Contraception最新文献_第8页

COLLECTIVE IMPACT APPROACH: LESSONS FROM SOUTH CAROLINA’S CONTRACEPTIVE ACCESS INITIATIVE 集体影响方法：南卡罗来纳避孕措施获取倡议的经验教训

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111138

AJ Khoury, KE Beatty, LM Ventura, D Quesenberry, R Adelli, A Weber, MG Smith

Objectives

Choose Well, a statewide contraceptive access initiative in South Carolina, adopted a collective impact framework to enhance contraceptive access through collaboration, funding, and infrastructure support. This study evaluates facilitators, challenges, and lessons learned reported by leadership and staff implementing Choose Well and program grantees in federally qualified health center (FQHC) systems. This study is novel in examining implementation of a statewide contraceptive access initiative through collective impact principles: common agenda, shared measurement, mutually reinforcing activities, continuous communication, and backbone support.

Methods

Semi-structured interviews were conducted in 2022-2023, at the end of the initial six years of program implementation, with Choose Well staff (n=8) and FQHC administrators/clinicians (n=19) to explore implementation experiences, facilitators, and challenges. Using qualitative content analysis guided by the collective impact framework, data were triangulated to integrate perspectives from both groups.

Results

Facilitators of successful implementation included a shared vision for contraceptive access; shift to contraceptive equity and an expanded funding model; tailored clinic-level implementation with direct support; multi-channel communication through partner convenings and a web-based platform for training, resources, and collaborative communication; and clinic workflow and electronic medical record enhancements to improve efficiency. Challenges included delays in shared measurement development, variability in data reporting, and limited capacity for tracking contraceptive service metrics. Competing priorities within FQHCs and staff turnover further impacted shared measurement and learning/improvement opportunities.

Conclusions

Collective impact principles can advance statewide contraceptive access initiatives. Shared measurement challenges require investments in data infrastructure and training. Future initiatives should emphasize bidirectional communication, flexible implementation strategies, and sustainable infrastructure to enhance service delivery.

“选择好”是南卡罗来纳州的一项全州范围的避孕措施获取倡议，它采用了一个集体影响框架，通过合作、资金和基础设施支持来提高避孕措施的获取。本研究评估了在联邦合格医疗中心（FQHC）系统中实施“选择好”和项目受助人的领导和工作人员报告的促进因素、挑战和经验教训。本研究通过集体影响原则（共同议程、共享测量、相互加强的活动、持续沟通和骨干支持）检验了全州避孕药具获取倡议的实施情况，这是一项新颖的研究。方法在2022-2023年，即项目实施的最初六年结束时，与Choose Well工作人员（n=8）和FQHC管理人员/临床医生（n=19）进行了半结构化访谈，以探讨实施经验、促进因素和挑战。采用由集体影响框架指导的定性内容分析，对数据进行三角化，以整合两组的观点。结果成功实施的促进因素包括对获得避孕药具的共同愿景；转向避孕公平和扩大筹资模式；量身定制的临床级实施，并提供直接支持；通过合作伙伴会议和基于网络的培训、资源和协作沟通平台进行多渠道沟通；并对门诊工作流程和电子病历进行了增强，提高了工作效率。挑战包括共享测量开发的延迟、数据报告的可变性以及跟踪避孕服务指标的能力有限。fqhc内部的竞争优先级和员工流动进一步影响了共享测量和学习/改进机会。结论集体影响原则可以促进全州避孕措施的可及性。共享度量挑战需要对数据基础设施和培训进行投资。未来的倡议应强调双向沟通、灵活的实施战略和可持续的基础设施，以加强服务的提供。

{"title":"COLLECTIVE IMPACT APPROACH: LESSONS FROM SOUTH CAROLINA’S CONTRACEPTIVE ACCESS INITIATIVE","authors":"AJ Khoury, KE Beatty, LM Ventura, D Quesenberry, R Adelli, A Weber, MG Smith","doi":"10.1016/j.contraception.2025.111138","DOIUrl":"10.1016/j.contraception.2025.111138","url":null,"abstract":"<div><h3>Objectives</h3><div>Choose Well, a statewide contraceptive access initiative in South Carolina, adopted a collective impact framework to enhance contraceptive access through collaboration, funding, and infrastructure support. This study evaluates facilitators, challenges, and lessons learned reported by leadership and staff implementing Choose Well and program grantees in federally qualified health center (FQHC) systems. This study is novel in examining implementation of a statewide contraceptive access initiative through collective impact principles: common agenda, shared measurement, mutually reinforcing activities, continuous communication, and backbone support.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted in 2022-2023, at the end of the initial six years of program implementation, with Choose Well staff (n=8) and FQHC administrators/clinicians (n=19) to explore implementation experiences, facilitators, and challenges. Using qualitative content analysis guided by the collective impact framework, data were triangulated to integrate perspectives from both groups.</div></div><div><h3>Results</h3><div>Facilitators of successful implementation included a shared vision for contraceptive access; shift to contraceptive equity and an expanded funding model; tailored clinic-level implementation with direct support; multi-channel communication through partner convenings and a web-based platform for training, resources, and collaborative communication; and clinic workflow and electronic medical record enhancements to improve efficiency. Challenges included delays in shared measurement development, variability in data reporting, and limited capacity for tracking contraceptive service metrics. Competing priorities within FQHCs and staff turnover further impacted shared measurement and learning/improvement opportunities.</div></div><div><h3>Conclusions</h3><div>Collective impact principles can advance statewide contraceptive access initiatives. Shared measurement challenges require investments in data infrastructure and training. Future initiatives should emphasize bidirectional communication, flexible implementation strategies, and sustainable infrastructure to enhance service delivery.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111138"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277856","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

HOW EARLIER ABORTION PROVISION CONTRIBUTED TO INCREASED ABORTION INCIDENCE 2017-2020 2017-2020年早期堕胎条款是如何导致堕胎率增加的

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111108

AJ Stevenson, L Root

Objectives

National abortion incidence increased 2017-2020. We describe how the shift to earlier abortion contributed to this increase.

