Contraception最新文献_第6页

WHEN STATE POLICY CLASHES WITH OPINION: POST-DOBBS INCREASES IN SUPPORT FOR ABORTION AMONG OHIO WOMEN 当州政策与舆论发生冲突时：多布斯事件后俄亥俄州妇女对堕胎的支持率上升

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110608

MH Smith, A Underwood, E Warren, A Norris Turner, M Gallo

Objectives

The Dobbs v Jackson Women’s Health Organization decision granted states more authority in regulating abortion care. In the 12 weeks following Dobbs, Ohio enacted a six-week ban despite public support for abortion in the state. We assessed changes in abortion support post-Dobbs among women in Ohio, an abortion-restrictive state that recently passed a ballot initiative aimed at protecting access to care.

Methods

We used two independent, cross-sectional waves of a representative survey of adult reproductive age Ohio women to compare abortion attitudes before and after Dobbs. NORC collected this data from October 2018-June 2019 (pre-Dobbs) and September 2022-August 2023 (post-Dobbs). We assessed abortion attitudes using four measures: whether someone should be arrested for abortion, whether abortion should be available, whether abortion is acceptable, and pro-life/pro-choice identity. We created a scale combining these measures and calculated 95% confidence intervals comparing pre- and post-Dobbs results.

Results

All measures showed statistically significant increases in abortion support post-Dobbs. Comparing pre- and post-Dobbs results, 58% versus 77% felt abortion should be available, 68% versus 85% felt someone should not be arrested for abortion, 26% vs. 46% felt that abortion was acceptable in all circumstances, and 40% vs. 59% identified as pro-choice. From our combined scale, 25% vs. 43% of respondents were supportive across all four measures.

Conclusions

Women in Ohio, an abortion-restrictive state, have shown consistent support for abortion, which increased following Dobbs. These findings provide necessary context for the recent success of the November 2023 reproductive rights ballot initiative. They also underscore the important relationship between policy and opinion.

目标多布斯诉杰克逊妇女健康组织案的裁决赋予各州更多的权力来管理堕胎护理。在多布斯案判决后的 12 周内，尽管俄亥俄州公众支持堕胎，但该州还是颁布了为期六周的堕胎禁令。我们评估了俄亥俄州妇女在多布斯案后对堕胎支持的变化，该州是一个限制堕胎的州，最近通过了一项旨在保护堕胎者获得堕胎护理的投票倡议。NORC 收集了 2018 年 10 月至 2019 年 6 月（多布斯之前）和 2022 年 9 月至 2023 年 8 月（多布斯之后）的数据。我们使用四种测量方法来评估堕胎态度：是否有人应该因堕胎而被捕、是否应该提供堕胎、堕胎是否可以接受以及支持生命/支持选择的身份。我们创建了一个量表，将这些指标结合在一起，并计算出 95% 的置信区间，将多布斯调查前后的结果进行比较。比较多布斯调查前后的结果，58% 对 77% 的人认为应该提供堕胎服务，68% 对 85% 的人认为不应该因堕胎而被捕，26% 对 46% 的人认为堕胎在任何情况下都是可以接受的，40% 对 59% 的人认为自己是支持堕胎的。从我们的综合量表来看，25% 对 43% 的受访者在所有四项指标上都表示支持。这些研究结果为近期 2023 年 11 月生殖权利投票倡议的成功提供了必要的背景。它们还强调了政策与舆论之间的重要关系。

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引用次数: 0

CHANGES IN KNOWLEDGE OF ABORTION LEGALITY FOLLOWING DOBBS 多布斯案之后堕胎合法性知识的变化

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110593

MF Gallo, A Underwood, M Smith, E Warren, A Norris Turner

Objectives

We analyzed two independent waves of a population-representative survey of adult, reproductive-age women in Ohio to assess beliefs about legality of abortion and 11 other reproductive health practices in the state. Abortion was legal in Ohio until 22 weeks of gestation during both waves; however, during a brief period between waves, abortion was restricted to about 6 weeks of gestation.

Methods

We used logistic regression to compare the prevalence of believing abortion is illegal in Ohio pre-Dobbs (October 2018–June 2019; n=2,516) vs. post-Dobbs (September 2022–August 2023; n=2,421). We also measured beliefs about legality of 11 other practices post-Dobbs and identified correlates of holding these beliefs.

