Contraception最新文献_第6页

EXPERIENCES WITH MEXICO-BASED ABORTION SUPPORT AMONG PEOPLE IN THE US POST-DOBBS 美国术后患者在墨西哥接受堕胎支持的经验

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111079

SE Baum, A Wollum, S Braunstein, V Cruz Sánchez

Objectives

In response to abortion restrictions, Mexico-based accompaniment groups provide virtual support for self-managed abortion in the US. This study aimed to examine the characteristics and abortion experiences of people contacting the groups.

Methods

Quantitatively, we analyzed demographics, pregnancy characteristics, state abortion policies, and rates of request by zip-code tabulation areas (ZCTAs) from 2023 records at two accompaniment groups. Qualitatively, we analyzed six in-depth interviews and15 asynchronous text interviews among people in the US who obtained Mexico-based support.

Results

Among 2,850 records of people in the US supported by these groups, 83% of people resided in states with complete abortion bans. People in states without bans tended to access support later in pregnancy. We found higher rates of utilizing Mexico-based accompaniment among those in ZCTAs 4+ hours from an abortion clinic and with a higher percentage of their residents living at or below the poverty level. Interviewees sought accompaniment support due to restrictive laws, preference to avoid clinical care, and financial considerations. They raised concerns about criminalization and surveillance, and fears around the medication abortion process. Many had initial skepticism toward the model of care and built trust through referrals from social networks, receipt of abortion pills, and timely, person-centered communication. Information provision and emotional support contributed to feelings of preparedness.

Conclusions

Accompaniment networks supporting people to self-manage their abortion are important sources of affordable care for people who may be further away from a clinic or with fewer resources. Evidence-based information and support from these and allied groups can increase access and reduce the risk of criminalization.

为了应对堕胎限制，墨西哥的陪伴团体为美国的自我管理堕胎提供了虚拟支持。本研究旨在探讨与该群体接触的人的特征和流产经历。方法定量分析两个陪伴组的2023份记录的人口统计学、妊娠特征、州堕胎政策和要求率（按邮政编码制表区（ZCTAs））。在定性上，我们分析了6次深度访谈和15次异步文本访谈，这些访谈对象是在墨西哥获得支持的美国人。结果在这些团体支持的2850份美国人的记录中，83%的人居住在完全禁止堕胎的州。在没有禁令的州，人们倾向于在怀孕后期获得支持。我们发现，在距离堕胎诊所4小时以上的zcta中，使用墨西哥陪伴的比例较高，其居民生活在贫困线或贫困线以下的比例较高。受访者寻求陪伴支持的原因是法律的限制，倾向于避免临床护理，以及经济方面的考虑。他们提出了对刑事定罪和监视的担忧，以及对药物流产过程的担忧。许多人最初对这种护理模式持怀疑态度，并通过社交网络推荐、接受堕胎药以及及时、以人为本的沟通建立了信任。信息提供和情感支持有助于提高备灾感。结论支持流产患者自我管理的陪伴网络是远离诊所或资源较少的人群可负担得起的医疗服务的重要来源。来自这些团体和相关团体的基于证据的信息和支持可以增加获取机会并降低定罪风险。

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引用次数: 0

LEGAL EXCEPTIONS AND PREGNANCY RISK: PERSPECTIVES OF PATIENTS AND SUPPORT PEOPLE IN GEORGIA 法律例外和怀孕风险：格鲁吉亚患者和支持人员的观点

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111096

V Larrivey, P Goedken, V Walke, M Kottke, N Verma

Objectives

Georgia’s six-week abortion ban contains exceptions for “medical emergency” and “medically futile pregnancy.” This study aims to explore how patients and their support people interpret these exceptions. We will also investigate areas of alignment and conflict between personal assessments of acceptable pregnancy risk and the definitions outlined in the exceptions.

Methods

We conducted in-depth interviews with patients and support people at an independent clinic in Atlanta, Georgia. The interviews focused on participants’ understanding of medical exceptions in Georgia’s abortion law, and their approach to making pregnancy risk assessments for themselves and loved ones. We transcribed, coded, and analyzed the interviews in MAXQDA, and present a subset of themes. We consulted regularly with our community advisory board throughout this work.

Results

We conducted 16 interviews for patient (n=8) and support person (n=8) roles, including four male participants. Participants described expansive understandings of what high-risk pregnancy means to them, beyond the narrow definitions in Georgia’s law. These understandings included mental health, life experiences (poverty, race, gender), and the impact of pregnancy on families, finances, and lifestyle. Many participants misunderstood the law’s exceptions to be much broader than they actually are, and trusted doctors and the healthcare system to know how to interpret and apply the law.

