.1，p<0.01）。受到多次访问挑战的参与者采取了更多行动来支付费用（平均=1.1，而未受到多次访问挑战的参与者为 0.8，p<0.01）。总体而言，28.5% 的参与者延迟支出以支付费用，其中 37.8% 的参与者因多次出差而延迟支出，24.7% 的参与者未因多次出差而延迟支出（p<0.01）。结论许多寻求堕胎的俄亥俄州人将两次就诊要求视为一项挑战。两次就诊要求与其他挑战同时存在，并可能加剧其他挑战，尤其是经济压力。应允许患者与他们的医疗服务提供者合作，以确定适合他们的就诊次数。

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引用次数: 0

ABORTION PATIENTS’ AWARENESS AND UNDERSTANDING OF AN EARLY PREGNANCY ABORTION BAN AND ACCESS TO IN-STATE CARE 堕胎患者对早孕堕胎禁令的认识和理解，以及获得州内护理的机会

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110612

K White, W Arey, AD Beasley, A Chatillon, C Chadwick, A Dane’el, O Leyser-Whalen, T Weitz

Objectives

Explore We aimed to explore pregnant Texans’ awareness and understanding of a 2021 state law prohibiting abortion after detectable embryonic cardiac activity when navigating to abortion care.

Methods

We recruited Texans who obtained out-of-state abortion care after implementation of Senate Bill 8 (SB8) by providing flyers to abortion facilities in seven states and using online ads. Between October 2021 and February 2022, we conducted in-depth telephone interviews with English-speaking participants ≥15 years of age to explore their experiences seeking care. We used inductive and deductive codes in our thematic analysis describing participants’ understanding of how the law limited abortions.

Results

Most of the 65 participants discovered their pregnancy soon after a missed period, and less than half had heard of SB8 prior to pregnancy. Those who identified their pregnancy early and heard SB8 changed when an abortion could be obtained described the stress of scheduling appointments to confirm whether they could secure in-state care; a few felt rushed to make a decision. Having heard SB8 described as a six-week ban, participants were upset and frustrated to learn they were ineligible for in-state care because clinicians dated their pregnancy from weeks since last menstrual period (vs conception), there was evidence of cardiac activity before six weeks gestation, or cardiac activity appeared between ultrasound visits.

Conclusions

Pregnant Texans’ limited awareness of SB8 and the disjuncture between their understanding of the law and how it applied in early pregnancy increased time pressures and logistical burdens during their process seeking abortion care.

目标探索我们旨在探索德克萨斯州孕妇在接受人工流产护理时对 2021 年禁止在检测到胚胎心脏活动后进行人工流产的州法律的认识和理解。方法我们通过向七个州的人工流产机构提供传单和使用在线广告，招募了在参议院第 8 号法案（SB8）实施后获得州外人工流产护理的德克萨斯人。2021 年 10 月至 2022 年 2 月期间，我们对年龄≥15 岁的英语参与者进行了深入的电话访谈，以了解他们寻求护理的经历。我们在主题分析中使用了归纳和演绎代码，描述了参与者对法律如何限制堕胎的理解。结果65 名参与者中的大多数人在月经错过后不久发现自己怀孕，不到一半的人在怀孕前听说过 SB8。那些很早就发现自己怀孕并听说 SB8 法案改变了堕胎时间的参与者描述了她们在安排预约以确认是否能获得州内医疗服务时所承受的压力；少数人感到急于做出决定。在听说 SB8 被描述为六周禁令后，参与者在得知自己没有资格获得州内护理时感到不安和沮丧，因为临床医生根据末次月经（与受孕）后的周数来确定其怀孕时间，有证据表明在妊娠六周前出现心脏活动，或在超声波检查之间出现心脏活动。

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引用次数: 0

STUDENT EXPERIENCES WITH EMERGENCY CONTRACEPTION AND PREFERENCES FOR ON-CAMPUS VENDING MACHINES 学生使用紧急避孕药具的经验和对校内自动售货机的偏好

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110648

S Knifton, M Quasebarth, V Manthena, L Hasselbacher

Objectives

Vending machines that sell emergency contraception (EC) at discounted prices are becoming increasingly common on US college campuses. These machines facilitate convenient and timely access for college students by mitigating common barriers to obtaining EC. Limited research has investigated students’ attitudes toward this resource.

