Contraception最新文献_第5页

“LIKE A BUSINESS TRANSACTION”: BLACK WOMEN’S TRUST IN ABORTION HEALTHCARE IN OHIO “像商业交易一样”：俄亥俄州黑人妇女对堕胎医疗的信任

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111085

SE Bostic, H Sihra, A Norris Turner, D Bessett, T Odum

Objectives

Growing research has examined the prevalence of medical mistrust among Black people and its impact on healthcare access, adherence, and outcomes. However, trust in the context of abortion has been seldom studied. These preliminary findings shed light on Black women’s conceptualizations of trust in their experiences with abortion and reproductive healthcare with the emergent theme of abortion as transactional.

Methods

We are conducting semi-structured, in-depth interviews with Black women in Ohio, asking them to describe their abortion and reproductive healthcare experiences. We used an iterative, inductive coding approach to analyze interview transcripts, allowing for insights from early interviews to inform ongoing data collection and refinement of codes.

Results

Many participants describe their abortion experience as being “like a business transaction,” with providers “just doing their job,” and the clinic “feeling like an assembly line” where “nothing moves without the payment,” highlighting the impersonal, bureaucratic, and commodified aspects of their care. Preliminary findings indicate transactional abortion experiences, with themes of clinical detachment, emotional distance, and perceived commodification of care. However, these experiences were not monolithic; some participants also reported moments of emotional connection and validation within clinical settings, reflecting the negotiation of trust and necessity under constrained circumstances of limited choice for care, resources, and time.

Conclusions

These initial findings complicate binary notions of medical trust and mistrust, suggesting that Black women navigate abortion care through nuanced and conditional forms of trust. Understanding these negotiations offers crucial insight into how reproductive healthcare systems can better address the specific needs and experiences of Black women.

越来越多的研究调查了黑人中普遍存在的医疗不信任及其对医疗服务获取、依从性和结果的影响。然而，在堕胎的背景下，信任很少被研究。这些初步研究结果揭示了黑人妇女在堕胎和生殖保健方面的信任概念，以及堕胎作为交易性的新兴主题。方法我们正在对俄亥俄州的黑人妇女进行半结构化的深入访谈，要求她们描述她们的堕胎和生殖保健经历。我们使用了一种迭代的、归纳的编码方法来分析访谈记录，允许从早期访谈中获得洞察力，从而为正在进行的数据收集和代码的改进提供信息。结果许多参与者将他们的堕胎经历描述为“像一笔商业交易”，提供者“只是在做他们的工作”，诊所“感觉就像一条流水线”，“没有钱就什么都不动”，突出了他们护理的非人情味、官僚主义和商品化方面。初步发现表明事务性流产经验，与临床脱离，情感距离和感知的商品化护理的主题。然而，这些体验并不是单一的；一些参与者还报告了在临床环境中情感联系和验证的时刻，反映了在有限的护理，资源和时间选择的限制情况下信任和必要性的谈判。这些初步发现使医疗信任和不信任的二元概念复杂化，表明黑人妇女通过微妙和有条件的信任形式来进行堕胎护理。了解这些谈判对生殖保健系统如何更好地满足黑人妇女的特殊需求和经历提供了至关重要的见解。

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引用次数: 0

RACIAL DISCRIMINATION AND PERSON-CENTERED CONTRACEPTIVE CARE IN THE US SOUTHEAST 种族歧视与美国东南部以人为本的避孕护理

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111070

AA Luke, A Newton-Levinson, S Narasimhan, MD Livingston, C Gary, S Parikh, JM Sales, SK Redd, WS Rice

Objectives

We assessed how lifetime experiences of general and stereotype-based racial discrimination during family planning care relate to patient perceptions of person-centered care during their most recent family planning visit.

Methods

People of color aged 18-44 living in Southern states who can become pregnant and sought family planning services in the past year (n=339) completed a cross-sectional survey from August to September 2024. Patient-centered care was measured dichotomously, using Dehlendorf's four-item scale with “excellent” ratings on all items. Racial discrimination was assessed using a seven-item version of the Bird-Bogart scale, examined as a count of discrimination types (0-7) and as two subscales (general and stereotype discrimination). We conducted descriptive, bivariate, and multivariable logistic regression analyses adjusting for sociodemographic variables.

