Contraception最新文献_第8页

CHANGES IN DISTANCE TRAVELED AMONG CHICAGO ABORTION FUND CALLERS FROM 2020-2023 2020-2023 年芝加哥堕胎基金来电者旅行距离的变化

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110609

LA McGuinn, M Quasebarth, M Daniel, L Hasselbacher, K Rivlin

Objectives

To examine changes in the distance traveled by Chicago Abortion Fund (CAF) callers from 2020-2023, overall and by demographic and geographic indicators.

Methods

We included 6,512 out-of-state CAF callers seeking abortion care in Illinois between 2020-2023 who provided a zip code of residence. We approximated distance traveled by calculating the distance from each caller’s population-weighted zip code centroid to the clinic location. We defined urban/rural status using zip code derived Rural-Urban Community Area categories. We derived area level social deprivation measures using US Census data. We assessed median differences in distances (miles) traveled for callers over time and by geographic indicators.

Results

Overall, among out-of-state CAF callers, 68% (n=4,404) traveled ≥ 100 miles to access abortion care. The median one-way travel distance decreased from 90.3 miles (interquartile range [IQR]: 123) in 2020 to 50.6 miles (IQR: 126) in 2021. However, it then increased to 173 miles (IQR: 323) in 2022 and further to 191 miles (IQR: 384) in 2023. Individuals residing in rural zip codes had a median travel distance of 277 miles (IQR: 258), compared to 164 miles (IQR: 315) for those residing in urban zip codes. Individuals in more deprived rural areas traveled further (median: 373 miles, IQR:294) compared to those in less deprived rural areas (median 204 miles, IQR: 200).

Conclusions

CAF callers experience complex challenges accessing abortion, including intersections between geography and socioeconomic status. Abortion funds play a critical role in maintaining abortion access for those living in restrictive states, and should account for the structural barriers their grantees face.

目标研究 2020-2023 年期间芝加哥堕胎基金（CAF）来电者旅行距离的总体变化以及人口和地理指标的变化。方法我们纳入了 2020-2023 年期间在伊利诺伊州寻求堕胎护理的 6512 位提供居住地邮政编码的外州 CAF 来电者。我们通过计算每位来电者的人口加权邮政编码中心点到诊所地点的距离来近似计算旅行距离。我们使用邮政编码得出的农村-城市社区区域类别来定义城市/农村状态。我们利用美国人口普查数据得出了地区级社会贫困度量。结果总体而言，在州外的 CAF 求诊者中，68%（n=4,404）的求诊距离≥ 100 英里。单程旅行距离的中位数从 2020 年的 90.3 英里（四分位数间距 [IQR]：123）下降到 2021 年的 50.6 英里（四分位数间距 [IQR]：126）。然而，2022 年又增至 173 英里（四分位数间距 [IQR]：323），2023 年进一步增至 191 英里（四分位数间距 [IQR]：384）。居住在农村邮政编码的居民的中位旅行距离为 277 英里（IQR：258），而居住在城市邮政编码的居民的中位旅行距离为 164 英里（IQR：315）。与贫困程度较低的农村地区（中位数为 204 英里，IQR：200）相比，贫困程度较高的农村地区的个人旅行距离更远（中位数：373 英里，IQR：294）。堕胎基金在维持生活在限制性州的人们获得堕胎机会方面发挥着至关重要的作用，并应考虑到其受赠者所面临的结构性障碍。

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引用次数: 0

OXYTOCIN RECEPTION EXPRESSION IN PREGNANCY: “IS IT TIME TO ADD THE PIT?” 妊娠期催产素接收表达："是时候加坑了吗？

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110595

JA Reid, M Baldwin, A Edelman, J Jensen, S Yao, R Godiah, L Han

Objectives

We aimed to measure oxytocin receptor (OXTR) expression changes in the myometrium throughout pregnancy to inform clinical management of post-abortion hemorrhage.

Methods

We obtained myometrial tissue through transcervical core needle biopsies under ultrasound guidance in anesthetized participants immediately following procedural abortion. We also obtained tissue from non-pregnant and term control participants. We compared relative OXTR expression throughout pregnancy using quantitative PCR (qPCR) to evaluate gene expression and immunohistochemistry to assess OXTR protein in samples.