Results

Higher fractions of women believed that abortion was illegal in 2022-2023 compared to 2018-2019 (40.5% versus 10.1%, respectively; p<0.001). At both times, many reported not knowing the legal status (28.7% and 26.5%, respectively). Similarly, substantial percentages of women in 2022-2023 reported not knowing the legality of practices such as using assisted reproductive technology (17.3%), traveling out of state to obtain an abortion (44.3%), obtaining medical care during or after miscarriage (21.3%), or receiving care for ectopic pregnancy (27.7%). Women with higher socioeconomic status had higher odds of knowing abortion was legal in Ohio post-Dobbs.

Conclusions

Despite being legal, 40.5% of adult, reproductive-age women in Ohio in 2022-2023 believed abortion was illegal in the state, a large increase from pre-Dobbs. Rapid changes in state-level abortion laws following Dobbs could have caused confusion about the legality of abortion and introduced concerns about the legality of other reproductive health practices.

目标我们对俄亥俄州成年育龄妇女的两次独立的人口代表性调查进行了分析，以评估该州对堕胎合法性和其他 11 种生殖健康行为的看法。在这两次调查中，俄亥俄州的堕胎在妊娠 22 周前都是合法的；然而，在两次调查之间的短暂时期，堕胎被限制在妊娠 6 周左右。方法我们使用逻辑回归比较了认为俄亥俄州多布斯调查前（2018 年 10 月至 2019 年 6 月；n=2,516）与多布斯调查后（2022 年 9 月至 2023 年 8 月；n=2,421）堕胎非法的流行率。我们还测量了多布斯会议后对 11 种其他做法合法性的看法，并确定了持有这些看法的相关因素。结果与 2018-2019 年相比，2022-2023 年有更高比例的妇女认为堕胎是非法的（分别为 40.5% 对 10.1%；p<0.001）。在这两个时间段，许多人表示不知道法律地位（分别为 28.7% 和 26.5%）。同样，2022-2023 年有相当比例的妇女表示不知道使用辅助生殖技术（17.3%）、到州外堕胎（44.3%）、在流产期间或之后获得医疗护理（21.3%）或接受宫外孕护理（27.7%）等做法的合法性。结论尽管堕胎合法，但 2022-2023 年俄亥俄州仍有 40.5%的成年育龄妇女认为堕胎在该州是非法的，与多布斯案之前相比大幅增加。在多布斯案之后，州一级的堕胎法律发生了迅速变化，这可能会造成对堕胎合法性的混淆，并引发对其他生殖健康行为合法性的担忧。

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引用次数: 0

RESTORING, PROTECTING, AND EXPANDING ABORTION ACCESS IN THE US: SEEKING CONSENSUS THROUGH THE DELPHI METHOD 恢复、保护和扩大美国的堕胎机会：通过德尔菲法寻求共识

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110586

S Pickering, M Manze, JV Lazarus, D Romero

Objectives

The Dobbs v Jackson Women’s Health Organization decision exacerbated inequitable access to abortion in the US. Agreement is needed on which strategies should be prioritized to restore, protect, and expand abortion access.

Methods

We convened a multidisciplinary, geographically diverse Delphi panel of clinical, research, policy, legal, and advocacy experts to reach consensus (ie, agreement >67%) on recommended actions. Using feedback from three rounds of surveys, and input from a select expert advisory group (n=10), we iteratively refined the consensus points.

Results

The panel (n=85) developed 25 consensus statements and 32 recommendations for action in states with protected, mixed, or restricted access to abortion based on categorizations by the Guttmacher Institute. In states with protected access, key recommendations (ie, >70% agreement) were to incorporate abortion into primary care and expand clinical services to include all types of abortion. In states with mixed access, key recommendations were to establish pathways for patients seeking abortion, lobby for Medicaid coverage of abortion, expand clinical services to include all types of abortion, and build broad coalitions for abortion access. In states with restricted access to abortion, the key recommendations were to combat gerrymandering and voter suppression, train emergency room staff in abortion care, establish protections against criminalization, and flip state legislatures.

Conclusions

This Delphi study identified actionable priorities in addressing inequitable access to abortion in states with varied policy environments. It also highlights areas where more strategic discussions are needed (eg, the utility of boycotts in states with abortion bans).

