Contraception最新文献_第8页

Understanding intimate partner reproductive coercion: A qualitative assessment responding to methodologic demands of health equity research 理解亲密伴侣生殖强迫：对健康公平研究方法要求的定性评估。

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-12-01 Epub Date: 2025-09-01 DOI: 10.1016/j.contraception.2025.111202

Kathryn E. Fay , Kristen Jozkowski , Lori Gawron , David K. Turok , Jami Baayd

Objectives

This study aimed to generate formative data for conceptualization of intimate partner reproductive coercion (RC) as part of a health equity approach to antiviolence research and clinical interventions.

Study design

This qualitative study recruited 11 RC researchers from a national cohort and 20 community members from a state-wide research panel to participate in individual semistructured interviews or videoconferencing community discussions. We analyzed data using modified grounded theory and the Framework Method.

Results

Participants confirmed that RC lacks a consensus definition, and its historical conceptualization as a pregnancy-promoting phenomenon excludes important aspects of individuals’ experience. Intimate partner violence provides structure for understanding RC through mutual grounding in the constructs of power and control; this framework facilitates academic, clinical, and community understanding of RC. Through the framing in power and control, rather than partner intent regarding reproductive outcomes, RC conceptualization is enhanced through a focus on individual distress, report of interference in sexual and reproductive health goals, and means of resistance to partner abuse. Finally, RC is one of a multitude of intersecting oppressions relevant to clinical and research spaces.

Conclusions

Assessing the potentially significant role of RC in sexual and reproductive health research and clinical care requires rigorous evaluations of those with lived and investigational experience. RC researchers and community members offer insights that can guide meaningful efforts to address RC, its relevance to reproductive and sexual health, and support health equity.

Implications

Reproductive coercion is a common form of violence that disrupts sexual and reproductive health with growing recognition but limited formal conceptualization. These formative data encourage broader conceptualization of this phenomenon, providing the substrate for the development of a more comprehensive measurement instrument.

目的：为亲密伴侣生殖强迫（RC）的概念化提供形成性数据，作为反暴力研究和临床干预的健康公平方法的一部分。研究设计：这项定性研究从全国队列中招募了11名RC研究人员，从全州研究小组中招募了20名社区成员，参加个人半结构化访谈或视频会议社区讨论。我们使用修正的扎根理论和框架方法分析数据。结果：参与者确认生殖障碍缺乏共识的定义，其历史概念作为一种促进怀孕的现象排除了个人经验的重要方面。亲密伴侣暴力通过权力和控制结构的相互基础为理解RC提供了结构；这个框架促进了学术、临床和社区对RC的理解。通过权力和控制的框架，而不是伴侣对生殖结果的意图，通过关注个人痛苦，报告对性健康和生殖健康目标的干扰以及抵制伴侣虐待的手段，加强了RC概念。最后，RC是与临床和研究空间相关的众多交叉压迫之一。结论：评估RC在性健康和生殖健康研究和临床护理中的潜在重要作用需要对那些有生活和研究经验的人进行严格的评估。红十字会研究人员和社区成员提供的见解可以指导有意义的努力，以解决红十字会及其与生殖健康和性健康的相关性，并支持卫生公平。影响：生殖强迫是一种常见的暴力形式，破坏性健康和生殖健康，人们越来越认识到这一点，但正式概念化有限。这些形成性数据鼓励对这一现象进行更广泛的概念化，为开发更全面的测量工具提供基础。

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引用次数: 0

Induced and spontaneous abortion outcomes among individuals with sickle cell disease 镰状细胞病患者的人工流产和自然流产结局

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-12-01 Epub Date: 2025-08-15 DOI: 10.1016/j.contraception.2025.111052

Emma Braun , Kyler McVay , Nathanael Koelper , Nadia Ali , Kandace Gollomp , Andrea H. Roe

Objective

Describe induced and spontaneous abortion outcomes among individuals with sickle cell disease (SCD).

Study Design

Retrospective review of outcomes and complications within 30 days of patients with SCD at an academic tertiary care center undergoing procedural or medication management for induced or spontaneous abortions up to 23w6d.

Results

Among 71 unique pregnancies (59 induced, 12 spontaneous abortions), 67 (94%) had procedural management, with rare hemorrhagic (2, 3%), infectious (1, 1%), and thromboembolic (0, 0%) complications. The most common complication was presentation to the emergency room within 30 days for vaso-occlusive pain (17, 25%), which was associated with number of SCD-related emergency room visits within the prior year.