Results

We collected myometrial samples from 29 participants including n=22 following abortion at 6-26 weeks, n=3 undergoing cesarean delivery at term prior to labor, and n=4 undergoing laparoscopic permanent contraception (non-pregnant). Using qPCR, we observed an increase in relative OXTR expression with increasing gestational age. Compared to non-pregnant levels, the relative expression ranges increased from 2.5-fold (SD 3.9) in the first trimester to 96-fold (SD 10.3) at term. To further investigate the changes in expression in the second trimester, we compared mRNA expression in early-, mid-, and late-second trimester subgroups. Compared to the first trimester (<14 week), relative expression increased by 5.8-fold at 14-17 weeks, 16.2-fold at 18-20 weeks, 22.4-fold at 20-26 weeks, and 38.4-fold at term (>37 weeks). Immunohistochemical staining confirmed gestational week dependent increases in OXTR protein levels in the cytosol of myometrial cells.

Conclusions

This study defines changes in OXTR expression throughout pregnancy and provides evidence for an increase in the second trimester. This supports the use of oxytocin in second trimester hemorrhage management, with a notable increase in expression by 18 weeks.

目的我们旨在测量整个妊娠期子宫肌层中催产素受体（OXTR）表达的变化，为人工流产后大出血的临床治疗提供参考。方法我们在超声引导下，通过经宫颈核心针活检获取子宫肌层组织，受检者在手术流产后立即进行麻醉。我们还从未孕和足月的对照组参与者身上获取了组织。我们使用定量 PCR（qPCR）评估基因表达，并使用免疫组织化学方法评估样本中的 OXTR 蛋白，从而比较了整个妊娠期间 OXTR 的相对表达。通过 qPCR，我们观察到随着妊娠年龄的增加，OXTR 的相对表达量也在增加。与未孕水平相比，相对表达范围从头三个月的 2.5 倍（标准差 3.9）增加到足月时的 96 倍（标准差 10.3）。为了进一步研究妊娠后三个月的表达变化，我们比较了妊娠后三个月早期、中期和晚期亚组的 mRNA 表达。与妊娠头三个月（14 周）相比，相对表达量在 14-17 周增加了 5.8 倍，18-20 周增加了 16.2 倍，20-26 周增加了 22.4 倍，足月时（37 周）增加了 38.4 倍。免疫组化染色证实，子宫肌细胞胞浆中 OXTR 蛋白水平的增加与孕周有关。这支持了催产素在妊娠后三个月出血处理中的应用，其表达在 18 周时显著增加。

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引用次数: 0

“PEOPLE ARE GETTING STERILIZED TO STAY SAFE”: PERMANENT CONTRACEPTION AMONG YOUNG ADULTS AFTER DOBBS "人们做绝育手术是为了安全"：多布斯事件后青壮年中的永久性避孕措施

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110649

J Strasser, E Schenk, S Luckenbill, D Tsevat, L King, Q Luo, J Maslowsky

Objectives

Young people face a unique constellation of barriers to contraception access and are among the most vulnerable groups who may be forced into parenthood following Dobbs v Jackson Women’s Health Organization. The purpose of this study was to measure young adults’ utilization of vasectomy or tubal sterilization after the leaked Dobbs opinion in May 2022, and to examine adolescents’ and young adults’ perceptions about these methods.

Methods

This concurrent mixed-methods analysis used (1) IQVIA medical claims data for 563,273 adults (ages 19-44) from 2021 and 2022 and (2) survey responses from 1,234 adolescents and young adults (ages 14-24) responding to MyVoice surveys in 2022 and 2023. Using claims data, we conducted difference-in-difference analyses of monthly tubal sterilization and vasectomy services among ages 19-26 and 27-44, by state policy category. We conducted thematic content analyses of open-text survey responses from MyVoice, a text-based anonymous poll for individuals ages 14-24.

Results

Tubal sterilization and vasectomy services increased in the months following the Dobbs decision leak for all age groups, with greater increases among ages 19-26 than 27-44. Difference-in-difference analyses found greater increases in tubal sterilization (1%, p=0.02) and vasectomy (2%, p =0.02) in states likely to ban abortion compared to states not likely to ban abortion; state-level differences among ages 27-44 were not statistically significant. Survey responses highlight fear for loss of bodily autonomy and changes to pregnancy plans after Dobbs.

Conclusions

Young adults increasingly obtained permanent contraception post-Dobbs, especially in states deemed likely to ban abortion, and continue to face challenges to their bodily autonomy.