Methods

We build national pregnancy life tables for 2017-2020 based on published national statistics on pregnancy exits (deliveries, abortions, reported pregnancy loss, miscarriage rate schedules, and deaths during pregnancy). Using cause-deleted life tables in which abortion is removed as a cause of exit, we estimate the fraction of abortions at each week gestation that, if not terminated, would end in miscarriage by each subsequent week of pregnancy. From this we estimate the number of 2020 abortions that would have ended in miscarriage before the pregnant person accessed abortion, had gestational duration of abortions remained constant 2017-2020. By varying our assumptions, we test the sensitivity of our results and generate a range of estimates.

Results

If abortions had not occurred at earlier gestational durations between 2017 and 2020, some 10,000-20,000 pregnancies that ended in abortion in 2020 would have ended in miscarriage before the pregnant person could successfully access abortion. Therefore, abortion incidence increased by 1-2 percentage points between 2017 and 2020 just due to the shift to earlier gestational durations at abortion. Thus, 15-30% of the overall increase in abortion 2017-2020 could be due to abortions occurring at earlier gestational durations.

Conclusions

As abortions occur at earlier gestational durations, abortion incidence increases simply because fewer pregnancies end in miscarriage before abortion is accessed. Stable abortion incidence over a period when abortion is increasingly accessed earlier in pregnancy may reflect declining success securing wanted abortions.

目的2017-2020年全国人工流产率呈上升趋势。我们描述了向早期堕胎的转变是如何促成这一增长的。方法根据已公布的国家妊娠退出统计数据（分娩、流产、报告的妊娠丢失、流产率表和妊娠期间死亡），构建2017-2020年国家妊娠生命表。使用删除原因生命表，其中堕胎作为退出的原因被删除，我们估计在每个妊娠周流产的比例，如果不终止，将在随后的每个妊娠周流产。由此我们估计，如果2017-2020年妊娠期堕胎保持不变，在孕妇进行堕胎之前，2020年流产的数量将以流产告终。通过改变我们的假设，我们测试了结果的敏感性，并产生了一系列的估计。结果如果2017年至2020年妊娠期未发生流产，那么在2020年流产的约1万~ 2万例妊娠在孕妇成功流产之前就已流产。因此，在2017年至2020年期间，流产率增加了1-2个百分点，仅仅是因为流产时妊娠期提前。因此，2017-2020年堕胎总增长的15-30%可能是由于妊娠期较早发生的堕胎。结论妊娠期越早发生流产，流产发生率越高，其原因是在流产前流产的孕妇较少。在妊娠早期堕胎越来越多的时期内，稳定的堕胎发生率可能反映了获得所需堕胎的成功率下降。

{"title":"HOW EARLIER ABORTION PROVISION CONTRIBUTED TO INCREASED ABORTION INCIDENCE 2017-2020","authors":"AJ Stevenson, L Root","doi":"10.1016/j.contraception.2025.111108","DOIUrl":"10.1016/j.contraception.2025.111108","url":null,"abstract":"<div><h3>Objectives</h3><div>National abortion incidence increased 2017-2020. We describe how the shift to earlier abortion contributed to this increase.</div></div><div><h3>Methods</h3><div>We build national pregnancy life tables for 2017-2020 based on published national statistics on pregnancy exits (deliveries, abortions, reported pregnancy loss, miscarriage rate schedules, and deaths during pregnancy). Using cause-deleted life tables in which abortion is removed as a cause of exit, we estimate the fraction of abortions at each week gestation that, if not terminated, would end in miscarriage by each subsequent week of pregnancy. From this we estimate the number of 2020 abortions that would have ended in miscarriage before the pregnant person accessed abortion, had gestational duration of abortions remained constant 2017-2020. By varying our assumptions, we test the sensitivity of our results and generate a range of estimates.</div></div><div><h3>Results</h3><div>If abortions had not occurred at earlier gestational durations between 2017 and 2020, some 10,000-20,000 pregnancies that ended in abortion in 2020 would have ended in miscarriage before the pregnant person could successfully access abortion. Therefore, abortion incidence increased by 1-2 percentage points between 2017 and 2020 just due to the shift to earlier gestational durations at abortion. Thus, 15-30% of the overall increase in abortion 2017-2020 could be due to abortions occurring at earlier gestational durations.</div></div><div><h3>Conclusions</h3><div>As abortions occur at earlier gestational durations, abortion incidence increases simply because fewer pregnancies end in miscarriage before abortion is accessed. Stable abortion incidence over a period when abortion is increasingly accessed earlier in pregnancy may reflect declining success securing wanted abortions.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111108"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277842","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

RESTRICTING RIGHTS: THE CONNECTION BETWEEN VOTING AND ABORTION RESTRICTIONS 限制权利：投票与限制堕胎之间的联系

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111101

AK Hing, M Mahoney, A Hassan

Objectives

We aimed to determine if an association exists between state-level voting restrictions and abortion restrictions. When barriers to voting increase, it can become more difficult for already marginalized people to access the ballot and make their voices heard. As a consequence, states may move further away from social and health equity rather than toward it. We hypothesize that states with a higher cost of voting will pass more abortion restrictions.

Methods

With data from the Guttmacher Institute, we counted the number of abortion restrictions passed from 2012 to 2021 and combined it with the Cost of Voting Index (COVI) 2012, 2016, and 2020, which ranks each state based on the level of difficulty of voting. We then ran a negative binomial regression of the mean COVI rank (1 to 50, with 1 being the state with the fewest barriers) for each state on the total number of abortion restrictions passed.

Results

The results of the bivariate negative binomial regression indicate a significant positive relationship between barriers to voting and the number of abortion restrictions. For a one-unit increase in mean COVI rank score, we would expect a 1.046 increase in the rate for abortion restrictions. Thus, we predict 1.72 restrictions in the state where it is easiest to vote and 15.8 restrictions in the state where it is hardest to vote.

Conclusions

We observe a higher rate of abortion restrictions passed in states where it is harder to vote, suggesting that attacks on voting rights and reproductive rights are connected.