目标多布斯诉杰克逊妇女健康组织案的判决加剧了美国堕胎机会的不公平。我们召集了一个由临床、研究、政策、法律和宣传专家组成的多学科、地域多元化德尔菲小组，就建议采取的行动达成共识（即 67% 的一致意见）。根据古特马赫研究所的分类，专家小组（人数=85）制定了 25 项共识声明和 32 项行动建议，适用于堕胎机会受到保护、混合或限制的州。在堕胎机会受保护的州，主要建议（即 70% 的一致意见）是将堕胎纳入初级保健，并扩大临床服务以包括所有类型的堕胎。在允许混合堕胎的州，主要建议是为寻求堕胎的患者建立途径，游说医疗补助计划覆盖堕胎，扩大临床服务以包括所有类型的堕胎，并建立广泛的堕胎联盟。在限制堕胎机会的州，主要建议是打击选区划分和选民压制，对急诊室工作人员进行堕胎护理培训，建立防止定罪的保护措施，以及翻转州立法机构。它还强调了需要进行更具战略性讨论的领域（例如，在禁止堕胎的州抵制堕胎的效用）。

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引用次数: 0

YOUNG PEOPLE’S ONLINE SOURCES OF CONTRACEPTIVE INFORMATION AND ASSOCIATIONS WITH CONTRACEPTIVE KNOWLEDGE AND ATTITUDES 年轻人的网上避孕信息来源以及与避孕知识和态度的联系

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110643

ZH Pleasure, EA Pleasants, B Whitfield, C Larsen, D Johnson, RJ Steiner, L Lindberg

Objectives

We aimed to assess concordance between adolescent and young adults’ (AYA) preferred and actual sources of online contraceptive information; and examine associations between sources and contraceptive attitudes and knowledge.

Methods

We used data from a 2023 online national survey of AYA (15-29 years) assigned-female-at-birth (n=1,150). We examined the prevalence of preferred and actual information sources, and assessed multivariable associations between information received from websites and social networking sites (SNS) and four contraceptive knowledge and attitude measures.

Results

One-third of respondents preferred websites as a contraceptive information source (33%), but they were an actual source for only 15% in the past year. Conversely, SNS were a preferred source for only 10%, yet the second most common actual source (22%). Adjusting for age, sexual activity, and other information sources, receiving information from websites was positively associated with identifying the most effective contraceptive method (adjusted OR (aOR)=2.83, 95%-CI:1.82-4.40) and, marginally, with agreeing that hormonal contraception is safe (aOR=1.63, 95%-CI:0.98-2.70). Receiving information from SNS was positively associated with identifying the most effective contraceptive method (aOR=1.87, 95%-CI:1.26-2.77), but had a marginal negative association with believing that benefits outweigh side effects (aOR=0.72, 95%-CI:0.48-1.08).

Conclusions

Websites were a desired source with potential positive impacts on contraceptive outcomes, but AYA face challenges accessing them. SNS, while less desired than websites, are a more common source with potential positive and negative impacts on outcomes. Future research, advocacy, and clinical practice should distinguish between these online sources, monitor the impacts of SNS, and leverage websites as preferred and beneficial contraceptive information sources for AYA.

目标我们旨在评估青少年和年轻成人（AYA）首选和实际在线避孕信息来源之间的一致性；并研究信息来源与避孕态度和知识之间的关联。方法我们使用了 2023 年对分配给出生时女性的青少年和年轻成人（15-29 岁）（n=1,150）进行的全国在线调查的数据。我们研究了首选和实际信息来源的普遍性，并评估了从网站和社交网站（SNS）获得的信息与四项避孕知识和态度测量指标之间的多变量关联。结果三分之一的受访者首选网站作为避孕信息来源（33%），但在过去一年中只有 15%的受访者将网站作为实际信息来源。相反，只有 10% 的受访者首选 SNS 作为信息来源，但 SNS 却是第二大最常见的实际信息来源（22%）。在对年龄、性活动和其他信息来源进行调整后，从网站获取信息与确定最有效的避孕方法呈正相关（调整后 OR (aOR)=2.83, 95%-CI:1.82-4.40），与同意激素避孕是安全的呈略相关（aOR=1.63, 95%-CI:0.98-2.70）。从 SNS 获取信息与确定最有效的避孕方法呈正相关（aOR=1.87，95%-CI:1.26-2.77），但与认为避孕方法利大于弊呈负相关（aOR=0.72，95%-CI:0.48-1.08）。SNS 虽然不如网站受欢迎，但却是一种更常见的渠道，对避孕结果具有潜在的积极和消极影响。未来的研究、宣传和临床实践应区分这些在线来源，监测 SNS 的影响，并将网站作为青少年首选的、有益的避孕信息来源。

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引用次数: 0

OPIATE-SPARING ANALGESIA PROTOCOL FOR PAIN AFTER OSMOTIC DILATOR PLACEMENT: A QUALITY IMPROVEMENT STUDY 针对放置渗透扩张器后疼痛的阿片类镇痛方案：质量改进研究

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110624

PD Kendall, J Sheeder, S Wilson, N Fang

Objectives

We aimed to compare maximum overnight pain scores and patient satisfaction with routine opiate provision versus an opiate-sparing analgesia protocol after osmotic dilator placement before dilation and evacuation.