Conclusion

The results reported in this study support the safety of uterine evacuation procedures for induced and spontaneous abortion in patients with SCD.

Implications

While outcomes of childbirth among individuals with SCD are well described, little is known about pregnancies that end in the first and second trimesters of pregnancy in this population. We describe outcomes after induced and spontaneous abortion among patients with SCD and show that procedural complications were uncommon.

虽然在镰状细胞病（SCD）患者中分娩与显著的发病率和死亡率相关，但对该人群中妊娠早期和中期的情况知之甚少。我们试图描述SCD患者的人工流产和自然流产结果。我们进行了一项回顾性队列研究，这些SCD患者接受了人工流产或自然流产的手术或药物治疗，时间长达23w6d。我们描述了30天内的处理方式、手术结果和并发症。61例患者有71例独特妊娠，其中人工流产59例，自然流产12例。67例（94%）进行了程序性治疗，出血（2.3%）和感染（1.1%）等并发症罕见；没有患者出现术后静脉血栓栓塞。最常见的并发症是因血管闭塞性疼痛而去急诊室就诊，预测这一结果的唯一基线特征是前一年scd相关急诊室就诊次数较多。本研究证实了子宫引流术对SCD患者人工流产和自然流产的安全性。需要进一步的研究来描述药物管理结果，并指导SCD患者早期和中期妊娠手术围手术期管理的标准化。目的：描述镰状细胞病（SCD）患者的人工流产和自然流产结局。研究设计：回顾性分析在学术三级保健中心接受手术或药物治疗的SCD患者在30天内的结局和并发症，这些患者的人工流产或自然流产持续到23w6d。结果：71例独特妊娠（59例引产，12例自然流产）中，67例（94%）有手术处理，罕见出血（2.3%）、感染性（1.1%）和血栓栓塞（0.1%）并发症。最常见的并发症是在30天内出现血管闭塞性疼痛（17.25%），这与前一年scd相关的急诊室就诊次数有关。结论：本研究报告的结果支持子宫引流术用于SCD患者人工流产和自然流产的安全性。提示：虽然SCD患者的分娩结果被很好地描述了，但在这一人群中，在妊娠的前三个月和中期结束的妊娠却知之甚少。我们描述了SCD患者在人工流产和自然流产后的结果，并表明手术并发症是罕见的。

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引用次数: 0

Cesarean delivery scar ectopic pregnancy diagnosed after no-test abortion: A case report 未经检测流产后诊断为剖宫产瘢痕异位妊娠1例。

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-12-01 Epub Date: 2025-09-04 DOI: 10.1016/j.contraception.2025.111206

Clarice Hu, Kiranpreet Chawla, Kara Hostetter, Katrina Mark

We present a case of cesarean scar ectopic pregnancy that was diagnosed after failed no-test medication abortion at 4 weeks gestation. The patient was treated with dilation, suction aspiration and intrauterine Foley balloon placement. No adverse outcome occurred.

我们提出一例剖宫产瘢痕异位妊娠，是在妊娠4周无试验药物流产失败后确诊的。患者接受扩张、吸痰和宫内Foley球囊放置治疗。无不良结果发生。

引用次数: 0

Fluidity in contraceptive decision-making throughout pregnancy and the postpartum period among patients at an urban county hospital in Ohio 俄亥俄州城市县医院患者在整个妊娠期和产后期间避孕决策的流动性。

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-11-01 Epub Date: 2025-07-31 DOI: 10.1016/j.contraception.2025.111047

Brooke W. Bullington , Molly Platt , Tyler Soy , Lauren Coombs , Grace A. Trompeter , Elizabeth Pleasants , Kavita Shah Arora

Objectives

Contraceptive decision-making is a complex, dynamic process influenced by personal values, experiences, and circumstances. Existing research often captures contraceptive decisions at a single time point, limiting understanding of how preferences evolve over time. This study prospectively examines the fluidity of contraceptive preferences and plans throughout pregnancy and postpartum among patients receiving care at an urban county hospital in Ohio.

