Contraception最新文献_第4页

POSTPARTUM PERMANENT CONTRACEPTIVE PROCEDURES: A 360-DEGREE QUALITATIVE INVESTIGATION 产后永久避孕程序：360 度定性调查

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110628

K Crofton, A Johnston, S Kaszubinski, S Betstadt, E Tal, R Flink-Bochacki

Objectives

We aimed to explore interdisciplinary factors affecting completion of postpartum permanent contraceptive procedures after vaginal delivery.

Methods

We conducted a multi-center qualitative study on completion or non-completion of postpartum permanent contraceptive procedures at three academic institutions from July 2023-March 2024. We recruited postpartum patients who desired permanent contraceptive procedures following vaginal delivery. We conducted semi-structured interviews with patients and their nursing, obstetric, and anesthesia teams. We double-coded transcripts using Dedoose and performed inductive thematic content analysis, concluding data collection after thematic saturation.

Results

We interviewed 19 patients (11 completed and 9 non-completed procedures) and 47 staff (mean 2.5/patient). We identified three major themes: (1) Standard perioperative counseling can be overshadowed by a focus on overcoming obstacles to completion (“What did [your doctors] tell you to expect?” “Really nothing, they just asked if I was sure I want it…”); (2) Healthcare workers’ personal values influence the prioritization of these procedures (“I believe that some are elective and some are more urgent”); (3) Procedure completion often relies on one champion to optimize interdisciplinary communication and push past barriers (“We could not get a slot for her on day 1…and then we did on day 2, mostly because [attending] advocated for her”).

Conclusions

Unlike most surgeries, the completion of postpartum permanent contraceptive procedures centers around overcoming barriers to access rather than patient needs. The propensity for clinician advocacy to detract from perioperative patient care is a novel finding, and it sustains a culture where contraceptive requests are actualized based on care-team factors rather than patient factors.

目的我们旨在探讨影响阴道分娩后完成产后永久避孕手术的跨学科因素。方法我们于 2023 年 7 月至 2024 年 3 月在三所学术机构开展了一项关于产后永久避孕手术完成或未完成情况的多中心定性研究。我们招募了希望在阴道分娩后接受永久避孕手术的产后患者。我们对患者及其护理、产科和麻醉团队进行了半结构化访谈。我们使用 Dedoose 对记录誊本进行了双重编码，并进行了归纳式主题内容分析，在主题饱和后结束了数据收集。我们确定了三大主题：(1) 标准的围手术期咨询可能会被对克服手术完成障碍的关注所掩盖（"（医生）告诉你要注意些什么？"真的没什么，他们只是问我是否确定要做......"）；（2）医护人员的个人价值观影响了这些手术的优先顺序（"我认为有些是选择性的，而有些则更紧急"）；（3）手术的完成往往依赖于一位倡导者来优化跨学科沟通并克服障碍（"我们在第一天没能为她争取到一个名额......然后我们在第二天争取到了，主要是因为[主治医生]为她做了宣传"）。结论与大多数手术不同，产后永久性避孕手术的完成主要围绕克服获得手术机会的障碍，而不是病人的需求。临床医生的宣传倾向会影响围手术期的患者护理，这是一个新的发现，它维持了一种文化，即避孕要求的实现是基于护理团队的因素而非患者的因素。

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引用次数: 0

ATTRIBUTES OF PROVIDER COUNSELING ASSOCIATED WITH CONTRACEPTIVE SATISFACTION 与避孕满意度相关的提供者咨询属性

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110646

N Luche, E Mosley, N Zite, S Borrero

Objectives

High-quality contraceptive counseling is associated with increased use of contraception. However, little is known about how counseling influences patient satisfaction with contraceptive method. This study sought to assess characteristics of counseling associated with method satisfaction.

Methods

Pregnant participants aged 21-45 years considering postpartum tubal sterilization were recruited from three sites and randomized to receipt of the MyDecision/MiDecisión decision aid tool vs. standard care. Surveys at three months postpartum included eight Likert scale items characterizing perinatal contraceptive counseling quality, and one item assessing current contraceptive method satisfaction. Response options of “strongly agree” (positively worded items) or “strongly disagree” (negatively worded items) were considered optimal. We examined bivariate associations between optimal counseling and optimal method satisfaction. Logistic regression models were then conducted, adjusted for randomization arm and confounding variables (p<0.10) identified in bivariate analysis (age, site).