Results

Some 71.7% of respondents reported at least one type of discrimination during lifetime family planning care, while 24.8% of respondents reported excellent patient-centered care. Each additional discrimination type experienced was associated with 33% lower odds of excellent person-centered care (aOR=0.67; 95% CI, 0.58-0.77), when we adjusted for sociodemographics. Analysis of discrimination subscales revealed that both general healthcare (aOR=0.56; 95% CI, 0.46-0.67) and stereotype-based discrimination (aOR=0.50; 95% CI, 0.36-0.69) were associated with lower odds of excellent person-centered care.

Conclusions

Lifetime experience of racial discrimination in family planning settings is significantly associated with reduced odds of reporting excellent patient-centered care at the most recent family planning visit. These findings highlight the need for structural interventions to address racism within family planning care.

目的：我们评估了在计划生育护理中普遍的和基于刻板印象的种族歧视的终生经历与患者在最近的计划生育就诊中对以人为本的护理的看法之间的关系。方法在2024年8月至9月期间，年龄在18-44岁、居住在美国南部各州、在过去一年中可以怀孕并寻求计划生育服务的有色人种（n=339）完成了一项横断面调查。以病人为中心的护理是两分法测量的，使用Dehlendorf的四项量表，所有项目都被评为“优秀”。种族歧视的评估采用Bird-Bogart量表的七项版本，作为歧视类型的计数（0-7）和两个子量表（一般歧视和刻板印象歧视）进行检查。我们进行了描述性、双变量和多变量逻辑回归分析，调整了社会人口变量。结果71.7%的受访者表示在终身计划生育服务中存在至少一种歧视，24.8%的受访者表示在终身计划生育服务中存在以患者为中心的良好服务。当我们调整社会人口统计学因素时，每增加一种歧视类型，获得以人为中心的优质护理的几率就会降低33% （aOR=0.67; 95% CI, 0.58-0.77）。对歧视亚量表的分析显示，普通医疗保健（aOR=0.56; 95% CI, 0.46-0.67）和基于刻板印象的歧视（aOR=0.50; 95% CI, 0.36-0.69）与较低的以人为本的优质护理相关。结论在计划生育环境中，终生的种族歧视经历与最近一次计划生育就诊中报告优秀的以患者为中心的护理的几率显著降低相关。这些发现突出表明，需要采取结构性干预措施来解决计划生育护理中的种族主义问题。

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引用次数: 0

BLEEDING EXPERIENCE AFTER MEDICATION ABORTION PRIOR TO FETAL CARDIAC ACTIVITY 胎儿心脏活动前药物流产后出血经验

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111074

AK Hoover, AE Heyse, MA Cohen, P Goedken, C Cwiak

Objectives

The purpose is to elucidate the bleeding experience after very early medication abortion in the setting of an abortion ban at fetal cardiac activity. The aims are to characterize the duration and quantity of bleeding and cramping, symptoms, and efficacy.

Methods

This is a prospective cohort study. A survey was administered prior to abortion initiation. Follow-up surveys were administered via text message daily for three days, weekly for four weeks, and once at six weeks. Chart abstraction was performed to obtain demographic and follow-up data.

Results

Some 250 participants were enrolled. At baseline, 73% of respondents reported typically moderate menses and 76% reported pregnancy symptoms. On days 1-3, participants reported bleeding at rates of 84.4%, 95.6%, and 98.4%, respectively. Less than half of respondents reported bleeding heavier than menses. Cramping on days 1-3 was noted at rates of 88.0%, 86.7%, and 79.2%, respectively. More than half of respondents reported cramping heavier than with menses on days one and two. At one week, 93.2% reported continued bleeding, with 24.0% heavier, 30.0% like, and 46.0% lighter than menses; 51.6% reported cramping, and 65.2% reported pregnancy symptoms resolved. At two weeks, 51.9% reported bleeding, 29.9% reported cramping, and 65.6% reported pregnancy symptoms resolved. At six weeks, approximately 73.0% of respondents had resumed menses while 11.3% had a positive pregnancy test.

Conclusions

Bleeding with medication abortion prior to fetal cardiac activity was similar to menses while cramping was heavier. Bleeding, cramping, and pregnancy symptoms had resolved by two weeks in most patients. Patient counseling on expectations should be adjusted accordingly.