Methods

We conducted a quality improvement study comparing out-of-clinic analgesia protocols for patients undergoing one and two days of osmotic dilator cervical preparation prior to dilation and evacuation at 16 to 26 weeks gestation. For two 13-week periods, we assessed the outcomes of our previous analgesia protocol of universal opiate prescription to our new protocol in which we only provided an opiate prescription at patient request or provider recommendation. Pain was assessed using an 11-point numerical rating scale (NRS; scale 0-10). The primary outcome was median individual pain score change from baseline to maximum. Patient and clinical characteristics, anxiety, sleep, activity disruptions, analgesic use, and patient satisfaction were assessed by medical record review and patient surveys.

Results

The routine opiate provision and opiate-sparing groups included 55 and 50 patients, respectively. 52 (92.9%) in the routine opiate provision group and 7 (14%) in the opiate sparing protocol received an opiate prescription (p=<0.001). For patients undergoing one and two days of osmotic dilators, the median change in pain from baseline to maximum did not differ between groups (7.0 (range:0-10) to 6.0 (0-10);p=0.06 and 8.0 (0-10) to 6.0 (5-10);p=0.45). Anxiety, satisfaction, other analgesic use, calls to providers, and complications did not differ between groups.

Conclusions

Clinicians can utilize an opiate-sparing protocol for analgesia after osmotic dilator placement to reduce opiate prescriptions while providing adequate analgesia and satisfaction.

方法我们进行了一项质量改进研究，比较了在妊娠 16 到 26 周时，在扩张和排空前为接受一到两天渗透扩张器宫颈准备的患者实施的诊室外镇痛方案。在两个为期 13 周的时间段内，我们评估了之前普遍使用阿片类药物处方的镇痛方案和新方案的效果，在新方案中，我们只在患者要求或医疗服务提供者推荐的情况下提供阿片类药物处方。疼痛采用 11 点数字评分量表（NRS，0-10 分）进行评估。主要结果是个人疼痛评分从基线到最大值的中位数变化。患者和临床特征、焦虑、睡眠、活动中断、镇痛剂使用和患者满意度通过病历审查和患者调查进行评估。常规阿片类药物供应组中有 52 人（92.9%）接受了阿片类药物处方，阿片类药物保留方案组中有 7 人（14%）接受了阿片类药物处方（p=<0.001）。对于接受一天和两天渗透性扩张剂治疗的患者，疼痛从基线到最大值的中位变化在各组之间没有差异（7.0（范围：0-10）至 6.0（0-10）；p=0.06 和 8.0（0-10）至 6.0（5-10）；p=0.45）。结论临床医生可以在放置渗透性扩张器后使用阿片类药物稀释方案进行镇痛，以减少阿片类药物处方，同时提供足够的镇痛和满意度。

{"title":"OPIATE-SPARING ANALGESIA PROTOCOL FOR PAIN AFTER OSMOTIC DILATOR PLACEMENT: A QUALITY IMPROVEMENT STUDY","authors":"PD Kendall, J Sheeder, S Wilson, N Fang","doi":"10.1016/j.contraception.2024.110624","DOIUrl":"10.1016/j.contraception.2024.110624","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to compare maximum overnight pain scores and patient satisfaction with routine opiate provision versus an opiate-sparing analgesia protocol after osmotic dilator placement before dilation and evacuation.</div></div><div><h3>Methods</h3><div>We conducted a quality improvement study comparing out-of-clinic analgesia protocols for patients undergoing one and two days of osmotic dilator cervical preparation prior to dilation and evacuation at 16 to 26 weeks gestation. For two 13-week periods, we assessed the outcomes of our previous analgesia protocol of universal opiate prescription to our new protocol in which we only provided an opiate prescription at patient request or provider recommendation. Pain was assessed using an 11-point numerical rating scale (NRS; scale 0-10). The primary outcome was median individual pain score change from baseline to maximum. Patient and clinical characteristics, anxiety, sleep, activity disruptions, analgesic use, and patient satisfaction were assessed by medical record review and patient surveys.</div></div><div><h3>Results</h3><div>The routine opiate provision and opiate-sparing groups included 55 and 50 patients, respectively. 52 (92.9%) in the routine opiate provision group and 7 (14%) in the opiate sparing protocol received an opiate prescription (p=<0.001). For patients undergoing one and two days of osmotic dilators, the median change in pain from baseline to maximum did not differ between groups (7.0 (range:0-10) to 6.0 (0-10);p=0.06 and 8.0 (0-10) to 6.0 (5-10);p=0.45). Anxiety, satisfaction, other analgesic use, calls to providers, and complications did not differ between groups.</div></div><div><h3>Conclusions</h3><div>Clinicians can utilize an opiate-sparing protocol for analgesia after osmotic dilator placement to reduce opiate prescriptions while providing adequate analgesia and satisfaction.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110624"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426174","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

