Contraception最新文献_第5页

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。

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引用次数: 0

BELIEFS ABOUT TRUSTING WOMEN TO MAKE THEIR OWN ABORTION DECISIONS AND PUNISHMENT FOR SELF-MANAGED MEDICATION ABORTION IN A NATIONALLY REPRESENTATIVE SAMPLE 在全国代表性样本中，关于信任妇女自行做出堕胎决定的信念以及对自我管理的药物流产的惩罚情况

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110613

A Becker, R Schroeder, L Ralph, S Kaller, MA Biggs

Objectives

Given the anticipated increase in self-managed medication abortion due to decreased access to facility-based abortion in the US after Dobbs v Jackson Women’s Health Organization, we examined lay attitudes regarding trusting pregnant people to make their own abortion decisions and whether trusting women is associated with beliefs about punishment for self-managed medication abortion.

Methods

We conducted a nationally representative cross-sectional survey of 7,148 people assigned female at birth (AFAB), aged 15–49 from May to July 2023, using a probability-based panel. Participants were asked to indicate whether they agree or disagree that “Most women are capable of making the best decision on abortion for themselves.” We calculated a mean Trust women score (1–5, 5=higher trust). We conducted multivariable regression to assess factors associated with trusting women and whether trusting women was associated with support for reporting people to Child Protective Services or the police, having them pay a fine, or jailing those who self-managed a medication abortion.

Results

The mean Trust Women score was 2.6 (SD= 1.24). Respondents were evenly split between trusting women (50.36% agreed/strongly agreed, 49.64% disagreed, strongly disagreed, or neither agreed nor disagreed). Identifying as a gender or sexual minority, as Democrat, as non-Hispanic Black, and supportive of legal access to in-clinic abortion were associated with higher odds in trusting women to make abortion decisions. Trusting women was associated with decreased support for all forms of punishment for self-managed medication abortion.

Conclusions

Beliefs about trusting women are polarized, with only half of AFAB people reporting trusting women to make their own abortion decisions; these attitudes are associated with beliefs about punishing those who self-manage a medication abortion.

目标鉴于美国在多布斯诉杰克逊妇女健康组织案之后，由于设施内堕胎的机会减少，自我管理的药物流产预计会增加，我们研究了非专业人士对于信任孕妇自己做出堕胎决定的态度，以及信任女性是否与自我管理药物流产的惩罚信念相关。调查要求参与者回答是否同意 "大多数女性有能力为自己做出堕胎的最佳决定"。我们计算了 "信任女性 "的平均得分（1-5，5=信任度更高）。我们进行了多变量回归，以评估与信任女性相关的因素，以及信任女性是否与支持向儿童保护服务机构或警方举报、让她们支付罚款或监禁自行管理药物流产者相关。受访者对女性的信任度各占一半（50.36% 表示同意/非常同意，49.64% 表示不同意、非常不同意或既不同意也不不同意）。性别或性少数群体、民主党人、非西班牙裔黑人以及支持合法获得诊所内堕胎服务的受访者信任女性做出堕胎决定的几率较高。信任妇女与减少对自行管理药物流产的各种形式惩罚的支持有关。结论信任妇女的信念是两极分化的，只有一半的非洲裔美国人报告说信任妇女能做出自己的流产决定；这些态度与惩罚自行管理药物流产者的信念有关。

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引用次数: 0

POSITIONALITY AND PRIVILEGE POST-DOBBS: A QUALITATIVE ANALYSIS OF OB-GYN GRADUATES’ DECISION-MAKING 后多布斯时代的地位和特权：对妇产科毕业生决策的定性分析

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110618

AL Woodcock, M Asadian, E Torres, J Kaiser, J Baayd

Objectives

We aimed to understand the impact of the Dobbs v Jackson Women’s Health Organization decision on recent obstetrician gynecologist (Ob-Gyn) graduates with an emphasis on career decisions.