目的探讨在胎儿心脏活动禁止流产的情况下，早期药物流产后的出血情况。目的是描述出血和痉挛的持续时间和数量、症状和疗效。方法前瞻性队列研究。在堕胎开始前进行了一项调查。后续调查通过短信进行，连续三天每天一次，四周每周一次，六周一次。进行图表抽象以获得人口统计和随访数据。结果共纳入受试者250人。在基线时，73%的应答者报告典型的中度月经，76%报告妊娠症状。在第1-3天，参与者报告的出血率分别为84.4%、95.6%和98.4%。不到一半的受访者报告出血比月经更严重。第1-3天抽筋的发生率分别为88.0%、86.7%和79.2%。超过一半的受访者表示，在第一天和第二天，痉挛比月经时更严重。1周时，93.2%报告持续出血，其中24.0%较月经重，30.0%类似，46.0%较月经轻；51.6%报告痉挛，65.2%报告妊娠症状缓解。两周时，51.9%报告出血，29.9%报告痉挛，65.6%报告妊娠症状缓解。在6周时，大约73.0%的受访者恢复了月经，11.3%的人怀孕试验呈阳性。结论胎心活动前药物流产出血与月经相似，但痉挛加重。大多数患者的出血、痉挛和妊娠症状在两周内消失。患者对期望的咨询应作相应调整。

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引用次数: 0

DOCTORS, FAMILY, OR PEERS? WHO TEENS SEEK WHEN NAVIGATING CONTRACEPTIVE SIDE EFFECTS 医生，家人，还是同龄人？青少年在面对避孕药具的副作用时会找谁

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111077

EK Wanyonyi, V Manthena, M Quasebarth, S Knifton, J Klugman, K Rivlin, L Hasselbacher

Objectives

Peers and cultural norms play critical roles in shaping adolescent attitudes. We explored spheres of influence in adolescent contraceptive decision making around side effects.

Methods

We conducted semi-structured interviews exploring experiences with contraception from December 2023 to September 2024 among adolescents aged 13 to 18. We recruited via flyers in Illinois clinics providing adolescent reproductive healthcare, snowball sampling, and targeted social media. Interviews examined side effect experiences and who adolescents sought support from when navigating side effects. Interviews were transcribed and qualitatively analyzed for themes using Dedoose.

Results

We interviewed 27 adolescent participants (41% Black, 37% White, 19% multiracial, 11% Hispanic or Latino). Adolescents described family members (parents, siblings, cousins, aunts) as holding the strongest influence over their contraceptive decision making related to side effects, especially when a family member had a negative experience. Adolescent participants sought advice from family members when experiencing a side effect, managing side effects, and deciding whether they should continue a method based on their side effect experiences. Respondents also continued or switched contraceptive methods based on provider recommendations and described relying less on peer advice, since many stated their peers were not yet using contraception. Many shared concerns about encountering misinformation on social media, though some reported supplementing side effect information gained from a parent or provider with user experiences shared on social media.

Conclusions

Given the significant role that family members play in influencing adolescent experiences with navigating contraception, educational interventions should incorporate family members into contraceptive counseling while continuing to center individual privacy and autonomy.

同伴和文化规范在形成青少年态度方面起着关键作用。我们探讨了青少年避孕决策中副作用的影响范围。方法对2023年12月至2024年9月13 ~ 18岁青少年进行半结构化访谈，探讨其避孕经历。我们通过伊利诺斯州提供青少年生殖保健的诊所的传单、雪球抽样和有针对性的社交媒体进行招募。采访调查了副作用的经历，以及青少年在应对副作用时向谁寻求支持。访谈记录和使用Dedoose对主题进行定性分析。结果我们采访了27名青少年参与者（41%的黑人，37%的白人，19%的多种族，11%的西班牙裔或拉丁裔）。青少年认为家庭成员（父母、兄弟姐妹、表兄弟姐妹、阿姨）对其避孕药具的副作用影响最大，特别是当家庭成员有负面经历时。青少年参与者在遇到副作用时向家人寻求建议，管理副作用，并根据他们的副作用经历决定是否应该继续使用这种方法。受访者还根据提供者的建议继续使用或改变避孕方法，并表示较少依赖同伴的建议，因为许多人表示他们的同伴尚未使用避孕措施。许多人都担心在社交媒体上遇到错误信息，尽管有些人报告说，他们从父母或提供者那里获得的副作用信息与社交媒体上分享的用户体验相辅相成。鉴于家庭成员在影响青少年避孕经验方面的重要作用，教育干预应将家庭成员纳入避孕咨询，同时继续以个人隐私和自主权为中心。

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引用次数: 0

AWARENESS OF ABORTION PILLS-BY-MAIL OPTIONS AMONG PATIENTS TRAVELING OUT-OF-STATE FOR ABORTION 在州外堕胎的患者中，堕胎药邮寄选择的意识

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111122

AL Woodcock, A Gero, S Elliott, C Sexsmith, T Proaño, DK Turok, J Sanders

Objectives

We aimed to understand if patients who traveled out-of-state for abortion care were aware of abortion medication by mail options and explore predictors of awareness.