ACCEPTABILITY OF AND PREFERENCES FOR LONG-ACTING INJECTABLE HORMONAL CONTRACEPTION: RESULTS FROM A NATIONAL ONLINE SURVEY WITH US WOMEN 长效注射荷尔蒙避孕药的可接受性和偏好：对美国妇女进行的全国性在线调查的结果

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110635

A Gottert, T Abuya, E Proos, I Johnson, NH Dormer, U Foley, G Saul, LB Haddad, DR Friend

Objectives

We conducted end-user research to optimize design of a sustained-release microsphere-based etonogestrel long-acting injectable (LAI) in development targeting 6- or 12-month windows of protection, steady hormone dose, and rapid return-to-fertility.

Methods

We implemented a national online survey including a discrete choice experiment (DCE) in June-July 2023, with cis-gender women ages 18-44 years. DCE attributes included duration of effectiveness (6/12/24-months), effect on menses, side-effects, and post-use return-to-fertility timing. Data analysis employed mixed-multinomial logit models.

Results

1,029 participants completed the survey (mean age 28.6 years, from 49 US states; 30.9% Black/African American; 11.6% Hispanic/Latina; 71.6% nulliparous; 49.0% not wanting a(nother) child). 35.7% currently use birth-control pills (37.4%); 35.7% male condoms; 19.8% withdrawal. In the DCE, participants strongly negatively preferred (in order-of-magnitude): may cause heavier/unpredictable periods, mild headaches/nausea, slight weight-gain, and delayed return-to-fertility (6-12-months vs. 3-months). Participants positively preferred: may cause no period, and shorter/lighter periods. Women significantly preferred 12-month to 6-month duration (p<0.03). Most participants (92.4%) were interested in using the LAI if it had no/minimal side-effects/heavier bleeding and quick return-to-fertility. Two-thirds preferred a 12/24-month duration; one-third a 6-month. Preference for 6-month duration was associated with wanting a child within five years, and higher discomfort with hormones (both p<0.001).

Conclusions

While most women report interest in an LAI, interest substantially decreases if it may cause heavier/unpredictable periods, other side-effects, or delayed return-to-fertility. Longer duration (12+ months) is preferred; a 6-month option appears important for women wanting to get pregnant relatively soon, and those concerned about hormones.

目标我们开展了最终用户研究，以优化正在开发的基于微球的缓释依托诺孕酮长效注射剂（LAI）的设计，该注射剂具有 6 个月或 12 个月的保护期、稳定的激素剂量和快速恢复受孕能力。方法我们于 2023 年 6 月至 7 月开展了一项全国在线调查，其中包括离散选择实验（DCE），调查对象为 18-44 岁的顺性别女性。离散选择实验的属性包括有效期（6/12/24 个月）、对月经的影响、副作用和使用后恢复生育的时间。数据分析采用了混合多项式对数模型。结果 1,029 名参与者完成了调查（平均年龄 28.6 岁，来自美国 49 个州；30.9% 为黑人/非裔美国人；11.6% 为西班牙裔/拉丁裔美国人；71.6% 为未婚先孕；49.0% 不想要孩子）。35.7%的人目前使用避孕药（37.4%）；35.7%的人使用男用避孕套；19.8%的人不使用避孕药。在 DCE 中，参与者强烈反对（按程度排序）：可能导致月经量增多/无法预测、轻微头痛/恶心、体重轻微增加、推迟恢复生育（6-12 个月与 3 个月）。参与者更倾向于选择：可能导致无月经，月经期更短/月经量更少。与 6 个月的疗程相比，女性更倾向于 12 个月的疗程（p<0.03）。如果LAI无副作用/副作用小/出血量较多，且能快速恢复生育能力，大多数参与者（92.4%）都有兴趣使用LAI。三分之二的人选择 12/24 个月的疗程，三分之一的人选择 6 个月。结论虽然大多数女性表示对 LAI 感兴趣，但如果它可能导致月经量增多/无法预测、其他副作用或推迟恢复生育，那么兴趣就会大大降低。较长的疗程（12 个月以上）是首选；6 个月的疗程对于希望尽快怀孕的妇女和担心荷尔蒙的妇女来说似乎很重要。