目的：我们旨在确定州一级的投票限制和堕胎限制之间是否存在关联。当投票障碍增加时，已经被边缘化的人就更难以参与投票并发出自己的声音。其结果是，各国可能进一步远离而不是走向社会和卫生公平。我们假设投票成本较高的州将通过更多的堕胎限制。方法利用古特马赫研究所（Guttmacher Institute）的数据，统计2012年至2021年通过的堕胎限制数量，并将其与2012年、2016年和2020年的投票成本指数（COVI）相结合，该指数根据投票难度对各州进行排名。然后，我们对每个州通过的堕胎限制总数的平均冠状病毒感染排名（1到50,1代表障碍最少的州）进行负二项回归。结果双变量负二项回归结果表明，投票障碍与堕胎限制次数之间存在显著正相关关系。对于平均冠状病毒感染排名得分增加一个单位，我们预计堕胎限制率将增加1.046。因此，我们预测在投票最容易的州有1.72个限制，在投票最难的州有15.8个限制。我们观察到，在投票更难的州，通过堕胎限制的比例更高，这表明对投票权和生育权的攻击是有联系的。

{"title":"RESTRICTING RIGHTS: THE CONNECTION BETWEEN VOTING AND ABORTION RESTRICTIONS","authors":"AK Hing, M Mahoney, A Hassan","doi":"10.1016/j.contraception.2025.111101","DOIUrl":"10.1016/j.contraception.2025.111101","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to determine if an association exists between state-level voting restrictions and abortion restrictions. When barriers to voting increase, it can become more difficult for already marginalized people to access the ballot and make their voices heard. As a consequence, states may move further away from social and health equity rather than toward it. We hypothesize that states with a higher cost of voting will pass more abortion restrictions.</div></div><div><h3>Methods</h3><div>With data from the Guttmacher Institute, we counted the number of abortion restrictions passed from 2012 to 2021 and combined it with the Cost of Voting Index (COVI) 2012, 2016, and 2020, which ranks each state based on the level of difficulty of voting. We then ran a negative binomial regression of the mean COVI rank (1 to 50, with 1 being the state with the fewest barriers) for each state on the total number of abortion restrictions passed.</div></div><div><h3>Results</h3><div>The results of the bivariate negative binomial regression indicate a significant positive relationship between barriers to voting and the number of abortion restrictions. For a one-unit increase in mean COVI rank score, we would expect a 1.046 increase in the rate for abortion restrictions. Thus, we predict 1.72 restrictions in the state where it is easiest to vote and 15.8 restrictions in the state where it is hardest to vote.</div></div><div><h3>Conclusions</h3><div>We observe a higher rate of abortion restrictions passed in states where it is harder to vote, suggesting that attacks on voting rights and reproductive rights are connected.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111101"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277848","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

STAFF ATTITUDES TOWARD PROVIDING MEDICATION ABORTION IN PRIMARY CARE SETTINGS 员工对在初级保健机构提供药物流产的态度

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111078

S Srinivasulu, MG Manze, HE Jones

Objectives

We assessed baseline staff attitudes toward providing medication abortion in 10 primary care clinics participating in a program to adopt medication abortion.

Methods

In 2024, staff champions from 10 organizations in eight states administered our online survey to staff at clinics preparing to introduce medication abortion (n=908). Eligibility criteria included non-champion staff who could directly or indirectly be involved in a medication abortion visit. Surveys queried on perspectives related to medication abortion acceptability and belonging in primary care, comfort working in a clinic providing it, and open-ended questions on benefits and concerns. We organized open-ended responses into common themes. We conducted regression analysis using cluster-robust standard errors to explore staff characteristics associated with medication abortion attitudes.

Results

Some 721 responded (79.4%); 454 met eligibility criteria. Some 387 (85.2%) believed medication abortion should be available in primary care; only 75 (16.5%) felt uncomfortable working in a clinic that provides it. Significant differences between organizations exist across all outcomes (p<0.04). After we controlled for clustering within organizations, acceptability of medication abortion implementation scores were significantly higher among participants at academic and community health centers than at federally qualified health centers (p<0.01); lower among those working in non-LGBTQ-specific clinics (p<0.001); and lower among patient-facing clinic staff than among providers (p<0.01). Perceived benefits included mitigating access barriers (50.5%), aligning with primary care values (36.8%), and promoting reproductive autonomy (10.6%). Concerns included safety risks (34.2%), training (28.2%), and staff opposition (17.6%). Some 31.3% explicitly stated no concerns.

Conclusions

Most staff at these primary care clinics are supportive of providing medication abortion, but have concerns that champions should address during implementation.

目的评估10家参与药物流产项目的初级保健诊所工作人员对提供药物流产的基本态度。方法在2024年，来自8个州10个组织的员工冠军对准备引入药物流产的诊所工作人员进行了在线调查（n=908）。资格标准包括可能直接或间接参与药物流产就诊的非冠军工作人员。调查询问了与药物流产的可接受性和在初级保健中的归属、在提供药物流产的诊所工作的舒适性以及关于益处和关注点的开放式问题有关的观点。我们根据共同的主题组织了开放式的回答。我们使用聚类稳健标准误差进行回归分析，探讨与药物流产态度相关的员工特征。结果回复721例（79.4%）；454人符合资格标准。约387人（85.2%）认为应在初级保健中提供药物流产；只有75人（16.5%）觉得在提供这种服务的诊所工作不舒服。各组织之间在所有结果上存在显著差异（p<0.04）。在我们控制了组织内的聚类后，学术和社区卫生中心的参与者对药物流产实施的接受度得分显著高于联邦合格卫生中心的参与者（p<0.01）；在非lgbtq诊所工作的人的比例更低（p<0.001）；面向患者的临床工作人员比服务人员更低（p < 0.01）。感知到的好处包括减轻获取障碍（50.5%），与初级保健价值观保持一致（36.8%），促进生殖自主（10.6%）。关注的问题包括安全风险（34.2%）、培训（28.2%）和员工反对（17.6%）。31.3%的人明确表示不担心。结论这些初级保健诊所的大多数工作人员都支持提供药物流产，但在实施过程中有一些问题需要解决。