Methods

From September 2024 to February 2025, we recruited patients who traveled out of their home state to receive an abortion at 15 Planned Parenthood clinics in Oregon, Washington, and Utah. Eligible participants were aged 18 or older and spoke English or Spanish. Survey questions included awareness of the option for medication abortion pills by mail and reasons for participants’ decision to travel for abortion. We assessed differences in and predictors of awareness of pills by mail using chi-squared test for categorical data and logistic regression.

Results

The final analytic sample included 113 respondents. Most participants, 82 (73%), identified their gestational age to be <11 weeks. A minority of participants were aware of pills by mail (n=41, 36.9%) and most (34/41, 83%) desired a medication abortion. Among those who were aware, 21 (59%) learned about the pills by mail option online and 10 (22%) from social media; only five (12%) learned of this option from a healthcare provider. Participants provided no dominant reason for traveling. Those aware of pills by mail were more likely to complete the survey in Spanish (OR, 3.66; 95% CI, 1.03-13.10) and have public health insurance vs. no insurance (OR, 3.85; 95% CI, 1.25-11.86).

Conclusions

Most participants traveling out of state for abortion were unaware of pill by mail options despite being <11 weeks’ gestation. A majority of those aware of the option still wanted a medication abortion in person.

目的了解外州流产患者是否通过邮寄方式了解流产药物，并探讨其知晓程度的预测因素。方法：从2024年9月到2025年2月，我们招募了离开家乡到俄勒冈州、华盛顿州和犹他州的15家计划生育诊所接受堕胎手术的患者。符合条件的参与者年龄在18岁或以上，会说英语或西班牙语。调查问题包括通过邮寄方式选择堕胎药的意识以及参与者决定旅行堕胎的原因。我们使用卡方检验对分类数据和逻辑回归评估邮寄药片意识的差异和预测因素。结果最终分析样本共113人。大多数参与者，82人（73%），确定他们的胎龄为11周。少数参与者通过邮件知道避孕药（n=41, 36.9%），大多数参与者（34/41,83%）希望药物流产。在知情的人中，21人（59%）通过在线邮件选项了解药物，10人（22%）从社交媒体了解药物；只有5人（12%）从医疗保健提供者那里了解到这种选择。参与者没有提供旅行的主要原因。那些通过邮件了解药片的人更有可能用西班牙语完成调查（OR, 3.66; 95% CI, 1.03-13.10），并且有公共健康保险与没有保险的人相比（OR, 3.85; 95% CI, 1.25-11.86）。结论：尽管怀孕11周，大多数出国堕胎的参与者都不知道邮寄避孕药的选择。大多数知道这种选择的人仍然希望亲自进行药物流产。

{"title":"AWARENESS OF ABORTION PILLS-BY-MAIL OPTIONS AMONG PATIENTS TRAVELING OUT-OF-STATE FOR ABORTION","authors":"AL Woodcock, A Gero, S Elliott, C Sexsmith, T Proaño, DK Turok, J Sanders","doi":"10.1016/j.contraception.2025.111122","DOIUrl":"10.1016/j.contraception.2025.111122","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to understand if patients who traveled out-of-state for abortion care were aware of abortion medication by mail options and explore predictors of awareness.</div></div><div><h3>Methods</h3><div>From September 2024 to February 2025, we recruited patients who traveled out of their home state to receive an abortion at 15 Planned Parenthood clinics in Oregon, Washington, and Utah. Eligible participants were aged 18 or older and spoke English or Spanish. Survey questions included awareness of the option for medication abortion pills by mail and reasons for participants’ decision to travel for abortion. We assessed differences in and predictors of awareness of pills by mail using chi-squared test for categorical data and logistic regression.</div></div><div><h3>Results</h3><div>The final analytic sample included 113 respondents. Most participants, 82 (73%), identified their gestational age to be <11 weeks. A minority of participants were aware of pills by mail (n=41, 36.9%) and most (34/41, 83%) desired a medication abortion. Among those who were aware, 21 (59%) learned about the pills by mail option online and 10 (22%) from social media; only five (12%) learned of this option from a healthcare provider. Participants provided no dominant reason for traveling. Those aware of pills by mail were more likely to complete the survey in Spanish (OR, 3.66; 95% CI, 1.03-13.10) and have public health insurance vs. no insurance (OR, 3.85; 95% CI, 1.25-11.86).</div></div><div><h3>Conclusions</h3><div>Most participants traveling out of state for abortion were unaware of pill by mail options despite being <11 weeks’ gestation. A majority of those aware of the option still wanted a medication abortion in person.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111122"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278389","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