Results

Of 244 participants, 160 (65.6%) reported optimal method satisfaction. In bivariate analysis, optimal ratings on feeling respected, feeling pressured into sterilization or other methods, receiving adequate explanations regarding sterilization or other methods, receiving answers to questions, and counseling satisfaction were all associated with optimal method satisfaction (all p<0.01). In adjusted analysis, optimal ratings on feeling respected (adjusted OR (aOR):5.80;95%CI:2.32-14.49), receiving adequate explanations regarding non-sterilization contraception (aOR:2.14;95%CI:1.07-4.30), feeling minimally pressured into non-sterilization methods (aOR:2.30;95%CI:1.01-5.22), receiving answers (aOR:3.35;95%CI:1.43-7.83), and counseling satisfaction (aOR:4.61;95%CI:2.18-9.74) remained significantly associated with method satisfaction.

Conclusions

Aspects of provider contraception counseling that are aligned with patient-centered care are significantly associated with contraceptive method satisfaction. Provision of high-quality contraceptive counseling may have implications both for uptake and continued use of methods.

目标高质量的避孕咨询与避孕药具使用率的提高有关。然而，人们对咨询如何影响患者对避孕方法的满意度知之甚少。本研究试图评估与避孕方法满意度相关的咨询特点。方法从三个地点招募考虑产后输卵管绝育的 21-45 岁孕妇，随机分配接受 MyDecision/MiDecisión 决策辅助工具与标准护理。产后三个月的调查包括八个李克特量表项目，描述围产期避孕咨询质量的特点，以及一个评估当前避孕方法满意度的项目。我们认为 "非常同意"（正面表述项目）或 "非常不同意"（负面表述项目）是最佳的回答选项。我们研究了最佳咨询与最佳避孕方法满意度之间的二元关联。结果在 244 名参与者中，160 人（65.6%）报告了最佳方法满意度。在双变量分析中，感觉受到尊重、感觉受到绝育或其他方法的压力、得到有关绝育或其他方法的充分解释、问题得到解答以及咨询满意度的最佳评分均与最佳方法满意度相关（均为 p<0.01）。在调整分析中，感觉受到尊重（调整 OR (aOR):5.80;95%CI:2.32-14.49）、获得有关非绝育避孕的充分解释（aOR:2.14;95%CI:1.07-4.30）、感觉在非绝育方法上压力最小（aOR:2.30;95%CI:1.01-5.22）、获得解答（aOR:3.结论服务提供者的避孕咨询与以患者为中心的护理相一致，与避孕方法满意度显著相关。提供高质量的避孕咨询可能会对避孕方法的接受和持续使用产生影响。

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引用次数: 0

DISTANCES TRAVELLED FOR ABORTIONS AND INEQUITIES FOR RURAL RESIDENTS IN OREGON 俄勒冈州农村居民的堕胎路程和不公平现象

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110616

EC Nacev, A Mandelbaum, MF Fuerst, MI Rodriguez

Objectives

Abortion access is dire in most rural areas of the US. Recent studies have shown that most reproductive-aged women live greater than a 30 minute drive from the nearest abortion clinic. True travel distances to abortion care may be even higher, given restrictions in availability by type of abortion and gestational age. This study aims to describe the burden of travel to abortion care for residents of Oregon, a state with no legal restrictions on abortion, by rurality of residence.

Methods

We conducted a descriptive study of vital statistics from the Oregon Health Authority of all abortions in Oregon from 2015 to 2021. We calculated distances between county of residence and county of abortion occurrence.

Results

Of 57,533 abortions, 90% (n=51,781) were to Oregon residents. Individuals from every county in Oregon needed abortion care during our study period, however abortions were provided in only 25% of counties (n=9). Those that travelled outside their county for abortion care (n=21,808, 37.4%) travelled an average of 56 miles for abortion care. Residents of rural counties (n=4,284) had an average travel distance of 103 miles, with maximum distance travelled of 432 miles.

Conclusions

This recent, real-world study describes a high burden of travel for rural residents, even in a state where abortion is legal. This data can support efforts to creatively, strategically, and equitably increase access to abortion, particularly for those with geographic challenges to access.