{"title":"STAFF ATTITUDES TOWARD PROVIDING MEDICATION ABORTION IN PRIMARY CARE SETTINGS","authors":"S Srinivasulu, MG Manze, HE Jones","doi":"10.1016/j.contraception.2025.111078","DOIUrl":"10.1016/j.contraception.2025.111078","url":null,"abstract":"<div><h3>Objectives</h3><div>We assessed baseline staff attitudes toward providing medication abortion in 10 primary care clinics participating in a program to adopt medication abortion.</div></div><div><h3>Methods</h3><div>In 2024, staff champions from 10 organizations in eight states administered our online survey to staff at clinics preparing to introduce medication abortion (n=908). Eligibility criteria included non-champion staff who could directly or indirectly be involved in a medication abortion visit. Surveys queried on perspectives related to medication abortion acceptability and belonging in primary care, comfort working in a clinic providing it, and open-ended questions on benefits and concerns. We organized open-ended responses into common themes. We conducted regression analysis using cluster-robust standard errors to explore staff characteristics associated with medication abortion attitudes.</div></div><div><h3>Results</h3><div>Some 721 responded (79.4%); 454 met eligibility criteria. Some 387 (85.2%) believed medication abortion should be available in primary care; only 75 (16.5%) felt uncomfortable working in a clinic that provides it. Significant differences between organizations exist across all outcomes (p<0.04). After we controlled for clustering within organizations, acceptability of medication abortion implementation scores were significantly higher among participants at academic and community health centers than at federally qualified health centers (p<0.01); lower among those working in non-LGBTQ-specific clinics (p<0.001); and lower among patient-facing clinic staff than among providers (p<0.01). Perceived benefits included mitigating access barriers (50.5%), aligning with primary care values (36.8%), and promoting reproductive autonomy (10.6%). Concerns included safety risks (34.2%), training (28.2%), and staff opposition (17.6%). Some 31.3% explicitly stated no concerns.</div></div><div><h3>Conclusions</h3><div>Most staff at these primary care clinics are supportive of providing medication abortion, but have concerns that champions should address during implementation.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111078"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277850","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

EXPERIENCES WITH THE M+A HOTLINE: SUPPORT ALONG THE SPECTRUM OF SELF-MANAGED ABORTION m + a热线的经验：对自我管理堕胎的支持

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111062

E Chew Murphy, J Novaes, J Karlin

Objectives

The clinician-run Miscarriage and Abortion Hotline (“M+A hotline”) offers evidence-based reproductive health information, including information on self-sourced and self-managed abortion, while maintaining privacy and anonymity. The hotline has supported thousands of individuals experiencing a miscarriage or abortion from across the US, and has seen a continued increase in the number of people seeking support since its inception in 2019. The purpose of this study is to describe the experiences of people who access the M+A hotline and examine the hotline’s impact on their abortion experience.

Methods

From June 2024 to January 2025, we recruited 28 individuals from 19 US states who contacted the M+A hotline and completed an online survey. Participants were based throughout the US in states with and without restrictive abortion policies. We conducted anonymous in-depth interviews in English and stopped recruitment when conceptual saturation had been approximated. We analyzed transcripts using inductive and deductive codes and completed thematic analysis.

Results

The analysis revealed three key themes: Direct and personalized information from a clinician perspective facilitated participants’ trust in the hotline; by providing and validating information on abortion, the hotline alleviated participants’ concerns about prevalent disinformation; and amidst participants’ fears of the legal repercussions of self-sourced and self-managed abortion, the hotline provided a secure, anonymous way to communicate directly with clinicians for medical information and support.

Conclusions

Our ﬁndings demonstrate that abortion experiences exist along a spectrum of informal to formal care utilization, and that the M+A hotline functions within this ecosystem to mitigate abortion stigma and disinformation.

目的由临床医生运营的流产和堕胎热线（“ M+A热线”）提供循证生殖健康信息，包括自我来源和自我管理的堕胎信息，同时保持隐私和匿名性。该热线已为美国各地数千名经历流产或堕胎的人提供了支持，自2019年开通以来，寻求支持的人数持续增加。本研究的目的是描述人们访问M+A热线的经历，并检查热线对其堕胎经历的影响。方法：从2024年6月到2025年1月，我们从美国19个州招募了28名联系并购热线的个人，并完成了在线调查。参与者来自美国各地有或没有限制堕胎政策的州。我们用英语进行匿名深度访谈，当概念饱和接近时停止招聘。我们使用归纳和演绎代码分析转录本，并完成主题分析。结果分析揭示了三个关键主题：从临床医生角度出发的直接和个性化信息促进了参与者对热线的信任；通过提供和验证有关堕胎的信息，热线减轻了参与者对普遍存在的虚假信息的担忧；在参与者担心自行来源和自行管理堕胎的法律后果时，热线提供了一种安全、匿名的方式，可以直接与临床医生沟通，以获取医疗信息和支持。结论我们的研究结果表明，堕胎经历存在于非正式到正式护理利用的范围内，并且M+ a热线在这个生态系统中发挥作用，以减轻堕胎耻辱和虚假信息。

{"title":"EXPERIENCES WITH THE M+A HOTLINE: SUPPORT ALONG THE SPECTRUM OF SELF-MANAGED ABORTION","authors":"E Chew Murphy, J Novaes, J Karlin","doi":"10.1016/j.contraception.2025.111062","DOIUrl":"10.1016/j.contraception.2025.111062","url":null,"abstract":"<div><h3>Objectives</h3><div>The clinician-run Miscarriage and Abortion Hotline (“M+A hotline”) offers evidence-based reproductive health information, including information on self-sourced and self-managed abortion, while maintaining privacy and anonymity. The hotline has supported thousands of individuals experiencing a miscarriage or abortion from across the US, and has seen a continued increase in the number of people seeking support since its inception in 2019. The purpose of this study is to describe the experiences of people who access the M+A hotline and examine the hotline’s impact on their abortion experience.</div></div><div><h3>Methods</h3><div>From June 2024 to January 2025, we recruited 28 individuals from 19 US states who contacted the M+A hotline and completed an online survey. Participants were based throughout the US in states with and without restrictive abortion policies. We conducted anonymous in-depth interviews in English and stopped recruitment when conceptual saturation had been approximated. We analyzed transcripts using inductive and deductive codes and completed thematic analysis.</div></div><div><h3>Results</h3><div>The analysis revealed three key themes: Direct and personalized information from a clinician perspective facilitated participants’ trust in the hotline; by providing and validating information on abortion, the hotline alleviated participants’ concerns about prevalent disinformation; and amidst participants’ fears of the legal repercussions of self-sourced and self-managed abortion, the hotline provided a secure, anonymous way to communicate directly with clinicians for medical information and support.</div></div><div><h3>Conclusions</h3><div>Our ﬁndings demonstrate that abortion experiences exist along a spectrum of informal to formal care utilization, and that the M+A hotline functions within this ecosystem to mitigate abortion stigma and disinformation.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111062"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278166","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

ABORTION ACCESS FOR US SERVICEWOMEN POST-DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION: A QUALITATIVE STUDY 美国服兵役妇女在产后堕胎的机会与杰克逊妇女健康组织：一个定性研究

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111127

C Russell

Objectives

We aimed to explore the lived experiences of active-duty servicewomen obtaining abortion care and assess their knowledge, attitudes, and beliefs regarding policy changes made by the Department of Defense meant to facilitate access to abortion care following the Dobbs decision.