COLLECTIVE IMPACT APPROACH: LESSONS FROM SOUTH CAROLINA’S CONTRACEPTIVE ACCESS INITIATIVE 集体影响方法：南卡罗来纳避孕措施获取倡议的经验教训

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111138

AJ Khoury, KE Beatty, LM Ventura, D Quesenberry, R Adelli, A Weber, MG Smith

Objectives

Choose Well, a statewide contraceptive access initiative in South Carolina, adopted a collective impact framework to enhance contraceptive access through collaboration, funding, and infrastructure support. This study evaluates facilitators, challenges, and lessons learned reported by leadership and staff implementing Choose Well and program grantees in federally qualified health center (FQHC) systems. This study is novel in examining implementation of a statewide contraceptive access initiative through collective impact principles: common agenda, shared measurement, mutually reinforcing activities, continuous communication, and backbone support.

Methods

Semi-structured interviews were conducted in 2022-2023, at the end of the initial six years of program implementation, with Choose Well staff (n=8) and FQHC administrators/clinicians (n=19) to explore implementation experiences, facilitators, and challenges. Using qualitative content analysis guided by the collective impact framework, data were triangulated to integrate perspectives from both groups.

Results

Facilitators of successful implementation included a shared vision for contraceptive access; shift to contraceptive equity and an expanded funding model; tailored clinic-level implementation with direct support; multi-channel communication through partner convenings and a web-based platform for training, resources, and collaborative communication; and clinic workflow and electronic medical record enhancements to improve efficiency. Challenges included delays in shared measurement development, variability in data reporting, and limited capacity for tracking contraceptive service metrics. Competing priorities within FQHCs and staff turnover further impacted shared measurement and learning/improvement opportunities.

Conclusions

Collective impact principles can advance statewide contraceptive access initiatives. Shared measurement challenges require investments in data infrastructure and training. Future initiatives should emphasize bidirectional communication, flexible implementation strategies, and sustainable infrastructure to enhance service delivery.

“选择好”是南卡罗来纳州的一项全州范围的避孕措施获取倡议，它采用了一个集体影响框架，通过合作、资金和基础设施支持来提高避孕措施的获取。本研究评估了在联邦合格医疗中心（FQHC）系统中实施“选择好”和项目受助人的领导和工作人员报告的促进因素、挑战和经验教训。本研究通过集体影响原则（共同议程、共享测量、相互加强的活动、持续沟通和骨干支持）检验了全州避孕药具获取倡议的实施情况，这是一项新颖的研究。方法在2022-2023年，即项目实施的最初六年结束时，与Choose Well工作人员（n=8）和FQHC管理人员/临床医生（n=19）进行了半结构化访谈，以探讨实施经验、促进因素和挑战。采用由集体影响框架指导的定性内容分析，对数据进行三角化，以整合两组的观点。结果成功实施的促进因素包括对获得避孕药具的共同愿景；转向避孕公平和扩大筹资模式；量身定制的临床级实施，并提供直接支持；通过合作伙伴会议和基于网络的培训、资源和协作沟通平台进行多渠道沟通；并对门诊工作流程和电子病历进行了增强，提高了工作效率。挑战包括共享测量开发的延迟、数据报告的可变性以及跟踪避孕服务指标的能力有限。fqhc内部的竞争优先级和员工流动进一步影响了共享测量和学习/改进机会。结论集体影响原则可以促进全州避孕措施的可及性。共享度量挑战需要对数据基础设施和培训进行投资。未来的倡议应强调双向沟通、灵活的实施战略和可持续的基础设施，以加强服务的提供。

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引用次数: 0

HOW EARLIER ABORTION PROVISION CONTRIBUTED TO INCREASED ABORTION INCIDENCE 2017-2020 2017-2020年早期堕胎条款是如何导致堕胎率增加的

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111108

AJ Stevenson, L Root

Objectives

National abortion incidence increased 2017-2020. We describe how the shift to earlier abortion contributed to this increase.

Methods

We build national pregnancy life tables for 2017-2020 based on published national statistics on pregnancy exits (deliveries, abortions, reported pregnancy loss, miscarriage rate schedules, and deaths during pregnancy). Using cause-deleted life tables in which abortion is removed as a cause of exit, we estimate the fraction of abortions at each week gestation that, if not terminated, would end in miscarriage by each subsequent week of pregnancy. From this we estimate the number of 2020 abortions that would have ended in miscarriage before the pregnant person accessed abortion, had gestational duration of abortions remained constant 2017-2020. By varying our assumptions, we test the sensitivity of our results and generate a range of estimates.

