Contraception最新文献_第8页

CHANGES IN FREQUENCY AND DECISION-MAKING FOR FEMALE PERMANENT CONTRACEPTION FOLLOWING THE DOBBS DECISION 多布斯决定后女性永久性避孕频率和决策的变化

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110644

R Flink-Bochacki, S Pogge, A Cai, S Horvath

Objectives

We aimed to compare the frequency of female permanent contraceptive procedures before and after the Dobbs v Jackson Women’s Health Organization decision, and to assess impact of political factors on patient decision-making.

Methods

We conducted a retrospective cohort study of patients who underwent interval permanent contraceptive procedures in New York and Pennsylvania, comparing a pre-Dobbs (7/1/2020-6/30/2022) and post-Dobbs cohort (7/1/2022-6/30/2023). The primary outcome was change in procedure volume; secondary outcomes included differences in patient characteristics. We implemented standardized decision-making documentation beginning summer 2022, which allowed assessment of patient considerations in the post-Dobbs cohort. We performed Student t-tests, chi square tests, and descriptive statistics in Stata SE.

Results

There were 429 procedures pre-Dobbs and 310 post-Dobbs, including 194 (26.3%) procedures in New York and 545 (73.7%) in Pennsylvania. Volume grew significantly at both institutions, together increasing from an average 8.9 to 12.9 procedures/month (p=0.009). Patients post-Dobbs were more often under age 30 (31.7% vs. 39.0%, p=0.039) and nulliparous (10.7% vs. 21.0%, p<0.001). Decision-making documentation was recorded for 96 patients and was similar between sites, with 20% of patients considering future access to permanent contraception, 18% considering future access to reversible contraception, and 23% considering future access to abortion. At both sites, 47% of patients said their decision was somewhat or very related to current political events.

Conclusions

In two states without new abortion restrictions, permanent contraception was sought by more patients post-Dobbs, particularly younger and nulliparous patients. Fear of losing access to future reproductive options is integrated into reproductive decision-making, illustrating the wide-reaching impact of political threats to patient autonomy.

方法我们对在纽约州和宾夕法尼亚州接受间歇性永久避孕手术的患者进行了一项回顾性队列研究，比较了多布斯案之前（7/1/2020-6/30/2022）和多布斯案之后（7/1/2022-6/30/2023）的队列。主要结果是手术量的变化；次要结果包括患者特征的差异。我们从 2022 年夏季开始实施标准化决策文档，从而可以评估后多布斯队列中患者的考虑因素。我们在 Stata SE 中进行了学生 t 检验、卡方检验和描述性统计。结果多布斯手术前有 429 例，多布斯手术后有 310 例，其中纽约州有 194 例（26.3%），宾夕法尼亚州有 545 例（73.7%）。两家机构的手术量都有大幅增长，从平均每月 8.9 例增加到 12.9 例（P=0.009）。多布斯手术后的患者多在30岁以下（31.7%对39.0%，p=0.039）和无子宫（10.7%对21.0%，p<0.001）。96名患者的决策文件记录显示，两地患者的决策情况相似，20%的患者考虑将来采取永久性避孕措施，18%的患者考虑将来采取可逆性避孕措施，23%的患者考虑将来采取人工流产措施。在这两个地点，47% 的患者表示他们的决定与当前的政治事件有一定或非常大的关系。对失去未来生育选择权的恐惧被纳入了生育决策中，这说明了政治威胁对患者自主权的广泛影响。

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引用次数: 0

OUTCOMES OF UNDESIRED RAPE-RELATED PREGNANCIES WITH HYDE-ONLY COMPARED TO FULL MEDICAID COVERAGE OF ABORTIONS: A COST-EFFECTIVENESS ANALYSIS 与医疗补助对人工流产的全面覆盖相比，仅使用海德人工流产对与强奸有关的意外怀孕的结果：成本效益分析

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110575

KM Schaefer, MI Rodriguez

Objectives

We aimed to estimate the cost-effectiveness and pregnancy outcomes of undesired rape-related pregnancies (RRP) when Medicaid abortion coverage is limited to Hyde restrictions compared to full Medicaid coverage of abortions.

Methods

We used a theoretical cohort of 80,000 individuals on Medicaid who have an undesired RRP, with cohort size determined by CDC data. We used TreeAge to model RRP outcomes when abortions are covered only by Medicaid as permitted under the Hyde amendment and compare this to outcomes when abortions are covered by Medicaid under any circumstances over a ten year span. Outcomes include cost to Medicaid, quality-adjusted life-years, Medicaid-covered abortions, out-of-pocket abortions, first trimester abortions, second trimester abortions, and uncomplicated and complicated pregnancies resulting in births. Probabilities, costs, and utilities were derived from the literature. A Medicaid perspective was assumed.

Results

Our model demonstrated that among RRPs, limiting abortion coverage to Hyde restrictions results in fewer Medicaid-paid abortions, more out-of-pocket abortions, and more pregnancies resulting in births compared to the counterfactual of full Medicaid abortion coverage. In a Hyde-only coverage scenario, there would be 44,228 fewer Medicaid-paid abortions – a 96% decrease relative to Medicaid-paid abortions with full coverage – and 21,577 more out-of-pocket abortions. Full Medicaid coverage of abortion in this population would avert 22,988 pregnancies with cost-savings of $313.6 million.