Study design

We conducted a prospective, longitudinal study of pregnant patients (N = 123) in 2023 at five time points: three during pregnancy and two postpartum. Participants reported contraceptive method preferences, attitudes, and perceptions at each follow-up survey. We descriptively analyzed changes in planned postpartum contraceptive method and key factors, including contraceptive attributes and perceptions, influencing contraceptive decision-making.

Results

Method effectiveness was the most important contraceptive attribute for included participants at all time points, regardless of contraceptive plan. One-third of participants maintained a consistent contraceptive plan across all five visits. Participants’ contraceptive plans sometimes did not align with their stated method attribute preferences.

Conclusions

Contraceptive decision-making in the perinatal period is a fluid and evolving process. Our findings underscore the need for patient-centered counseling that acknowledges this variability and supports individuals in navigating changing preferences over time.

Implications

Contraceptive plans shift throughout pregnancy and postpartum and may not always align with patients’ stated priorities. Clinicians should provide ongoing, patient-centered counseling that acknowledges the fluidity of contraceptive decision-making and supports individuals in navigating evolving reproductive goals.

目的：避孕决策是一个复杂的动态过程，受个人价值观、经验和环境的影响。现有的研究通常在一个时间点捕捉避孕决定，限制了对偏好如何随时间演变的理解。本研究前瞻性地考察了在俄亥俄州城市县医院接受护理的患者在整个怀孕和产后的避孕偏好和计划的流动性。研究设计：我们在2023年对孕妇（N=123）进行了一项前瞻性、纵向研究，分为五个时间点：三个孕期和两个产后。参与者在每次后续调查中报告避孕方法的偏好、态度和看法。我们描述性地分析了计划产后避孕方法的变化，以及影响避孕决策的关键因素，包括避孕属性和观念。结果：无论采用何种避孕方案，方法有效性都是纳入的参与者在所有时间点最重要的避孕属性。三分之一的参与者在所有五次访问中保持一致的避孕计划。参与者的避孕计划有时与他们陈述的方法属性偏好不一致。结论：围产儿的避孕决策是一个不断变化的过程。我们的研究结果强调了以患者为中心的咨询的必要性，这种咨询承认这种可变性，并支持个体随着时间的推移而改变偏好。启示：避孕计划在整个怀孕期间和产后发生变化，可能并不总是与患者声明的优先事项一致。临床医生应该提供持续的、以患者为中心的咨询，承认避孕决策的流动性，并支持个人在不断发展的生殖目标中导航。

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引用次数: 0

OPERATIONALIZE REPRODUCTIVE JUSTICE: MODELING COMMUNITY-DRIVEN HEALTHCARE 实施生殖正义：模拟社区驱动的医疗保健

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-11-01 Epub Date: 2025-10-13 DOI: 10.1016/j.contraception.2025.111134

CL Irwin, Z Julian, A Robinson, D Rivers, C Drayton, R Archer, N Desta-Bell, S Reyes, S Porter, J Caicedo, L Dary Restrepo

Objectives

Among the pillars of reproductive justice are the rights to determine the optimal conditions under which one will give birth with dignity in safe, affordable, and sustainable environments. This project aims to utilize community accountable, reproductive justice approaches to ascertain intervention points to address gaps in care and inform our postpartum clinical services, thereby establishing the method our reproductive health organization will use for ongoing community feedback and service evolution.

Methods

Focus group interview guides were created by the organization’s team members in collaboration with the Black Mamas Matter Alliance. Cohorts of self-identified 1) transgender individuals, 2) Spanish-speaking Latinx people, 3) persons of color with pregnancy and birth experiences, and 4) birth workers were recruited and provided video links to participate in virtual group discussions with open-ended interview questions. Recorded sessions were qualitatively analyzed for common themes and frequent responses.

Results

Four cohorts of 20 people with birth experiences and two cohorts of eight birth workers participated. Focus group participants described their ideal prenatal and postpartum experiences, including high quality, comprehensive, respectful and affordable care that addresses equity and underserved populations. Service needs included extending prenatal visits to discuss other topics like nutrition, creating financial stability for birth workers, and increasing education around postpartum mental health support.

Conclusions

Focus group data directly informed the development and implementation of a post-natal services program that will include in-home post-natal visits by advanced practice nurses and referrals for mental health providers and other resources, initiating the community-led model that will be used by the organization moving forward.