目标在美国大多数农村地区，堕胎的机会非常渺茫。最近的研究表明，大多数育龄妇女的居住地距离最近的人工流产诊所有 30 分钟以上的车程。由于人工流产类型和妊娠年龄的限制，人工流产护理的实际路程可能更远。俄勒冈州是一个对人工流产没有法律限制的州，本研究旨在描述俄勒冈州居民前往人工流产医疗机构的旅行负担，并按居住地的偏远程度进行分类。方法我们对俄勒冈州卫生局提供的 2015 年至 2021 年俄勒冈州所有人工流产的生命统计数据进行了描述性研究。我们计算了居住地所在县与堕胎发生地所在县之间的距离。在我们的研究期间，俄勒冈州每个县的居民都需要人工流产护理，但只有 25% 的县（n=9）提供了人工流产服务。到县外接受人工流产治疗的患者（人数=21,808，占 37.4%）平均需要走 56 英里才能接受人工流产治疗。农村县居民（n=4,284）的平均旅行距离为 103 英里，最远旅行距离为 432 英里。结论这项最新的真实世界研究描述了农村居民的高旅行负担，即使在堕胎合法的州也是如此。这些数据可为创造性地、战略性地、公平地增加堕胎机会提供支持，尤其是那些在地理位置上难以获得堕胎机会的人。

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引用次数: 0

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) FOR PAIN CONTROL DURING FIRST-TRIMESTER PROCEDURAL ABORTION: A BLINDED RANDOMIZED CONTROLLED TRIAL 经皮神经电刺激（Tens）用于控制第一胎程序性流产期间的疼痛：一项盲法随机对照试验

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110617

A Henkel, EP Cahill, S Chavez, JM Shorter, SM Liu, SI Amaya, S Kaur, KA Shaw

Objectives

We aimed to evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) to manage pain during first-trimester procedural abortion for those not eligible for or otherwise foregoing sedation.

Methods

This is a double-blinded, block-randomized superiority trial (IRB approved, NCT05320432) comparing TENS (placed posteriorly, T10-L1 and S2-S4) to sham for pain management during first-trimester procedural abortion. We enrolled pregnant people less than 12 weeks gestation, English- or Spanish-speaking at two outpatient clinics who were not receiving sedation. The primary outcome was self-reported pain by visual analog scale (VAS, 100 mm) with passage of largest cervical dilator. We planned to enroll 70 patients to show a 15 mm difference in median pain score (80% power, α = 0.05).

Results

Between January 2023 and March 2024, we enrolled 70 participants. Baseline demographics were balanced between groups: median (range) gestational duration 6.8 (5.1-11.8) weeks, 35.7% nulliparous. Median (range) reported pain with passage of largest dilator was 44mm (0–88) and 50mm (0–96) in the TENS and sham groups, respectively (p=0.56). We did not find a difference in median pain at any collected time point including placement of tenaculum, paracervical block, aspiration, or recovery. The active TENS group was more likely to say they would recommend this method of pain control to others (94mm vs 73mm, p=0.01). More participants receiving TENS unit correctly identified their group allocation (91.4% vs 63.6%, p<0.001).

Conclusions

While we did not demonstrate a difference in pain during the procedure, TENS is a non-pharmacologic alternative that may improve patient experience during uterine aspiration.

方法这是一项双盲、整群随机优效试验（IRB 批准，NCT05320432），比较了 TENS（置于后方，T10-L1 和 S2-S4）和假TENS 在第一胎人工流产术中的止痛效果。我们在两家门诊诊所招募了妊娠不足 12 周、讲英语或西班牙语且未接受镇静剂治疗的孕妇。主要结果是通过视觉模拟量表（VAS，100 毫米）显示最大宫颈扩张器通过时的自述疼痛。我们计划招募 70 名患者，以显示中位疼痛评分有 15 毫米的差异（80% 功率，α = 0.05）。结果在 2023 年 1 月至 2024 年 3 月期间，我们招募了 70 名参与者。各组的基线人口统计学特征均衡：中位数（范围）妊娠持续时间为 6.8（5.1-11.8）周，35.7% 为单胎。TENS 组和假阴道组报告的最大扩张器通过时的疼痛中位数（范围）分别为 44 毫米（0-88）和 50 毫米（0-96）（P=0.56）。我们没有发现在任何收集的时间点，包括放置腱膜、宫颈旁阻滞、抽吸或恢复时，疼痛中位数存在差异。主动接受 TENS 治疗组更有可能表示会向他人推荐这种疼痛控制方法（94 毫米 vs 73 毫米，P=0.01）。更多接受 TENS 装置的参与者正确识别了他们的组别分配（91.4% vs 63.6%，p<0.001）。结论虽然我们没有证明手术过程中疼痛的差异，但 TENS 是一种非药物替代方法，可能会改善子宫吸引术中患者的体验。