Conclusions

This study suggests that limiting Medicaid coverage of abortions to strictly Hyde Amendment exceptions decreases payment for and access to abortions for rape-related pregnancies, despite these abortions meeting Hyde criteria for federal funding. This demonstrates a failure of Medicaid to pay for 96% of abortions for undesired RRP and comes at a significantly increased cost to Medicaid.

目标我们旨在估算当医疗补助计划的人工流产覆盖范围仅限于海德限制时，与医疗补助计划完全覆盖人工流产时，与强奸相关的意外怀孕（RRP）的成本效益和妊娠结果。方法我们使用了一个理论队列，该队列包含 8 万名医疗补助计划中的意外 RRP 患者，队列规模由疾病预防控制中心的数据确定。我们使用 TreeAge 对海德修正案允许的仅由医疗补助计划承保堕胎的 RRP 结果进行建模，并将其与医疗补助计划在任何情况下承保堕胎的十年结果进行比较。结果包括医疗补助计划的成本、质量调整生命年、医疗补助计划承保的人工流产、自费人工流产、前三个月人工流产、后三个月人工流产以及导致分娩的无并发症和并发症妊娠。概率、成本和效用均来自文献。结果我们的模型表明，在 RRPs 中，与完全覆盖 Medicaid 堕胎的反事实相比，将堕胎覆盖范围限制在海德限制范围内会导致更少的 Medicaid 付费堕胎、更多的自费堕胎以及更多的妊娠导致分娩。在仅适用海德方案的情况下，医疗补助计划支付的堕胎费用将减少 44 228 例（与医疗补助计划全面覆盖的堕胎费用相比减少了 96%），自费堕胎费用将增加 21 577 例。这项研究表明，将医疗补助计划的堕胎覆盖范围严格限制在海德修正案的例外情况下，会减少对强奸相关妊娠堕胎的支付和获取，尽管这些堕胎符合联邦资助的海德标准。这表明，医疗补助计划未能支付 96% 的非意愿 RRP 流产，而且医疗补助计划的成本大幅增加。

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引用次数: 0

IS TIKTOK THE NEW CONTRACEPTIVE COUNSELOR? DESCRIBING CONTRACEPTIVE SIDE EFFECTS DISCOURSE ON TIKTOK Tiktok 是新的避孕顾问吗？描述避孕药具的副作用关于 tiktok 的论述

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110632

E Pleasants, B Whitfield, ZH Pleasure, C Smith, E Norrell, C Fallon, L Lindberg

Objectives

To quantify the frequency and characterize discussions of contraceptive side effects in popular TikTok videos.

Methods

We used two third-party TikTok scrapers to collect the most-viewed TikToks using hashtags (#contraception, #birthcontrol) and search terms (“contraception”, “birth control”). The study team screened each TikTok for mention of the effects of using or not using contraception (‘side effects’), excluding irrelevant videos. Qualitative thematic analysis captured the contraceptive method(s) and side effect(s) discussed.

Results

We identified 805 relevant TikToks with at least one-million views. Preliminarily, 54% discussed contraceptive side effects, and video creators included contraceptive users, healthcare providers, and wellness influencers. In TikToks about side effects, videos most commonly discussed the contraceptive pill (28%), intrauterine device (IUD) (13%), and implant (9%). Nearly one-quarter of videos were about unspecified hormonal methods. Discussions of side effects mostly focused on people’s experiences with the effects of using or stopping contraceptives, including changes in weight, mood, attraction to sexual/romantic partners, and pain from device insertion. A substantial portion of videos focused on the perceived short- and long-term risks of hormonal contraception and discontinuation of hormonal contraception as an empowering health decision.

Conclusions

Over half of the most-viewed TikToks about contraception discussed side effects, suggesting that these videos perform well in the TikTok algorithm as highly resonant or attention-capturing. Our findings suggest that individuals who search TikTok for contraception information likely see videos about side effects, which has ramifications for contraceptive perceptions and use. Providers should continue to consider the influences of TikTok on contraceptive perceptions and decision making.

方法我们使用两个第三方 TikTok 搜刮器，使用标签（#避孕、#节育）和搜索词（"避孕"、"节育"）收集浏览量最高的 TikTok。研究小组对每个 TikTok 进行了筛选，以确定是否提及了使用或不使用避孕措施的影响（"副作用"），并排除了不相关的视频。定性专题分析捕捉了所讨论的避孕方法和副作用。初步统计，54%的视频讨论了避孕药具的副作用，视频创作者包括避孕药具使用者、医疗保健提供者和健康影响者。在有关副作用的 TikToks 中，最常讨论避孕药（28%）、宫内节育器（13%）和皮下埋植剂（9%）的视频。近四分之一的视频涉及未指定的荷尔蒙避孕方法。关于副作用的讨论主要集中在人们使用或停止使用避孕药具的经历，包括体重、情绪、对性/恋爱伴侣的吸引力的变化，以及插入避孕器时的疼痛。有相当一部分视频关注的是激素避孕的短期和长期风险，以及停止使用激素避孕药具是一种增强健康能力的决定。我们的研究结果表明，在 TikTok 上搜索避孕信息的人很可能会看到有关副作用的视频，这对避孕观念和避孕药具的使用都有影响。医疗服务提供者应继续考虑 TikTok 对避孕观念和决策的影响。