Conclusions

Our results indicate that exceptions do not cover the full spectrum of experiences that people consider as high-risk when making pregnancy decisions. Interestingly, there is misalignment in people’s perceived trust in clinicians’ ability to interpret the law and apply the exceptions broadly, compared with the current reality.

格鲁吉亚的六周堕胎禁令包含了“医疗紧急情况”和“医学无效怀孕”的例外情况。本研究旨在探讨患者及其支持人员如何解释这些例外情况。我们还将调查可接受妊娠风险的个人评估与例外情况中概述的定义之间的一致性和冲突领域。方法：我们对乔治亚州亚特兰大市一家独立诊所的患者和支持人员进行了深入访谈。访谈的重点是参与者对格鲁吉亚堕胎法中医疗例外情况的理解，以及他们为自己和亲人进行怀孕风险评估的方法。我们对MAXQDA中的访谈进行转录、编码和分析，并呈现主题子集。在整个工作过程中，我们定期与社区顾问委员会进行咨询。结果共对患者（n=8）和辅助人员（n=8）进行了16次访谈，其中男性4人。参与者描述了对高风险怀孕对他们意味着什么的广泛理解，超出了格鲁吉亚法律的狭隘定义。这些理解包括心理健康、生活经历（贫困、种族、性别）以及怀孕对家庭、财务和生活方式的影响。许多参与者误解了法律的例外情况比实际情况要广泛得多，并且相信医生和医疗保健系统知道如何解释和应用法律。结论我们的研究结果表明，例外情况并不包括人们在做出怀孕决定时认为是高风险的所有经历。有趣的是，与目前的现实相比，人们对临床医生解释法律和广泛应用例外的能力的信任存在偏差。

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引用次数: 0

IMPACT OF DOBBS ON SEVERE EARLY PREGNANCY MORBIDITY AT AN ACADEMIC HOSPITAL IN UTAH 多布斯对犹他州一家学术医院严重早期妊娠发病率的影响

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111075

SE Nourse, A Gero, TT Hunt-Smith, DK Turok, LM Gawron, R Simmons, MP Debbink, JS Sanders

Objectives

We evaluated the relationship between Dobbs v Jackson Women’s Health Organization and severe early pregnancy morbidity (SEPM) in pregnancies less than 24 weeks.

Methods

We identified pregnant patients at University of Utah hospital from January 2017 to December 2023 with diagnosis codes, blood product administration records, or intensive care transfer records indicating SEPM at less than 24 weeks. We defined SEPM using CDC severe maternal morbidity (SMM) diagnosis codes, ACOG/SMFM SMM criteria, or abortion-related morbidity including hemorrhage, pelvic infection, or damage to pelvic organs. We reviewed records to verify the presence of SEPM and assessed preventability using the Alliance for Innovation on Maternal Health SMM review form. We performed an interrupted time series analysis comparing the pre- and post-Dobbs rate of SEPM per 10,000 pregnancies per month and the rate of preventable events per 100 SEPM events per quarter. A sensitivity analysis excluded years affected by the COVID-19 pandemic.

Results

At baseline, we saw 16 SEPM events per 10,000 pregnancies (95% CI, 10.7-20.4). Prior to Dobbs, the rate of SEPM declined by 0.03 events per 10,000 pregnancies each month (-0.14, 0.10). Immediately following Dobbs, we found a non-significant increase in severe early pregnancy morbidity of 1.0 event per 10,000 pregnancies (-5.4, 7.4) and an additional monthly decline of -0.1 severe morbidity events per 10,000 pregnancies (-0.50, 0.34). An increase in proportion of preventable SEPM was noted immediately following Dobbs of 18 preventable events per 100 SEPM events (6.7, 29.5).

Conclusions

Following the Dobbs decision, overall rate of SEPM events did not increase, though the rate of preventable events increased.

目的探讨Dobbs v Jackson妇女健康组织与24周以下妊娠严重早孕发病率（SEPM）的关系。方法选取2017年1月至2023年12月在犹他大学医院就诊的孕妇，这些孕妇的诊断代码、血液制品管理记录或重症监护转院记录均显示在24周内发生SEPM。我们使用CDC严重产妇发病率（SMM）诊断代码、ACOG/SMFM SMM标准或流产相关发病率（包括出血、盆腔感染或盆腔器官损伤）来定义SEPM。我们审查了记录以验证SEPM的存在，并使用产妇保健SMM审查表创新联盟评估了可预防性。我们进行了中断时间序列分析，比较了dobbs前后每月每10,000例妊娠中SEPM的发生率和每季度每100例SEPM可预防事件的发生率。敏感性分析排除了受COVID-19大流行影响的年份。结果基线时，每10,000例妊娠中有16例SEPM事件（95% CI, 10.7-20.4）。在Dobbs之前，SEPM的发生率下降了0.03 / 10000妊娠每个月（-0.14,0.10）。在Dobbs之后，我们发现严重的早期妊娠发病率无显著增加，为每10,000例妊娠1.0例（-5.4,7.4），并且每10,000例妊娠严重发病率每月下降-0.1例（-0.50,0.34）。在Dobbs报告每100例SEPM事件中有18例可预防事件后，可预防SEPM的比例立即增加（6.7,29.5）。结论：Dobbs判决后，SEPM事件的总体发生率没有增加，但可预防事件的发生率增加了。

