Contraception最新文献_第8页

BRAKES AND ACCELERATORS TO ABORTION ACCESS POST-DOBBS: WHERE CAN WE BEST INTERVENE? 堕胎后的刹车和加速器：我们在哪里可以最好地干预？

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111054

JA Higgins, E Albert, C Emily Hendrick, M Lands, E Romell, L Senderowicz, J Seymour, M Ufot, S Zhao

Objectives

A long-standing Society research challenge is the recruitment of people who consider abortion but never connect with a clinic. This need is urgent in post-Dobbs v Jackson Women’s Health Organization restrictive states, including Wisconsin. To address these needs, we located abortion considerers through innovative recruitment mechanisms, and examined their experiences within a state-based context.

Methods

Using three recruitment arms, we enrolled pregnant Wisconsinites who had considered abortion between June 2022 and February 2025: 1) callers to abortion clinics; 2) prenatal patients in Madison, Wisconsin; and 3) people seeking information online about abortion. Participants completed in-depth interviews about abortion consideration. We analyzed interview data using a qualitative descriptive approach.

Results

We completed 42 interviews (n=8 clinic callers, 30 prenatal patients, 4 online information seekers). Interviewees described nearly 20 brakes and accelerators to abortion, from legal (Wisconsin’s telehealth ban) to logistical (lack of transportation), personal (pregnancy ambivalence) to relational (interpersonal violence), cultural (stigma) to structural (housing insecurity). Three intervenable factors emerged as critical to abortion access: finances and insurance coverage; state-based restrictions (eg, 1849 law, two-visit requirement); and patient navigation services and resources (eg, clinic referrals, lodging assistance).

Conclusions

In this study of post-Dobbs abortion considerers, most of whom never connected with an abortion clinic, we documented a wide range of brakes and accelerators to abortion access. Three factors — insurance coverage, state-based restrictions, and navigation services — were powerful in predicting access and could be addressed through policy and program levers. These factors’ impact would likely have been underestimated if participants were only recruited from abortion clinics.

目的一个长期存在的社会研究挑战是招募那些考虑堕胎但从未与诊所联系的人。在多布斯诉杰克逊妇女健康组织案结束后，这种需求在包括威斯康辛州在内的限制性州尤为迫切。为了满足这些需求，我们通过创新的招聘机制找到了堕胎考虑者，并在基于州的背景下检查了他们的经历。方法采用三个招募组，我们招募了在2022年6月至2025年2月期间考虑过堕胎的威斯康星州孕妇：1)致电堕胎诊所；2)威斯康星州麦迪逊市产前患者；3)人们在网上寻找有关堕胎的信息。参与者完成了关于堕胎考虑的深度访谈。我们使用定性描述方法分析访谈数据。结果共完成42次访谈，其中门诊访视者8例，产前访视者30例，网上访视者4例。受访者描述了堕胎的近20个刹车和加速器，从法律（威斯康星州的远程医疗禁令）到后勤（缺乏交通工具），个人（怀孕矛盾心理）到关系（人际暴力），文化（污名）到结构（住房不安全）。三个可干预因素对获得堕胎服务至关重要：财政和保险覆盖；基于州的限制（例如，1849年的法律，两次访问要求）；以及患者导航服务和资源（例如，诊所转介，住宿援助）。结论：在对多布斯后堕胎患者的研究中，我们记录了大量的阻碍和促进堕胎的因素，其中大多数人从未去过堕胎诊所。三个因素——保险覆盖范围、基于州的限制和导航服务——在预测获取情况方面具有强大的作用，可以通过政策和项目杠杆加以解决。如果参与者只从堕胎诊所招募，这些因素的影响可能会被低估。

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引用次数: 0

AWARENESS OF TELEHEALTH SERVICES AND REASONS FOR SEEKING IN-PERSON ABORTION CARE 对远程保健服务的认识和寻求亲自堕胎护理的原因

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111104

S Kaller, L Ralph, R Schroeder, MA Biggs

Objectives

Telehealth abortion care has rapidly expanded, even in states with abortion bans. Yet, many people still travel for in-person care, although their reasons for traveling are understudied.