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引用次数: 0

DECEIVED, PRAGMATIC, STRATEGIC: ABORTION-SEEKERS’ APPROACHES TO CONTACTING CRISIS PREGNANCY CENTERS FOLLOWING TEXAS SENATE BILL 8 受骗、务实、策略：德克萨斯州参议院第 8 号法案之后寻求堕胎者联系危机怀孕中心的方法

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110590

A Chatillon, W Arey, K Lerma, G Alemán, J Draper, A Beasley, K White

Objectives

We aimed to explore pregnant Texans’ experiences with crisis pregnancy centers (CPCs) following implementation of Senate Bill 8 (SB8), which prohibited abortions after embryonic cardiac activity.

Methods

Between October 2021 and August 2022, we conducted in-depth interviews with English-speaking Texans aged ≥15 years who were seeking abortion about their experiences navigating to care. We recruited participants through online ads and by providing flyers to abortion facilities in seven states. We interviewed Texans with varied pregnancy outcomes, including out-of-state abortions, self-managed abortions, and continued pregnancies, all of whom initially sought abortion in Texas. We used inductive and deductive coding to identify themes in participants’ understandings of and experiences with CPCs.

Results

Of 120 participants, 36 contacted CPCs. Roughly half the 36 were deceived: they reached out for support accessing abortion care, unaware of CPCs’ mission to prevent abortion. Most remaining participants contacted CPCs pragmatically: unaware of CPCs’ missions, they were simply drawn to the organizations’ free and accessible pregnancy tests/ultrasounds. A minority, however, knew of CPCs’ missions and used CPCs’ pregnancy confirmation/dating strategically to determine next steps toward an abortion. Participants with pragmatic interactions more often reported positive experiences with CPCs, while those who were deceived or strategic frequently described negative experiences. Regardless of motivation, participants noted the importance of having free and accessible services, including pregnancy tests and ultrasounds, in their communities.

Conclusions

In a restrictive abortion setting with limited access to reproductive and pregnancy-related healthcare services, pregnant Texans sought free services from CPCs instead of medical professionals, including for pragmatic or strategic reasons.

目标我们旨在探讨德克萨斯州的孕妇在第 8 号参议院法案（SB8）实施后在危机妊娠中心（CPCs）的经历，该法案禁止在胚胎心脏活动后进行堕胎。方法在 2021 年 10 月至 2022 年 8 月期间，我们对年龄≥15 岁的寻求堕胎的英语德克萨斯州人进行了深度访谈，了解他们的就医经历。我们通过在线广告和向七个州的堕胎机构发放传单的方式招募参与者。我们采访了不同妊娠结果的德克萨斯人，包括州外堕胎、自行堕胎和继续妊娠，他们最初都是在德克萨斯州寻求堕胎。我们使用归纳法和演绎法进行编码，以确定参与者对 CPC 的理解和经历中的主题。在这 36 人中，约有一半是受骗者：他们在不了解 CPCs 的使命是防止堕胎的情况下，寻求支持以获得堕胎护理。剩下的大多数参与者都是出于实用的目的联系 CPC：他们不知道 CPC 的使命，只是被这些组织免费提供的孕期检查/超声波检查所吸引。然而，少数人知道 CPCs 的使命，并战略性地利用 CPCs 的怀孕确认/约会来决定流产的下一步。务实互动的参与者更多地报告了与 CPC 的正面经历，而受骗或策略性互动的参与者则经常描述负面经历。无论动机如何，参与者都指出在其社区内提供免费且方便的服务（包括妊娠测试和超声波检查）的重要性。结论在限制堕胎的环境中，获得生殖和妊娠相关医疗保健服务的途径有限，德克萨斯州的孕妇寻求 CPC 的免费服务，而不是医疗专业人员，其中包括出于实用性或策略性原因。

{"title":"DECEIVED, PRAGMATIC, STRATEGIC: ABORTION-SEEKERS’ APPROACHES TO CONTACTING CRISIS PREGNANCY CENTERS FOLLOWING TEXAS SENATE BILL 8","authors":"A Chatillon, W Arey, K Lerma, G Alemán, J Draper, A Beasley, K White","doi":"10.1016/j.contraception.2024.110590","DOIUrl":"10.1016/j.contraception.2024.110590","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to explore pregnant Texans’ experiences with crisis pregnancy centers (CPCs) following implementation of Senate Bill 8 (SB8), which prohibited abortions after embryonic cardiac activity.</div></div><div><h3>Methods</h3><div>Between October 2021 and August 2022, we conducted in-depth interviews with English-speaking Texans aged ≥15 years who were seeking abortion about their experiences navigating to care. We recruited participants through online ads and by providing flyers to abortion facilities in seven states. We interviewed Texans with varied pregnancy outcomes, including out-of-state abortions, self-managed abortions, and continued pregnancies, all of whom initially sought abortion in Texas. We used inductive and deductive coding to identify themes in participants’ understandings of and experiences with CPCs.</div></div><div><h3>Results</h3><div>Of 120 participants, 36 contacted CPCs. Roughly half the 36 were <em>deceived</em>: they reached out for support accessing abortion care, unaware of CPCs’ mission to prevent abortion. Most remaining participants contacted CPCs <em>pragmatically</em>: unaware of CPCs’ missions, they were simply drawn to the organizations’ free and accessible pregnancy tests/ultrasounds. A minority, however, knew of CPCs’ missions and used CPCs’ pregnancy confirmation/dating <em>strategically</em> to determine next steps toward an abortion. Participants with pragmatic interactions more often reported positive experiences with CPCs, while those who were deceived or strategic frequently described negative experiences. Regardless of motivation, participants noted the importance of having free and accessible services, including pregnancy tests and ultrasounds, in their communities.</div></div><div><h3>Conclusions</h3><div>In a restrictive abortion setting with limited access to reproductive and pregnancy-related healthcare services, pregnant Texans sought free services from CPCs instead of medical professionals, including for pragmatic or strategic reasons.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110590"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426342","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