生殖正义的支柱之一是确定在安全、负担得起和可持续的环境中有尊严地分娩的最佳条件的权利。该项目旨在利用社区负责任的生殖正义方法，确定干预点，以解决护理方面的差距，并为我们的产后临床服务提供信息，从而确定我们的生殖健康组织将用于持续社区反馈和服务改进的方法。方法由该组织团队成员与黑人母亲问题联盟合作制定焦点小组访谈指南。研究人员招募了自认为是1)跨性别者、2)说西班牙语的拉丁人、3)有怀孕和生育经历的有色人种以及4)生育工作者，并提供视频链接，让他们参与虚拟小组讨论，并提出开放式面试问题。对记录的会议进行了定性分析，以确定共同主题和经常的答复。结果共分为4个队列（20人）和2个队列（8人）。焦点小组参与者描述了他们理想的产前和产后经历，包括高质量、全面、尊重和负担得起的护理，以解决公平和服务不足的人群。服务需求包括延长产前检查，以讨论营养等其他话题，为助产士创造经济稳定，以及加强有关产后心理健康支持的教育。焦点小组的数据直接为产后服务计划的制定和实施提供了信息，该计划将包括高级执业护士的产后上门访问和心理健康提供者的转介以及其他资源，启动了社区主导的模式，该模式将被该组织继续使用。

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引用次数: 0

ABORTION VOLUME IN WESTERN PENNSYLVANIA BEFORE AND AFTER DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION 多布斯诉杰克逊妇女健康组织案前后宾夕法尼亚州西部的堕胎量

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-11-01 Epub Date: 2025-10-13 DOI: 10.1016/j.contraception.2025.111105

RL Shay, BA Chen, KP Himes

Objectives

We compared the number and characteristics of abortions in two practice settings in western Pennsylvania before and after Dobbs v Jackson Women’s Health Organization.

Methods

We conducted a retrospective cohort study of all abortions performed at an academic medical center (in-hospital) and a freestanding abortion clinic (out-of-hospital) between July 1, 2021 and May 31, 2023. We collected data on total number of abortions, gestational duration, proportion performed in the second trimester, type of abortion, and patient age and state of residence. We compared abortions between July 2021 and May 2022 (pre-Dobbs) with those between July 2022 and May 2023 (post-Dobbs) using t tests, Mann-Whitney U tests, and chi-square tests. We repeated the analysis stratifying by site.

Results

The total number of abortions across the two sites was 3,114 pre-Dobbs and 3,153 post-Dobbs. Post-Dobbs in-hospital abortions had a lower median gestational duration than did those pre-Dobbs (9 vs. 12 weeks, p<0.01) and these patients were less likely to be from out-of-state (8.8% vs. 13.1%, p=0.04). In contrast, post-Dobbs out-of-hospital abortion patients had a higher median gestational duration than did those pre-Dobbs (9 vs. 8 weeks, p<0.01) and patients were more likely to be from out-of-state (26.6% vs. 16.3%, p<0.01).

Conclusions

Out-of-hospital abortions were more likely to be from out-of-state and occurred at later gestational ages post-Dobbs than pre-Dobbs, while the opposite trends were seen for in-hospital abortion patients. The differences between sites suggest that the burden of increased demand from out-of-state patients was disproportionately absorbed by community abortion providers.

目的比较多布斯诉杰克逊妇女健康组织案前后宾夕法尼亚州西部两家诊所的堕胎数量和特点。方法对2021年7月1日至2023年5月31日期间在一家学术医疗中心（院内）和一家独立堕胎诊所（院外）进行的所有堕胎进行回顾性队列研究。我们收集了流产总数、妊娠期、妊娠中期比例、流产类型、患者年龄和居住州等数据。我们使用t检验、Mann-Whitney U检验和卡方检验比较了2021年7月至2022年5月（多布斯前）和2022年7月至2023年5月（多布斯后）的堕胎情况。我们按地点分层重复分析。结果多布斯前和多布斯后两地流产总数分别为3114例和3153例。多布斯手术后住院流产的中位妊娠持续时间比多布斯手术前低（9周对12周，p= 0.01），这些患者来自州外的可能性更低（8.8%对13.1%,p=0.04）。相比之下，多布斯手术后院外流产患者的中位妊娠期高于多布斯手术前的患者（9周vs. 8周，p<0.01），患者更可能来自州外（26.6% vs. 16.3%, p<0.01）。结论院外流产发生于州外，发生于多布斯手术后比多布斯手术前的胎龄更晚，而院内流产患者的趋势则相反。不同地点之间的差异表明，州外患者需求增加的负担被社区堕胎提供者不成比例地吸收了。

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引用次数: 0

REASONS CLINICIANS CONSIDERED LEAVING AND STAYING IN STATES WITH ABORTION BANS 临床医生考虑离开和留在有堕胎禁令的州的原因

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-11-01 Epub Date: 2025-10-13 DOI: 10.1016/j.contraception.2025.111107

W Arey, M Heisler, P Shah, L Green, T McHale

Objectives

We aimed to examine clinicians’ decisions about whether to leave or continue to practice in states with abortion restrictions.