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引用次数: 0

“IMAGINE A PREGNANCY”: PERSPECTIVES ON PREGNANCY, ABORTION, AND PARENTING OF LATINE EMERGING ADULTS IN AN AGRICULTURAL COMMUNITY IN CALIFORNIA "想象怀孕"：加利福尼亚一个农业社区的拉丁裔新成人对怀孕、堕胎和养育子女的看法

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110585

AE Bryson, PS Nordstrom Miranda, MS Zerofsky, AB Baez De Luna, AM Minnis, M Raymond-Flesch

Objectives

We aimed to describe perspectives on pregnancy, abortion, and parenting among Latine emerging adults.

Methods

In a mixed-methods prospective cohort study of emerging adults followed since eighth grade, interviews were conducted (5/2023-1/2024) with a subset selected to achieve variation in current relationship experience. Directed content and inductive analyses of transcripts were completed.

Results

Forty-one participants (ages 18-21 years; n=21 female, n=18 male, n=2 non-binary; 12% first generation, 71% second generation, and 17% third generation immigrants) were interviewed. Participant-reported reasons to prevent pregnancy currently included educational goals, maturity, “not ready”, finances, desire not to disappoint parents, and other personal goals. When asked to imagine if they (or their partner) were pregnant now, many reported negative feelings (“…being pregnant would be the worst thing right now”), while few reported positive feelings. Participants were split between preferring abortion (“…I just feel like I would have to abort it just because I can’t even take care of myself”) and parenting (“I think if I had a child, I would really want to raise it and be involved in its life”). Adoption was rarely discussed and arose as a second-tier option if abortion was not available. Family values, support systems, and future goals were critical factors driving imagined pregnancy decisions.

Conclusions

We captured perspectives on pregnancy, abortion, and parenting of those typically underrepresented in abortion research, including emerging adults, male and non-binary individuals, and those with immigrant identities. Such research is critical to understanding how these populations are navigating their sexual and reproductive health in an evolving abortion policy landscape.

方法在一项混合方法的前瞻性队列研究中，对从八年级开始跟踪调查的新兴成年人进行了访谈（5/2023-1/2024），选择了一个子集以实现当前关系经历的变化。结果 41 名参与者（18-21 岁；女性 21 人，男性 18 人，非二元性 2 人；第一代移民 12%，第二代移民 71%，第三代移民 17%）接受了访谈。参与者报告的目前避孕的原因包括教育目标、成熟度、"还没准备好"、经济状况、不想让父母失望以及其他个人目标。当被要求想象自己（或伴侣）现在是否怀孕时，许多人表示有负面情绪（"......怀孕是现在最糟糕的事情"），而很少有人表示有正面情绪。参与者在堕胎（"......我只是觉得我必须堕胎，因为我甚至不能照顾好自己"）和养育孩子（"我想如果我有了孩子，我会非常想养育他并参与他的生活"）之间各执一词。领养很少被讨论，只是在无法堕胎的情况下作为第二选择出现。家庭价值观、支持系统和未来目标是驱动想象中的怀孕决定的关键因素。结论我们捕捉到了那些通常在堕胎研究中代表性不足的人对怀孕、堕胎和养育子女的观点，包括新兴成人、男性和非二元个体以及具有移民身份的人。此类研究对于了解这些人群如何在不断变化的人工流产政策环境中驾驭其性健康和生殖健康至关重要。

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引用次数: 0

ASSESSING EXPERIENCES OF DISCRIMINATION IN FAMILY PLANNING SETTINGS: AN EXPLORATORY FACTOR ANALYSIS 评估计划生育环境中的歧视经历：探索性因素分析

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110647

AA Luke, M Livingston, AM Gómez, AH Bennett, JM Sales, SK Redd, WS Rice

Objectives

Given the importance of high-quality, person-centered care, particularly for communities who have experienced reproductive oppression, this study aimed to test the psychometric properties of a nine-item measure of lifetime experiences of discrimination in family planning settings developed by Bird and Bogart (2001).