ASSOCIATION BETWEEN EXPERIENCES OF DISCRIMINATION AND CONCERNS ABOUT ACCESSING CONTRACEPTIVE CARE AMONG COMMUNITY COLLEGE STUDENTS IN TEXAS AND CALIFORNIA 德克萨斯州和加利福尼亚州社区大学生遭受歧视的经历与对获得避孕护理的担忧之间的联系

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110640

LA Tello Perez, J Yarger, HK Hecht, K Hopkins, I Rossetto, C Harper

Objectives

We aimed to identify whether experiences of discrimination are associated with students’ concerns about accessing contraception.

Methods

We analyzed baseline data (n=2,086) from an ongoing cluster randomized trial in Texas and California with sexually active community college students aged 18-25, assigned female at birth (gender- inclusive). Experiences of Discrimination (EOD) were measured using a validated and reliable scale (α = 0.8). We examined the association between EOD and concerns about being judged or disrespected by a medical provider, and whether the student felt comfortable discussing contraception with a provider. We used mixed effects logistic regression for clustered data, controlling for key sociodemographic factors.

Results

Overall, 21% of participants reported concerns about being judged or disrespected, and 17% reported feeling uncomfortable discussing contraception. EOD positively correlated with concerns about judgment or disrespect (adjusted OR (aOR)=1.13, CI 95% 1.09-1.16) and discomfort discussing contraception (aOR=1.04, CI 95% 1.01-1.08). Asian/Pacific Islanders had higher odds of worrying about judgment/disrespect (aOR=1.95, CI 95% 1.28-2.99) and discomfort discussing contraception (aOR=1.99, CI 95% 1.25-3.16) compared to White students. Latinx students also had higher odds of discomfort discussing contraception (aOR=1.52, CI 95% 1.04-2.23) as did first-generation college students (aOR=1.37, CI 95% 1.04-1.80). Finally, not speaking English at home was associated with concerns about judgment or disrespect (aOR=1.31, CI 95% 1.01-1.70).

Conclusions

Experiences of discrimination are associated with concerns about being judged or disrespected, as well as discomfort discussing contraception with providers. Healthcare providers and institutions should recognize and work to reduce the impact of discrimination on patients, particularly among young and marginalized patient communities.

方法我们分析了德克萨斯州和加利福尼亚州正在进行的群组随机试验的基线数据（n=2,086），这些数据来自 18-25 岁的性活跃社区大学生，他们出生时被分配为女性（包括性别）。歧视经历（EOD）采用经过验证的可靠量表进行测量（α = 0.8）。我们研究了 EOD 与担心被医疗服务提供者评判或不尊重以及学生是否愿意与医疗服务提供者讨论避孕问题之间的关联。我们使用混合效应逻辑回归法对聚类数据进行分析，并对主要社会人口学因素进行了控制。结果总体而言，21% 的参与者表示担心受到评判或不尊重，17% 的参与者表示在讨论避孕问题时感到不自在。EOD 与担心被评判或不被尊重（调整 OR (aOR)=1.13, CI 95% 1.09-1.16）和讨论避孕问题时感到不适（aOR=1.04, CI 95% 1.01-1.08）呈正相关。与白人学生相比，亚太裔学生担心被评判/不尊重（aOR=1.95，CI 95% 1.28-2.99）和在讨论避孕问题时感到不适（aOR=1.99，CI 95% 1.25-3.16）的几率更高。拉美裔学生与第一代大学生（aOR=1.37，CI 95% 1.04-1.80）相比，在讨论避孕问题时感到不适的几率也更高（aOR=1.52，CI 95% 1.04-2.23）。最后，在家不说英语与担心被评判或不被尊重有关（aOR=1.31，CI 95% 1.01-1.70）。医疗服务提供者和医疗机构应认识到并努力减少歧视对患者的影响，尤其是对年轻和边缘化患者群体的影响。