Methods

We conducted semi-structured interviews with clinicians providing care in Louisiana, Idaho, and Florida, after severely restrictive abortion policies went into effect from 2023 to 2024. In this secondary thematic analysis, we examined how these restrictions impacted clinicians’ thoughts about leaving states with bans.

Results

The interview sample comprised 57 clinicians and trainees. The majority (n=32) had considered leaving the state, and 12 had plans to leave, including all of the trainees. Twenty-eight said they would more seriously consider leaving if the laws became more restrictive, or would never have moved to the state given the current laws. Cited reasons for leaving included: not being able to use their full range of skills, criminal charges, and moral distress of providing care under laws. However, nine who considered leaving had since committed to staying. Primary cited reasons for staying were: to not abandon patients or concern about what kind of care would be provided if they were not there, to advocate to change the laws, to maintain established family ties in the state, or having moved there intentionally to provide abortions.

Conclusions

Participants’ responses highlighted that decision-points like residency or a more restrictive law might be catalysts to decide to leave. Clinicians who worked in practices that experienced fewer impacts from abortion restrictions, had stronger family ties, or had more advocacy-focused goals were more likely to consider staying in states with restrictions.

目的：我们的目的是检查临床医生是否决定离开或继续在有堕胎限制的州执业。方法：在2023年至2024年严格限制堕胎政策生效后，我们对路易斯安那州、爱达荷州和佛罗里达州的临床医生进行了半结构化访谈。在这个次要主题分析中，我们研究了这些限制如何影响临床医生对离开禁令州的想法。结果访谈样本包括57名临床医生和实习生。大多数人（n=32）考虑过离开该州，12人计划离开，包括所有的实习生。28人表示，如果法律变得更加严格，他们会更认真地考虑离开，或者根据现行法律，他们永远不会搬到该州。离职的原因包括：不能充分发挥他们的技能，受到刑事指控，以及根据法律提供护理的道德困境。然而，有9名考虑过离开的人后来决定留下来。留下来的主要原因是：不要抛弃病人，或者担心如果他们不在那里会提供什么样的护理，倡导改变法律，维护在该州建立的家庭关系，或者故意搬到那里提供堕胎。参与者的反应突出表明，居住地或更严格的法律等决策点可能是决定离开的催化剂。在堕胎限制影响较小、家庭关系较强或有更多倡导目标的实践中工作的临床医生更有可能考虑留在有限制的州。

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引用次数: 0

MIFEPRISTONE IN MEXICO: EVIDENCE OF CROSS-BORDER SPILLOVER 米非司酮在墨西哥：跨境溢出的证据

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-11-01 Epub Date: 2025-10-13 DOI: 10.1016/j.contraception.2025.111092

LR Woskie

Objectives

We aimed to assess whether restrictive abortion policies in the US — specifically Texas Senate Bill 8 (SB8) and Dobbs v Jackson Women’s Health Organization — affected mifepristone sales within the formal health sector in Mexico, potentially indicating cross-border spillover.

Methods

We used a Synthetic Control Model (SCM) to estimate counterfactual trends in mifepristone sales in Mexico following two policy shocks: SB8 (September 2021) and Dobbs (June 2022). “Synthetic Mexico” was constructed using a weighted combination of countries with stable pre-trends and no relevant policy changes. Countries were selected based on data completeness and consistency, and weights were assigned using non-negative least squares.

Results

Both US policy interventions were associated with significant increases in mifepristone sales in Mexico. Following SB8, average quarterly sales rose by 123.8 units (95% CI, 72.7–190.8; p<0.01). After Dobbs, sales increased by 94.8 units (95% CI, 23.5–166.1; p<0.01). Although overall volume was low and pre-trend variability limits precision, consistent upward divergence from synthetic controls suggests unique shifts at both policy points. These results are limited to the formal health sector; and SB8 coincides with Mexico’s internal decriminalization ruling, which may explain the larger increase in sales.