Results

If abortions had not occurred at earlier gestational durations between 2017 and 2020, some 10,000-20,000 pregnancies that ended in abortion in 2020 would have ended in miscarriage before the pregnant person could successfully access abortion. Therefore, abortion incidence increased by 1-2 percentage points between 2017 and 2020 just due to the shift to earlier gestational durations at abortion. Thus, 15-30% of the overall increase in abortion 2017-2020 could be due to abortions occurring at earlier gestational durations.

Conclusions

As abortions occur at earlier gestational durations, abortion incidence increases simply because fewer pregnancies end in miscarriage before abortion is accessed. Stable abortion incidence over a period when abortion is increasingly accessed earlier in pregnancy may reflect declining success securing wanted abortions.

目的2017-2020年全国人工流产率呈上升趋势。我们描述了向早期堕胎的转变是如何促成这一增长的。方法根据已公布的国家妊娠退出统计数据（分娩、流产、报告的妊娠丢失、流产率表和妊娠期间死亡），构建2017-2020年国家妊娠生命表。使用删除原因生命表，其中堕胎作为退出的原因被删除，我们估计在每个妊娠周流产的比例，如果不终止，将在随后的每个妊娠周流产。由此我们估计，如果2017-2020年妊娠期堕胎保持不变，在孕妇进行堕胎之前，2020年流产的数量将以流产告终。通过改变我们的假设，我们测试了结果的敏感性，并产生了一系列的估计。结果如果2017年至2020年妊娠期未发生流产，那么在2020年流产的约1万~ 2万例妊娠在孕妇成功流产之前就已流产。因此，在2017年至2020年期间，流产率增加了1-2个百分点，仅仅是因为流产时妊娠期提前。因此，2017-2020年堕胎总增长的15-30%可能是由于妊娠期较早发生的堕胎。结论妊娠期越早发生流产，流产发生率越高，其原因是在流产前流产的孕妇较少。在妊娠早期堕胎越来越多的时期内，稳定的堕胎发生率可能反映了获得所需堕胎的成功率下降。

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引用次数: 0

RESTRICTING RIGHTS: THE CONNECTION BETWEEN VOTING AND ABORTION RESTRICTIONS 限制权利：投票与限制堕胎之间的联系

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111101

AK Hing, M Mahoney, A Hassan

Objectives

We aimed to determine if an association exists between state-level voting restrictions and abortion restrictions. When barriers to voting increase, it can become more difficult for already marginalized people to access the ballot and make their voices heard. As a consequence, states may move further away from social and health equity rather than toward it. We hypothesize that states with a higher cost of voting will pass more abortion restrictions.

Methods

With data from the Guttmacher Institute, we counted the number of abortion restrictions passed from 2012 to 2021 and combined it with the Cost of Voting Index (COVI) 2012, 2016, and 2020, which ranks each state based on the level of difficulty of voting. We then ran a negative binomial regression of the mean COVI rank (1 to 50, with 1 being the state with the fewest barriers) for each state on the total number of abortion restrictions passed.

Results

The results of the bivariate negative binomial regression indicate a significant positive relationship between barriers to voting and the number of abortion restrictions. For a one-unit increase in mean COVI rank score, we would expect a 1.046 increase in the rate for abortion restrictions. Thus, we predict 1.72 restrictions in the state where it is easiest to vote and 15.8 restrictions in the state where it is hardest to vote.

Conclusions

We observe a higher rate of abortion restrictions passed in states where it is harder to vote, suggesting that attacks on voting rights and reproductive rights are connected.

目的：我们旨在确定州一级的投票限制和堕胎限制之间是否存在关联。当投票障碍增加时，已经被边缘化的人就更难以参与投票并发出自己的声音。其结果是，各国可能进一步远离而不是走向社会和卫生公平。我们假设投票成本较高的州将通过更多的堕胎限制。方法利用古特马赫研究所（Guttmacher Institute）的数据，统计2012年至2021年通过的堕胎限制数量，并将其与2012年、2016年和2020年的投票成本指数（COVI）相结合，该指数根据投票难度对各州进行排名。然后，我们对每个州通过的堕胎限制总数的平均冠状病毒感染排名（1到50,1代表障碍最少的州）进行负二项回归。结果双变量负二项回归结果表明，投票障碍与堕胎限制次数之间存在显著正相关关系。对于平均冠状病毒感染排名得分增加一个单位，我们预计堕胎限制率将增加1.046。因此，我们预测在投票最容易的州有1.72个限制，在投票最难的州有15.8个限制。我们观察到，在投票更难的州，通过堕胎限制的比例更高，这表明对投票权和生育权的攻击是有联系的。