{"title":"ASSOCIATION BETWEEN EXPERIENCES OF DISCRIMINATION AND CONCERNS ABOUT ACCESSING CONTRACEPTIVE CARE AMONG COMMUNITY COLLEGE STUDENTS IN TEXAS AND CALIFORNIA","authors":"LA Tello Perez, J Yarger, HK Hecht, K Hopkins, I Rossetto, C Harper","doi":"10.1016/j.contraception.2024.110640","DOIUrl":"10.1016/j.contraception.2024.110640","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to identify whether experiences of discrimination are associated with students’ concerns about accessing contraception.</div></div><div><h3>Methods</h3><div>We analyzed baseline data (n=2,086) from an ongoing cluster randomized trial in Texas and California with sexually active community college students aged 18-25, assigned female at birth (gender- inclusive). Experiences of Discrimination (EOD) were measured using a validated and reliable scale (α = 0.8). We examined the association between EOD and concerns about being judged or disrespected by a medical provider, and whether the student felt comfortable discussing contraception with a provider. We used mixed effects logistic regression for clustered data, controlling for key sociodemographic factors.</div></div><div><h3>Results</h3><div>Overall, 21% of participants reported concerns about being judged or disrespected, and 17% reported feeling uncomfortable discussing contraception. EOD positively correlated with concerns about judgment or disrespect (adjusted OR (aOR)=1.13, CI 95% 1.09-1.16) and discomfort discussing contraception (aOR=1.04, CI 95% 1.01-1.08). Asian/Pacific Islanders had higher odds of worrying about judgment/disrespect (aOR=1.95, CI 95% 1.28-2.99) and discomfort discussing contraception (aOR=1.99, CI 95% 1.25-3.16) compared to White students. Latinx students also had higher odds of discomfort discussing contraception (aOR=1.52, CI 95% 1.04-2.23) as did first-generation college students (aOR=1.37, CI 95% 1.04-1.80). Finally, not speaking English at home was associated with concerns about judgment or disrespect (aOR=1.31, CI 95% 1.01-1.70).</div></div><div><h3>Conclusions</h3><div>Experiences of discrimination are associated with concerns about being judged or disrespected, as well as discomfort discussing contraception with providers. Healthcare providers and institutions should recognize and work to reduce the impact of discrimination on patients, particularly among young and marginalized patient communities.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110640"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426891","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

USING THE SOCIAL VULNERABILITY INDEX AND ABORTIONFINDER.ORG TO DETERMINE THE RELATIONSHIP BETWEEN SOCIAL VULNERABILITY AND SPATIAL ACCESS TO SECOND TRIMESTER ABORTION 利用社会脆弱性指数和 abortionfinder.org 来确定社会脆弱性与在空间上获得第二孕期人工流产服务之间的关系

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110604

E Dindinger, RH Cohen, WB Allshouse, J Sheeder

Objectives

We aimed to assess the relationship between social vulnerability and driving distances from each US county to the closest second trimester abortion clinic as of October 2023.

Methods

Using AbortionFinder.org, we calculated drive time from the centroid of each US county to the closest second trimester abortion facility. Data was joined to the Social Vulnerability Index (SVI) by county FIPS code. Counties were stratified into three SVI tertiles. We compared the median driving distance for states where second trimester abortions were legal vs not-legal. We used logistic regression models to determine the SVI predictors (lowest tertile vs highest tertile) of living in a county with a >2-hour driving distance of a second trimester abortion facility (adjusted for state legality of second trimester abortions).

Results

We assessed 3,143 US counties; 67.1% of counties were within a two-hour drive of a second trimester abortion facility. The median travel time for counties in states with legal second trimester abortion was 1.6 (range:0.1–7.3) vs 4.2 (range:0.9–12.0) hours p<0.001. In logistic regression, counties with the lowest socioeconomic SVI score had increased odds of a >2-hour drive (adjusted OR (aOR) 1.63;95%CI:1.28–2.17) and counties with the lowest racial/ethnic SVI score had increased odds of a >2-hour drive (aOR 1.56;95%CI:1.18–2.04).

Conclusions

Abortion bans disproportionately affect not only those living in restrictive states but also those who are more socially vulnerable. Current legislative and judicial efforts further threaten access to first trimester abortions including medication abortion nationwide. The necessity for second trimester abortions and inequity in access may increase.

目标我们旨在评估社会脆弱性与截至 2023 年 10 月从美国各县到最近的第二孕期人工流产诊所的驾车距离之间的关系。方法利用 AbortionFinder.org，我们计算了从美国各县的中心点到最近的第二孕期人工流产设施的驾车时间。数据按县 FIPS 代码与社会脆弱性指数 (SVI) 相结合。各县被分为三个 SVI 分层。我们比较了合法与非法堕胎州的驾车距离中位数。我们使用逻辑回归模型来确定居住在距第二孕期人工流产机构 2 小时车程范围内的县的 SVI 预测因素（最低三分位数与最高三分位数）（根据各州第二孕期人工流产的合法性进行调整）。在第二孕期堕胎合法的州，各县的中位旅行时间为 1.6（范围：0.1-7.3）小时 vs 4.2（范围：0.9-12.0）小时 p<0.001。在逻辑回归中，社会经济 SVI 分数最低的县的 >2 小时车程的几率增加（调整 OR (aOR) 1.63;95%CI:1.28-2.17），种族/族裔 SVI 分数最低的县的 >2 小时车程的几率增加（aOR 1.56;95%CI:1.18-2.04）。目前的立法和司法努力进一步威胁着全国范围内第一孕期堕胎（包括药物流产）的可及性。第二孕期堕胎的必要性和不平等可能会增加。