Methods

We performed 30 semi-structured interviews of residents who graduated from residencies with Ryan Abortion training Programs in July 2023. Interviewees were invited from a list of those who had previously completed a national survey. Interview questions addressed the professional and personal impact of the Dobbs decision as well as its impact on decision-making for fellowship ranking or attending positions. We analyzed interview transcripts using the Template Analysis Method.

Results

Our template analysis resulted in the overarching theme of positionality and privilege. Participants experienced abortion restrictions distinctly in relation to opposing positionalities: being physically located in restrictive vs non-restrictive states, being an abortion vs non-abortion provider, being a healthcare provider vs a patient, and identifying as female vs male. Those of less impacted positionalities commonly cited feeling “privileged,” “fortunate,” or “lucky” when describing the lack of impact of Dobbs on their lives, both personally and professionally. When asked what they desire from lawmakers, the theme of positionality and privilege persisted. Respondents want lawmakers to check their privilege and empathize with the patients who seek abortion care by shadowing clinicians in the office or listening to their stories.

Conclusions

Recently graduated Ob-Gyns are navigating through different decision-making realities post-Dobbs. Sharing the experiences of these opposing positionalities can be used to inform shared action and advocacy nationally in abortion care.

方法我们对 2023 年 7 月从瑞安流产培训项目住院医师培训机构毕业的住院医师进行了 30 次半结构式访谈。受访者是从之前完成全国性调查的受访者名单中邀请的。访谈问题涉及多布斯决定对专业和个人的影响，以及对奖学金排名或主治医生职位决策的影响。我们采用模板分析法对访谈记录进行了分析。结果我们的模板分析得出了 "地位和特权 "这一总主题。参与者对堕胎限制的体验与对立的立场有关：身处限制州与非限制州、作为堕胎提供者与非堕胎提供者、作为医疗保健提供者与患者，以及女性身份与男性身份。那些受影响较小的人在描述多布斯对他们的个人和职业生活没有影响时，通常会说自己感到 "荣幸"、"幸运 "或 "幸运"。当被问及他们希望立法者做些什么时，地位和特权的主题依然存在。受访者希望立法者能够检查他们的特权，并通过在诊室里跟随临床医生或倾听他们的故事来同情寻求堕胎护理的患者。分享这些对立立场的经验可用于在全国范围内开展堕胎护理方面的共同行动和宣传。

{"title":"POSITIONALITY AND PRIVILEGE POST-DOBBS: A QUALITATIVE ANALYSIS OF OB-GYN GRADUATES’ DECISION-MAKING","authors":"AL Woodcock, M Asadian, E Torres, J Kaiser, J Baayd","doi":"10.1016/j.contraception.2024.110618","DOIUrl":"10.1016/j.contraception.2024.110618","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to understand the impact of the <em>Dobbs v Jackson Women’s Health Organization</em> decision on recent obstetrician gynecologist (Ob-Gyn) graduates with an emphasis on career decisions.</div></div><div><h3>Methods</h3><div>We performed 30 semi-structured interviews of residents who graduated from residencies with Ryan Abortion training Programs in July 2023. Interviewees were invited from a list of those who had previously completed a national survey. Interview questions addressed the professional and personal impact of the <em>Dobbs</em> decision as well as its impact on decision-making for fellowship ranking or attending positions. We analyzed interview transcripts using the Template Analysis Method.</div></div><div><h3>Results</h3><div>Our template analysis resulted in the overarching theme of positionality and privilege. Participants experienced abortion restrictions distinctly in relation to opposing positionalities: being physically located in restrictive vs non-restrictive states, being an abortion vs non-abortion provider, being a healthcare provider vs a patient, and identifying as female vs male. Those of less impacted positionalities commonly cited feeling “privileged,” “fortunate,” or “lucky” when describing the lack of impact of <em>Dobbs</em> on their lives, both personally and professionally. When asked what they desire from lawmakers, the theme of positionality and privilege persisted. Respondents want lawmakers to check their privilege and empathize with the patients who seek abortion care by shadowing clinicians in the office or listening to their stories.</div></div><div><h3>Conclusions</h3><div>Recently graduated Ob-Gyns are navigating through different decision-making realities post-<em>Dobbs</em>. Sharing the experiences of these opposing positionalities can be used to inform shared action and advocacy nationally in abortion care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110618"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426440","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