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引用次数: 0

STAFF ATTITUDES TOWARD PROVIDING MEDICATION ABORTION IN PRIMARY CARE SETTINGS 员工对在初级保健机构提供药物流产的态度

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111078

S Srinivasulu, MG Manze, HE Jones

Objectives

We assessed baseline staff attitudes toward providing medication abortion in 10 primary care clinics participating in a program to adopt medication abortion.

Methods

In 2024, staff champions from 10 organizations in eight states administered our online survey to staff at clinics preparing to introduce medication abortion (n=908). Eligibility criteria included non-champion staff who could directly or indirectly be involved in a medication abortion visit. Surveys queried on perspectives related to medication abortion acceptability and belonging in primary care, comfort working in a clinic providing it, and open-ended questions on benefits and concerns. We organized open-ended responses into common themes. We conducted regression analysis using cluster-robust standard errors to explore staff characteristics associated with medication abortion attitudes.

Results

Some 721 responded (79.4%); 454 met eligibility criteria. Some 387 (85.2%) believed medication abortion should be available in primary care; only 75 (16.5%) felt uncomfortable working in a clinic that provides it. Significant differences between organizations exist across all outcomes (p<0.04). After we controlled for clustering within organizations, acceptability of medication abortion implementation scores were significantly higher among participants at academic and community health centers than at federally qualified health centers (p<0.01); lower among those working in non-LGBTQ-specific clinics (p<0.001); and lower among patient-facing clinic staff than among providers (p<0.01). Perceived benefits included mitigating access barriers (50.5%), aligning with primary care values (36.8%), and promoting reproductive autonomy (10.6%). Concerns included safety risks (34.2%), training (28.2%), and staff opposition (17.6%). Some 31.3% explicitly stated no concerns.

Conclusions

Most staff at these primary care clinics are supportive of providing medication abortion, but have concerns that champions should address during implementation.

目的评估10家参与药物流产项目的初级保健诊所工作人员对提供药物流产的基本态度。方法在2024年，来自8个州10个组织的员工冠军对准备引入药物流产的诊所工作人员进行了在线调查（n=908）。资格标准包括可能直接或间接参与药物流产就诊的非冠军工作人员。调查询问了与药物流产的可接受性和在初级保健中的归属、在提供药物流产的诊所工作的舒适性以及关于益处和关注点的开放式问题有关的观点。我们根据共同的主题组织了开放式的回答。我们使用聚类稳健标准误差进行回归分析，探讨与药物流产态度相关的员工特征。结果回复721例（79.4%）；454人符合资格标准。约387人（85.2%）认为应在初级保健中提供药物流产；只有75人（16.5%）觉得在提供这种服务的诊所工作不舒服。各组织之间在所有结果上存在显著差异（p<0.04）。在我们控制了组织内的聚类后，学术和社区卫生中心的参与者对药物流产实施的接受度得分显著高于联邦合格卫生中心的参与者（p<0.01）；在非lgbtq诊所工作的人的比例更低（p<0.001）；面向患者的临床工作人员比服务人员更低（p < 0.01）。感知到的好处包括减轻获取障碍（50.5%），与初级保健价值观保持一致（36.8%），促进生殖自主（10.6%）。关注的问题包括安全风险（34.2%）、培训（28.2%）和员工反对（17.6%）。31.3%的人明确表示不担心。结论这些初级保健诊所的大多数工作人员都支持提供药物流产，但在实施过程中有一些问题需要解决。