Methods

As part of a larger study of people accessing facility-based abortion care in protected-access states, from January to April 2025, we surveyed people presenting for abortion at five clinics in California, New Mexico, and Illinois regarding their experiences accessing abortion. We examined whether abortion patients had ever heard of telehealth abortion services and their reasons “to come to this facility in-person instead of having a medication abortion using telehealth.”

Results

Among the 544 people surveyed to date, 503 had complete outcome data, of whom 61% traveled from another state to access care; 79% were <13 weeks pregnant, and 40% received governmental assistance. One in five (23%) participants had ever heard of telehealth abortion services (20% out-of-state vs. 28% in-state, p<0.01). The most common reasons for seeking in-person (vs. telehealth) care included “didn’t know about telehealth” (47%), followed by “preferred to see a clinician in-person” (31%), and “easier/faster to come to a clinic” (17%). Few (11.5%) indicated uncertainty about telehealth safety as a reason.

Conclusions

Findings suggest that while many people who might benefit from telehealth abortion care, particularly those who travel from out-of-state, are unaware of this as a potential care option, many may still continue to prefer in-person care. Increasing awareness of and access to both telehealth and in-person abortion care are essential to meeting people’s needs and preferences.

即使在禁止堕胎的州，医疗堕胎护理也迅速扩大。然而，许多人仍然为了亲自护理而旅行，尽管他们旅行的原因尚未得到充分研究。方法作为2025年1月至4月在受保护的州获得基于设施的堕胎护理的人们的更大研究的一部分，我们调查了在加利福尼亚州，新墨西哥州和伊利诺伊州的五家诊所进行堕胎的人的堕胎经历。我们调查了堕胎患者是否听说过远程医疗堕胎服务，以及他们“亲自来这家机构而不是使用远程医疗进行药物堕胎”的原因。结果在迄今为止接受调查的544人中，503人有完整的结果数据，其中61%的人从另一个州前往获得护理；79%的人怀孕13周，40%的人接受政府援助。五分之一（23%）的参与者曾听说过远程保健堕胎服务（州外20%对州内28%，p<0.01）。寻求面对面（相对于远程医疗）治疗的最常见原因包括“不知道远程医疗”（47%），其次是“更喜欢亲自去看临床医生”（31%），以及“更容易/更快地去诊所”（17%）。很少有人（11.5%）表示不确定远程医疗安全是原因。研究结果表明，虽然许多可能受益于远程堕胎医疗的人，特别是那些从州外旅行的人，并没有意识到这是一种潜在的护理选择，但许多人可能仍然更喜欢亲自护理。提高对远程保健和现场堕胎护理的认识和获取对于满足人们的需求和偏好至关重要。

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引用次数: 0

COST CONSEQUENCE ANALYSIS OF HORMONAL CONTRACEPTION IN THE US 美国激素避孕的成本后果分析

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111140

VP Patel, K Collins, K Heinemann, B Meissner, M Saeedian

Objectives

Various contraceptive methods are available for pregnancy prevention. A model was developed to assess if acquisition costs for the etonogestrel implant and intrauterine devices (IUDs), which are the most effective forms of reversible contraception, are offset via pregnancy prevention and pregnancy-related cost savings.

Methods

A Markov model with five-year time horizon simulated pregnancy outcomes among 1,000 women aged 18-49 initiating 1 of 8 hormonal contraceptive methods: branded or generic oral contraception (OC; progestin only and combined), medroxyprogesterone acetate injection, etonogestrel/ethinyl estradiol vaginal ring, norelgestromin/ethinyl estradiol transdermal patch, 3- or ≥5-year levonorgestrel IUD, and the implant. The model specified 28-day cycles. Contraceptive acquisition costs, typical-use failure rates, discontinuation rates, pregnancy outcomes and costs, and healthcare resource use were examined from a US-managed care perspective. Sensitivity analyses were conducted.