目标年轻人在获得避孕药具方面面临着一系列独特的障碍，他们是最脆弱的群体之一，在多布斯诉杰克逊妇女健康组织案之后，他们可能会被迫成为父母。本研究的目的是测量 2022 年 5 月多布斯意见书泄露后年轻成人对输精管结扎术或输卵管绝育术的使用情况，并考察青少年和年轻成人对这些方法的看法。方法本并行混合方法分析使用了（1）2021 年和 2022 年 563,273 名成人（19-44 岁）的 IQVIA 医疗索赔数据；（2）2022 年和 2023 年 1234 名青少年和年轻成人（14-24 岁）对 MyVoice 调查的回复。利用索赔数据，我们按州政策类别对 19-26 岁和 27-44 岁人群的每月输卵管绝育和输精管结扎服务进行了差异分析。我们对 "我的声音"（MyVoice）的开放文本调查回复进行了主题内容分析，这是一项针对 14-24 岁个人的基于文本的匿名投票。结果在多布斯决定泄漏后的几个月内，所有年龄组的输卵管绝育和输精管切除服务都有所增加，其中 19-26 岁年龄组的增幅大于 27-44 岁年龄组。差异分析发现，与不可能禁止堕胎的州相比，可能禁止堕胎的州的输卵管绝育手术（1%，p=0.02）和输精管结扎手术（2%，p=0.02）的增幅更大；27-44 岁年龄段的州级差异无统计学意义。结论年轻人在多布斯事件后越来越多地采取永久性避孕措施，尤其是在可能禁止堕胎的州，但他们的身体自主权仍面临挑战。

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引用次数: 0

Society of Family Planning Annual Meeting 2024 计划生育协会 2024 年年会。

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110680

引用次数: 0

FULFILLING AN UNMET NEED: PATIENT PERSPECTIVES ON INTEGRATING FAMILY PLANNING SERVICES INTO OFFICE-BASED ADDICTION THERAPY 满足未满足的需求：患者对将计划生育服务纳入诊室戒毒治疗的看法

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110582

SK O’Connor, R Pancholi, E Patton

Objectives

Our objective was to study patient perspectives on facilitators and barriers to incorporation of family planning services within office-based addiction therapy (OBAT). After previously exploring provider perspectives, we sought to understand the unique patient considerations on integration within the OBAT model with the goal to support design of a program tailored to meet the reproductive health needs of patients with substance use disorder (SUD).

Methods

Following IRB approval, we conducted 20 qualitative semi-structured interviews with Boston Medical Center OBAT patients. Interviews explored participants substance use and reproductive health, OBAT experiences and unique considerations when accessing reproductive healthcare within addiction care. Interview transcripts were analyzed using deductive codes utilizing a conceptual framework informed by our prior work.

Results

Our participants overwhelmingly saw reproductive services as not only acceptable within OBAT but preferable to accessing these services elsewhere. Participants described the nuance of early recovery that can hinder other healthcare needs including contraception care. Participants desired reproductive counseling put into context of this recovery process and desired these counseling conversations to be with their trusted addiction care providers who “already knew their stories”.

Conclusions

Our findings provide patient-voiced support to the idea that OBAT clinics are an important access point to reproductive health services for patients with SUD. The longitudinal relationship between patients and OBAT staff minimizes stigma and provides focused knowledge on the unique reproductive concerns of these patients. Our participants provide insight into factors necessary for successful integration of family planning services to support the patient-desired idea of an addiction care medical home.

目标我们的目标是研究患者对将计划生育服务纳入诊室成瘾治疗（OBAT）的促进因素和障碍的看法。在之前对提供者的观点进行探讨后，我们试图了解患者在将计划生育服务纳入 OBAT 模式时所考虑的独特因素，目的是支持设计一项专门满足药物使用障碍（SUD）患者生殖健康需求的计划。方法在获得 IRB 批准后，我们对波士顿医疗中心的 OBAT 患者进行了 20 次半结构式定性访谈。访谈探讨了参与者的药物使用和生殖健康、OBAT 经验以及在成瘾护理中获得生殖保健时的独特考虑。访谈记录采用演绎代码进行分析，并使用了我们先前工作中参考的概念框架。结果我们的绝大多数参与者认为，生殖服务不仅在 OBAT 中可以接受，而且比在其他地方获得这些服务更可取。参与者描述了早期康复的细微差别，这些细微差别可能会阻碍包括避孕护理在内的其他医疗保健需求。参与者希望在康复过程中获得生殖咨询，并希望与他们信任的、"已经了解他们的故事 "的戒毒治疗提供者进行这些咨询对话。结论：我们的研究结果为以下观点提供了患者意见支持：OBAT 诊所是 SUD 患者获得生殖健康服务的重要途径。患者与 OBAT 工作人员之间的纵向关系最大限度地减少了耻辱感，并提供了关于这些患者独特生殖问题的重点知识。我们的参与者深入了解了成功整合计划生育服务的必要因素，以支持患者所希望的 "成瘾护理医疗之家 "理念。