{"title":"STAFF ATTITUDES TOWARD PROVIDING MEDICATION ABORTION IN PRIMARY CARE SETTINGS","authors":"S Srinivasulu, MG Manze, HE Jones","doi":"10.1016/j.contraception.2025.111078","DOIUrl":"10.1016/j.contraception.2025.111078","url":null,"abstract":"<div><h3>Objectives</h3><div>We assessed baseline staff attitudes toward providing medication abortion in 10 primary care clinics participating in a program to adopt medication abortion.</div></div><div><h3>Methods</h3><div>In 2024, staff champions from 10 organizations in eight states administered our online survey to staff at clinics preparing to introduce medication abortion (n=908). Eligibility criteria included non-champion staff who could directly or indirectly be involved in a medication abortion visit. Surveys queried on perspectives related to medication abortion acceptability and belonging in primary care, comfort working in a clinic providing it, and open-ended questions on benefits and concerns. We organized open-ended responses into common themes. We conducted regression analysis using cluster-robust standard errors to explore staff characteristics associated with medication abortion attitudes.</div></div><div><h3>Results</h3><div>Some 721 responded (79.4%); 454 met eligibility criteria. Some 387 (85.2%) believed medication abortion should be available in primary care; only 75 (16.5%) felt uncomfortable working in a clinic that provides it. Significant differences between organizations exist across all outcomes (p<0.04). After we controlled for clustering within organizations, acceptability of medication abortion implementation scores were significantly higher among participants at academic and community health centers than at federally qualified health centers (p<0.01); lower among those working in non-LGBTQ-specific clinics (p<0.001); and lower among patient-facing clinic staff than among providers (p<0.01). Perceived benefits included mitigating access barriers (50.5%), aligning with primary care values (36.8%), and promoting reproductive autonomy (10.6%). Concerns included safety risks (34.2%), training (28.2%), and staff opposition (17.6%). Some 31.3% explicitly stated no concerns.</div></div><div><h3>Conclusions</h3><div>Most staff at these primary care clinics are supportive of providing medication abortion, but have concerns that champions should address during implementation.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111078"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277850","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

EXPERIENCES WITH THE M+A HOTLINE: SUPPORT ALONG THE SPECTRUM OF SELF-MANAGED ABORTION m + a热线的经验：对自我管理堕胎的支持

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111062

E Chew Murphy, J Novaes, J Karlin

Objectives

The clinician-run Miscarriage and Abortion Hotline (“M+A hotline”) offers evidence-based reproductive health information, including information on self-sourced and self-managed abortion, while maintaining privacy and anonymity. The hotline has supported thousands of individuals experiencing a miscarriage or abortion from across the US, and has seen a continued increase in the number of people seeking support since its inception in 2019. The purpose of this study is to describe the experiences of people who access the M+A hotline and examine the hotline’s impact on their abortion experience.

Methods

From June 2024 to January 2025, we recruited 28 individuals from 19 US states who contacted the M+A hotline and completed an online survey. Participants were based throughout the US in states with and without restrictive abortion policies. We conducted anonymous in-depth interviews in English and stopped recruitment when conceptual saturation had been approximated. We analyzed transcripts using inductive and deductive codes and completed thematic analysis.

Results

The analysis revealed three key themes: Direct and personalized information from a clinician perspective facilitated participants’ trust in the hotline; by providing and validating information on abortion, the hotline alleviated participants’ concerns about prevalent disinformation; and amidst participants’ fears of the legal repercussions of self-sourced and self-managed abortion, the hotline provided a secure, anonymous way to communicate directly with clinicians for medical information and support.

Conclusions

Our ﬁndings demonstrate that abortion experiences exist along a spectrum of informal to formal care utilization, and that the M+A hotline functions within this ecosystem to mitigate abortion stigma and disinformation.

目的由临床医生运营的流产和堕胎热线（“ M+A热线”）提供循证生殖健康信息，包括自我来源和自我管理的堕胎信息，同时保持隐私和匿名性。该热线已为美国各地数千名经历流产或堕胎的人提供了支持，自2019年开通以来，寻求支持的人数持续增加。本研究的目的是描述人们访问M+A热线的经历，并检查热线对其堕胎经历的影响。方法：从2024年6月到2025年1月，我们从美国19个州招募了28名联系并购热线的个人，并完成了在线调查。参与者来自美国各地有或没有限制堕胎政策的州。我们用英语进行匿名深度访谈，当概念饱和接近时停止招聘。我们使用归纳和演绎代码分析转录本，并完成主题分析。结果分析揭示了三个关键主题：从临床医生角度出发的直接和个性化信息促进了参与者对热线的信任；通过提供和验证有关堕胎的信息，热线减轻了参与者对普遍存在的虚假信息的担忧；在参与者担心自行来源和自行管理堕胎的法律后果时，热线提供了一种安全、匿名的方式，可以直接与临床医生沟通，以获取医疗信息和支持。结论我们的研究结果表明，堕胎经历存在于非正式到正式护理利用的范围内，并且M+ a热线在这个生态系统中发挥作用，以减轻堕胎耻辱和虚假信息。

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引用次数: 0