Featured research at the 2024 Society of Family Planning Annual Meeting 2024 年计划生育协会年会上的特色研究。

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110679

Rana E. Barar (MPH; Society of Family Planning at large Board member), Anitra Beasley (MD, MPH; Society of Family Planning Board President-Elect), Nerys Benfield (MD, MPH; Society of Family Planning at large Board member), Catherine Cansino (MD, MPH; Society of Family Planning at large Board member and Co-chair of the Diversity, Equity, and Inclusion Advisory Group), Blair G. Darney (PhD, MPH; Society of Family Planning at large Board member), Sadia Haider (MD, MPH; Society of Family Planning Board President and Chair of scientific abstract selection), Kate Shaw (MD, MS; Society of Family Planning Board Secretary)

引用次数: 0

LEVONORGESTREL 52 MG INTRAUTERINE DEVICE PLACEMENT WITHOUT SOUNDING: A FEASIBILITY STUDY 左炔诺孕酮 52 毫克宫内节育器的无声放置：可行性研究

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110581

J Brown, S Yazdani, N Economou, A Flynn, H Rankin, MD Creinin

Objectives

We aimed to evaluate feasibility of levonorgestrel 52 mg intrauterine device (IUD) placement without sounding.

Methods

In this three-phase feasibility study, participants in phase one had uterine sounding prior to IUD placement. In the experimental phases, placement occurred without sounding and with (phase two) or without (phase three) concurrent transabdominal sonography. We timed procedure length from the sound (phase one) or IUD inserter (phases two/three) touching the cervix to full inserter removal. Providers used cervical anesthesia per their discretion. Participants rated pain using a 100 mm Visual Analogue Scale. Physicians described procedures as easy, moderate, or difficult. Participants in phases two and three had three-month follow-up with ultrasonography. We estimated 30 participants per phase were needed to ensure that if one failed placement occurred, the lower 95% confidence interval for successful placement would be ≥90%.

Results

We enrolled 30 participants per phase. Successful placement without sounding occurred in 30 (100%) participants in phase two and 28 (93.3%) in phase three. Median instrumentation was shorter without sounding (79.7 vs 23.3 vs 42.4 seconds; p=0.04). Median pain was lowest in phase one (21.0 vs 25.5, vs 36.0; p=0.04). Physicians rated IUD placement easy most often in phase two (n=29, 96.7%) compared to phases one (n=22, 73.3%) or three (n=22, 73.3%; p=0.03). Complications included one perforation and one expulsion in phase three.

Conclusions

IUD placement without sounding is feasible with concurrent transabdominal sonography. Placement without sounding results in shorter instrumentation time but does not decrease pain. Large studies are indicated to evaluate complication rates when no sound and no ultrasonography is used.

方法在这项分三个阶段进行的可行性研究中，第一阶段的参与者在放置宫内节育器前进行了子宫探查。在实验阶段，放置宫内节育器时不进行探查，同时进行（第二阶段）或不进行（第三阶段）经腹超声检查。我们对从宫颈探音（第一阶段）或宫内节育器置入器（第二/三阶段）接触宫颈到完全取出置入器的过程进行了计时。医生酌情使用宫颈麻醉。参与者使用 100 毫米视觉模拟量表对疼痛进行评分。医生将手术分为简单、中等和困难三个等级。第二和第三阶段的参与者接受了为期三个月的超声波随访。我们估计每个阶段需要 30 名参与者，以确保即使出现一次置管失败，成功置管的 95% 置信区间下限也将≥90%。第二阶段有 30 人（100%）成功置管，第三阶段有 28 人（93.3%）成功置管。中位器械置入时间更短（79.7 秒 vs 23.3 秒 vs 42.4 秒；P=0.04），无探头。第一阶段的疼痛中位数最低（21.0 vs 25.5，vs 36.0；P=0.04）。与第一阶段（22 人，73.3%）或第三阶段（22 人，73.3%；P=0.03）相比，第二阶段（29 人，96.7%）医生最常将宫内节育器放置简单化。并发症包括第三阶段的一次穿孔和一次脱出。无探头放置可缩短器械植入时间，但不会减少疼痛。有必要进行大规模研究，以评估不探查和不使用超声波检查时的并发症发生率。