Methods

Currently enrolled students at a private university in Illinois were recruited via flyers and listservs to complete an electronic survey on EC accessibility between November 2023 and February 2024. Anonymous survey responses were recorded via RedCap and exported to Microsoft Excel and SPSS for analysis.

Results

372 students completed the survey. The majority of participants identified as cisgender women (73.1%), straight (45.8%), White (52.6%), and as undergraduate (60.1%). Results found that over one-third (38.2%) of participants had previously purchased EC. Nearly 20% of these participants found the experience difficult, mainly due to the high cost of EC. Over half (56.4%) of participants had concern about being noticed or having to interact with staff when obtaining EC at a store or at student health clinic. Most (90.4%) participants reported that they would use an on-campus EC vending machine if they needed EC. Less than half (43.6%) indicated that they would be willing to spend more than $20 for EC.

Conclusions

EC vending machines are a practical solution to increase EC accessibility on college campuses and support students’ reproductive and educational goals, especially in the face of increasing abortion restrictions. To best address student concerns, ensuring that EC is low-cost and machines are placed in an accessible, but confidential, location is crucial.

目的以折扣价出售紧急避孕药（EC）的自动售货机在美国大学校园里越来越常见。这些自动售货机减轻了大学生在获取紧急避孕药具时遇到的常见障碍，从而为他们提供了方便和及时的服务。方法通过传单和列表服务器招募伊利诺伊州一所私立大学的在校学生，让他们在 2023 年 11 月至 2024 年 2 月期间完成一项有关 EC 可及性的电子调查。匿名调查回复通过 RedCap 进行记录，并导出到 Microsoft Excel 和 SPSS 中进行分析。大多数参与者认为自己是顺性别女性（73.1%）、异性恋者（45.8%）、白人（52.6%）和本科生（60.1%）。结果发现，超过三分之一（38.2%）的参与者以前购买过心血管疾病药物。其中近 20%的参与者认为购买过程比较困难，主要原因是价格昂贵。超过一半（56.4%）的参与者担心在商店或学生健康诊所购买避孕药时会被注意到或与工作人员打交道。大部分參加者(90.4%)表示，如需要使用安全套，他們會使用校內的安全套售賣機。不到半数（43.6%）的参与者表示，他们愿意花费超过 20 美元购买安全套。结论自动售货机是一个切实可行的解决方案，可以增加大学校园内的安全用药，并支持学生的生殖和教育目标，尤其是在堕胎限制不断增加的情况下。为了最大限度地解决学生的顾虑，确保安全套价格低廉，并将自动售货机放置在方便使用但保密的地点至关重要。

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引用次数: 0

ADVANCING INNOVATIVE MEASUREMENT OF PREGNANCY PREFERENCES WITH A SHORT-FORM DESIRE TO AVOID PREGNANCY SCALE 用简表避免怀孕意愿量表推进对怀孕偏好的创新测量

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110577

I Muñoz, BW Bullington, MR Wilson, CH Rocca

Objectives

The Desire to Avoid Pregnancy (DAP) Scale represents an important step forward for pregnancy “intention” measurement. The 14-item psychometric instrument captures pregnancy preferences prospectively across domains (cognitive, affective, consequences) and allows for nuance, uncertainty, and ambivalence. However, a DAP short-form scale is needed to reduce respondent burden and facilitate integration of this rigorous, person-centered measure into future research and surveillance.

Methods

We used state-representative data from >30,000 self-identified women, aged 18-44 years, from nine diverse US states (Surveys of Women, 2017–2023) to develop a four-item version of the DAP scale (DAP-4). After splitting the dataset in half, stratified by state, we used classical test theory and item response theory methods to iteratively identify a reduced item set that maintained construct validity (eg, included items across conceptual domains and were worded negatively and positively), internal structure validity (eg, monotonicity), and external validity (eg, no differential item functioning), while maintaining reasonable internal consistency reliability. Scale properties were retested on the second half of the dataset.