Methods

Data came from the nationally representative Person-Centered Contraceptive Access Metrics survey (unweighted n=3,059). We performed an exploratory factor analysis using principal axis extraction and Promax rotation. We assessed reliability using the coefficient omega. To assess known-groups validity, we employed weighted linear regression with survey sampling weights, using race as the predictor and the discrimination scale score as the outcome variable.

Results

The factor analysis resulted in a two-factor solution using 7/9 discrimination items: (1) Interpersonal Discrimination in Family Planning Care, including items reflecting differential treatment and disrespect; and (2) Racial Stereotyping in Family Planning Care, capturing assumptions based on race/ethnicity about welfare status, family size, sexual behavior, and sexually transmitted diseases. The measure demonstrated strong reliability (coefficient omega 0.97) and goodness-of-fit (TLI=0.988, RMSEA=0.066). Known-groups validity testing indicated that people of color experienced higher levels of discrimination in family planning settings compared to White respondents.

Conclusions

The validation of this measure assessing experiences of discrimination in family planning settings provides a tool to support research on the prevalence of racial discrimination and its impact on reproductive autonomy, including preferred method use, and access to care. Understanding these impacts can inform interventions promoting access to high-quality, equitable, and just reproductive healthcare.

目标鉴于高质量、以人为本的医疗保健的重要性，尤其是对经历过生殖压迫的群体而言，本研究旨在测试 Bird 和 Bogart（2001 年）开发的九个项目的计划生育环境中终生受歧视经历测量方法的心理测量特性。方法数据来自具有全国代表性的 "以人为本的避孕普及度量调查"（未加权 n=3059）。我们使用主轴提取和 Promax 旋转法进行了探索性因子分析。我们使用欧米茄系数评估了可靠性。为了评估已知群体的有效性，我们采用了调查抽样加权线性回归，将种族作为预测因子，将歧视量表得分作为结果变量。结果因子分析使用 7/9 个歧视项目得出了一个双因子解决方案：（1）计划生育关怀中的人际歧视，包括反映区别对待和不尊重的项目；（2）计划生育关怀中的种族刻板印象，包括基于种族/民族对福利状况、家庭规模、性行为和性传播疾病的假设。该测量结果显示出很强的可靠性（Ω系数为 0.97）和拟合度（TLI=0.988，RMSEA=0.066）。已知群体有效性测试表明，与白人受访者相比，有色人种在计划生育环境中遭受歧视的程度更高。结论这项评估计划生育环境中歧视经历的测量方法的验证为研究种族歧视的普遍性及其对生殖自主权（包括首选方法的使用）和获得护理的影响提供了支持工具。了解这些影响可以为促进获得高质量、公平和公正的生殖保健服务的干预措施提供依据。

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引用次数: 0

CHANGES IN CONTRACEPTIVE METHOD CHOICES FOLLOWING DOBBS IN A STATEWIDE CONTRACEPTIVE ACCESS INITIATIVE: PATH4YOU 在全州范围内开展的 "避孕药具普及行动：Path4you "中，多布斯之后避孕方法选择的变化情况

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110645

M Ruggles, BT Edmonds, J Peipert, R Evans, M Fernandez, K Wendholt, SS Bhamidipalli, TA Wilkinson, C Bernard

Objectives

The Dobbs v Jackson Women’s Health Organization decision significantly impacted abortion access, and Indiana was the first state to legislate an abortion ban in August 2022. The objective of this study was to evaluate changes in contraceptive method choice among participants using our statewide contraceptive access initiative, PATH4YOU. Our hypothesis was that more people would choose contraceptive methods with higher effectiveness due to concern for lack of abortion access in case of unintended pregnancy.

Methods

We analyzed programmatic data of 1,224 reproductive-aged people receiving care through PATH4YOU from September 2021 to September 2023, including 178 pre-Dobbs and 1,034 post-Dobbs. All participants received pregnancy intention screening, comprehensive contraceptive counseling/decision support, and same-day, free reversible method access. We analyzed the study population via age and zip code, including the social deprivation index (SDI), and the method mix before and after the Dobbs decision.