Results

Over five years, the implant and IUDs were associated with the fewest pregnancies (60 (implant), 105 (3-year IUD), and 104 (≥5-year IUD), respectively) and the lowest costs per-woman ($3,428 (implant), $5,275 (3-year IUD), and $4,728 (≥5-year IUD), respectively). Cost offsets occurred in year 1 and increased incrementally through year 5. In comparison, branded and generic OCs were associated with 299 and 323 pregnancies, respectively, and $8,477 and $8,678 in costs per-woman; the vaginal ring, injection, and patch were associated with 328, 265, and 327 pregnancies, respectively, with costs per-woman ranging from $8,781 to $13,963. Discontinuation rates, not acquisition costs, were the primary driver impacting overall costs.

Conclusions

The implant and IUDs produced the greatest cost savings due to the lower number of pregnancies and associated costs.

目的预防妊娠的避孕方法多种多样。建立了一个模型来评估是否通过预防怀孕和节省与怀孕相关的成本来抵消炔诺孕酮植入物和宫内节育器（iud）的购置成本，这是最有效的可逆避孕形式。方法采用Markov模型，对1000名18-49岁的女性进行5年时间范围的妊娠结局模拟，这些女性采用8种激素避孕方法中的一种：品牌或普通口服避孕药（单用或联合使用）、醋酸甲孕酮注射、炔雌孕酮/炔雌醇阴道环、去甲孕酮/炔雌醇透皮贴剂、3年或≥5年的左炔诺孕酮宫内节育器和植入物。该模型规定了28天的周期。避孕药具获取成本，典型使用失败率，停药率，妊娠结局和成本，以及医疗资源的使用从美国管理的角度进行了检查。进行敏感性分析。结果5年内，植入物和宫内节育器的妊娠最少（植入物60例，3年宫内节育器105例，≥5年宫内节育器104例），人均成本最低（植入物3,428美元，3年宫内节育器5,275美元，≥5年宫内节育器4,728美元）。成本抵消发生在第1年，并在第5年逐渐增加。相比之下，品牌和非专利OCs分别与299次和323次怀孕有关，每位妇女的成本分别为8,477美元和8,678美元；阴道环、注射和贴片分别与328例、265例和327例怀孕有关，每位妇女的费用从8,781美元到13,963美元不等。中断率，而非获取成本，才是影响整体成本的主要因素。结论植入物和宫内节育器因其较少的妊娠次数和相关费用而节省了最大的成本。

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引用次数: 0

MEDICATION ABORTION ADVOCACY AND EXPANSION ON COLLEGE CAMPUSES 药物流产的倡导和在大学校园的推广

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111099

M Manze, S Srinivasulu, S Das

Objectives

Several states have mandated medication abortion services on public university campuses. We sought to understand the process for passing and implementing such legislation to help advocates in other states expand access.

Methods

We conducted in-depth interviews and focus groups with advocates, implementation experts, college staff, and legislative partners in California, New York, and Massachusetts (n=22). We asked participants about challenges, strategies, and lessons learned. Our team created and iteratively refined a case memo template for rapid qualitative analysis; two members completed each case memo. Memos were consolidated within states and themes identified across states.

Results

Student advocates partnered with allies from campuses and communities. Key challenges were policymaker and campus resistance, lack of health centers on campuses, safety concerns for students receiving medication abortion, clinic security concerns, and student advocacy leadership turnover. Such challenges were addressed by advocates applying pressure and using a reproductive justice lens, securing funding for campuses to improve safety measures, and identifying successors to ensure student leadership continuity. Participants described the importance of student storytellers in legislative hearings, research studies to demonstrate need, and modest funding for advocacy organizers and implementation. The national political context also mobilized legislators. Less demanding mandates, such as the readiness plan requirement in Massachusetts, allowed for easier campus collaboration but risked non-provision of medication abortion. Advocates and implementation experts felt that mandates should have accountability embedded in the policy language.

Conclusions

Advocates can use these findings to tailor their approach to promoting legislation that will ensure access to medication abortion for college students.