Results

The DAP-4 included two items in the cognitive domain and one each in the affective and practical consequences domains, and items worded in both directions. The internal consistency was high for a short-form (alpha=0.83), covered the full range of respondent pregnancy preferences, and met criteria for internal structure validity. We found no evidence of differential item functioning by age, race and ethnicity, relationship status or parity, and high correlation with the longer DAP scale (0.96).

Conclusions

A short-form DAP that maintains psychometric rigor is now available to measure pregnancy preferences.

避免怀孕意愿量表（DAP）是怀孕 "意愿 "测量的重要一步。该量表包含 14 个心理测量项目，可跨领域（认知、情感、后果）前瞻性地捕捉怀孕偏好，并可考虑细微差别、不确定性和矛盾心理。然而，我们需要一个 DAP 短式量表来减轻受访者的负担，并促进将这一严格的、以人为本的测量方法纳入未来的研究和监测中。方法我们使用了来自美国九个不同州的 >30,000 名自我认同的 18-44 岁女性的州代表性数据（妇女调查，2017-2023 年），开发了一个四项目版本的 DAP 量表（DAP-4）。在按州将数据集一分为二后，我们使用经典测验理论和项目反应理论方法反复确定了一个缩小的项目集，该项目集保持了建构效度（例如，包含跨概念领域的项目，并采用了否定和肯定的措辞）、内部结构效度（例如，单调性）和外部效度（例如，无差异项目功能），同时保持了合理的内部一致性可靠性。结果 DAP-4 包括认知领域的两个项目、情感和实际后果领域的各一个项目以及双向措辞的项目。短式问卷的内部一致性很高（α=0.83），涵盖了所有受访者的怀孕偏好，并符合内部结构有效性的标准。我们没有发现不同年龄、种族和民族、关系状况或胎次的项目功能有差异，而且与较长的 DAP 量表有很高的相关性（0.96）。

{"title":"ADVANCING INNOVATIVE MEASUREMENT OF PREGNANCY PREFERENCES WITH A SHORT-FORM DESIRE TO AVOID PREGNANCY SCALE","authors":"I Muñoz, BW Bullington, MR Wilson, CH Rocca","doi":"10.1016/j.contraception.2024.110577","DOIUrl":"10.1016/j.contraception.2024.110577","url":null,"abstract":"<div><h3>Objectives</h3><div>The Desire to Avoid Pregnancy (DAP) Scale represents an important step forward for pregnancy “intention” measurement. The 14-item psychometric instrument captures pregnancy preferences prospectively across domains (cognitive, affective, consequences) and allows for nuance, uncertainty, and ambivalence. However, a DAP short-form scale is needed to reduce respondent burden and facilitate integration of this rigorous, person-centered measure into future research and surveillance.</div></div><div><h3>Methods</h3><div>We used state-representative data from >30,000 self-identified women, aged 18-44 years, from nine diverse US states (Surveys of Women, 2017–2023) to develop a four-item version of the DAP scale (DAP-4). After splitting the dataset in half, stratified by state, we used classical test theory and item response theory methods to iteratively identify a reduced item set that maintained construct validity (eg, included items across conceptual domains and were worded negatively and positively), internal structure validity (eg, monotonicity), and external validity (eg, no differential item functioning), while maintaining reasonable internal consistency reliability. Scale properties were retested on the second half of the dataset.</div></div><div><h3>Results</h3><div>The DAP-4 included two items in the cognitive domain and one each in the affective and practical consequences domains, and items worded in both directions. The internal consistency was high for a short-form (alpha=0.83), covered the full range of respondent pregnancy preferences, and met criteria for internal structure validity. We found no evidence of differential item functioning by age, race and ethnicity, relationship status or parity, and high correlation with the longer DAP scale (0.96).</div></div><div><h3>Conclusions</h3><div>A short-form DAP that maintains psychometric rigor is now available to measure pregnancy preferences.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110577"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426167","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}