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引用次数: 0

IS A MISCARRIAGE AN EMERGENCY? A QUALITATIVE STUDY ASSESSING EMERGENCY MEDICINE PHYSICIANS’ VIEWS TOWARD APPROPRIATE CARE FOR EARLY PREGNANCY LOSS IN THE EMERGENCY DEPARTMENT 流产是急症吗？一项定性研究，评估急诊科医生对急诊科早期妊娠流产适当护理的看法

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110627

E Lantos, E McCoy, A Chipman, BT Nguyen, LS Benson

Objectives

Patients experiencing early pregnancy loss (EPL) commonly seek care in the emergency department (ED) and often report negative experiences. This qualitative study explores how emergency medicine (EM) physicians view EPL management in the emergency department.

Methods

We interviewed 22 EM physicians regarding their treatment of EPL in the ED; we included EM physicians in diverse practice settings, including states with and without abortion restrictions. Semi-structured interviews assessed participants’ current EPL diagnosis and management practices, their attitudes toward what EPL care should be provided in the ED, with attention to the impact of abortion restrictions and differing practice settings. Qualitative data were coded and analyzed for themes.

Results

Most participants reported commonly encountering EPL, though being limited by lack of access to ultrasound diagnosis. Most considered communicating EPL diagnoses as within EM’s scope of practice, but felt discomfort in counseling about management, citing lack of education and uncertainty around which options obstetrician gynecologists (Ob-Gyns) would offer. Most participants only felt comfortable providing expectant management without Ob-Gyn involvement. Time, space, lack of training, scope of practice, and medical-legal concerns were cited as barriers to providing medication and procedural treatment. Many believe EPL management could be improved in the ED but acknowledge competing acuity and lack of education as barriers. Abortion restrictions rarely affected participants' views on miscarriage management, but impacted their ability to provide appropriate care.

Conclusions

EPL is a common ED complaint, but care varies significantly based on practice setting. Standardization and collaboration between Ob-Gyns and EM may improve care for patients experiencing EPL in the ED.

目标经历过早期妊娠损失（EPL）的患者通常会到急诊科（ED）就诊，并经常报告负面经历。本定性研究探讨了急诊医学（EM）医生如何看待急诊科对早孕损失的处理。方法我们就急诊科对早孕损失的处理对 22 名 EM 医生进行了访谈；访谈对象包括不同执业环境下的 EM 医生，包括有堕胎限制和无堕胎限制的州。半结构式访谈评估了参与者目前的 EPL 诊断和管理实践，以及他们对急诊科应提供哪些 EPL 护理的态度，并关注了堕胎限制和不同实践环境的影响。对定性数据进行了编码和主题分析。结果大多数参与者表示，他们通常会遇到 EPL，但由于无法获得超声波诊断而受到限制。大多数人认为，传达 EPL 诊断结果属于急诊科的工作范围，但在提供处理建议时感到不适，因为他们缺乏教育，也不确定妇产科医生（Ob-Gyns）会提供哪些选择。大多数参与者认为，只有在没有妇产科医生参与的情况下，才能提供预产期管理。时间、空间、缺乏培训、执业范围和医疗法律问题被认为是提供药物和程序性治疗的障碍。许多人认为，急诊室的待产处理工作可以得到改善，但也承认竞争激烈和缺乏教育是障碍。流产限制很少影响参与者对流产管理的看法，但影响了他们提供适当护理的能力。妇产科医生和急诊科医生之间的标准化合作可改善急诊室对流产患者的护理。