Results

The average age of participants was 28 years; 77% received care in-person, 23% via telehealth. Based on zip code, 88% were urban and were evenly split among the SDI quartiles (22% in the most vs 26% in the least deprived quartiles). Overall, participants chose 35% LARC, 31% pill/patch/ring, 12% injectable, 3% barrier/EC, and 11% other/none. After the Dobbs decision, significantly more participants chose more effective methods, including LARC (37% vs 24%, p<0.001) and injectables (13% vs 5%, p=0.003), while fewer chose pill/patch/ring (29% vs 41%, p=0.03).

Conclusions

The Dobbs decision and concerns about abortion access appear to have influenced contraceptive method choice for participants in PATH4YOU.

目标多布斯诉杰克逊妇女健康组织案的判决极大地影响了堕胎机会，印第安纳州于 2022 年 8 月成为第一个立法禁止堕胎的州。本研究的目的是评估使用全州避孕药具获取计划 PATH4YOU 的参与者在避孕方法选择上的变化。我们的假设是，由于担心意外怀孕时无法获得堕胎服务，更多的人会选择有效性更高的避孕方法。方法我们分析了 2021 年 9 月至 2023 年 9 月期间通过 PATH4YOU 接受护理的 1,224 名育龄人群的项目数据，其中包括多布斯法案前的 178 人和多布斯法案后的 1,034 人。所有参与者都接受了怀孕意愿筛查、综合避孕咨询/决策支持以及当天免费可逆避孕方法的使用。我们通过年龄和邮政编码对研究人群进行了分析，包括社会贫困指数（SDI）以及多布斯决定前后的避孕方法组合。根据邮政编码，88%的参与者为城市居民，在 SDI 四分位数中平均分布（22% 在最贫困的四分位数中，26% 在最不贫困的四分位数中）。总体而言，35% 的参与者选择了 LARC，31% 选择了避孕药/避孕贴/避孕环，12% 选择了注射，3% 选择了屏障/EC，11% 选择了其他/无。在多布斯决定之后，明显有更多的参与者选择了更有效的方法，包括 LARC（37% vs 24%，p<0.001）和注射剂（13% vs 5%，p=0.003），而选择药/贴/环的人数则较少（29% vs 41%，p=0.03）。

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引用次数: 0

CHANGES IN FREQUENCY AND DECISION-MAKING FOR FEMALE PERMANENT CONTRACEPTION FOLLOWING THE DOBBS DECISION 多布斯决定后女性永久性避孕频率和决策的变化

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110644

R Flink-Bochacki, S Pogge, A Cai, S Horvath

Objectives

We aimed to compare the frequency of female permanent contraceptive procedures before and after the Dobbs v Jackson Women’s Health Organization decision, and to assess impact of political factors on patient decision-making.

Methods

We conducted a retrospective cohort study of patients who underwent interval permanent contraceptive procedures in New York and Pennsylvania, comparing a pre-Dobbs (7/1/2020-6/30/2022) and post-Dobbs cohort (7/1/2022-6/30/2023). The primary outcome was change in procedure volume; secondary outcomes included differences in patient characteristics. We implemented standardized decision-making documentation beginning summer 2022, which allowed assessment of patient considerations in the post-Dobbs cohort. We performed Student t-tests, chi square tests, and descriptive statistics in Stata SE.

Results

There were 429 procedures pre-Dobbs and 310 post-Dobbs, including 194 (26.3%) procedures in New York and 545 (73.7%) in Pennsylvania. Volume grew significantly at both institutions, together increasing from an average 8.9 to 12.9 procedures/month (p=0.009). Patients post-Dobbs were more often under age 30 (31.7% vs. 39.0%, p=0.039) and nulliparous (10.7% vs. 21.0%, p<0.001). Decision-making documentation was recorded for 96 patients and was similar between sites, with 20% of patients considering future access to permanent contraception, 18% considering future access to reversible contraception, and 23% considering future access to abortion. At both sites, 47% of patients said their decision was somewhat or very related to current political events.

Conclusions

In two states without new abortion restrictions, permanent contraception was sought by more patients post-Dobbs, particularly younger and nulliparous patients. Fear of losing access to future reproductive options is integrated into reproductive decision-making, illustrating the wide-reaching impact of political threats to patient autonomy.