引用次数: 0

TRANSGENDER, NONBINARY, AND GENDER-EXPANSIVE EXPERIENCES WITH TELEHEALTH MEDICATION ABORTION AND IMPLICATIONS FOR HEALTH EQUITY IN THE US 美国变性人、非二元性别者和性别扩张者在远程医疗药物流产方面的经验及其对健康公平的影响

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110572

A Becker, SM Shuster, LR Koenig, J Ko, UD Upadhyay

Objectives

Transgender, nonbinary, and gender-expansive (TGE) patients need abortion care. However, little is known about TGE patients’ experiences with telehealth abortion care, a growing mode of abortion service post-Dobbs.

Methods

We conducted 13 in-depth interviews with TGE patients of three US virtual abortion clinics — Choix, Hey Jane, and Abortion on Demand — who obtained telehealth abortion care between April 2021 and January 2024. Interviews were transcribed and analyzed abductively using Dedoose.

Results

The direct-to-patient telehealth model for abortion reduced barriers for trans and nonbinary patients. Many interviewees appreciated the ability to avoid entering an abortion clinic, a space typically associated with “women’s health.” Telehealth allowed patients to circumvent potential gender discrimination or uncomfortable gender-related interactions with providers and other patients, which they expected from in-person care. Patients appreciated the option to either report their preferred name and/or pronouns on intake forms or to not disclose their gender identity altogether — particularly for those who received care through asynchronous secure messaging without any face-to-face interaction. TGE Interviewees also appreciated the increased privacy, anonymity, reduced logistics, and speed of telehealth.

Conclusions

Telehealth abortion care is highly acceptable and beneficial for TGE patients, as they benefit from an at-home experience coupled with reduced gender discrimination. Findings can help direct gender-affirming abortion care in-person and via virtual clinics.

目标变性、非二元和性别扩张（TGE）患者需要人工流产护理。方法我们对 2021 年 4 月至 2024 年 1 月期间在 Choix、Hey Jane 和 Abortion on Demand 三家美国虚拟堕胎诊所接受远程健康堕胎护理的 TGE 患者进行了 13 次深入访谈。我们使用 Dedoose 对访谈进行了誊写和归纳分析。结果直接面向患者的远程医疗堕胎模式减少了变性和非二元患者的障碍。许多受访者对能够避免进入堕胎诊所这一通常与 "女性健康 "相关的场所表示赞赏。远程医疗让患者避免了潜在的性别歧视，也避免了与医疗服务提供者和其他患者进行与性别相关的不愉快互动，而这正是他们所期望的面对面医疗服务。患者可以选择在入院表格上报告自己喜欢的名字和/或代词，或者完全不披露自己的性别身份，他们对此表示赞赏，尤其是那些通过异步安全信息接受治疗而没有任何面对面交流的患者。TGE 受访者还对远程医疗增加的隐私、匿名性、减少的物流和速度表示赞赏。结论远程医疗流产护理对 TGE 患者来说是非常容易接受和有益的，因为他们受益于在家体验和减少的性别歧视。这些研究结果有助于引导患者亲自或通过虚拟诊所接受性别肯定的人工流产护理。

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引用次数: 0

PUBLIC SUPPORT FOR REPORTING AND PUNISHING PEOPLE WHO USE ALCOHOL OR DRUGS WHILE PREGNANT 公众支持举报和惩罚在怀孕期间酗酒或吸毒的人

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110564

S Auerbach, SCM Roberts, LJ Ralph, S Kaller, R Schroeder, MA Biggs

Objectives

Given increased criminalization of pregnant people and erosion of abortion rights, we need a better understanding of the extent of public support for reporting or punishing people for using alcohol or drugs while pregnant.