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引用次数: 0

US ABORTION BANS AND MATERNAL AND PREGNANCY-ASSOCIATED DEATH: IMPACTS AND DATA ISSUES 美国堕胎禁令和孕产妇及妊娠相关死亡：影响和数据问题

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111098

SO Bell, AM Franks, A Ozinsky, S Anjur-Dietrich, CE Margerison, EA Stuart, A Feller, A Gemmill

Objectives

The objective of this study is to estimate the impact of US abortion bans on maternal and pregnancy-associated mortality and investigate data quality issues.

Methods

This study used biannual (eg, January-June) counts of maternal and pregnancy-associated deaths among females aged 15-44 from restricted death certificate data compiled by the National Center for Health Statistics for all 50 states and the District of Columbia for 2012 through 2023. The outcomes include maternal and pregnancy-associated mortality rates, calculated as the number of deaths per 100,000 live births. We identified maternal deaths using ICD-10 codes and pregnancy-associated deaths via the pregnancy checkbox on the death certificate. Analyses used a Bayesian panel data approach to model counterfactual predictions of maternal and pregnancy-associated mortality rates in the 14 states that imposed a complete or six-week abortion ban.

Results

State-specific model diagnostics indicate potential data quality concerns. These concerns are most apparent for maternal mortality data in Alabama, and less so in Georgia. Model estimates suggest a significant increase in the pregnancy-associated mortality rate above what would have been expected in the absence of these bans; we found no corresponding detectable increase in maternal mortality. Assessing mortality trends by race and ethnicity imply the increase in pregnancy-associated mortality is concentrated among non-Hispanic Black individuals.

Conclusions

Results from this study suggest that abortion bans may increase pregnancy-associated mortality, though data quality concerns and stochastic variation in this rare outcome limit the certainty of this finding.

本研究的目的是估计美国堕胎禁令对孕产妇和妊娠相关死亡率的影响，并调查数据质量问题。方法本研究采用每两年一次（如1月至6月）的15-44岁女性孕产妇和妊娠相关死亡统计数据，这些数据来自美国国家卫生统计中心（National Center for Health Statistics）编制的2012年至2023年全美50个州和哥伦比亚特区的限制性死亡证明数据。结果包括孕产妇和与妊娠有关的死亡率，以每10万活产的死亡人数计算。我们使用ICD-10代码确定孕产妇死亡，并通过死亡证明上的妊娠复选框确定与妊娠相关的死亡。分析使用贝叶斯面板数据方法对14个实施完全或6周堕胎禁令的州的孕产妇和妊娠相关死亡率进行反事实预测。结果特定于状态的模型诊断表明潜在的数据质量问题。这些担忧在阿拉巴马州的孕产妇死亡率数据中最为明显，而在乔治亚州则不那么明显。模式估计表明，与怀孕有关的死亡率大大增加，高于没有这些禁令时的预期；我们没有发现相应的可检测到的产妇死亡率增加。按种族和族裔评估死亡率趋势表明，妊娠相关死亡率的增加主要集中在非西班牙裔黑人中。结论：本研究的结果表明，堕胎禁令可能会增加妊娠相关死亡率，尽管数据质量问题和这种罕见结果的随机变异限制了这一发现的确定性。

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引用次数: 0

TELEHEALTH EQUITY AMONG PATIENTS WITH MEDICAID 医疗补助患者的远程医疗公平性

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111133

T Thompson, C Brander, J Ko, UD Upadhyay

Objectives

Telehealth, which now comprises 20% of all abortion care, has been celebrated as a mechanism to improve health equity by making abortion care more convenient and affordable. However, many patients with Medicaid are not able to use their insurance to pay for their telehealth abortion. We sought to document and compare patient experiences between those who could and could not use their Medicaid insurance to pay for their abortion.