Methods

This is a qualitative study. Data were collected anonymously using online open response free-text questions. Participants could opt-in for a semi-structured interview. Thematic analysis was used to analyze data.

Results

Fifty participants (n=50) identifying as active-duty servicewomen who obtained abortion care after Dobbs completed the online open response free-text questions and four (n=4) participated in a semi-structured interview. The average age was 28.9 years; 54% (n=27) identified as White, 24% (n=12) as Hispanic; 60% (n=30) were married; 58% (n=29) were Officers; 66% (n=33) served in the Army; and 40% (n=20) were stationed in states with full or partial abortion bans. Only two participants used the DOD travel policy meant to facilitate access to care (but requiring pregnancy disclosure) and 52% (n=26) did not want to disclose their pregnancy to leadership. Medical and travel costs, unsupportive military healthcare providers and leadership, and a lack of training on abortion-related policies were identified as barriers to care. Online services providing medication abortions were identified as a facilitator to care.

Conclusions

Future policies meant to facilitate access to abortion care should ensure that servicewomen do not need to disclose their pregnancies to leadership.

目的：本研究旨在探讨现役女性获得堕胎护理的生活经历，并评估她们对国防部在多布斯判决后为促进获得堕胎护理而做出的政策变化的了解、态度和信念。方法定性研究。数据是通过在线开放回答的自由文本问题匿名收集的。参与者可以选择参加半结构化的面试。采用主题分析法对数据进行分析。结果50名（n=50）在Dobbs完成在线开放回答自由文本问题后接受堕胎护理的现役妇女，4名（n=4）参加了半结构化访谈。平均年龄28.9岁；54% （n=27）为白人，24% （n=12）为西班牙裔；60% （n=30）已婚；58% （n=29）为军官；66% （n=33）在陆军服役；40% （n=20）驻扎在完全或部分禁止堕胎的州。只有两名参与者使用了国防部的旅行政策，旨在促进获得医疗服务（但要求披露怀孕情况），52% （n=26）的人不想向领导透露自己的怀孕情况。医疗和旅行费用、不提供支持的军事保健提供者和领导以及缺乏有关堕胎政策的培训被认为是提供护理的障碍。提供药物流产的在线服务被确定为促进护理的工具。结论：未来旨在促进堕胎护理的政策应确保服役妇女不需要向领导披露其怀孕情况。

{"title":"ABORTION ACCESS FOR US SERVICEWOMEN POST-DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION: A QUALITATIVE STUDY","authors":"C Russell","doi":"10.1016/j.contraception.2025.111127","DOIUrl":"10.1016/j.contraception.2025.111127","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to explore the lived experiences of active-duty servicewomen obtaining abortion care and assess their knowledge, attitudes, and beliefs regarding policy changes made by the Department of Defense meant to facilitate access to abortion care following the <em>Dobbs</em> decision.</div></div><div><h3>Methods</h3><div>This is a qualitative study. Data were collected anonymously using online open response free-text questions. Participants could opt-in for a semi-structured interview. Thematic analysis was used to analyze data.</div></div><div><h3>Results</h3><div>Fifty participants (n=50) identifying as active-duty servicewomen who obtained abortion care after <em>Dobbs</em> completed the online open response free-text questions and four (n=4) participated in a semi-structured interview. The average age was 28.9 years; 54% (n=27) identified as White, 24% (n=12) as Hispanic; 60% (n=30) were married; 58% (n=29) were Officers; 66% (n=33) served in the Army; and 40% (n=20) were stationed in states with full or partial abortion bans. Only two participants used the DOD travel policy meant to facilitate access to care (but requiring pregnancy disclosure) and 52% (n=26) did not want to disclose their pregnancy to leadership. Medical and travel costs, unsupportive military healthcare providers and leadership, and a lack of training on abortion-related policies were identified as barriers to care. Online services providing medication abortions were identified as a facilitator to care.</div></div><div><h3>Conclusions</h3><div>Future policies meant to facilitate access to abortion care should ensure that servicewomen do not need to disclose their pregnancies to leadership.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111127"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278220","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

ARE GOOGLE ADS TOO EXPENSIVE FOR ABORTION RESEARCH?: A CASE STUDY IN RECRUITMENT METHODS 谷歌广告对堕胎研究来说是不是太贵了？招聘方法的案例研究

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111082

SM Sheffield, A Mastylak, AF Cartwright, SD Reed, JJ Swartz

Objectives

Google Ads has proven to be a successful recruitment tool for abortion-related research. However, online reproductive health research recruitment may be more challenging following the Dobbs v. Jackson Women’s Health Organization decision given concerns around digital privacy. No studies to date have reported on abortion research recruitment experiences using Google Ads in the post-Dobbs landscape.

Methods

Researchers led a Google Ads campaign from May to October 2024 to recruit participants considering an abortion or who had had one in the past year for a 20-minute online survey on abortion decision-making. Sample keywords included: “abortion centers near me,” and “buy abortion pills online.” Alternate recruitment strategies included a study invitation link on a non-profit abortion information website and use of a Centiment online panel, with eligibility criteria modified to include individuals who would consider abortion if pregnant within the next year.

Results

Approximately $6,500 was spent on Google Ads over six months. During active advertising periods, the ads yielded 650 clicks and four completed surveys per month at an average of $282 per completed survey. The non-profit abortion information website link cost $52 per completed survey, and the survey vendor cost $6 per completed survey.

Conclusions

Google Ads recruitment proved more costly than other strategies. However, our average cost of $282 per completed survey was inside the range ($32 to $532) reported in prior studies. Findings support existing literature showing Google Ads is a relatively expensive recruitment tool for abortion research, which may be exacerbated in the post-Dobbs era.