Conclusions

These data offer empirical evidence that US abortion restrictions displace demand across borders, increasing mifepristone sales in Mexico. Concurrent policy shifts within Mexico make it challenging to attribute causality for SB8, but results underscore the need for a regional perspective on reproductive health access and policy impact.

目的：我们旨在评估美国的限制性堕胎政策——特别是德克萨斯州参议院第8号法案（SB8）和多布斯诉杰克逊妇女健康组织——是否影响了墨西哥正规卫生部门的米非司酮销售，可能表明跨境溢出效应。方法：我们使用综合控制模型（SCM）来估计两次政策冲击（SB8（2021年9月）和Dobbs（2022年6月））后墨西哥米非司酮销售的反事实趋势。“合成墨西哥”的构建使用了具有稳定的前期趋势且没有相关政策变化的国家的加权组合。根据数据的完整性和一致性选择国家，并使用非负最小二乘法分配权重。结果美国的两项政策干预都与墨西哥米非司酮销售的显著增加有关。继SB8之后，平均季度销量增加了123.8台（95% CI, 72.7-190.8; p<0.01）。在Dobbs之后，销量增加了94.8台（95% CI, 23.5-166.1; p<0.01）。尽管总体成交量较低，趋势前的可变性限制了精度，但与综合控制的持续上升背离表明，两个政策点都有独特的转变。这些结果仅限于正规卫生部门；而SB8恰好与墨西哥内部的非刑事化裁决相吻合，这或许可以解释销量的大幅增长。这些数据提供了经验证据，证明美国的堕胎限制取代了跨境需求，增加了米非司酮在墨西哥的销售。墨西哥国内同时发生的政策转变使得很难确定SB8的因果关系，但结果强调需要从区域角度看待生殖健康机会和政策影响。

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引用次数: 0

PREFERRED SELF-MANAGED ABORTION SUPPORT IN MISSISSIPPI: A DISCRETE CHOICE EXPERIMENT 密西西比州对自我管理堕胎的支持：一个离散的选择实验

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-11-01 Epub Date: 2025-10-13 DOI: 10.1016/j.contraception.2025.111111

HH Leslie, M Griffith, D Nelson, V Robinson, K Holt

Objectives

Self-managed medication abortion (SMMA) is increasingly common, yet little is known about SMMA decision-making in states with complete bans. We sought to quantify preferences for SMMA support models in Mississippi.

Methods

We drew on academic and community input to design a discrete choice experiment with attributes of pill source (levels: online, telehealth, community), cost ($0-$150), information support (handout, hotline, clinic consult, doula) and material support (none, essentials, self-care package). We used community-based convenience sampling to recruit pregnancy-capable Mississippi residents aged 18-45. Respondents selected a hypothetical SMMA model from three alternatives in each of 10 choice tasks. We estimated preferences and willingness to pay with Hierarchical Bayes models.

Results

Between August 2024 and February 2025, 163 respondents completed the discrete choice experiment: median age was 30; 84% identified as Black, and 39% could not cover an unexpected $200 medical expense. Half had at least one child and 27% reported a pregnancy ending without live birth; 69% had heard of abortion pills. Cost was the most important consideration in selecting an SMMA model; respondents also valued material support (willing to pay $49 for self-care package vs. no support) and less so information support (willing to pay $25 for an in-person support option vs. hotline). Preferences did not differ based on pregnancy history. Respondents unable to cover unexpected medical expenses strongly preferred lower costs.

Conclusions

Source of pills mattered less to Mississippi adults than cost and availability of material support in selecting a hypothetical SMMA model. A focus on access alone may overlook SMMA users’ preferences.