一些州已经强制要求在公立大学校园提供药物流产服务。我们试图了解通过和实施此类立法的过程，以帮助其他州的倡导者扩大使用范围。方法我们对加利福尼亚州、纽约州和马萨诸塞州的倡导者、实施专家、大学工作人员和立法伙伴进行了深度访谈和焦点小组讨论（n=22）。我们向参与者询问了挑战、策略和经验教训。我们的团队创建并迭代改进了案例备忘录模板，用于快速定性分析；每个案例备忘录由两名成员完成。备忘录在各州内合并，主题在各州之间确定。学生倡导者与来自校园和社区的盟友合作。主要的挑战是政策制定者和校园抵制，校园缺乏健康中心，对接受药物流产的学生的安全问题，诊所安全问题，以及学生倡导领导的更替。这些挑战的解决办法包括：倡导人士施加压力，从生殖正义的角度考虑问题，为校园争取资金，以改善安全措施，并确定继任者，以确保学生领导的连续性。与会者描述了学生讲故事者在立法听证会上的重要性，为证明需求而进行的研究，以及为倡导组织者和实施提供的适度资金。国家的政治环境也调动了立法者。要求较低的规定，如马萨诸塞州的准备计划要求，允许更容易的校园合作，但有可能不提供药物流产。倡导者和执行专家认为，任务规定应在政策语言中包含问责制。倡导者可以利用这些发现来调整他们的方法来促进立法，以确保大学生能够获得药物流产。

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引用次数: 0

Copyright info/Contents 版权信息/内容

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/S0010-7824(25)00412-3

引用次数: 0

ASSOCIATIONS BETWEEN STRUCTURAL RACISM AND DELAYED ACCESS TO ABORTION IN MINNESOTA 明尼苏达州结构性种族主义与延迟堕胎之间的关系

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111060

A Hassan, AK Hing, JM Wolf, M Mahoney, T Riley, C Boraas

Objectives

Structural racism has been increasingly recognized as a key determinant of racial disparities in abortion access, yet few studies have quantitatively examined its impact. This study aimed to investigate how structural racism shapes delays in abortion access for Black and White Minnesotans.

Methods

We analyzed retrospective electronic health record data from 9,467 abortions (≤11 weeks’ gestation) among Black and White Minnesota residents who received care between 2019 and 2023; we linked these records with US Census Bureau American Community Survey (ACS) data. Population-level structural racism was measured using multiple unidimensional indices derived from ACS data. Using generalized estimating equations, we examined the association between these structural racism measures and delays in abortion access, defined as the number of days between appointment scheduling and the visit date.

Results

When estimating the unadjusted difference in mean wait times for abortion by race and time period, we found that Black patients experienced an average delay of 0.87 (range, 0.57–1.2) more days than White patients, a statistically significant difference. Higher levels of structural racism were associated with longer wait times for Black abortion seekers. In the adjusted regression models, the mean adjusted difference in wait times between Black and White patients in areas with average levels of structural racism ranged from 0.35 to 0.40 more days.

Conclusions

This study identifies structural racism as a barrier to access to timely abortions for Black people, even in politically “safe” contexts, emphasizing the importance of assessing structural factors in abortion access.

结构性种族主义越来越被认为是堕胎机会中种族差异的关键决定因素，但很少有研究对其影响进行定量研究。本研究旨在调查结构性种族主义如何影响明尼苏达州黑人和白人堕胎的延迟。方法回顾性分析2019年至2023年期间接受护理的明尼苏达州黑人和白人居民9,467例流产（妊娠≤11周）的电子健康记录数据；我们将这些记录与美国人口普查局美国社区调查（ACS）的数据联系起来。使用来自ACS数据的多个单维指数来测量人口水平的结构性种族主义。使用广义估计方程，我们检查了这些结构性种族主义措施与堕胎延迟之间的关系，延迟定义为预约安排和访问日期之间的天数。结果黑人患者比白人患者平均延迟0.87天（范围0.57 ~ 1.2天），差异有统计学意义。结构性种族主义程度越高，寻求堕胎的黑人等待时间越长。在调整后的回归模型中，在结构性种族主义平均水平较高的地区，黑人和白人患者的平均调整后等待时间差异在0.35至0.40天之间。本研究认为，即使在政治上“安全”的情况下，结构性种族主义也是黑人获得及时堕胎的障碍，强调了评估堕胎获得结构性因素的重要性。

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引用次数: 0

CONTRACEPTIVE AND ABORTION INTERFERENCE BY PEOPLE ASSIGNED MALE AT BIRTH 出生时被指定为男性的人对避孕和堕胎的干扰

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111067

KT Grace, E Miller

Objectives

Reproductive coercion is abusive/controlling behavior encompassing pregnancy pressure, controlling pregnancy outcome, and contraceptive interference. Little is known about the perpetration of reproductive coercion. Contraceptive interference may or may not be intended to promote pregnancy, and research on the range of motivations is needed. The purpose of this study was to explore the prevalence of contraceptive and abortion interference, as well as motivations.