Methods

Working with six telehealth clinics serving patients across the US, we recruited telehealth abortion patients who indicated they had Medicaid insurance, regardless of whether they were able to use their insurance, to participate in an online survey. Patients were eligible if they were enrolled in Medicaid, were at least 14 years old, had had a medication abortion within the last 1-6 weeks, and were fluent in English or Spanish. The survey was available in English and Spanish and contained questions about participant demographics, pregnancy history, and their recent telehealth abortion experience.

Results

Among 359 enrolled participants, about half (n=159) could not use their Medicaid insurance to cover their abortion. Those in this group spent an average of $261 for their abortion care (range: $0-$970). Those with no Medicaid coverage were significantly more likely to report that their financial stress was worse than before the abortion (35% vs. 4%, p<0.001).

Conclusions

Medicaid coverage makes a difference even for telehealth abortion, which is a less costly abortion option. These findings support efforts to overturn telehealth and Medicaid coverage restrictions, and establish coverage and payment parity for telehealth services.

医疗保健目前占所有堕胎护理的20%，它被誉为一种通过使堕胎护理更加方便和负担得起来改善卫生公平的机制。然而，许多享受医疗补助的病人无法使用他们的保险来支付远程医疗堕胎的费用。我们试图记录和比较那些能够和不能使用医疗补助保险支付堕胎费用的患者的经历。方法：我们与美国六家为患者提供服务的远程医疗诊所合作，招募了远程医疗堕胎患者，他们表示他们有医疗补助保险，无论他们是否能够使用他们的保险，都参加了一项在线调查。如果患者参加了医疗补助计划，年龄至少14岁，在过去1-6周内进行过药物流产，并且英语或西班牙语流利，则符合条件。该调查以英语和西班牙语提供，并包含有关参与者人口统计、怀孕史和他们最近的远程保健堕胎经历的问题。结果在359名参与者中，约有一半（n=159）无法使用医疗补助保险来支付堕胎费用。这些人在堕胎护理上平均花费261美元（范围：0- 970美元）。那些没有医疗补助的人更有可能报告他们的财务压力比堕胎前更严重（35%比4%，p<0.001）。结论医疗补助覆盖对远程医疗流产也有影响，远程医疗流产是一种成本较低的流产选择。这些发现支持推翻远程医疗和医疗补助覆盖限制的努力，并建立远程医疗服务的覆盖和支付均等。

{"title":"TELEHEALTH EQUITY AMONG PATIENTS WITH MEDICAID","authors":"T Thompson, C Brander, J Ko, UD Upadhyay","doi":"10.1016/j.contraception.2025.111133","DOIUrl":"10.1016/j.contraception.2025.111133","url":null,"abstract":"<div><h3>Objectives</h3><div>Telehealth, which now comprises 20% of all abortion care, has been celebrated as a mechanism to improve health equity by making abortion care more convenient and affordable. However, many patients with Medicaid are not able to use their insurance to pay for their telehealth abortion. We sought to document and compare patient experiences between those who could and could not use their Medicaid insurance to pay for their abortion.</div></div><div><h3>Methods</h3><div>Working with six telehealth clinics serving patients across the US, we recruited telehealth abortion patients who indicated they had Medicaid insurance, regardless of whether they were able to use their insurance, to participate in an online survey. Patients were eligible if they were enrolled in Medicaid, were at least 14 years old, had had a medication abortion within the last 1-6 weeks, and were fluent in English or Spanish. The survey was available in English and Spanish and contained questions about participant demographics, pregnancy history, and their recent telehealth abortion experience.</div></div><div><h3>Results</h3><div>Among 359 enrolled participants, about half (n=159) could not use their Medicaid insurance to cover their abortion. Those in this group spent an average of $261 for their abortion care (range: $0-$970). Those with no Medicaid coverage were significantly more likely to report that their financial stress was worse than before the abortion (35% vs. 4%, p<0.001).</div></div><div><h3>Conclusions</h3><div>Medicaid coverage makes a difference even for telehealth abortion, which is a less costly abortion option. These findings support efforts to overturn telehealth and Medicaid coverage restrictions, and establish coverage and payment parity for telehealth services.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111133"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277929","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

CRIMINALIZATION CONCERNS AMONG PEOPLE SEEKING FACILITY-BASED ABORTION CARE POST-DOBBS 堕胎后寻求机构堕胎护理的人的犯罪化问题

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111059

R Schroeder, LJ Ralph, S Kaller, M Antonia Biggs

Objectives

Following Dobbs v Jackson Women’s Health Organization, efforts to criminalize pregnancy-related healthcare have increased. This study describes concerns around criminalization among people seeking facility-based abortion.