方法我们对在纽约州和宾夕法尼亚州接受间歇性永久避孕手术的患者进行了一项回顾性队列研究，比较了多布斯案之前（7/1/2020-6/30/2022）和多布斯案之后（7/1/2022-6/30/2023）的队列。主要结果是手术量的变化；次要结果包括患者特征的差异。我们从 2022 年夏季开始实施标准化决策文档，从而可以评估后多布斯队列中患者的考虑因素。我们在 Stata SE 中进行了学生 t 检验、卡方检验和描述性统计。结果多布斯手术前有 429 例，多布斯手术后有 310 例，其中纽约州有 194 例（26.3%），宾夕法尼亚州有 545 例（73.7%）。两家机构的手术量都有大幅增长，从平均每月 8.9 例增加到 12.9 例（P=0.009）。多布斯手术后的患者多在30岁以下（31.7%对39.0%，p=0.039）和无子宫（10.7%对21.0%，p<0.001）。96名患者的决策文件记录显示，两地患者的决策情况相似，20%的患者考虑将来采取永久性避孕措施，18%的患者考虑将来采取可逆性避孕措施，23%的患者考虑将来采取人工流产措施。在这两个地点，47% 的患者表示他们的决定与当前的政治事件有一定或非常大的关系。对失去未来生育选择权的恐惧被纳入了生育决策中，这说明了政治威胁对患者自主权的广泛影响。

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引用次数: 0

OUTCOMES OF UNDESIRED RAPE-RELATED PREGNANCIES WITH HYDE-ONLY COMPARED TO FULL MEDICAID COVERAGE OF ABORTIONS: A COST-EFFECTIVENESS ANALYSIS 与医疗补助对人工流产的全面覆盖相比，仅使用海德人工流产对与强奸有关的意外怀孕的结果：成本效益分析

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110575

KM Schaefer, MI Rodriguez

Objectives

We aimed to estimate the cost-effectiveness and pregnancy outcomes of undesired rape-related pregnancies (RRP) when Medicaid abortion coverage is limited to Hyde restrictions compared to full Medicaid coverage of abortions.

Methods

We used a theoretical cohort of 80,000 individuals on Medicaid who have an undesired RRP, with cohort size determined by CDC data. We used TreeAge to model RRP outcomes when abortions are covered only by Medicaid as permitted under the Hyde amendment and compare this to outcomes when abortions are covered by Medicaid under any circumstances over a ten year span. Outcomes include cost to Medicaid, quality-adjusted life-years, Medicaid-covered abortions, out-of-pocket abortions, first trimester abortions, second trimester abortions, and uncomplicated and complicated pregnancies resulting in births. Probabilities, costs, and utilities were derived from the literature. A Medicaid perspective was assumed.

Results

Our model demonstrated that among RRPs, limiting abortion coverage to Hyde restrictions results in fewer Medicaid-paid abortions, more out-of-pocket abortions, and more pregnancies resulting in births compared to the counterfactual of full Medicaid abortion coverage. In a Hyde-only coverage scenario, there would be 44,228 fewer Medicaid-paid abortions – a 96% decrease relative to Medicaid-paid abortions with full coverage – and 21,577 more out-of-pocket abortions. Full Medicaid coverage of abortion in this population would avert 22,988 pregnancies with cost-savings of $313.6 million.

Conclusions

This study suggests that limiting Medicaid coverage of abortions to strictly Hyde Amendment exceptions decreases payment for and access to abortions for rape-related pregnancies, despite these abortions meeting Hyde criteria for federal funding. This demonstrates a failure of Medicaid to pay for 96% of abortions for undesired RRP and comes at a significantly increased cost to Medicaid.