{"title":"USING THE SOCIAL VULNERABILITY INDEX AND ABORTIONFINDER.ORG TO DETERMINE THE RELATIONSHIP BETWEEN SOCIAL VULNERABILITY AND SPATIAL ACCESS TO SECOND TRIMESTER ABORTION","authors":"E Dindinger, RH Cohen, WB Allshouse, J Sheeder","doi":"10.1016/j.contraception.2024.110604","DOIUrl":"10.1016/j.contraception.2024.110604","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to assess the relationship between social vulnerability and driving distances from each US county to the closest second trimester abortion clinic as of October 2023.</div></div><div><h3>Methods</h3><div>Using AbortionFinder.org, we calculated drive time from the centroid of each US county to the closest second trimester abortion facility. Data was joined to the Social Vulnerability Index (SVI) by county FIPS code. Counties were stratified into three SVI tertiles. We compared the median driving distance for states where second trimester abortions were legal vs not-legal. We used logistic regression models to determine the SVI predictors (lowest tertile vs highest tertile) of living in a county with a >2-hour driving distance of a second trimester abortion facility (adjusted for state legality of second trimester abortions).</div></div><div><h3>Results</h3><div>We assessed 3,143 US counties; 67.1% of counties were within a two-hour drive of a second trimester abortion facility. The median travel time for counties in states with legal second trimester abortion was 1.6 (range:0.1–7.3) vs 4.2 (range:0.9–12.0) hours p<0.001. In logistic regression, counties with the lowest socioeconomic SVI score had increased odds of a >2-hour drive (adjusted OR (aOR) 1.63;95%CI:1.28–2.17) and counties with the lowest racial/ethnic SVI score had increased odds of a >2-hour drive (aOR 1.56;95%CI:1.18–2.04).</div></div><div><h3>Conclusions</h3><div>Abortion bans disproportionately affect not only those living in restrictive states but also those who are more socially vulnerable. Current legislative and judicial efforts further threaten access to first trimester abortions including medication abortion nationwide. The necessity for second trimester abortions and inequity in access may increase.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110604"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426176","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

COMPARISON OF BLEEDING PATTERNS WITH REPLACEMENT VERSUS EXTENDED USE OF THE CONTRACEPTIVE IMPLANT 置换避孕植入物与长期使用避孕植入物的出血模式比较

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110633

SK Mody, G Kully, MC Hildebrand, S Averbach

Objectives

We aimed to compare bleeding days and spotting days and satisfaction among individuals who replaced their contraceptive implant at three years versus those who extended use of the implant past three years.

Methods

We conducted a prospective cohort study. Participants reported number of bleeding and spotting days for 30 days prior to their implant appointment, decided to replace (replacers) or extend (extenders) use, and then reported number of bleeding and spotting days for 30 days after. Participants also recorded their satisfaction with the amount of bleeding and/or spotting. We used Wilcoxon Rank Sum tests to compare unadjusted median differences between groups and multivariable median (quantile) regression to adjust for co-variates.

Results

Among 52 participants, there was no significant difference between the two groups 30 days before or 30 days after replacing or extending use of the implant for spotting only days (0 vs 0, p=1.00) or any bleeding days (0 vs. 0, p=0.39). There were more spotting days 30 days prior to the appointment among those who decided to replace their implant, however the difference was not statistically significant (2 vs. 1, p=0.06). We found no statistically significant differences in median number of days reporting satisfaction with bleeding/spotting patterns from before and after 30 days (0 vs. -1, p=0.85).

Conclusions

Neither implant replacers nor extenders experienced significant changes in bleeding 30 days before or after replacing or extending. This data can help clinicians counsel patients regarding bleeding patterns when they are deciding to keep or replace their contraceptive implant at three years.

目标我们旨在比较在三年内更换避孕植入物的人与在三年后延长使用植入物的人的出血天数和出血天数以及满意度。方法我们进行了一项前瞻性队列研究。参与者报告了在预约植入前 30 天的出血天数和点滴出血天数，决定更换（更换者）或延长（延长者）使用，然后报告了更换后 30 天的出血天数和点滴出血天数。参与者还记录了他们对出血和/或点滴出血量的满意度。我们使用 Wilcoxon 秩和检验来比较组间未调整的中位数差异，并使用多变量中位数（量级）回归来调整共变量。结果在 52 名参与者中，更换或延长使用植入物前 30 天或更换或延长使用植入物后 30 天，两组之间在仅出血天数（0 对 0，p=1.00）或任何出血天数（0 对 0，p=0.39）方面没有显著差异。决定更换植入物的患者在预约前 30 天的点滴出血天数较多，但差异无统计学意义（2 对 1，P=0.06）。我们发现，30 天前和 30 天后对出血/点状出血模式表示满意的天数中位数差异无统计学意义（0 vs. -1, p=0.85）。结论无论是种植体置换者还是延长者，在置换或延长种植体 30 天前后的出血情况都没有发生显著变化。这些数据可以帮助临床医生在患者决定保留或更换避孕植入物三年时，就出血模式为患者提供咨询。