{"title":"IS A MISCARRIAGE AN EMERGENCY? A QUALITATIVE STUDY ASSESSING EMERGENCY MEDICINE PHYSICIANS’ VIEWS TOWARD APPROPRIATE CARE FOR EARLY PREGNANCY LOSS IN THE EMERGENCY DEPARTMENT","authors":"E Lantos, E McCoy, A Chipman, BT Nguyen, LS Benson","doi":"10.1016/j.contraception.2024.110627","DOIUrl":"10.1016/j.contraception.2024.110627","url":null,"abstract":"<div><h3>Objectives</h3><div>Patients experiencing early pregnancy loss (EPL) commonly seek care in the emergency department (ED) and often report negative experiences. This qualitative study explores how emergency medicine (EM) physicians view EPL management in the emergency department.</div></div><div><h3>Methods</h3><div>We interviewed 22 EM physicians regarding their treatment of EPL in the ED; we included EM physicians in diverse practice settings, including states with and without abortion restrictions. Semi-structured interviews assessed participants’ current EPL diagnosis and management practices, their attitudes toward what EPL care should be provided in the ED, with attention to the impact of abortion restrictions and differing practice settings. Qualitative data were coded and analyzed for themes.</div></div><div><h3>Results</h3><div>Most participants reported commonly encountering EPL, though being limited by lack of access to ultrasound diagnosis. Most considered communicating EPL diagnoses as within EM’s scope of practice, but felt discomfort in counseling about management, citing lack of education and uncertainty around which options obstetrician gynecologists (Ob-Gyns) would offer. Most participants only felt comfortable providing expectant management without Ob-Gyn involvement. Time, space, lack of training, scope of practice, and medical-legal concerns were cited as barriers to providing medication and procedural treatment. Many believe EPL management could be improved in the ED but acknowledge competing acuity and lack of education as barriers. Abortion restrictions rarely affected participants' views on miscarriage management, but impacted their ability to provide appropriate care.</div></div><div><h3>Conclusions</h3><div>EPL is a common ED complaint, but care varies significantly based on practice setting. Standardization and collaboration between Ob-Gyns and EM may improve care for patients experiencing EPL in the ED.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110627"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426171","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

INCIDENCE OF ECTOPIC PREGNANCY AMONG PEOPLE SEEKING AND NOT SEEKING ABORTION IN A LARGE INTEGRATED HEALTHCARE DELIVERY SYSTEM: A CASE-CONTROL STUDY 大型综合医疗服务系统中寻求和不寻求人工流产者的宫外孕发生率：病例对照研究

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110623

MA Biggs, M Armstrong, L Tucker, S Kaller, J Rabbani, JW Lee, D Grossman

Objectives

We aimed to compare the incidence of ectopic pregnancy, associated risk factors, and presentation to care among people seeking and not seeking abortion, using a retrospective case-control study.

Methods

We selected a random sample of 2,201 ectopic and 1,153 intrauterine pregnancies (out of 385,081 pregnancies) of people enrolled at Kaiser Permanente Northern California from 2016-2021. We reviewed electronic health records to classify pregnancies as seeking or not seeking abortion and to obtain medical history. We used logistic regression analyses weighted to the total pregnancy pool (n=385,081) to assess incidence of ectopic pregnancies, associated risk factors, and whether risk factors accurately identify people with ectopic pregnancies.

Results

The adjusted incidence of ectopic pregnancy was lower for people seeking abortion (0.39%) than for people not seeking abortion (1.74%, p<0.001). People seeking abortion were less likely to present with bleeding symptoms (53% and 64%, p<0.01), equally likely to present with unilateral pain (35% and 35%) and received more timely care than people not seeking abortion, including fewer encounters until diagnosis (2.2 vs 2.6, p<0.001) and earlier treatment for ectopic pregnancy (53 days gestation vs 55 days, p<0.05). Among people seeking abortion (n=511), history of IUD use, ectopic pregnancy, and tubal surgery, together identified 12.7% (sensitivity) of ectopic cases, with 93.5% specificity, and a 55.5% area under the receiver operating characteristic (AUROC).

Conclusions

People seeking abortion are at lower risk of ectopic pregnancy and receive more timely ectopic care than those not seeking abortion. History-based screening in abortion care may not accurately distinguish people with and without ectopic pregnancy.

方法我们随机抽取了 2016-2021 年在北加州凯泽医疗注册的 2201 例异位妊娠和 1153 例宫内妊娠（共 385 081 例）。我们查阅了电子健康记录，将怀孕分为寻求流产和不寻求流产，并获取病史。我们使用加权到总妊娠库（n=385,081）的逻辑回归分析来评估宫外孕的发生率、相关风险因素以及风险因素是否能准确识别宫外孕患者。结果寻求人工流产者的调整后宫外孕发生率（0.39%）低于不寻求人工流产者（1.74%，p<0.001）。寻求人工流产者出现出血症状的几率较低（53% 和 64%，p<0.01），出现单侧疼痛的几率相同（35% 和 35%），与未寻求人工流产者相比，寻求人工流产者得到了更及时的治疗，包括较少的就诊时间（2.2 对 2.6，p<0.001）和较早的异位妊娠治疗（妊娠 53 天对 55 天，p<0.05）。在寻求人工流产的人（n=511）中，宫内节育器使用史、宫外孕史和输卵管手术史加在一起可识别出 12.7% 的宫外孕病例（灵敏度），特异性为 93.5%，接收者操作特征下面积 (AUROC) 为 55.5%。人工流产护理中基于病史的筛查可能无法准确区分宫外孕患者和非宫外孕患者。