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引用次数: 0

USING THE AMERICAN COMMUNITY SURVEY AND THE MYERS ABORTION DASHBOARD TO DETERMINE THE RELATIONSHIP BETWEEN SPATIAL POLARIZATION AND ACCESS TO IN-PERSON ABORTION CARE 利用美国社区调查和迈尔斯堕胎仪表板确定空间两极化与获得亲自堕胎护理之间的关系

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110603

E Dindinger, RH Cohen, WB Allshouse, J Sheeder

Objectives

We aimed to assess the relationship between spatial polarization and driving times from each US county to the closest abortion clinic before and after Dobbs v Jackson Women’s Health Organization.

Methods

We calculated county-level Index of Concentrations at the Extremes (ICE), which quantifies extremes of disadvantage and privilege and is used as a proxy for structural racism. We calculated the distance from the centroid of each US county to the closest abortion clinic before (March 2022) and after Dobbs (March 2023). We compared travel times before and after Dobbs using a medians test. We used logistic regression to determine ICE quintile predictors of the closest facility being ≥2-hours adjusted for legality of abortion and time period.

Results

We assessed 3,143 US counties. Median travel time increased from 1.6 (range:0.1-6.7) to 2.0 (range:0-11.6) hours post-Dobbs; p<0.001. In logistic regression, those in the most-disadvantaged race and income ICE quintile versus those in the least-disadvantaged quintile had increased odds of living in a county ≥2 hours from an abortion facility of (adjusted OR (aOR) 2.32; 95%CI:1.94–2.79) and the odds of living ≥2 hours from a facility increased by (aOR 2.24; 95%CI:2.01-2.51) post-Dobbs. Similarly, those in the most-disadvantaged ethnicity and income quintiles verses those in the least-disadvantaged quintile had increased odds of living ≥2 hours from an abortion facility of 2.50;95%CI[2.09–3.01]) and the odds of living ≥2 hours from a facility increased by 2.25;95%CI[2.01-2.52] post-Dobbs.

Conclusions

Abortion bans are increasing the travel time to the closest facility which may be increasing barriers to care among communities already facing systemic poverty and structural racism.

方法我们计算了县级的极端集中指数（ICE），该指数量化了不利条件和特权的极端程度，可作为结构性种族主义的替代指标。我们计算了在多布斯案之前（2022 年 3 月）和之后（2023 年 3 月）美国每个县的中心点到最近的堕胎诊所的距离。我们使用中位数检验比较了多布斯案前后的旅行时间。我们使用逻辑回归法来确定最近设施≥2 小时的 ICE 五分位预测因素，并对堕胎合法性和时间段进行了调整。中位旅行时间在多布斯事件后从 1.6（范围：0.1-6.7）小时增加到 2.0（范围：0-11.6）小时；p<0.001。在逻辑回归中，处于最弱势种族和收入 ICE 五分位数的人与处于最不弱势五分位数的人相比，在多布斯事件后，居住地距离人工流产机构≥2 小时的几率增加了（调整 OR (aOR) 2.32；95%CI:1.94-2.79），居住地距离人工流产机构≥2 小时的几率增加了（aOR 2.24；95%CI:2.01-2.51）。同样，处于最不利种族和收入五分位数的人与处于最不利五分位数的人相比，居住地距离人工流产机构≥2 小时的几率增加了 2.50;95%CI[2.09-3.01]），居住地距离人工流产机构≥2 小时的几率增加了 2.结论堕胎禁令增加了前往最近堕胎设施的旅行时间，这可能会增加已经面临系统性贫困和结构性种族主义的社区获得护理的障碍。

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引用次数: 0

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

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

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

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

Objectives

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

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

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

Objectives

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

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

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

Objectives

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0