谷歌广告已被证明是一个成功的招聘工具，堕胎相关的研究。然而，考虑到对数字隐私的担忧，在多布斯诉杰克逊妇女健康组织的决定之后，在线生殖健康研究招聘可能更具挑战性。到目前为止，还没有研究报告在多布斯之后使用b谷歌广告的堕胎研究招聘经验。方法研究人员从2024年5月到10月发起了一项b谷歌广告活动，招募正在考虑堕胎或在过去一年中有过堕胎经历的参与者，对堕胎决策进行20分钟的在线调查。样本关键词包括：“我附近的堕胎中心”和“在线购买堕胎药”。另一种招募策略包括非营利堕胎信息网站上的研究邀请链接和使用Centiment在线小组，资格标准修改为包括在明年怀孕时会考虑堕胎的个人。结果在6个月的时间里，在bb0广告上花费了大约6500美元。在活跃广告期间，广告每月产生650次点击和4次完成调查，平均每个完成调查的费用为282美元。非营利性堕胎信息网站链接每次完成调查的费用为52美元，调查供应商每次完成调查的费用为6美元。事实证明，谷歌广告招聘比其他策略成本更高。然而，我们每次完成调查的平均成本282美元，在之前研究报告的范围内（32美元至532美元）。研究结果支持现有文献，表明b谷歌广告是堕胎研究中相对昂贵的招募工具，这可能在后多布斯时代加剧。

{"title":"ARE GOOGLE ADS TOO EXPENSIVE FOR ABORTION RESEARCH?: A CASE STUDY IN RECRUITMENT METHODS","authors":"SM Sheffield, A Mastylak, AF Cartwright, SD Reed, JJ Swartz","doi":"10.1016/j.contraception.2025.111082","DOIUrl":"10.1016/j.contraception.2025.111082","url":null,"abstract":"<div><h3>Objectives</h3><div>Google Ads has proven to be a successful recruitment tool for abortion-related research. However, online reproductive health research recruitment may be more challenging following the <em>Dobbs v. Jackson Women’s Health Organization</em> decision given concerns around digital privacy. No studies to date have reported on abortion research recruitment experiences using Google Ads in the post-<em>Dobbs</em> landscape.</div></div><div><h3>Methods</h3><div>Researchers led a Google Ads campaign from May to October 2024 to recruit participants considering an abortion or who had had one in the past year for a 20-minute online survey on abortion decision-making. Sample keywords included: “abortion centers near me,” and “buy abortion pills online.” Alternate recruitment strategies included a study invitation link on a non-profit abortion information website and use of a Centiment online panel, with eligibility criteria modified to include individuals who would consider abortion if pregnant within the next year.</div></div><div><h3>Results</h3><div>Approximately $6,500 was spent on Google Ads over six months. During active advertising periods, the ads yielded 650 clicks and four completed surveys per month at an average of $282 per completed survey. The non-profit abortion information website link cost $52 per completed survey, and the survey vendor cost $6 per completed survey.</div></div><div><h3>Conclusions</h3><div>Google Ads recruitment proved more costly than other strategies. However, our average cost of $282 per completed survey was inside the range ($32 to $532) reported in prior studies. Findings support existing literature showing Google Ads is a relatively expensive recruitment tool for abortion research, which may be exacerbated in the post-<em>Dobbs</em> era.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111082"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278223","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

EXPULSION RISK FACTORS FOR A LOW-DOSE COPPER IUD 低剂量铜节育器排出危险因素

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111064

C Bernard, P Blumenthal, C Cwiak, PM Castaño, E Gray, K Peters, M Jo Schreifels, KR Culwell, DK Turok

Objectives

This analysis evaluates expulsion rates among participants in a phase 3 study of a novel, low-dose copper (Cu 175mm²) intrauterine device (IUD) with a flexible nitinol frame.

Methods

In this prospective, single-arm, open-label study, participants at risk for pregnancy aged 17-45 received a Cu 175mm² IUD and were followed for three years. This secondary analysis evaluates expulsion rates for all enrolled participants with successful device placement and used logistic regression to assess expulsion risk by parity, menstrual cup use (any time during study), BMI category, breastfeeding status, postpartum status (birth within one year prior to enrollment), and age.

Results

Of 1,601 participants who had the device successfully placed, 960 (60.0%) were nulliparous; 151 (9.4%) used menstrual cups; 510 (31.9%) had a BMI ≥30.0 kg/m²; 33 (2.1%) reported breastfeeding at the time of placement; and 127 (7.9%) were within one year postpartum. Participants’ mean (SD) age was 27.6 (5.8) years. Overall, 36 (2.2%) participants experienced device expulsion in year 1 and 63 (3.9%) over three years. Over three years, the Kaplan-Meier cumulative incidence of expulsion for menstrual cup users vs. non-menstrual-cup users was 0.11 (95% CI, 0.07-0.17) vs. 0.05 (95% CI, 0.03-0.06). Cumulative expulsion did not vary significantly based on parity, BMI category, breastfeeding status, or postpartum status. Logistic regression only associated menstrual cup use with IUD expulsion over three years (OR, 4.0; p<0.0001).

Conclusions

After three years of follow-up, novel Cu 175mm² IUD users experienced a low rate of expulsion with only menstrual cup use associated with a significantly increased risk for IUD expulsion.

目的：本研究评估了一种新型低剂量铜（175mm2）柔性镍钛合金框架宫内节育器（IUD）的iii期研究参与者的排出率。方法在这项前瞻性、单臂、开放标签的研究中，17-45岁有怀孕风险的参与者接受了175mm2 Cu的宫内节育器，随访3年。这项二级分析评估了所有成功植入设备的参与者的驱逐率，并使用logistic回归评估了按胎次、月经杯使用（研究期间的任何时间）、BMI类别、母乳喂养状况、产后状况（入组前一年内出生）和年龄的驱逐风险。结果在1,601名成功放置该装置的参与者中，960名（60.0%）未生育；151例（9.4%）使用月经杯；BMI≥30.0 kg/m2 510例（31.9%）；33名（2.1%）报告在放置婴儿时母乳喂养；产后1年内127例（7.9%）。参与者的平均（SD）年龄为27.6（5.8）岁。总体而言，36名（2.2%）参与者在第一年经历了器械驱逐，63名（3.9%）参与者在三年内经历了器械驱逐。在三年内，月经杯使用者和非月经杯使用者的Kaplan-Meier累积开除率分别为0.11 （95% CI, 0.07-0.17）和0.05 （95% CI, 0.03-0.06）。累积驱逐并未因胎次、BMI类别、母乳喂养状况或产后状况而有显著差异。Logistic回归仅将月经杯使用与三年内宫内节育器排出相关（OR, 4.0; p<0.0001）。经过三年的随访，新型cu175mm2宫内节育器使用者的排出率较低，仅使用月经杯与宫内节育器排出风险显著增加相关。