{"title":"COMPARISON OF BLEEDING PATTERNS WITH REPLACEMENT VERSUS EXTENDED USE OF THE CONTRACEPTIVE IMPLANT","authors":"SK Mody, G Kully, MC Hildebrand, S Averbach","doi":"10.1016/j.contraception.2024.110633","DOIUrl":"10.1016/j.contraception.2024.110633","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to compare bleeding days and spotting days and satisfaction among individuals who replaced their contraceptive implant at three years versus those who extended use of the implant past three years.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study. Participants reported number of bleeding and spotting days for 30 days prior to their implant appointment, decided to replace (replacers) or extend (extenders) use, and then reported number of bleeding and spotting days for 30 days after. Participants also recorded their satisfaction with the amount of bleeding and/or spotting. We used Wilcoxon Rank Sum tests to compare unadjusted median differences between groups and multivariable median (quantile) regression to adjust for co-variates.</div></div><div><h3>Results</h3><div>Among 52 participants, there was no significant difference between the two groups 30 days before or 30 days after replacing or extending use of the implant for spotting only days (0 vs 0, p=1.00) or any bleeding days (0 vs. 0, p=0.39). There were more spotting days 30 days prior to the appointment among those who decided to replace their implant, however the difference was not statistically significant (2 vs. 1, p=0.06). We found no statistically significant differences in median number of days reporting satisfaction with bleeding/spotting patterns from before and after 30 days (0 vs. -1, p=0.85).</div></div><div><h3>Conclusions</h3><div>Neither implant replacers nor extenders experienced significant changes in bleeding 30 days before or after replacing or extending. This data can help clinicians counsel patients regarding bleeding patterns when they are deciding to keep or replace their contraceptive implant at three years.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110633"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426189","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

COMPARISON OF SAFETY AND EFFICACY BETWEEN TELEMEDICINE AND CLINIC-BASED MEDICATION ABORTION AT A SINGLE ACADEMIC CENTER 在一个学术中心比较远程医疗和诊所药物流产的安全性和有效性

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110605

R Patil, R Woofter, J Gipson, M Sudhinaraset

Objectives

Despite the rise in telemedicine medication abortion rates in the US, there is limited evidence comparing this model (NTMA) to traditional clinic-based medication abortion (CBMA). We aim to further the evidence around safety and efficacy of telemedicine medication abortion by comparing NTMA to CBMA to address the growing demand for abortion access.

Methods

We conducted a retrospective cohort study comparing safety and efficacy outcomes using electronic medical records for patients who either had a CBMA(n=800) or NTMA(n=171) up to 77 days of gestation between June 1, 2018 and December 31, 2022, at a large academic health center in California. Secondary outcomes included comparing completion rates of post-treatment follow-up and assessing the four-week home pregnancy test results for NTMA patients.

Results

A total of 91% of CBMA and 92% of NTMA patients had successful abortions without surgical intervention (p>0.05). After controlling for covariates, successful abortion rates did not statistically significantly differ by modality [adjusted OR (aOR) 1.10, p>0.05]. Less than 1% of both groups experienced an adverse event (p>0.05), with no missed ongoing or missed ectopic pregnancies for either modality. A greater proportion of NTMA patients completed a first follow-up visit compared to CBMA patients, although this difference was not statistically significant [aOR 1.78, p>0.05]. Approximately 18% of NTMA patients had positive pregnancy tests at a four-week follow-up appointment.

Conclusions

NTMA is an equally safe and effective abortion care model as CBMA. If not already offered, the provision of telemedicine medication abortion should be considered to meet the growing demand for abortion access.

目的尽管美国远程医疗药物流产率有所上升，但将这种模式（NTMA）与传统诊所药物流产（CBMA）进行比较的证据却很有限。我们旨在通过比较 NTMA 与 CBMA，进一步证实远程医疗药物流产的安全性和有效性，以满足日益增长的流产需求。方法我们开展了一项回顾性队列研究，使用电子病历比较了加利福尼亚州一家大型学术健康中心在 2018 年 6 月 1 日至 2022 年 12 月 31 日期间妊娠 77 天以内接受 CBMA（n=800）或 NTMA（n=171）的患者的安全性和有效性结果。次要结果包括比较治疗后随访的完成率和评估NTMA患者四周后的家庭妊娠测试结果。结果共有91%的CBMA和92%的NTMA患者在没有手术干预的情况下成功流产（p>0.05）。控制协变量后，不同方式的成功流产率在统计学上无显著差异[调整OR (aOR) 1.10，p>0.05]。两组中均有不到1%的患者发生不良事件（p>0.05），两种方式均无漏诊持续妊娠或漏诊异位妊娠。与 CBMA 患者相比，完成首次随访的 NTMA 患者比例更高，但差异无统计学意义 [aOR 1.78，p>0.05]。约 18% 的 NTMA 患者在四周的随访中妊娠测试呈阳性。如果尚未提供远程医疗药物流产，则应考虑提供远程医疗药物流产，以满足日益增长的流产需求。