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引用次数: 0

LATINO MEN’S ATTITUDES ON NOVEL MALE CONTRACEPTIVE METHODS 拉丁美洲男性对新型男性避孕方法的态度

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110567

A Montes De Oca, B Nguyen, L Wise, M Withers

Objectives

Unintended pregnancies and non-use of contraception are disproportionately represented among Latino populations. While novel male contraceptives (NMCs) can fill a gap in contraceptive need, patriarchal norms may prevent uptake among Latino men.

Methods

We conducted in-depth semi-structured interviews with heterosexually active, reproductive-aged (18–50), English-speaking Latino men in Los Angeles, CA in 2017. Demographics and reproductive histories were collected. Interviewees were asked about experiences with general contraception, attitudes toward and willingness to use NMCs, with focus on sociocultural barriers. Interviews were transcribed and thematically analyzed.

Results

Of 19 participants (mean age, 29), 74% had a high school degree or less, 63% identified as Christian/Catholic, 32% reported an unintended pregnancy, and 68% wanted more children. Nearly all (89.5%) respondents expressed that men should use NMCs, more than half (68.4%) agreed or strongly agreed that they would use NMCs themselves. The majority expressed concerns about NMC use falling into three themes: 1) machismo negatively influencing family, friends’, and personal attitudes about participating in traditionally feminine roles; 2) religion’s effect of censoring discussions of sex, leading to lack of comfort with contraception use in general; and 3) intergenerational involvement in family planning affecting contraceptive autonomy. An additional theme was that these concerns could be mitigated by catering to their desires for more male-based reproductive control and shared reproductive responsibility.

Conclusions

Even if they are open to using NMCs themselves, Latino men may still be deterred by sociocultural factors. Framing NMCs as a man’s responsibility may be a strategy for overcoming machismo.

目标在拉丁裔人口中，意外怀孕和不使用避孕药具的比例过高。虽然新型男性避孕药（NMC）可以填补避孕需求方面的空白，但父权制规范可能会阻碍拉丁裔男性采取避孕措施。方法我们于 2017 年在加利福尼亚州洛杉矶市对异性恋活跃、育龄期（18-50 岁）、讲英语的拉丁裔男性进行了深入的半结构式访谈。我们收集了人口统计数据和生育史。受访者被问及一般避孕经验、对使用 NMC 的态度和意愿，重点关注社会文化障碍。结果在 19 名参与者（平均年龄 29 岁）中，74% 的人拥有高中或以下学历，63% 的人被认定为基督徒/天主教徒，32% 的人报告意外怀孕，68% 的人想要更多的孩子。几乎所有的受访者（89.5%）都表示男性应该使用非避孕药具，超过一半的受访者（68.4%）同意或非常同意他们自己会使用非避孕药具。大多数受访者对使用 NMC 表示担忧，主要有三个主题：1）大男子主义对家人、朋友和个人参与传统女性角色的态度产生负面影响；2）宗教对性讨论的审查作用，导致对使用避孕药具普遍感到不自在；以及 3）代际参与计划生育影响避孕自主权。另一个主题是，可以通过满足他们对更多基于男性的生殖控制和共同承担生殖责任的愿望来减轻这些担忧。将非药物性流产界定为男性的责任可能是克服大男子主义的一种策略。

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引用次数: 0

ACCESSING EMERGENCY CONTRACEPTION NEAR US COLLEGE CAMPUSES: A COMPARISON OF SAME-DAY EMERGENCY CONTRACEPTION AVAILABILITY BY STATE AFTER THE DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION DECISION 在美国大学校园附近获取紧急避孕药具：多布斯诉杰克逊妇女健康组织案判决后各州当天紧急避孕药具供应情况比较

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110641

A Rashid, K Patel, M Wood, C Chuang

Objectives

We aimed to compare same-day emergency contraception (EC) availability near US universities in abortion-restrictive versus abortion-protective states after Dobbs v Jackson Women’s Health Organization.