Methods

This was an explanatory sequential mixed-methods study with people assigned male at birth, using the Prolific crowdsourcing platform (3,214 surveys, 20 interviews). Descriptive qualitative and statistical analyses were conducted.

Results

The most common type of contraceptive interference was taking off condoms during sex (13.0%, n=419), which was motivated by desire for pregnancy (4.8%) and dislike of condoms (81.8%). Also common was telling partners not to use contraception (6.8%, n=220), of which 36.8% reported doing this to get the partner pregnant. Some 2.4% (n=78) of the sample reported coercing a partner to get an abortion, and 4.3% (n=138) reported preventing an abortion. Qualitative data expand on these findings and add nuance to the motivations behind these behaviors.

Conclusions

Condom interference is less likely to be motivated by a desire for pregnancy, but consequences for partners include pregnancy and other risks. Controlling access to abortion is particularly salient given current state abortion restrictions, and the necessity of abortion as a safety strategy for many abused people. These findings add to our understanding of this common type of coercive behavior and have implications for researchers and clinicians.

目的生殖强迫是一种包括妊娠压力、控制妊娠结局和避孕干预在内的虐待/控制行为。人们对强迫生育的行为知之甚少。避孕干预可能有意或无意促进怀孕，需要对各种动机进行研究。本研究的目的是探讨避孕和堕胎干预的流行程度，以及动机。方法这是一项解释性顺序混合方法研究，使用多产众包平台，对出生时被指定为男性的人进行了3214次调查，20次访谈。进行描述性定性分析和统计分析。结果最常见的避孕干扰类型是在性交过程中脱套（13.0%,n=419），其动机分别是想怀孕（4.8%）和不喜欢安全套（81.8%）。同样常见的是告诉伴侣不要采取避孕措施（6.8%,n=220），其中36.8%的人报告说这样做是为了让伴侣怀孕。约2.4% （n=78）的样本报告强迫伴侣堕胎，4.3% （n=138）的样本报告阻止堕胎。定性数据扩展了这些发现，并为这些行为背后的动机增添了细微差别。结论：避孕套干扰的动机不太可能是想怀孕，但对伴侣的后果包括怀孕和其他风险。鉴于目前各州对堕胎的限制，以及堕胎作为许多受虐待者的安全策略的必要性，控制堕胎的机会尤为突出。这些发现增加了我们对这种常见强迫行为的理解，并对研究人员和临床医生产生了影响。

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引用次数: 0

CENTERING BLACK VOICES: A QUALITATIVE EXPLORATION OF THE IDEAL ABORTION EXPERIENCE 以黑人声音为中心：对理想堕胎体验的定性探索

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111090

LET Swan, E Strelitz-Block, K Lerma, M Ufot, TL Green

Objectives

Persistent policy threats have limited our ability to set aspirational goals for abortion access that center patient preferences. In particular, we have a limited understanding of the abortion care preferences of historically excluded groups. We address this knowledge gap by assessing Black abortion seekers’ care priorities and preferences.

Methods

As a part of a sequential mixed-methods study, we conducted 30 semi-structured interviews with abortion facilitators supporting Black abortion seekers (n=15) and Black adults who had an abortion recently (n=15). In addition to asking participants about abortion care preferences, we explored what could make the process easier or better. We analyzed the interview data using the Sort and Sift, Think and Shift approach to systematically and iteratively identify and label key ideas.

Results

When envisioning the ideal abortion experience, participants imagined: (1) abortion being supported in social systems (eg, insurance coverage; embedded into primary care; clear and reliable abortion information widely available); (2) abortion care being safe, respectful, and meeting patients’ needs (eg, holistic, expansive pain management; facility policies that don’t create barriers; services and information available in preferred language and format); (3) the abortion seeker being physically and emotionally supported (eg, doula or mental health support; help with travel and caregiving responsibilities).