Methods

The Burden Study aims to recruit 800 people aged ≥15 seeking abortion at six facilities in three abortion-supportive states (California, Illinois, and New Mexico) that serve many out-of-state patients. We surveyed people presenting for abortion care regarding their concerns about “getting into trouble with the law,” both personally and for their support people (prompts: “[I]/ [Someone who helped me get care] might get in trouble with the law for seeking care to end this pregnancy”). Using descriptive statistics and logistic regressions, we examined associations between concerns about criminalization and out-of-state travel for care.

Results

From January to April 2025, we recruited 557 people at five facilities; 539 completed questions about legal concerns. Participants’ median age was 26; 34% had Medicaid/other state insurance coverage; and 62% traveled out-of-state for their abortion. While 15% of participants reported that they were “very” or “somewhat” worried about getting into trouble with the law for seeking abortion care, this proportion was higher for out-of-state participants (21% vs. 5%, p<0.001). Fewer participants (10%) were worried about a support person getting in trouble with the law, although concerns were also higher among out-of-state participants (12% vs. 5%, p=0.004).

Conclusions

Concerns about criminalization related to abortion are prevalent among people seeking abortion post-Dobbs, particularly among those traveling from out-of-state, and may impact people’s care-seeking behaviors and mental health.

在多布斯诉杰克逊妇女健康组织之后，将与怀孕有关的医疗保健定为刑事犯罪的努力有所增加。这项研究描述了人们对寻求基于设施的堕胎的犯罪化的担忧。方法负担研究旨在招募800名年龄≥15岁的人，他们在三个支持堕胎的州（加利福尼亚州，伊利诺伊州和新墨西哥州）的六个机构寻求堕胎，这些机构为许多州外患者提供服务。我们对前来堕胎护理的人进行了调查，了解他们对“触犯法律”的担忧，包括个人和支持他们的人（提示：“[我]/[帮助我获得护理的人]可能会因为寻求终止妊娠的护理而触犯法律”）。使用描述性统计和逻辑回归，我们检查了对刑事定罪和州外护理旅行的关注之间的关联。结果从2025年1月到4月，我们在5个机构招募了557人；539人填写了有关法律问题的问题。参与者的年龄中位数为26岁；34%的人有医疗补助/其他州保险；62%的人到州外堕胎。15%的参与者报告说，他们“非常”或“有些”担心在寻求堕胎护理时遇到法律上的麻烦，这一比例在州外的参与者中更高（21%对5%，p<0.001）。较少的参与者（10%）担心支持人员会惹上法律麻烦，尽管州外参与者的担忧也更高（12%对5%，p=0.004）。结论：在多布斯事件后寻求堕胎的人群中，对与堕胎相关的刑事定罪的担忧普遍存在，尤其是那些来自外州的人，这可能会影响人们的求医行为和心理健康。

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引用次数: 0

VARIATION IN OB-GYN RESIDENTS’ ABORTION-RELATED SKILLS 妇产科住院医师堕胎相关技能的差异

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111057

A Beasley, G Sierra, E King, J Keller, T Ogburn, K White

Objectives

We aimed to assess variation in abortion-related skills Ob-Gyn residents anticipate having upon program completion.

Methods

In January 2024, as part of the CREOG exam, Ob-Gyn residents self-reported their anticipated ability to provide miscarriage and abortion care after residency. We categorized 12 key skills as medical (counseling/medication management), procedural (uterine aspiration/evacuation), and medical/procedural for abortion. We computed percentage of PGY3/4 residents who indicated that they would be able to competently and independently perform each skill. We used chi-squared tests to evaluate the association between state policy context and abortion training importance when signaling programs and medical, procedural, and abortion-specific skills.

Results

PGY3/4 respondents (n=1,660), anticipated being able to perform 10 of 12 (SD=1.7) skills, on average. Confidence was lowest for dilation and evacuation procedures (64%) and highest in management of spontaneous abortion complications (99%). Although 95% were confident they would achieve all core medical skills, fewer were confident about achieving all procedural (63%) and abortion-related skills (71%). A higher percentage of residents in abortion-protected states vs. restricted states anticipated competence in procedural (73% vs. 46%) and abortion-related skills (81% vs. 55%; all p<0.001). Residents who considered abortion training important were more confident about medical (96% vs. 92%; p=0.01), procedural (73% vs. 42%; p<0.001), and abortion-related skills (81% vs. 50%; p<0.001) than those for whom abortion training was less important.

Conclusions

Graduating residents, particularly those in more restricted states or for whom abortion training was less important, are not confident in their ability to independently and competently perform several core patient care skills.