{"title":"EXPULSION RISK FACTORS FOR A LOW-DOSE COPPER IUD","authors":"C Bernard, P Blumenthal, C Cwiak, PM Castaño, E Gray, K Peters, M Jo Schreifels, KR Culwell, DK Turok","doi":"10.1016/j.contraception.2025.111064","DOIUrl":"10.1016/j.contraception.2025.111064","url":null,"abstract":"<div><h3>Objectives</h3><div>This analysis evaluates expulsion rates among participants in a phase 3 study of a novel, low-dose copper (Cu 175mm<sup>2</sup>) intrauterine device (IUD) with a flexible nitinol frame.</div></div><div><h3>Methods</h3><div>In this prospective, single-arm, open-label study, participants at risk for pregnancy aged 17-45 received a Cu 175mm<sup>2</sup> IUD and were followed for three years. This secondary analysis evaluates expulsion rates for all enrolled participants with successful device placement and used logistic regression to assess expulsion risk by parity, menstrual cup use (any time during study), BMI category, breastfeeding status, postpartum status (birth within one year prior to enrollment), and age.</div></div><div><h3>Results</h3><div>Of 1,601 participants who had the device successfully placed, 960 (60.0%) were nulliparous; 151 (9.4%) used menstrual cups; 510 (31.9%) had a BMI ≥30.0 kg/m<sup>2</sup>; 33 (2.1%) reported breastfeeding at the time of placement; and 127 (7.9%) were within one year postpartum. Participants’ mean (SD) age was 27.6 (5.8) years. Overall, 36 (2.2%) participants experienced device expulsion in year 1 and 63 (3.9%) over three years. Over three years, the Kaplan-Meier cumulative incidence of expulsion for menstrual cup users vs. non-menstrual-cup users was 0.11 (95% CI, 0.07-0.17) vs. 0.05 (95% CI, 0.03-0.06). Cumulative expulsion did not vary significantly based on parity, BMI category, breastfeeding status, or postpartum status. Logistic regression only associated menstrual cup use with IUD expulsion over three years (OR, 4.0; p<0.0001).</div></div><div><h3>Conclusions</h3><div>After three years of follow-up, novel Cu 175mm<sup>2</sup> IUD users experienced a low rate of expulsion with only menstrual cup use associated with a significantly increased risk for IUD expulsion.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111064"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278168","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

REPRODUCTIVE GOVERNANCE AND THE ROLE OF UNCERTAINTY IN CONTRACEPTIVE DECISION MAKING 生殖管理和不确定性在避孕决策中的作用

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111061

S Banks, E Czaja, M Polavarapu, A Bell, V Boydell

Objectives

The Dobbs v. Jackson Women’s Health Organization decision introduced heightened abortion policy uncertainty across the US, disproportionately impacting Black women already navigating intersecting structural barriers to reproductive care. This study examined how Black women in Ohio respond to this uncertainty by exploring the personal, social, and institutional factors influencing their contraceptive decision making in a restrictive and evolving reproductive policy landscape.

Methods

In-depth interviews were conducted with 27 Black women of reproductive age from diverse socioeconomic and geographic backgrounds across Ohio. Using a phenomenological qualitative approach, we employed semi-structured interviews to examine participants’ contraceptive decision making processes. Thematic analysis, guided by Braun and Clarke’s six-step framework, was used to identify recurring patterns and themes. We synthesized findings from these narratives to capture the complexities of reproductive decision making amid policy uncertainty.

Results

While some participants modified their contraceptive use to mitigate perceived threats to their reproductive autonomy, political discourse had a limited impact on contraceptive behaviors overall. Decision making was primarily driven by personal, social, and health-related factors, rather than political narratives.

Conclusions

The research underscores the nuanced and deliberative nature of contraceptive decision making in the face of policy-driven uncertainty around abortion access. Contraceptive decision making among Black women in Ohio is shaped by intersecting personal, relational, and systemic factors, reflecting the complexity of navigating reproductive autonomy in a restrictive policy environment. Addressing each of these factors is essential to ensuring informed, autonomous reproductive health decision making in the post-Dobbs era.

多布斯诉杰克逊妇女健康组织案的判决在全美范围内加剧了堕胎政策的不确定性，对已经面临生殖保健交叉结构性障碍的黑人妇女造成了不成比例的影响。本研究考察了俄亥俄州黑人妇女如何应对这种不确定性，探讨了在限制性和不断发展的生殖政策环境中影响她们避孕决策的个人、社会和制度因素。方法对来自俄亥俄州不同社会经济和地理背景的27名育龄黑人妇女进行深度访谈。采用现象学定性方法，我们采用半结构化访谈来检查参与者的避孕决策过程。在Braun和Clarke的六步框架的指导下，主题分析被用来识别重复的模式和主题。我们综合了这些叙述的发现，以捕捉政策不确定性下生育决策的复杂性。结果虽然一些参与者改变了避孕措施的使用，以减轻对其生殖自主的威胁，但政治话语对避孕行为的总体影响有限。决策主要是由个人、社会和健康相关因素驱动的，而不是政治叙事。结论：该研究强调，面对政策驱动的流产获取不确定性，避孕决策的微妙和审慎性质。俄亥俄州黑人妇女的避孕决策受到个人、关系和系统因素的交叉影响，反映了在限制性政策环境中引导生殖自主的复杂性。处理每一个这些因素对于确保在后多布斯时代作出知情和自主的生殖健康决策至关重要。