Methods

We administered a national probability-based online survey (December 2021-January 2022) to English- and Spanish-speaking people assigned female at birth (AFAB, ages 15-49) or male at birth (AMAB, ages 18-49) regarding their attitudes about punishing or reporting pregnant people who use alcohol or drugs and whether abortions performed within or outside the healthcare system should be legal. We used weighted analyses to estimate national support for reporting (reporting to police, to child protective services (CPS) and punishing (paying a fine, going to jail) pregnant people who use alcohol or drugs and their association with views on abortion legality.

Results

Among the 7,016 AFAB and 360 AMAB survey respondents, most supported reporting pregnant people for using alcohol or drugs to the police (57.6% AFAB, 54.8% AMAB) and CPS (69.1% AFAB, 71.3% AMAB); while fewer respondents supported punishing people with a fine (40.2% AFAB, 40.3% AMAB) or jail (31.3% AFAB, 35.1% AMAB). Support for reporting and punishing people for using alcohol or drugs while pregnant was associated with believing abortion, within or outside the healthcare system, should be illegal (OR 3.0, 95%CI 2.6-3.4 AFAB; OR 1.8, 95%CI 0.9-3.2 AMAB).

Conclusions

Public support for criminalizing alcohol and drug use during pregnancy is high and largely associated with views on abortion legality.

目标鉴于对孕妇的刑事定罪和对堕胎权利的侵蚀日益严重，我们需要更好地了解公众在多大程度上支持举报或惩罚在怀孕期间酗酒或吸毒的人。方法我们对出生时被分配为女性（AFAB，15-49 岁）或男性（AMAB，18-49 岁）的讲英语和西班牙语的人进行了基于概率的全国性在线调查（2021 年 12 月至 2022 年 1 月），调查内容涉及他们对惩罚或举报酗酒或吸毒的孕妇的态度，以及在医疗系统内或外进行的堕胎是否应该合法。我们使用加权分析来估计全国对举报（向警方、儿童保护服务机构 (CPS) 举报）和惩罚（支付罚款、入狱）酗酒或吸毒孕妇的支持率及其与堕胎合法性观点的关联。结果在接受调查的 7,016 名非洲裔美国人协会和 360 名阿拉伯裔美国人协会受访者中，大多数人支持向警方（57.6% 的非洲裔美国人协会受访者，54.8% 的阿拉伯裔美国人协会受访者）和儿童保护机构（69.1% 的非洲裔美国人协会受访者，71.3% 的阿拉伯裔美国人协会受访者）举报酗酒或吸毒的孕妇；而较少受访者支持对酗酒或吸毒的孕妇处以罚款（40.2% 的非洲裔美国人协会受访者，40.3% 的阿拉伯裔美国人协会受访者）或监禁（31.3% 的非洲裔美国人协会受访者，35.1% 的阿拉伯裔美国人协会受访者）。支持举报和惩罚在怀孕期间酗酒或吸毒的人与认为在医疗系统内外堕胎应属非法有关（OR 3.0，95%CI 2.6-3.4AFAB；OR 1.8，95%CI 0.9-3.2AMAB）。

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引用次数: 0

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110559

O Wasser, L Ralph, S Kaller, MA Biggs

Objectives

We aimed to estimate the proportion of people seeking abortion whose out-of-pocket abortion-related costs constitute a catastrophic health expenditure (CHE) and whether these are associated with in-state or out-of-state travel for care.

Methods

In 2019, we surveyed people aged 15–45 seeking abortion in four clinics located in abortion-supportive states that serve many out-of-state patients. We calculated participants’ out-of-pocket abortion-related costs (procedure, transportation, accommodation, childcare, previous appointments, missed work, and other expenses) and assessed whether these costs were financially catastrophic by applying a 40% threshold to their estimated non-subsistence monthly household income, based on published methods (Zuniga et al, 2020). Using multivariable Poisson regressions, we examined associations between traveling in-state or out-of-state for care and experiencing abortion-related costs as CHE.