目的：我们旨在评估妇产科住院医师在项目完成后预期的堕胎相关技能的变化。方法2024年1月，作为CREOG考试的一部分，妇产科住院医师自我报告了他们在住院后提供流产和流产护理的预期能力。我们将12项关键技能分类为医学（咨询/药物管理）、程序（子宫抽吸/排出）和堕胎的医学/程序。我们计算了PGY3/4的居民中表示他们能够胜任并独立执行每项技能的百分比。我们使用卡方检验来评估国家政策背景与流产培训重要性之间的关联，当信号程序与医疗、程序和流产特定技能相关时。结果spgy3 /4受访者（n=1,660）平均预计能够执行12项技能中的10项（SD=1.7）。置信度最低的是扩张和疏散手术（64%），最高的是自然流产并发症的处理（99%）。虽然95%的人有信心掌握所有核心医疗技能，但对掌握所有程序（63%）和堕胎相关技能（71%）有信心的人较少。与限制堕胎的州相比，堕胎保护州的居民预期在程序（73%对46%）和堕胎相关技能（81%对55%；所有p<；0.001）方面的能力更高。认为堕胎培训重要的住院医生对医疗（96%对92%；p=0.01）、程序（73%对42%；p<0.001）和堕胎相关技能（81%对50%；p<0.001）比那些认为堕胎培训不那么重要的住院医生更有信心。结论：即将毕业的住院医生，特别是那些在堕胎限制较多的州或对堕胎培训不太重要的州的住院医生，对自己独立和称职地执行几项核心病人护理技能的能力缺乏信心。

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引用次数: 0

PHARMACIST-PRESCRIBED MEDICATION ABORTION: A QUALITATIVE EXPLORATION IN MASSACHUSETTS 药剂师处方流产：马萨诸塞州的定性探索

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111087

A Youm, S Filippa, IR Carter-Bolick, SE Baum, S Rafie, KO White, KM Treder, A Wollum

Objectives

Efforts to increase access to medication abortion in the US are urgently needed. We gathered the perspectives of key partners in Massachusetts to explore expanding medication abortion access through a pharmacist-prescribed care model.

Methods

Between January and October 2024, we conducted 31 interviews with patients, pharmacists, policymakers, clinicians, and advocates in Massachusetts. Interviews explored views on pharmacy-based medication abortion access, key patient support needed, and the barriers and facilitators to implementation. Interviews were analyzed thematically using MAXQDA.

Results

Participants were largely supportive of the model, indicating that pharmacist-prescribed medication abortion could improve access, particularly for communities who face barriers, including young people, unhoused individuals, and those in rural settings or with limited transport. Other benefits included faster access to care compared to in-clinic or telemedicine models. However, a variety of challenges were raised, including a lack of confidential counseling spaces, concerns around reimbursement for pharmacists’ services, and limited staff time and resources. Key factors for successful implementation were thought to include comprehensive follow-up care, enhanced privacy in pharmacies, affordable pharmacist training, insurance coverage of patient care and pharmacist counseling, and coalitions comprising community organizations and abortion providers.

Conclusions

Our findings contribute to the growing body of literature showing the potential benefits of expanding pharmacists’ role in abortion care in the US and highlights the importance of addressing structural and financial challenges for successful implementation and expansion of abortion care.

目的提高美国药物流产的可及性是迫切需要的。我们收集了马萨诸塞州主要合作伙伴的观点，探索通过药剂师处方护理模式扩大药物流产的准入。方法在2024年1月至10月期间，我们对马萨诸塞州的患者、药剂师、政策制定者、临床医生和倡导者进行了31次访谈。访谈探讨了对基于药物的药物流产获取，关键患者支持需求，以及实施的障碍和促进因素的看法。使用MAXQDA对访谈进行主题分析。结果大部分参与者都支持该模式，表明药剂师处方药物流产可以改善获取，特别是对于面临障碍的社区，包括年轻人，无家可归的人，以及农村环境或交通有限的人。其他好处包括与诊所或远程医疗模式相比，更快地获得护理。然而，提出了各种各样的挑战，包括缺乏保密的咨询空间，对药剂师服务报销的担忧，以及有限的工作人员时间和资源。成功实施的关键因素被认为包括全面的后续护理、加强药房的隐私、负担得起的药剂师培训、病人护理和药剂师咨询的保险范围以及由社区组织和堕胎提供者组成的联盟。结论我们的研究结果有助于越来越多的文献显示扩大药剂师在美国堕胎护理中的作用的潜在好处，并强调解决结构性和财政挑战对成功实施和扩大堕胎护理的重要性。

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引用次数: 0

ELIGIBILITY FOR MEDICATION ABORTION WITH ASYNCHRONOUS SCREENING VS. IN-PERSON CARE 异步筛查与现场护理的药物流产的资格

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111084

L Ralph, C Baba, K Ehrenreich, N Morris, MA Biggs, M Cervantes, T Kromenaker, G Moayedi, J Perritt, N Kapp, E Raymond, K White, K Blanchard, D Grossman

Objectives

Asynchronous, no-test screening for medication abortion has recently expanded rapidly. However, there is minimal evidence on how asynchronous clinician assessment of medication abortion eligibility using patient-reported health history and symptoms compares with eligibility determined through synchronous, in-person care.