Methods

Using a “mystery shopper” script, we conducted a cross-sectional telephone survey in 2023 to ascertain same-day OTC EC availability in pharmacies near universities in abortion-protective states (NY, CA), and abortion-restrictive states (TX, AK). Multivariable analysis modeled likelihood of same-day EC availability by state abortion status, controlling for chain vs. non-chain pharmacies and urban or rural locations. Alternative pharmacy locations were obtained from pharmacies where EC was unavailable.

Results

Of the 402 pharmacies contacted, 75% had same-day OTC EC availability, representing 65% of pharmacies in abortion-restrictive vs. 85% in abortion-protective states (p<0.001). Chain pharmacies were more likely to have same-day availability than non-chain pharmacies (92% vs. 52%, p<0.001). In the adjusted analysis, EC was less likely to be available in abortion-restrictive states (adjusted OR (aOR) 0.31, 95% CI 0.17-0.56), and more likely in chain pharmacies (aOR 11.58, 95% CI 6.45-20.80). Of the 102 pharmacies where same-day EC was unavailable, 61 (59%) did not provide an alternative location: 74% were in abortion-restrictive states, while 26% were in abortion-protective states.

Conclusions

This study revealed same-day OTC EC availability near universities is lower in abortion-restrictive states compared to abortion-protective states. Fewer pharmacies in abortion-restrictive states compared to abortion-protective states provided an alternative pharmacy if OTC EC was unavailable. Incentives to increase OTC EC availability in non-pharmacy locations and encourage anticipatory purchase should be implemented on and near college campuses to reduce the risk of unintended pregnancy.

方法使用 "神秘顾客 "脚本，我们在 2023 年进行了一次横断面电话调查，以确定在保护人工流产州（纽约州、加利福尼亚州）和限制人工流产州（德克萨斯州、亚利桑那州）的大学附近的药店是否提供当天的 OTC EC。多变量分析根据各州的人工流产状况，对当天是否有药店提供避孕药进行了建模，并对连锁药店与非连锁药店以及城市或农村地区进行了控制。结果在所联系的 402 家药店中，75% 的药店可提供当天的 OTC EC，其中限制堕胎州的药店占 65%，而保护堕胎州的药店占 85%（p<0.001）。与非连锁药店相比，连锁药店更有可能提供当天可用的产品（92% 对 52%，p<0.001）。在调整后的分析中，限制堕胎的州提供安琪儿的可能性较低（调整后 OR (aOR) 0.31，95% CI 0.17-0.56），而连锁药店提供安琪儿的可能性较高（aOR 11.58，95% CI 6.45-20.80）。在 102 家无法提供当天 EC 的药店中，61 家（59%）没有提供替代地点：74%的药店位于限制堕胎的州，26%的药店位于保护堕胎的州。与堕胎保护州相比，限制堕胎州的药店在无法获得非处方药避孕药时提供替代药店的数量较少。应在大学校园内及附近实施激励措施，增加非药房地点的非处方药物避孕药具供应，并鼓励预期购买，以降低意外怀孕的风险。

{"title":"ACCESSING EMERGENCY CONTRACEPTION NEAR US COLLEGE CAMPUSES: A COMPARISON OF SAME-DAY EMERGENCY CONTRACEPTION AVAILABILITY BY STATE AFTER THE DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION DECISION","authors":"A Rashid, K Patel, M Wood, C Chuang","doi":"10.1016/j.contraception.2024.110641","DOIUrl":"10.1016/j.contraception.2024.110641","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to compare same-day emergency contraception (EC) availability near US universities in abortion-restrictive versus abortion-protective states after <em>Dobbs v Jackson Women’s Health Organization</em>.</div></div><div><h3>Methods</h3><div>Using a “mystery shopper” script, we conducted a cross-sectional telephone survey in 2023 to ascertain same-day OTC EC availability in pharmacies near universities in abortion-protective states (NY, CA), and abortion-restrictive states (TX, AK). Multivariable analysis modeled likelihood of same-day EC availability by state abortion status, controlling for chain vs. non-chain pharmacies and urban or rural locations. Alternative pharmacy locations were obtained from pharmacies where EC was unavailable.</div></div><div><h3>Results</h3><div>Of the 402 pharmacies contacted, 75% had same-day OTC EC availability, representing 65% of pharmacies in abortion-restrictive vs. 85% in abortion-protective states (p<0.001). Chain pharmacies were more likely to have same-day availability than non-chain pharmacies (92% vs. 52%, p<0.001). In the adjusted analysis, EC was less likely to be available in abortion-restrictive states (adjusted OR (aOR) 0.31, 95% CI 0.17-0.56), and more likely in chain pharmacies (aOR 11.58, 95% CI 6.45-20.80). Of the 102 pharmacies where same-day EC was unavailable, 61 (59%) did not provide an alternative location: 74% were in abortion-restrictive states, while 26% were in abortion-protective states.</div></div><div><h3>Conclusions</h3><div>This study revealed same-day OTC EC availability near universities is lower in abortion-restrictive states compared to abortion-protective states. Fewer pharmacies in abortion-restrictive states compared to abortion-protective states provided an alternative pharmacy if OTC EC was unavailable. Incentives to increase OTC EC availability in non-pharmacy locations and encourage anticipatory purchase should be implemented on and near college campuses to reduce the risk of unintended pregnancy.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110641"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426203","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