目的自我管理药物流产（SMMA）越来越普遍，但在完全禁止的州，对SMMA的决策知之甚少。我们试图量化密西西比州对SMMA支持模式的偏好。方法利用学术界和社区的意见，设计了一个离散选择实验，包括药物来源（级别：在线、远程医疗、社区）、成本（0- 150美元）、信息支持（分发、热线、诊所咨询、导乐）和物质支持（无、必需品、自我保健包）的属性。我们采用基于社区的方便抽样方法，招募年龄在18-45岁的密西西比州有怀孕能力的居民。被调查者从10个选择任务中的每个选项中选择一个假设的SMMA模型。我们用层次贝叶斯模型估计了偏好和支付意愿。结果在2024年8月至2025年2月期间，163名受访者完成了离散选择实验：年龄中位数为30岁；84%的人被认为是黑人，39%的人无法支付意外的200美元医疗费用。一半的人至少有一个孩子，27%的人报告没有活产就结束了妊娠；69%的人听说过堕胎药。成本是选择SMMA模型时最重要的考虑因素；受访者还重视物质支持（愿意为自我护理套餐支付49美元，而不是没有支持），不太重视信息支持（愿意为面对面的支持选项支付25美元，而不是热线）。孕妇的偏好并没有因怀孕史而有所不同。无法支付意外医疗费用的受访者强烈倾向于降低成本。结论在选择假设的SMMA模型时，药物来源对密西西比州成年人的影响小于成本和物质支持的可得性。仅仅关注接入可能会忽视SMMA用户的偏好。

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引用次数: 0

“IT WAS SO EASY, IT DIDN’T FEEL REAL”: POSITIVE ABORTION EXPERIENCES POST-DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION “这太容易了，感觉不真实”：多布斯诉杰克逊妇女健康组织的积极堕胎经历

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-11-01 Epub Date: 2025-10-13 DOI: 10.1016/j.contraception.2025.111112

C Beavin, H Gyuras, J Sinclair, A Kirkendall, D Bessett, ML McGowan

Objectives

Post-Dobbs research has focused on new and increased barriers to abortion in the US, while less attention has been paid to positive experiences with abortion. This “joy deficit” in US-based abortion research may lead abortion seekers to anticipate abortion as a negative experience.

Methods

Between July 2022 and December 2024, we conducted interviews with 74 people from abortion-restrictive states who faced logistic and legal challenges obtaining abortions after Dobbs.

Results

Interviews revealed that increased costs and interstate travel can make finding and obtaining abortion care highly burdensome. However, the majority of interviewees also shared positive experiences about the process. Caring and nonjudgmental clinic staff and volunteers at abortion funds and practical support networks helped affirm and destigmatize abortion for participants and made an unnecessarily difficult experience more bearable. These interactions left meaningful impressions, highlighting how quality care and plentiful resources contribute to positive abortion experiences for those living in abortion-restrictive states. Some expressed that despite numerous barriers, their post-Dobbs abortion experience was better and easier than other medical experiences because of strong clinical staff and practical supports they encountered.

Conclusions

This study highlights how care providers and support personnel create joy in the abortion-seeking process for those living in restrictive states post-Dobbs. The constellation of actors who care for abortion seekers can counteract the negative effects of barriers to abortion, pointing to the need for shoring up clinics, advocacy groups, and mutual aid collectives in affirming and destigmatizing abortion and contributing to positive outcomes for abortion patients.

多布斯之后的研究集中在美国新的和增加的堕胎障碍上，而很少关注堕胎的积极经历。美国堕胎研究中的这种“快乐缺失”可能会导致寻求堕胎的人将堕胎视为一种消极的经历。方法在2022年7月至2024年12月期间，我们对74名来自堕胎限制州的人进行了访谈，这些人在多布斯手术后堕胎面临后勤和法律方面的挑战。结果访谈显示，费用的增加和州际旅行使寻找和获得堕胎护理变得非常困难。然而，大多数受访者也分享了对这个过程的积极体验。在堕胎基金和实际支持网络中，有爱心和不加评判的诊所工作人员和志愿者帮助参与者肯定和消除了堕胎的污名，并使不必要的困难经历变得更容易忍受。这些互动留下了有意义的印象，突出了高质量的护理和丰富的资源如何有助于生活在堕胎限制国家的人积极的堕胎经历。有些人表示，尽管有许多障碍，但由于有强大的临床工作人员和实际支持，她们在多布斯堕胎后的经历比其他医疗经历更好、更容易。本研究强调了护理提供者和支持人员如何在寻求堕胎过程中为那些生活在多布斯后限制性国家的人创造快乐。关心堕胎寻求者的行动者可以抵消堕胎障碍的负面影响，指出需要支持诊所，倡导团体和互助团体，以肯定和消除堕胎的污名，并为堕胎患者带来积极的结果。

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