Methods

We recruited patients seeking in-person medication abortion at five facilities in three US states from July to December 2024. Before their appointment, participants completed a survey on medication abortion eligibility criteria; their responses were blinded and reviewed asynchronously by an onsite clinician who assessed eligibility. Participants then proceeded with routine care, and we abstracted clinical encounter data. We examine concordance between clinician asynchronous review of patient self-reported eligibility and in-person clinical encounter.

Results

Of 260 approached, 172 enrolled and 146 met the criteria to have clinicians review survey responses. Overall, 112 (77%) were eligible for medication abortion on clinician review of survey responses; reasons for ineligibility were gestational duration (n=17), ectopic concern (n=15), and another contraindication (n=4). During the clinical encounter, 90% (n=132) were eligible for medication abortion; reasons for ineligibility were negative pregnancy test/miscarriage (n=8), gestational duration (n=5), ectopic concern (n=1) and another contraindication (n=1). Concordance on eligibility between clinician review of patient-reported survey responses and clinical encounter was 114/146 (78%). Six cases were eligible on clinician review but deemed ineligible during clinical encounter (3 gestational duration; 3 not pregnant). Twenty-six were ineligible on clinician review but deemed eligible on clinical encounter.

Conclusions

Results suggest current asynchronous, no-test screening for medication abortion is conservative, and results in more people screening out of no-test care vs. being given medications when medication abortion is contraindicated.

目的近年来，药物流产的非同步、无检测筛查迅速扩大。然而，很少有证据表明，使用患者报告的健康史和症状的非同步临床医生评估药物流产资格与通过同步亲自护理确定的资格相比。方法：我们于2024年7月至12月在美国3个州的5个机构招募寻求亲自药物流产的患者。在预约之前，参与者完成了一项关于药物流产资格标准的调查；他们的反应是盲法的，并由现场临床医生评估资格进行异步审查。然后参与者继续进行常规护理，我们提取临床就诊数据。我们检查了临床医生对患者自我报告资格的异步审查与亲自临床接触之间的一致性。结果在260例患者中，172例入组，146例符合临床医生审查调查反应的标准。总体而言，112例（77%）符合药物流产的条件；不合格的原因是妊娠期（n=17）、异位（n=15）和其他禁忌症（n=4）。临床就诊时，90% （n=132）符合药物流产条件；不合格的原因是妊娠试验阴性/流产（n=8）、妊娠期（n=5）、异位（n=1）和其他禁忌症（n=1）。临床医生对患者报告的调查反应的评价与临床就诊的一致性为114/146（78%）。6例经临床医生审查符合条件，但在临床就诊时被认为不符合条件（3例妊娠期；3例未怀孕）。26例临床医生评审不合格，但临床接触合格。结论目前对药物流产的非同步、无检测筛查是保守的，在药物流产禁忌症时，筛查出无检测护理的患者多于给予药物治疗的患者。

{"title":"ELIGIBILITY FOR MEDICATION ABORTION WITH ASYNCHRONOUS SCREENING VS. IN-PERSON CARE","authors":"L Ralph, C Baba, K Ehrenreich, N Morris, MA Biggs, M Cervantes, T Kromenaker, G Moayedi, J Perritt, N Kapp, E Raymond, K White, K Blanchard, D Grossman","doi":"10.1016/j.contraception.2025.111084","DOIUrl":"10.1016/j.contraception.2025.111084","url":null,"abstract":"<div><h3>Objectives</h3><div>Asynchronous, no-test screening for medication abortion has recently expanded rapidly. However, there is minimal evidence on how asynchronous clinician assessment of medication abortion eligibility using patient-reported health history and symptoms compares with eligibility determined through synchronous, in-person care.</div></div><div><h3>Methods</h3><div>We recruited patients seeking in-person medication abortion at five facilities in three US states from July to December 2024. Before their appointment, participants completed a survey on medication abortion eligibility criteria; their responses were blinded and reviewed asynchronously by an onsite clinician who assessed eligibility. Participants then proceeded with routine care, and we abstracted clinical encounter data. We examine concordance between clinician asynchronous review of patient self-reported eligibility and in-person clinical encounter.</div></div><div><h3>Results</h3><div>Of 260 approached, 172 enrolled and 146 met the criteria to have clinicians review survey responses. Overall, 112 (77%) were eligible for medication abortion on clinician review of survey responses; reasons for ineligibility were gestational duration (n=17), ectopic concern (n=15), and another contraindication (n=4). During the clinical encounter, 90% (n=132) were eligible for medication abortion; reasons for ineligibility were negative pregnancy test/miscarriage (n=8), gestational duration (n=5), ectopic concern (n=1) and another contraindication (n=1). Concordance on eligibility between clinician review of patient-reported survey responses and clinical encounter was 114/146 (78%). Six cases were eligible on clinician review but deemed ineligible during clinical encounter (3 gestational duration; 3 not pregnant). Twenty-six were ineligible on clinician review but deemed eligible on clinical encounter.</div></div><div><h3>Conclusions</h3><div>Results suggest current asynchronous, no-test screening for medication abortion is conservative, and results in more people screening out of no-test care vs. being given medications when medication abortion is contraindicated.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111084"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278225","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