“I TAKE IT WHEN I WANT IT”: EXPLORING USE OF ADVANCE PROVISION OF ULIPRISTAL ACETATE AND ITS PROMOTION OF REPRODUCTIVE AUTONOMY FOR POSTPARTUM PATIENTS "我想服用时就服用"：探索预先提供醋酸乌利司他及其对产后患者生育自主权的促进作用

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110636

CF Lu, M Serino, L Wegner, L Patterson, M Gurra, A Turner

Objectives

Emergency contraception remains underutilized with barriers to access. We assess how advance provision of ulipristal acetate (UA) facilitates use and expands reproductive autonomy for postpartum people declining high-efficacy contraception

Methods

Participants choosing lower-efficacy contraception were recruited postpartum and received UA prior to discharge (n=73). Surveys were completed at baseline, 6 weeks, 3 months, and 6 months postpartum. Univariate logistic regression models examined the association between UA use and participant demographics. In-depth interviews were conducted at 6 weeks with early UA users and at 6 months with all participants, exploring topics around contraception and reproductive autonomy. Reflexivity and memo-writing enhanced data collection. Interviews were inductively coded in NVivo 12 and analyzed using grounded theory.

Results

Twelve participants (16%) reported using UA, with a mean of 2.6 UA uses per participant (SD: 2.4). Those who identified as Latinx had 5.3 greater odds of using UA (95% CI: [1.41, 20.5], p=0.013). Participants with lower income (<$100,000) also had higher odds of using UA (OR: 8.40, 95% CI: [1.37, 163], p=0.019). Semi-structured interviews (n=19) revealed strong approval of advance provision of UA. Participants endorsed improved access, ease and confidence in use, and greater control over their reproductive decision-making. This was especially relevant for those with prior negative experiences with contraception and/or unwanted or coercive counseling from providers.

Conclusions

Postpartum patients choosing lower-efficacy contraception valued advance provision of UA and reflected on UA as a user-controlled option, bolstering reproductive autonomy. Advance provision of UA can be a useful intervention to increase contraceptive access for postpartum patients prior to discharge.

目标紧急避孕药具的使用率仍然偏低，存在获取障碍。我们评估了提前提供醋酸乌利司他（UA）如何促进拒绝使用高效避孕药具的产后妇女使用避孕药具并扩大其生育自主权。调查分别在基线、产后 6 周、3 个月和 6 个月完成。单变量逻辑回归模型检验了 UA 使用与参与者人口统计学特征之间的关联。在产后 6 周和 6 个月时，分别对早期 UA 使用者和所有参与者进行了深入访谈，探讨了与避孕和生殖自主相关的话题。反思和备忘录写作加强了数据收集工作。访谈在 NVivo 12 中进行归纳编码，并使用基础理论进行分析。那些被认定为拉丁裔的人使用 UA 的几率要高出 5.3（95% CI：[1.41, 20.5]，p=0.013）。收入较低（100,000 美元）的参与者使用 UA 的几率也更高（OR：8.40，95% CI：[1.37, 163]，p=0.019）。半结构式访谈（n=19）显示，预先提供尿液分析得到了强烈认可。参与者表示，他们可以更方便、更自信地使用，并能更好地控制自己的生育决策。结论选择低效避孕药具的产后患者重视提前提供超前尿液分析，并认为超前尿液分析是一种由用户控制的选择，增强了生殖自主权。在出院前为产后患者提前提供超前尿液分析是一种有效的干预措施，可以增加产后患者获得避孕药具的机会。

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