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引用次数: 0

“I WORK WITH WHAT I HAVE”: MANAGING MEDICATION ABORTION AND MISCARRIAGE IN THE UNHOUSED COMMUNITY "我尽我所能"：无房社区的药物流产和流产管理

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110588

LE Adams, MJ Arzate, KR Barnes, J Karlin

Objectives

We sought to provide better support to houseless individuals’ experiences with medication abortion.

Methods

We recruited pregnancy-capable persons from Sacramento between the ages of 18-55 who had experienced an abortion or miscarriage, were currently or previously unhoused, and spoke English. Fifteen, 30-minute interviews were conducted where participants were asked about their medication abortion or miscarriage experience, and how they would manage a medication abortion while unhoused given their experience. Inductive and deductive coding were utilized for theme development.

Results

Unmet needs fell into three main categories: (1) lack of access to a safe location to complete a medication abortion including hygiene facilities; (2) lack of social support including childcare and communication from their provider throughout and after the medication abortion; and (3) a lack of access to appropriate supplies including pain and bleeding management supplies.

Conclusions

Houseless individuals have specific experiences with medication abortion which lead to unique, and unmet, needs when compared with the general population of pregnancy-capable people. Public health providers can ensure patient-centered care by providing them with appropriate resources, such as social services and material goods, to navigate their abortion plan beyond the clinic. Next steps include offering these services and supplies to this population and assessing if the medication abortion experience is improved.

方法我们从萨克拉门托招募了 18-55 岁之间有怀孕能力的人，他们都有过堕胎或流产经历，目前或以前没有住房，会讲英语。我们对参与者进行了 15 次 30 分钟的访谈，询问他们药物流产或流产的经历，以及根据他们的经历，在没有住房的情况下如何处理药物流产。结果未满足的需求主要分为三类：(1) 缺乏完成药物流产的安全地点，包括卫生设施；(2) 缺乏社会支持，包括儿童保育以及在药物流产的整个过程中和之后与医疗服务提供者的沟通；(3) 缺乏适当的用品，包括止痛和止血用品。公共卫生服务提供者可以通过向他们提供适当的资源（如社会服务和物质产品）来确保以患者为中心的护理，使他们能够在诊所之外完成流产计划。接下来的步骤包括向这些人群提供这些服务和用品，并评估药物流产的体验是否得到改善。

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引用次数: 0

CHANGES IN BELIEFS ABOUT ABORTION SAFETY IN A NATIONALLY REPRESENTATIVE SAMPLE BETWEEN 2022 AND 2023 2022 至 2023 年间全国代表性样本中有关堕胎安全的观念变化

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110589

R Schroeder, L Ralph, A Becker, S Kaller, MA Biggs

Objectives

We aimed to estimate changes in beliefs about abortion safety among the US population assigned female at birth (AFAB) before and after Dobbs v Jackson Women’s Health Organization.

Methods

We administered two serial cross-sectional surveys to English- or Spanish-speaking members of a nationally-representative panel of AFAB respondents, ages 15-49, pre-Dobbs (December 2021/January 2022; n=6,943) and post-Dobbs (June/July 2023; n=3,533). We asked participants to indicate whether they agree (ranging from strongly disagree to strongly agree) “that it is usually safe for a pregnant person to end a pregnancy", by (1) having an in-clinic abortion procedure; (2) using abortion pills obtained at a clinic or doctor’s office; and (3) using abortion pills obtained outside the formal healthcare system. Using weighted logistic regression models with year as the independent variable, we assessed changes in safety beliefs pre- to post-Dobbs, both overall and among subgroups.