POSTPARTUM PERMANENT CONTRACEPTION ACCESS FOR NONCITIZENS AFTER EXPANDING MEDICAID 扩大医疗补助后，非公民获得产后永久避孕

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111069

LD Brown, E Zhao, M Bielman, L Pritchett, A Mueller, C Sufrin

Objectives

We aimed to determine if expansion of Medicaid to noncitizen pregnant patients through the Maryland Healthy Babies Equity Act (HBEA) impacted fulfillment of postpartum permanent contraception (PC).

Methods

We conducted a retrospective, observational, interrupted time series analysis of patients who underwent postpartum PC within the Johns Hopkins Health System from January 2019 to September 2024. We included all deliveries at Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, and Howard County General Hospital. Maternal demographics, delivery information, neonatal outcome, and postpartum contraception methods were extracted from EPIC. Citizenship status was confirmed via manual chart review. We compared postpartum PC rates before and after HBEA implementation for citizens and noncitizens. Mixed effects logistic regression was used to compare postpartum PC rates before and after HBEA implementation, stratified by citizenship.

Results

There were 35,996 deliveries among 30,007 individuals at Johns Hopkins hospitals during the study period. Individuals’ mean (SD) age was 30.9 years (5.7). Some 25,652 (85.5%) were citizens, and 4,355 (14.5%) were noncitizens. Among noncitizens, postpartum PC rates increased from 8.5% (332/3,925) pre-HBEA to 12.5% (134/10,755) post-HBEA. Among citizens, rates remained stable from 5.4% (1,346/25,003) pre-HBEA to 5.3% (318/5,993) post-HBEA. The increase in postpartum PC rate from pre to post-HBEA among noncitizens was significantly greater than the change in postpartum PC rate among citizens (p<0.001).

Conclusions

Expansion of Emergency Medicaid under the HBEA to include postpartum care was associated with a significant increase in postpartum PC among noncitizens. Such policy changes help overcome systemic barriers to postpartum care for low-income, noncitizen individuals.

目的：我们旨在确定通过马里兰州健康婴儿公平法案（HBEA）将医疗补助扩大到非公民孕妇是否影响了产后永久避孕（PC）的实现。方法对2019年1月至2024年9月在约翰霍普金斯卫生系统接受产后PC治疗的患者进行回顾性、观察性、中断时间序列分析。我们纳入了约翰霍普金斯医院、约翰霍普金斯湾景医疗中心和霍华德县总医院的所有分娩。从EPIC中提取产妇人口统计资料、分娩信息、新生儿结局和产后避孕方法。通过手工图表审查确认公民身份。我们比较了实施HBEA前后公民和非公民的产后PC率。采用混合效应logistic回归比较实施HBEA前后的产后PC率，按国籍分层。结果在研究期间，在约翰霍普金斯医院的30007人中有35996人分娩。个体平均（SD）年龄为30.9岁（5.7岁）。25652人（85.5%）是公民，4355人（14.5%）是非公民。在非公民中，产后PC率从孕前的8.5%（332/3,925）上升到孕后的12.5%（134/10,755）。在公民中，发病率保持稳定，从hbea前的5.4%（1,346/25,003）到hbea后的5.3%（318/5,993）。非市民产后PC率从孕前到孕后的增加显著大于市民产后PC率的变化（p<0.001）。结论：在HBEA下扩大紧急医疗补助以包括产后护理与非公民产后PC的显著增加有关。这些政策变化有助于克服低收入、非公民个人产后护理的系统性障碍。

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引用次数: 0