目标我们旨在估算当医疗补助计划的人工流产覆盖范围仅限于海德限制时，与医疗补助计划完全覆盖人工流产时，与强奸相关的意外怀孕（RRP）的成本效益和妊娠结果。方法我们使用了一个理论队列，该队列包含 8 万名医疗补助计划中的意外 RRP 患者，队列规模由疾病预防控制中心的数据确定。我们使用 TreeAge 对海德修正案允许的仅由医疗补助计划承保堕胎的 RRP 结果进行建模，并将其与医疗补助计划在任何情况下承保堕胎的十年结果进行比较。结果包括医疗补助计划的成本、质量调整生命年、医疗补助计划承保的人工流产、自费人工流产、前三个月人工流产、后三个月人工流产以及导致分娩的无并发症和并发症妊娠。概率、成本和效用均来自文献。结果我们的模型表明，在 RRPs 中，与完全覆盖 Medicaid 堕胎的反事实相比，将堕胎覆盖范围限制在海德限制范围内会导致更少的 Medicaid 付费堕胎、更多的自费堕胎以及更多的妊娠导致分娩。在仅适用海德方案的情况下，医疗补助计划支付的堕胎费用将减少 44 228 例（与医疗补助计划全面覆盖的堕胎费用相比减少了 96%），自费堕胎费用将增加 21 577 例。这项研究表明，将医疗补助计划的堕胎覆盖范围严格限制在海德修正案的例外情况下，会减少对强奸相关妊娠堕胎的支付和获取，尽管这些堕胎符合联邦资助的海德标准。这表明，医疗补助计划未能支付 96% 的非意愿 RRP 流产，而且医疗补助计划的成本大幅增加。

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引用次数: 0

IS TIKTOK THE NEW CONTRACEPTIVE COUNSELOR? DESCRIBING CONTRACEPTIVE SIDE EFFECTS DISCOURSE ON TIKTOK Tiktok 是新的避孕顾问吗？描述避孕药具的副作用关于 tiktok 的论述

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110632

E Pleasants, B Whitfield, ZH Pleasure, C Smith, E Norrell, C Fallon, L Lindberg

Objectives

To quantify the frequency and characterize discussions of contraceptive side effects in popular TikTok videos.

Methods

We used two third-party TikTok scrapers to collect the most-viewed TikToks using hashtags (#contraception, #birthcontrol) and search terms (“contraception”, “birth control”). The study team screened each TikTok for mention of the effects of using or not using contraception (‘side effects’), excluding irrelevant videos. Qualitative thematic analysis captured the contraceptive method(s) and side effect(s) discussed.

Results

We identified 805 relevant TikToks with at least one-million views. Preliminarily, 54% discussed contraceptive side effects, and video creators included contraceptive users, healthcare providers, and wellness influencers. In TikToks about side effects, videos most commonly discussed the contraceptive pill (28%), intrauterine device (IUD) (13%), and implant (9%). Nearly one-quarter of videos were about unspecified hormonal methods. Discussions of side effects mostly focused on people’s experiences with the effects of using or stopping contraceptives, including changes in weight, mood, attraction to sexual/romantic partners, and pain from device insertion. A substantial portion of videos focused on the perceived short- and long-term risks of hormonal contraception and discontinuation of hormonal contraception as an empowering health decision.

Conclusions

Over half of the most-viewed TikToks about contraception discussed side effects, suggesting that these videos perform well in the TikTok algorithm as highly resonant or attention-capturing. Our findings suggest that individuals who search TikTok for contraception information likely see videos about side effects, which has ramifications for contraceptive perceptions and use. Providers should continue to consider the influences of TikTok on contraceptive perceptions and decision making.

方法我们使用两个第三方 TikTok 搜刮器，使用标签（#避孕、#节育）和搜索词（"避孕"、"节育"）收集浏览量最高的 TikTok。研究小组对每个 TikTok 进行了筛选，以确定是否提及了使用或不使用避孕措施的影响（"副作用"），并排除了不相关的视频。定性专题分析捕捉了所讨论的避孕方法和副作用。初步统计，54%的视频讨论了避孕药具的副作用，视频创作者包括避孕药具使用者、医疗保健提供者和健康影响者。在有关副作用的 TikToks 中，最常讨论避孕药（28%）、宫内节育器（13%）和皮下埋植剂（9%）的视频。近四分之一的视频涉及未指定的荷尔蒙避孕方法。关于副作用的讨论主要集中在人们使用或停止使用避孕药具的经历，包括体重、情绪、对性/恋爱伴侣的吸引力的变化，以及插入避孕器时的疼痛。有相当一部分视频关注的是激素避孕的短期和长期风险，以及停止使用激素避孕药具是一种增强健康能力的决定。我们的研究结果表明，在 TikTok 上搜索避孕信息的人很可能会看到有关副作用的视频，这对避孕观念和避孕药具的使用都有影响。医疗服务提供者应继续考虑 TikTok 对避孕观念和决策的影响。

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引用次数: 0