Results

Between 2022 and 2023, the proportion of respondents agreeing that each abortion method was “usually safe” increased: in-clinic procedure: 57.8% to 64.1% (p<0.001); in-clinic medication abortion: 52.2% to 59.6% (p<0.001); and pills obtained outside of the formal healthcare system: 7.4% to 9.6% (p<0.001). In stratified analyses, subgroups associated with increased endorsement of safety between years included respondents identifying as a Democrat, with no history of abortion, and who support in-clinic procedural abortion legality (p<0.05 for all abortion method outcomes).

Conclusions

In a nationally representative sample, belief that abortion methods are safe increased between 2022 and 2023 despite increasing abortion restrictions and policies claiming abortion is unsafe. Still, public knowledge about abortion safety remains low.

方法我们在多布斯诉杰克逊妇女健康组织案之前（2021 年 12 月/2022 年 1 月；n=6943）和多布斯案之后（2023 年 6 月/7 月；n=3533）对具有全国代表性的 15-49 岁 AFAB 受访者小组中讲英语或西班牙语的成员进行了两次连续横断面调查。我们要求参与者通过以下方式表明他们是否同意（从非常不同意到非常同意）"孕妇结束妊娠通常是安全的"：(1) 在诊所内进行人工流产手术；(2) 使用在诊所或医生办公室获得的人工流产药片；(3) 使用在正规医疗系统外获得的人工流产药片。使用以年份为自变量的加权逻辑回归模型，我们评估了从多布斯事件前到多布斯事件后安全观念的变化，包括总体变化和各亚组之间的变化：57.8%增至64.1%（p<0.001）；诊所内药物流产：52.2%增至59.6%（p<0.001）：52.2%增至59.6%（p<0.001）；在正规医疗系统外获得的药片：7.4%增至9.6%（p<0.001）。在分层分析中，与不同年份间安全性认可度增加相关的亚组包括认同民主党、无人工流产史以及支持诊所内程序性人工流产合法性的受访者（所有人工流产方法结果的 p<0.05 ）。结论在一个具有全国代表性的样本中，尽管人工流产限制和声称人工流产不安全的政策不断增加，但在 2022 年至 2023 年期间，人们对人工流产方法安全性的信念有所增加。然而，公众对堕胎安全的了解仍然较少。

{"title":"CHANGES IN BELIEFS ABOUT ABORTION SAFETY IN A NATIONALLY REPRESENTATIVE SAMPLE BETWEEN 2022 AND 2023","authors":"R Schroeder, L Ralph, A Becker, S Kaller, MA Biggs","doi":"10.1016/j.contraception.2024.110589","DOIUrl":"10.1016/j.contraception.2024.110589","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to estimate changes in beliefs about abortion safety among the US population assigned female at birth (AFAB) before and after <em>Dobbs v Jackson Women’s Health Organization</em>.</div></div><div><h3>Methods</h3><div>We administered two serial cross-sectional surveys to English- or Spanish-speaking members of a nationally-representative panel of AFAB respondents, ages 15-49, pre-<em>Dobbs</em> (December 2021/January 2022; n=6,943) and post-<em>Dobbs</em> (June/July 2023; n=3,533). We asked participants to indicate whether they agree (ranging from strongly disagree to strongly agree) “that it is usually safe for a pregnant person to end a pregnancy\", by (1) having an in-clinic abortion procedure; (2) using abortion pills obtained at a clinic or doctor’s office; and (3) using abortion pills obtained outside the formal healthcare system. Using weighted logistic regression models with year as the independent variable, we assessed changes in safety beliefs pre- to post-<em>Dobbs</em>, both overall and among subgroups.</div></div><div><h3>Results</h3><div>Between 2022 and 2023, the proportion of respondents agreeing that each abortion method was “usually safe” increased: in-clinic procedure: 57.8% to 64.1% (p<0.001); in-clinic medication abortion: 52.2% to 59.6% (p<0.001); and pills obtained outside of the formal healthcare system: 7.4% to 9.6% (p<0.001). In stratified analyses, subgroups associated with increased endorsement of safety between years included respondents identifying as a Democrat, with no history of abortion, and who support in-clinic procedural abortion legality (p<0.05 for all abortion method outcomes).</div></div><div><h3>Conclusions</h3><div>In a nationally representative sample, belief that abortion methods are safe increased between 2022 and 2023 despite increasing abortion restrictions and policies claiming abortion is unsafe. Still, public knowledge about abortion safety remains low.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110589"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426178","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