Conclusions

Our analysis identified concrete opportunities to improve abortion care for Black abortion seekers nationally, which would positively impact all communities. Using this roadmap, we must strive to meet the ideal care standards outlined by participants to provide patients with abortion care that honors preferences and respects dignity.

目的持续的政策威胁限制了我们为堕胎服务设定理想目标的能力，这些目标以患者的偏好为中心。特别是，我们对历史上被排斥的群体的堕胎护理偏好了解有限。我们通过评估黑人堕胎寻求者的护理优先事项和偏好来解决这一知识差距。方法作为顺序混合方法研究的一部分，我们对支持黑人堕胎寻求者（n=15）和最近堕胎的黑人成年人（n=15）的堕胎促进者进行了30次半结构化访谈。除了询问参与者对堕胎护理的偏好外，我们还探讨了如何使这一过程更容易或更好。我们使用Sort和Sift、Think和Shift方法分析访谈数据，系统地、迭代地识别和标记关键思想。结果：在设想理想的堕胎体验时，参与者想象：(1)堕胎得到社会系统的支持（如保险覆盖，嵌入初级保健，清晰可靠的堕胎信息广泛可用）；(2)堕胎护理是安全的，尊重的，并满足患者的需求（例如，全面的，广泛的疼痛管理；不造成障碍的设施政策；以首选语言和格式提供服务和信息）；(3)寻求堕胎者得到身体和情感上的支持（例如，助产师或精神健康支持；在旅行和照顾责任方面的帮助）。结论sour分析确定了在全国范围内改善黑人堕胎寻求者堕胎护理的具体机会，这将对所有社区产生积极影响。利用这一路线图，我们必须努力达到参与者概述的理想护理标准，为堕胎患者提供尊重偏好和尊重尊严的护理。

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引用次数: 0

EXPANDING ACCESS TO ABORTION WITH MIFEPRISTONE AND MISOPROSTOL THROUGH 84 DAYS ESTIMATED GESTATIONAL DURATION 在估计妊娠期84天内扩大米非司酮和米索前列醇流产的可及性

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111117

R Wallace, S Diemert, O Ades-Lawlor, R Topp, H Simons

Objectives

We aimed to assess efficacy and safety of a combined medication abortion regimen, using mifepristone and repeat buccal misoprostol dosing, for patients seeking abortion at 78-84 days estimated gestational duration in an outpatient setting in the US.

Methods

We are conducting a secondary analysis of data from 14 US-based Planned Parenthood affiliates that provided medication abortion for eligible patients with an estimated gestational duration of 78-84 days from April 2024 to December 2024, with additional data through March 2025 expected. Affiliates reported the total number of patients receiving medication abortion at this gestational duration (n=711) and available outcome data. Among medication abortions with known outcomes (n=217), we will calculate the incidence rates and 95% confidence intervals for completed abortion, ongoing pregnancy, subsequent procedure, and emergency department or hospital visits associated with medication abortion.

Results

Out of 217 known outcomes of the 711 total medication abortions provided at 78-84 days estimated gestational duration, preliminary raw data includes 27 ongoing pregnancies, 22 aspirations performed for ongoing pregnancies, 10 aspirations performed for other reasons, and 21 visits to an emergency department or hospital.

Conclusions

Use of medication abortion at 78-84 days estimated gestational duration in our study’s US-based outpatient health centers resulted in similarly low ongoing pregnancy and need for aspiration as shown by prior research conducted in international inpatient settings. Offering medication abortion with a combined regimen, including mifepristone followed 24-48 hours later by buccal misoprostol every four hours for 2-3 doses, may increase access to safe, effective abortion beyond 77 days of pregnancy.

