Contraception最新文献_第4页

Exploring the availability and accessibility of medication abortion pills in Delhi, India: A mystery client study in community pharmacies 探索印度德里药物流产药片的可用性和可及性：社区药房神秘顾客研究。

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-11-08 DOI: 10.1016/j.contraception.2024.110745

Anvita Dixit , Dipesh Suvarna , Raywat Deonandan , Angel M. Foster

Objectives

Although medication abortion drugs technically require a prescription in India, research suggests that they are often available directly from pharmacies. We conducted a mystery client study in the capital city of Delhi to explore the availability, accessibility, and pharmacy dispensing practices of mifepristone/misoprostol in the absence of a prescription.

Study design

Using two predetermined client profiles—one of an unmarried woman and one of her male partner—we visited community pharmacies in different neighborhoods. Mystery clients began the interaction with a request for “a pill to bring back” a period after a positive pregnancy test. We documented product availability, price, and outcome and assessed the quality of the client–pharmacy worker interaction. We analyzed these encounters using descriptive statistics and for themes.

Results

In late 2022, we made 172 visits to 86 pharmacies. Medication abortion pills were available at more than half of the pharmacy visits (n = 91, 53%), and our mystery clients purchased the drugs without a prescription during 22% (n = 37) of all visits. The woman and man clients purchased mifepristone/misoprostol on a similar number of occasions, but we assessed the pharmacy worker interactions with the man as more positive. Pharmacy workers provided varied information about the regimen, and the encounters were brief.

Conclusions

Medication abortion drugs appear to be available without a prescription in a sizable minority of pharmacies in Delhi, India. Our findings suggest that identifying ways to work with pharmacy workers to support their ability to provide medically accurate information about the optimal mifepristone/misoprostol regimen is warranted.

Implications

Pharmacy access to mifepristone/misoprostol has the potential to greatly reduce barriers to accessing abortion care in India. Despite technically requiring a prescription, medication abortion drugs are available behind the counter at a sub-set of pharmacies in Delhi. Future research on formalizing and supporting pharmacy access and exploring abortion seekers’ experiences with pharmacy access is warranted.

目的：尽管在印度，药物流产药物在技术上需要处方，但研究表明，这些药物通常可以直接从药店买到。我们在首都德里开展了一项神秘客户研究，以探讨米非司酮/米索前列醇在没有处方的情况下的可用性、可及性和药房配药方法：研究设计：我们使用两个预先确定的客户档案--一个是未婚女性，另一个是其男性伴侣--走访了不同社区的社区药店。神秘顾客在妊娠试验呈阳性后，以要求 "让月经恢复 "的 "一片药 "开始互动。我们记录了产品的可用性、价格和结果，并评估了客户与药店工作人员互动的质量。我们使用描述性统计和主题对这些接触进行了分析：2022 年底，我们对 86 家药店进行了 172 次访问。半数以上的药店（n=91，53%）提供药物流产药，我们的神秘客户在22%（n=37）的访问中无需处方即可购买药物。女性和男性客户购买米非司酮/米索前列醇的次数相似，但我们认为药剂师与男性客户的互动更为积极。药剂师提供了不同的方案信息，而且接触时间很短：在印度德里，有相当一部分药店似乎无需处方即可提供药物流产药物。我们的研究结果表明，有必要确定与药房工作人员合作的方式，以支持他们提供有关米非司酮/米索前列醇最佳方案的准确医学信息：在印度，通过药房获取米非司酮/米索前列醇有可能大大减少获得人工流产护理的障碍。尽管从技术上讲需要处方，但在德里的部分药店可以买到非处方药流产药物。未来有必要对药房渠道的正规化和支持进行研究，并探索寻求堕胎者在药房渠道方面的经验。

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引用次数: 0

The impact of lifetime intimate partner violence on abortion method choice 终生亲密伴侣暴力对堕胎方式选择的影响》（The Impact of Lifetime Intimate Partner Violence on Abortion Method Choice）。

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-11-05 DOI: 10.1016/j.contraception.2024.110732

Lauren Sobel , Madison Bernstein , Namita Arunkumar , Jennifer Fortin , Isabel Fulcher , Youri Hwang , Alisa B. Goldberg

Objective(s)

To evaluate if the type of abortion patients prefer differs for those with a history of intimate partner violence (IPV) compared to those without a history of IPV.

Study design

We compared choice of medication versus procedural abortion between those with a history of lifetime IPV and those without a history of IPV among patients seeking abortion at 11 weeks’ gestation or less. Secondarily, we compared preferred abortion characteristics and assessed reproductive autonomy. Individuals presenting for abortion care were recruited for an anonymous, cross-sectional survey study at Planned Parenthood League of Massachusetts, Boston Health Center from September 2021 to August 2022. We required 336 subjects to detect a 20% difference in abortion method between those with a lifetime history of IPV and those without, with 80% power.