Results

784 people (of 1,092 approached) completed the survey; 675 responded to the abortion-related costs questions. We found that 42% of participants experienced out-of-pocket abortion-related costs as financially catastrophic. Patients who traveled out-of-state for care were significantly more likely to experience abortion-related costs as CHE (65%, adjusted Prevalence Ratio (aPR) 2.24, 95% confidence interval (CI) 1.67-3.00) than in-state patients (32%). Individuals who resided more than 100 miles from the clinic (aPR 2.05, 95% CI 1.54-2.74) or sought abortion beyond 13 weeks’ gestation (aPR 1.80, 95% CI 1.30-2.51) were also significantly more likely to experience abortion as CHE, compared to their counterparts.

Conclusions

Out-of-pocket costs for abortion care are financially catastrophic for many abortion patients, especially those traveling out-of-state. The adverse impact on people’s financial well-being is likely exacerbated post-Dobbs v Jackson Women’s Health Organization, where more people are traveling for abortion care.

目标我们旨在估算寻求人工流产的人群中自付人工流产相关费用构成灾难性医疗支出（CHE）的比例，以及这些费用是否与州内或州外的就医旅行有关。方法2019 年，我们在位于支持人工流产州的四家诊所对寻求人工流产的 15-45 岁人群进行了调查，这些诊所为许多州外患者提供服务。我们计算了参与者自付的人工流产相关费用（手术、交通、住宿、儿童保育、之前的预约、误工及其他费用），并根据已公布的方法（Zuniga et al，2020 年），对其估计的非自给性家庭月收入采用 40% 的阈值，以评估这些费用是否具有经济灾难性。利用多变量泊松回归，我们研究了州内或州外就医与经历与流产相关的费用之间的关联。结果有 784 人（共 1092 人）完成了调查；675 人回答了与流产相关的费用问题。我们发现，42% 的参与者认为自付的人工流产相关费用在经济上是灾难性的。与州内患者（32%）相比，前往州外接受治疗的患者更有可能将人工流产相关费用视为灾难性费用（65%，调整流行率 (aPR) 2.24，95% 置信区间 (CI)1.67-3.00）。与同类患者相比，居住地距离诊所超过 100 英里（aPR 2.05，95% 置信区间 1.54-2.74）或寻求妊娠超过 13 周的人工流产（aPR 1.80，95% 置信区间 1.30-2.51）的患者经历 CHE 人工流产的可能性也明显更高。多布斯诉杰克逊妇女健康组织一案发生后，越来越多的人前往州外接受堕胎治疗，这可能会加剧对人们经济福祉的不利影响。

{"title":"ABORTION-RELATED COSTS AS CATASTROPHIC HEALTH EXPENDITURES AND THEIR ASSOCIATIONS WITH IN-STATE OR OUT-OF-STATE TRAVEL TO ABORTION CARE","authors":"O Wasser, L Ralph, S Kaller, MA Biggs","doi":"10.1016/j.contraception.2024.110559","DOIUrl":"10.1016/j.contraception.2024.110559","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to estimate the proportion of people seeking abortion whose out-of-pocket abortion-related costs constitute a catastrophic health expenditure (CHE) and whether these are associated with in-state or out-of-state travel for care.</div></div><div><h3>Methods</h3><div>In 2019, we surveyed people aged 15–45 seeking abortion in four clinics located in abortion-supportive states that serve many out-of-state patients. We calculated participants’ out-of-pocket abortion-related costs (procedure, transportation, accommodation, childcare, previous appointments, missed work, and other expenses) and assessed whether these costs were financially catastrophic by applying a 40% threshold to their estimated non-subsistence monthly household income, based on published methods (Zuniga et al, 2020). Using multivariable Poisson regressions, we examined associations between traveling in-state or out-of-state for care and experiencing abortion-related costs as CHE.</div></div><div><h3>Results</h3><div>784 people (of 1,092 approached) completed the survey; 675 responded to the abortion-related costs questions. We found that 42% of participants experienced out-of-pocket abortion-related costs as financially catastrophic. Patients who traveled out-of-state for care were significantly more likely to experience abortion-related costs as CHE (65%, adjusted Prevalence Ratio (aPR) 2.24, 95% confidence interval (CI) 1.67-3.00) than in-state patients (32%). Individuals who resided more than 100 miles from the clinic (aPR 2.05, 95% CI 1.54-2.74) or sought abortion beyond 13 weeks’ gestation (aPR 1.80, 95% CI 1.30-2.51) were also significantly more likely to experience abortion as CHE, compared to their counterparts.</div></div><div><h3>Conclusions</h3><div>Out-of-pocket costs for abortion care are financially catastrophic for many abortion patients, especially those traveling out-of-state. The adverse impact on people’s financial well-being is likely exacerbated post-<em>Dobbs v Jackson Women’s Health Organization</em>, where more people are traveling for abortion care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110559"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426317","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}