{"title":"REPRODUCTIVE GOVERNANCE AND THE ROLE OF UNCERTAINTY IN CONTRACEPTIVE DECISION MAKING","authors":"S Banks, E Czaja, M Polavarapu, A Bell, V Boydell","doi":"10.1016/j.contraception.2025.111061","DOIUrl":"10.1016/j.contraception.2025.111061","url":null,"abstract":"<div><h3>Objectives</h3><div>The <em>Dobbs v. Jackson Women’s Health Organization</em> decision introduced heightened abortion policy uncertainty across the US, disproportionately impacting Black women already navigating intersecting structural barriers to reproductive care. This study examined how Black women in Ohio respond to this uncertainty by exploring the personal, social, and institutional factors influencing their contraceptive decision making in a restrictive and evolving reproductive policy landscape.</div></div><div><h3>Methods</h3><div>In-depth interviews were conducted with 27 Black women of reproductive age from diverse socioeconomic and geographic backgrounds across Ohio. Using a phenomenological qualitative approach, we employed semi-structured interviews to examine participants’ contraceptive decision making processes. Thematic analysis, guided by Braun and Clarke’s six-step framework, was used to identify recurring patterns and themes. We synthesized findings from these narratives to capture the complexities of reproductive decision making amid policy uncertainty.</div></div><div><h3>Results</h3><div>While some participants modified their contraceptive use to mitigate perceived threats to their reproductive autonomy, political discourse had a limited impact on contraceptive behaviors overall. Decision making was primarily driven by personal, social, and health-related factors, rather than political narratives.</div></div><div><h3>Conclusions</h3><div>The research underscores the nuanced and deliberative nature of contraceptive decision making in the face of policy-driven uncertainty around abortion access. Contraceptive decision making among Black women in Ohio is shaped by intersecting personal, relational, and systemic factors, reflecting the complexity of navigating reproductive autonomy in a restrictive policy environment. Addressing each of these factors is essential to ensuring informed, autonomous reproductive health decision making in the post-<em>Dobbs</em> era.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111061"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278116","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

DEVELOPMENT OF A DILATION AND EVACUATION SIMULATOR AND TRAINING CURRICULUM 开发膨胀和疏散模拟器和培训课程

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-13 DOI: 10.1016/j.contraception.2025.111091

C Wynn, Z Lucier-Julian

Objectives

We aimed to develop a low-cost, low fidelity dilation and evacuation simulator and training program. We sought to increase resident exposure, skills, and confidence with dilation and evacuation in an abortion-restrictive state.

Methods

The dilation and evacuation simulator was based on previously designed and tested simulators. A basic learning module was developed. Providers experienced in dilation and evacuation tested the model to assess for accuracy of simulation. The simulator was incorporated into resident didactic time and pre- and post-tests assessed knowledge, skills, and confidence in dilation and evacuation.

Results

Participating residents were evenly split between PGY-1 or 2 (n=5) and PGY-3 or 4 (n=5) training levels. Residents demonstrated improvement in knowledge of dilation and evacuation with average pretest score of 73.2% and average post test score of 90%. Prior to simulation, 80% of residents reported they knew the steps of a dilation and evacuation but only 50% felt comfortable performing one with supervision. Experienced providers felt that the cervical dilation was either realistic or very realistic, and that the simulation of calvarium, placenta, and fetal parts was somewhat realistic or neither realistic nor unrealistic.

Conclusions

Low-cost simulation can provide a reasonably realistic simulation of dilation and evacuation. Simulation is an effective way to improve resident knowledge and comfort with this procedure. Strengths of this study include a cohort evenly split by training levels and by residents who trained before and after restrictive abortion laws were in place. Limitations include limited number of experienced providers for simulator testing and lack of assessment of resident comfort or skills after training on the simulator.

目的：开发一种低成本、低保真度的扩张和疏散模拟器及训练程序。我们试图增加住院医生在限制流产状态下的扩张和疏散的暴露、技能和信心。方法在先前设计和测试的模拟装置的基础上，制作膨胀和疏散模拟装置。开发了一个基本的学习模块。具有扩张和疏散经验的提供者对模型进行了测试，以评估模拟的准确性。该模拟器被纳入住院医师的教学时间和前后测试评估的知识，技能和信心扩张和疏散。结果参与住院医师平均分为PGY-1或2 （n=5）和PGY-3或4 （n=5）培训水平。居民在扩张和疏散知识方面表现出改善，平均测试前得分为73.2%，平均测试后得分为90%。在模拟之前，80%的居民报告说他们知道扩张和疏散的步骤，但只有50%的人觉得在监督下执行这些步骤很舒服。经验丰富的医生认为宫颈扩张要么是现实的，要么是非常现实的，对颅骨、胎盘和胎儿部位的模拟有些现实，要么既不现实也不现实。结论慢成本模拟可以提供较为真实的膨胀和疏散模拟。模拟是提高住院医师对该程序的了解和熟练程度的有效途径。这项研究的优势包括按培训水平和在限制性堕胎法实施之前和之后接受培训的住院医生平均划分的队列。限制包括有经验的模拟器测试提供者数量有限，以及在模拟器培训后缺乏对居民舒适度或技能的评估。

{"title":"DEVELOPMENT OF A DILATION AND EVACUATION SIMULATOR AND TRAINING CURRICULUM","authors":"C Wynn, Z Lucier-Julian","doi":"10.1016/j.contraception.2025.111091","DOIUrl":"10.1016/j.contraception.2025.111091","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to develop a low-cost, low fidelity dilation and evacuation simulator and training program. We sought to increase resident exposure, skills, and confidence with dilation and evacuation in an abortion-restrictive state.</div></div><div><h3>Methods</h3><div>The dilation and evacuation simulator was based on previously designed and tested simulators. A basic learning module was developed. Providers experienced in dilation and evacuation tested the model to assess for accuracy of simulation. The simulator was incorporated into resident didactic time and pre- and post-tests assessed knowledge, skills, and confidence in dilation and evacuation.</div></div><div><h3>Results</h3><div>Participating residents were evenly split between PGY-1 or 2 (n=5) and PGY-3 or 4 (n=5) training levels. Residents demonstrated improvement in knowledge of dilation and evacuation with average pretest score of 73.2% and average post test score of 90%. Prior to simulation, 80% of residents reported they knew the steps of a dilation and evacuation but only 50% felt comfortable performing one with supervision. Experienced providers felt that the cervical dilation was either realistic or very realistic, and that the simulation of calvarium, placenta, and fetal parts was somewhat realistic or neither realistic nor unrealistic.</div></div><div><h3>Conclusions</h3><div>Low-cost simulation can provide a reasonably realistic simulation of dilation and evacuation. Simulation is an effective way to improve resident knowledge and comfort with this procedure. Strengths of this study include a cohort evenly split by training levels and by residents who trained before and after restrictive abortion laws were in place. Limitations include limited number of experienced providers for simulator testing and lack of assessment of resident comfort or skills after training on the simulator.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111091"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278118","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