Results

We enrolled 342 participants and excluded six with missing data. A total of 71 individuals (21%) reported a lifetime history of IPV. A majority of individuals with a lifetime history of IPV chose procedural abortion, although their abortion method choice did not differ significantly from individuals with no history of IPV (56.3% vs 47.2%, p = 0.244). Individuals with a lifetime IPV history used abortion funds more frequently than those without a history of lifetime IPV (8.5% vs 1.5%, p = 0.047). There was no statistical difference between individuals with and without a lifetime history of IPV regarding what individuals considered important for the type of abortion they chose or reproductive autonomy.

Conclusion(s)

Access to procedural abortion services and abortion funds are important to meet the abortion needs of patients with a lifetime history of IPV.

Implications

Providing both medication and procedural abortion and creating a trauma-informed environment are central to supporting individuals with a history of IPV. Safeguarding abortion fund access is important individuals with a history of IPV.

目的：评估有亲密伴侣暴力史（IPV）的患者与无 IPV 史的患者在选择堕胎类型时是否有所不同：研究设计：研究设计：在妊娠 11 周或 11 周以内寻求人工流产的患者中，我们比较了有终生 IPV 史者和无 IPV 史者对药物流产和手术流产的选择。其次，我们还比较了首选流产特征并评估了生殖自主权。2021 年 9 月至 2022 年 8 月期间，我们在马萨诸塞州计划生育联盟波士顿健康中心招募了接受人工流产护理的个人，进行匿名横断面调查研究。我们需要 336 名受试者，才能检测出一生中有过 IPV 史的受试者与没有 IPV 史的受试者在人工流产方法上 20% 的差异，功率为 80%：我们招募了 342 名参与者，并排除了 6 名数据缺失者。共有 71 人（21%）报告其一生中有过 IPV 史。大多数有终生 IPV 史的人选择了程序性人工流产，尽管他们对人工流产方法的选择与没有 IPV 史的人没有显著差异（56.3% 对 47.2%，P=.244）。有终生 IPV 史的人比没有终生 IPV 史的人更经常使用人工流产基金（8.5% 对 1.5%，P=.047）。在个人认为对其选择的人工流产类型或生殖自主权至关重要的方面，有和无终生 IPV 史的个人之间没有统计学差异：结论：获得程序性人工流产服务和人工流产基金对于满足有 IPV 终生史的患者的人工流产需求非常重要。

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引用次数: 0

The impact of the SB 8 Texas abortion ban on pregnancy duration at time of abortion in a large volume Colorado clinic 德克萨斯州 SB 8 号堕胎禁令对科罗拉多州一家大型诊所堕胎时怀孕时间的影响。

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-28 DOI: 10.1016/j.contraception.2024.110731

Eva Dindinger , Kate Coleman-Minahan , Jeanelle Sheeder , Nancy Z Fang

Objectives

To assess changes in type of abortion, gestational duration, and changes in the proportion of out-of-state residents at a university-affiliated clinic in Denver, Colorado after Texas passed Senate Bill 8 (SB 8) that banned abortion after embryonic cardiac activity can be detected.

Study design

We reviewed records of all visits of patients obtaining an abortion ≤22 weeks and 6 days gestation between January 2019 and June 2022. We created two time periods: before SB 8 (January 2019–August 2021) and after SB 8 (September 2021–June 2022). We assessed changes in type of abortion, gestational duration, and the proportion of out-of-state residents. We determined the odds of a second-trimester abortion (≥13 weeks and 0 day) after SB 8 using logistic regression models adjusted for gravida, parity, age, and the proportion of out-of-state residents.

Results

There were 3844 abortions: 2875 before and 969 after SB 8. Second trimester abortions increased from 16.8% to 24.4% for Colorado residents and from 19.5% to 33.5% for out-of-state residents (p < 0.001). The proportion of patients that were Texas residents increased from 1.2% to 17.7% after SB 8 (p < 0.001). The adjusted odds of a second trimester abortion nearly doubled overall (adjusted odds ratio [aOR] 1.86 95% CI 1.55–2.23) and for Colorado residents (aOR,1.76, 95% CI, 1.44–2.16, respectively), and more than doubled for out-of-state residents (aOR, 2.34, 95% CI,1.53–3.59).

Conclusions

Laws that ban abortion early in pregnancy delay care and increase abortions occurring later in pregnancy, not only for people forced to seek care out of state, but for residents of states with abortion access.