PHARMACIST PERSPECTIVES ON PRESCRIBING MEDICATION ABORTION: FINDINGS FROM A QUALITATIVE STUDY OF CALIFORNIA PHARMACISTS 药剂师对药物流产处方的看法：对加利福尼亚药剂师的定性研究结果

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110592

JJ Serpico, C Cohen, L Serrano, RM Beltran

Objectives

We aimed to explore pharmacist attitudes toward dispensing and prescribing medication abortion.

Methods

Semi-structured interviews were conducted among 30 practicing licensed California pharmacists from October 2022 to July 2023. Participants were recruited through snowball sampling with a focus on attaining a diverse sample. Twenty-nine interviews were analyzed. Key themes were identified using Hamilton’s (2019) Rapid Qualitative Analysis Approach.

Results

Five key themes emerged: (1) pharmacists strongly supported pharmacist-dispensed medication abortion; (2) pharmacists expressed qualified support for pharmacist-prescribed medication abortion; (3) pharmacists were concerned about legality and liability in the abortion context; (4) pharmacists both endorsed and critiqued abortion stigma; and (5) pharmacists articulated various visions of their appropriate role in care provision. Almost all pharmacists supported dispensing medication abortion. While most expressed some support for prescribing medication for abortion, many expressed concerns, primarily around the themes of legality/liability and abortion stigma, as well as two prescribing sub-themes: training needs and logistical/operational barriers. Pharmacists lacked clarity around legality and desired legal protections, including for providing medication abortion to out-of-state patients. Pharmacists expressed concerns about protestors or community backlash and endorsed the belief that abortion patients may need mental health counseling, which they did not feel equipped to provide. Some pharmacists highlighted their role as accessible healthcare providers with increasing responsibility, while others emphasized having distinct roles from prescribing providers. Overall, pharmacists emphasized providing non-judgmental care, including dispensing medication for abortion without questioning the patient’s or prescribing provider’s judgment.

Conclusions

Our results provide preliminary evidence that a meaningful portion of pharmacists may be open to prescribing medication abortion, if expressed concerns are addressed.

方法 2022 年 10 月至 2023 年 7 月，我们对加利福尼亚州 30 名执业药剂师进行了半结构式访谈。我们通过滚雪球抽样的方式招募参与者，重点是获得多元化的样本。对 29 个访谈进行了分析。结果出现了五个关键主题：（1）药剂师强烈支持药剂师配药流产；（2）药剂师对药剂师处方药物流产表示有条件的支持；（3）药剂师关注流产背景下的合法性和责任；（4）药剂师既赞同又批评流产耻辱化；以及（5）药剂师阐述了他们在提供护理中的适当角色的各种愿景。几乎所有药剂师都支持配药流产。虽然大多数药剂师对开具药物流产处方表示了一定的支持，但许多药剂师也表达了担忧，主要围绕合法性/责任和流产耻辱感这两个主题，以及两个处方次主题：培训需求和后勤/操作障碍。药剂师对合法性和所需的法律保护缺乏明确认识，包括向州外患者提供药物流产。药剂师表达了对抗议者或社区反弹的担忧，并赞同堕胎患者可能需要心理健康咨询的观点，但他们认为自己不具备提供心理健康咨询的能力。一些药剂师强调他们的角色是无障碍医疗服务提供者，责任越来越大，而另一些药剂师则强调他们的角色与处方提供者截然不同。总体而言，药剂师强调提供非评判性的护理，包括在不质疑患者或处方提供者的判断的情况下配药流产。结论我们的研究结果提供了初步证据，表明如果所表达的顾虑得到解决，相当一部分药剂师可能对开具药物流产处方持开放态度。

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