引用次数: 0

Copyright info/Contents 版权信息/内容

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/S0010-7824(24)00412-8

引用次数: 0

A QUALITATIVE STUDY EXPLORING PATIENT EXPERIENCES WITH TELEHEALTH AND IN-CLINIC MEDICATION ABORTION: STIGMA, PRIVACY, AND SUPPORT 一项定性研究，探讨患者在远程医疗和诊室药物流产方面的体验：耻辱感、隐私和支持

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110621

M Barnes, E Piqueiras, L Gutierrez-Palominos, R Patil

Objectives

We aimed to explore the experiences of people obtaining medication abortion through telemedicine medication abortion and clinic-based medication abortion at a single academic center.

Methods

We conducted an exploratory qualitative study utilizing semi-structured teleconference interviews with 23 (9 telemedicine medication abortion and 14 clinic-based medication abortion) patients with a gestational age up to 77 days who obtained a medication abortion between June 2018 and December 2022. Purposive sampling was adopted for the recruitment of participants at a single academic center in California. All interviews were recorded, transcribed, and coded by the authors to generate salient themes via thematic analysis.

Results

Participants discussed the effects of abortion stigma from society and social networks, leading to an increased desire for privacy, support, and urgency with time to appointment. Qualitative analysis indicates that telemedicine medication abortion participants preferred the increased privacy afforded via telemedicine. Clinic-based medication abortion participants highlighted the in-clinic environment as more invasive to their privacy, often requiring more people to know about their abortion which increased feelings of unease. Many participants described uncertainty about sharing abortion information with social networks because they (1) did not want to introduce others' opinions into their decision-making and (2) were unclear about how they might feel or react.

Conclusions

The results suggest that telemedicine abortion is an important tool to counteract pervasive societal stigma as well as improve accessibility. This study also suggests that abortion stigma (both actual and perceived) significantly impacts patient experiences despite being in a state with protective abortion laws, and improving accessibility and privacy can counteract the stigma associated with abortion care.

方法我们采用半结构化远程会议访谈的方式进行了一项探索性定性研究，访谈对象为 2018 年 6 月至 2022 年 12 月期间接受药物流产的 23 名（9 名远程医疗药物流产患者和 14 名门诊药物流产患者）孕龄不超过 77 天的患者。在加利福尼亚州的一个学术中心招募参与者时采用了有目的的抽样。所有访谈均由作者记录、转录和编码，通过主题分析产生突出主题。结果参与者讨论了社会和社交网络对人工流产污名化的影响，从而导致对隐私、支持和预约时间紧迫性的渴望增加。定性分析显示，远程医疗药物流产参与者更喜欢通过远程医疗增加隐私。门诊药物流产参与者强调，门诊环境更容易侵犯他们的隐私，往往需要更多的人知道他们的流产情况，这增加了他们的不安感。许多参与者表示不确定是否要与社交网络分享堕胎信息，因为他们（1）不想在做决定时引入他人的意见，（2）不清楚自己会有什么感觉或反应。这项研究还表明，尽管美国各州都有保护堕胎的法律，但堕胎耻辱感（包括实际耻辱感和感知耻辱感）会严重影响患者的体验，而提高可及性和隐私性可以抵消与堕胎护理相关的耻辱感。

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