Implications

Our data suggests that abortion bans may increase wait times, gestational duration, and force people to travel great distances for care. As more states ban abortion or restrict abortion, surrounding states where abortion is protected may need to meet the needs of those traveling in addition to their in-state residents.

目标：评估德克萨斯州通过第 8 号参议院法案（SB 8）禁止在可检测到胚胎心脏活动后进行人工流产后，科罗拉多州丹佛市一所大学附属诊所的人工流产类型、妊娠时间以及外州居民比例的变化：我们审查了 2019 年 1 月至 2022 年 6 月期间妊娠期≤22w6d 的所有人工流产患者的就诊记录。我们创建了两个时间段：SB 8 之前（2019 年 1 月至 2021 年 8 月）和 SB 8 之后（2021 年 9 月至 2022 年 6 月）。我们评估了流产类型、妊娠时间和外州居民比例的变化。我们使用逻辑回归模型确定了 SB 8 后第二孕期流产（≥13w0d）的几率，并对孕酮、胎次、年龄和外州居民比例进行了调整：结果：共有 3,844 例人工流产：结果：共有 3,844 例堕胎：SB 8 之前为 2,875 例，SB 8 之后为 969 例。科罗拉多州居民的第二孕期堕胎率从 16.8% 增加到 24.4%，州外居民的第二孕期堕胎率从 19.5% 增加到 33.5%（p 结论：禁止早期堕胎的法律会降低堕胎率：禁止孕早期堕胎的法律不仅会延误妊娠后期的护理，而且会增加妊娠后期的堕胎率，这不仅是对被迫到州外寻求护理的人而言，也是对可获得堕胎服务的各州居民而言：我们的数据表明，禁止堕胎可能会增加等待时间和妊娠时间，并迫使人们长途跋涉寻求治疗。随着越来越多的州禁止堕胎或限制堕胎，堕胎受到保护的周边州可能需要满足本州居民和旅行者的需求。

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引用次数: 0

Society of Family Planning Committee Statement: Contraception and body weight 计划生育协会委员会声明：避孕与体重。

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-11 DOI: 10.1016/j.contraception.2024.110725

Noor Zwayne , Elizabeth Lyman , Ashley Ebersole , Jessica Morse , with the assistance of Elise Boos and Antoinette Nguyen on behalf of the Clinical Affairs Committee, and Monica Skoko Rodríguez

Understanding the relationship between contraception and body weight is an important clinical consideration. Body weight and size has the potential to affect fertility and the effectiveness of some contraceptive methods, although historically this association has not been applied within a person-centered context that would allow individuals to select their preferred contraceptive method. Further, individuals with higher body weights and larger sizes have unmet contraceptive care and counseling needs. This document aims to provide evidence-based, person-centered, and equity-driven recommendations that destigmatize contraceptive care across all body weights. Clinicians should: provide person-centered, unbiased contraceptive care, including counseling pregnant-capable individuals on their risk of pregnancy based on sexual practices and contraceptive use regardless of body weight or size; utilize evidence-based and person-centered contraceptive counseling to offer the full range of contraceptive methods regardless of body weight or size; counsel patients about any risks and benefits associated with body weight and size to assist in their selection of contraceptive methods, including emergency contraception; counsel individuals about the potential for weight change, particularly weight gain, associated with contraceptive methods as a possible factor in decision-making; and counsel individuals regarding the potential impact of weight management approaches, such as bariatric surgery and glucagon-like peptide 1 (GLP-1) agonists, on contraceptive efficacy.

了解避孕与体重之间的关系是一个重要的临床考虑因素。体重和体型可能会影响生育率和某些避孕方法的效果，但从历史上看，这种关联并没有在以人为本的背景下得到应用，从而使个人能够选择自己喜欢的避孕方法。此外，体重较重和体型较大的人在避孕护理和咨询方面的需求尚未得到满足。本文件旨在提供以证据为基础、以人为本和反种族主义的建议，消除所有体重人群对避孕护理的偏见。临床医生应提供以人为本、公正的避孕护理，包括根据性行为和避孕药具的使用情况为有怀孕能力的个人提供怀孕风险咨询，而不论其体重或体型如何；利用循证和以人为本的避孕咨询，提供全套避孕方法，而不论其体重或体型如何；向患者提供与体重和体型相关的任何风险和益处的咨询，以帮助他们选择避孕方法，包括紧急避孕；向个人提供与避孕方法相关的体重变化（尤其是体重增加）的潜在影响的咨询，将其作为决策的一个可能因素；向个人提供体重控制方法（如减肥手术和胰高血糖素样肽 1 (GLP-1) 激动剂）对避孕效果的潜在影响的咨询。

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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