目的：本研究旨在评估美国门诊患者在78-84天（估计妊娠期）寻求流产的联合用药方案的有效性和安全性，该方案使用米非司酮和重复口服米索前列醇。方法：我们正在对美国14家计划生育附属机构的数据进行二次分析，这些附属机构为2024年4月至2024年12月期间估计妊娠期为78-84天的符合条件的患者提供药物流产，预计到2025年3月将有更多数据。附属机构报告了在该妊娠期接受药物流产的患者总数（n=711）和可用的结局数据。在已知结局的药物流产中（n=217），我们将计算与药物流产相关的完全流产、持续妊娠、后续手术和急诊或医院就诊的发生率和95%置信区间。结果711例在78 ~ 84天估计妊娠期进行药物流产的217例已知结局中，初步原始数据包括27例持续妊娠，22例因持续妊娠而进行人工流产，10例因其他原因进行人工流产，21例就诊于急诊科或医院。结论：在我们的研究中，美国门诊医疗中心估计妊娠期为78-84天的药物流产导致了同样低的妊娠持续率和抽吸需求，这与之前在国际住院患者环境中进行的研究结果一致。提供药物流产联合方案，包括米非司酮24-48小时后，每4小时口服米索前列醇2-3剂，可增加安全、有效的妊娠77天以上流产。

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引用次数: 0

PROFESSIONAL IDENTITY FORMATION AS AN ABORTION PROVIDER AMONG BLACK OB-GYN RESIDENTS 黑人妇产科住院医师作为堕胎提供者的职业认同形成

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111072

K Harris

Objectives

A barrier remains in understanding the decision making of Ob-Gyn residents to train in abortion based on racial identity. This qualitative study explores personal and professional culture as facilitators or barriers for Black Ob-Gyn residents considering abortion training during residency and sub-specialization in complex family planning.

Methods

Using the US national Ob-Gyn residency program director listserv, we recruited Black-identifying second-, third- and fourth-year Ob-Gyn residents. A pre-interview survey captured demographics and validated measures for degrees of activist tendencies (range 0-15) and religiosity (range 6-28). A trained interviewer conducted in-depth individual semi-structured interviews. Three coders utilized an inductive approach, developing a codebook and analyzing transcripts through an iterative process within Dedoose to identify themes, subthemes, and representative quotes.

Results

Of 20 recruited participants, 18 were female and 2 were male, from all four US-census regions. The average participant activism and religiosity scores were 8.3 and 12.9, respectively. Themes identified included: 1. Internal influences on decision making, including value of abortion training, hesitation to provide higher-gestation abortion care, and personal and professional safety concerns. 2. External influences on decision making, including culture, religion, and family, and post-residency plans. 3. Familiarity or lack thereof with sub specialization in complex family planning. 4. Importance of and access to Black mentorship in residency.

Conclusions

We identified themes in personal and professional identity formation for Black Ob-Gyn residents specific to abortion training and provision, with a hope of offering insight into the supports needed and barriers experienced by an understudied yet critically important cohort of Ob-Gyn abortion providers.

目的了解基于种族认同的妇产科住院医师堕胎培训决策仍存在障碍。本定性研究探讨了个人文化和职业文化在黑人妇产科住院医师考虑在住院期间进行堕胎培训和复杂计划生育分科培训中的促进因素或障碍。方法使用美国国家妇产科住院医师项目主任列表服务，我们招募了黑人识别的二、三、四年级妇产科住院医师。访谈前的调查收集了人口统计数据，并验证了激进倾向程度（范围0-15）和宗教信仰程度（范围6-28）的测量方法。一位训练有素的面试官进行了深入的个人半结构化面试。三名编码员利用归纳方法，开发了一个代码本，并通过Dedoose的迭代过程分析转录本，以确定主题、副主题和代表性引用。结果在20名被招募的参与者中，有18名女性和2名男性，来自美国所有四个人口普查地区。参与者积极主义和宗教信仰的平均得分分别为8.3分和12.9分。确定的主题包括：决策的内部影响，包括流产培训的价值，是否提供更高的妊娠流产护理的犹豫，以及个人和职业安全问题。2. 外部因素对决策的影响，包括文化、宗教、家庭和居住后计划。3. 熟悉或缺乏复杂计划生育的专业知识。4. 黑人住院医师指导的重要性和获得途径。结论：我们确定了黑人妇产科住院医生在堕胎培训和提供方面的个人和职业身份形成的主题，希望能够深入了解一个研究不足但至关重要的妇产科堕胎提供者群体所需要的支持和遇到的障碍。

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