{"title":"COMPARISON OF SAFETY AND EFFICACY BETWEEN TELEMEDICINE AND CLINIC-BASED MEDICATION ABORTION AT A SINGLE ACADEMIC CENTER","authors":"R Patil, R Woofter, J Gipson, M Sudhinaraset","doi":"10.1016/j.contraception.2024.110605","DOIUrl":"10.1016/j.contraception.2024.110605","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite the rise in telemedicine medication abortion rates in the US, there is limited evidence comparing this model (NTMA) to traditional clinic-based medication abortion (CBMA). We aim to further the evidence around safety and efficacy of telemedicine medication abortion by comparing NTMA to CBMA to address the growing demand for abortion access.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study comparing safety and efficacy outcomes using electronic medical records for patients who either had a CBMA(n=800) or NTMA(n=171) up to 77 days of gestation between June 1, 2018 and December 31, 2022, at a large academic health center in California. Secondary outcomes included comparing completion rates of post-treatment follow-up and assessing the four-week home pregnancy test results for NTMA patients.</div></div><div><h3>Results</h3><div>A total of 91% of CBMA and 92% of NTMA patients had successful abortions without surgical intervention (p>0.05). After controlling for covariates, successful abortion rates did not statistically significantly differ by modality [adjusted OR (aOR) 1.10, p>0.05]. Less than 1% of both groups experienced an adverse event (p>0.05), with no missed ongoing or missed ectopic pregnancies for either modality. A greater proportion of NTMA patients completed a first follow-up visit compared to CBMA patients, although this difference was not statistically significant [aOR 1.78, p>0.05]. Approximately 18% of NTMA patients had positive pregnancy tests at a four-week follow-up appointment.</div></div><div><h3>Conclusions</h3><div>NTMA is an equally safe and effective abortion care model as CBMA. If not already offered, the provision of telemedicine medication abortion should be considered to meet the growing demand for abortion access.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110605"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426198","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

NAVIGATING PREGNANCY OF UNKNOWN LOCATION MANAGEMENT AFTER DOBBS: A SURVEY OF RYAN PROGRAMS IN THE US 多布斯手术后妊娠位置不明的管理：美国莱恩计划调查

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110629

MV Smith, J Turk, R Mercier, J Steinauer, K Vinekar

Objectives

We aimed to assess the impact of state and institutional policies in managing pregnancies of unknown location (PUL) at US Ryan residency programs.

Methods

We conducted a cross-sectional electronic survey of all US Ryan residency program directors (n=113) in March–April 2024. Using Guttmacher state abortion restriction classifications, we compared the perceived influence of institutional and state policies on PUL management among Ryan programs in restrictive vs. non-restrictive abortion climates. Provision of diagnostic uterine aspiration (UA) for undesired PUL was a secondary outcome. We compared response proportions with Fisher’s exact tests.

Results

Sixty-eight (60%) Ryan program directors responded from 31 states. Of these, 26 (38.2%) were from states with restrictive abortion policies. Six programs (8.8%) changed PUL management after the Dobbs v Jackson Women’s Health Organization decision. Compared to programs in protective states, programs in restrictive states were more likely to report that state policy “severely” or “somewhat” inhibits their ability to care for patients with PULs (50% vs. 2.4%, p<0.001), rarely or never offer diagnostic uterine aspiration (30.8% vs. 7.1%, p=0.02), and identify institutional leadership as a barrier to offering diagnostic UAs (19.2% vs. 2.4%, p=0.03). The most frequently cited institutional barriers to providing diagnostic UA were staffing and faculty comfort/willingness, which did not differ significantly by state abortion climate.

Conclusions

State abortion policy may impact the options available to patients with PULs. Programs should work to address barriers to providing diagnostic uterine aspiration in the setting of undesired PULs.

方法我们于 2024 年 3-4 月对所有美国瑞安住院医师培训项目主任（n=113）进行了一项横断面电子调查。我们使用 Guttmacher 州人工流产限制分类法，比较了限制性与非限制性人工流产环境下瑞安项目的机构和州政策对 PUL 管理的影响。为不想要的 PUL 提供诊断性子宫吸引术（UA）是次要结果。我们用费雪精确检验比较了回复比例。结果来自 31 个州的 68 名（60%）Ryan 计划负责人做出了回复。其中 26 个（38.2%）来自限制堕胎政策的州。六个项目（8.8%）在多布斯诉杰克逊妇女健康组织案判决后改变了 PUL 管理。与保护性州的项目相比，限制性州的项目更有可能报告州政策 "严重 "或 "一定程度上 "限制了他们护理 PUL 患者的能力（50% vs. 2.4%，p<0.001），很少或从未提供诊断性子宫吸引术（30.8% vs. 7.1%，p=0.02），并认为机构领导力是提供诊断性子宫吸引术的障碍（19.2% vs. 2.4%，p=0.03）。最常被提及的提供诊断性 UA 的机构障碍是人员配备和教职员工的舒适度/意愿，这两个因素在各州堕胎氛围上没有显著差异。项目应努力解决在不想要的 PUL 情况下提供诊断性子宫吸引术的障碍。

{"title":"NAVIGATING PREGNANCY OF UNKNOWN LOCATION MANAGEMENT AFTER DOBBS: A SURVEY OF RYAN PROGRAMS IN THE US","authors":"MV Smith, J Turk, R Mercier, J Steinauer, K Vinekar","doi":"10.1016/j.contraception.2024.110629","DOIUrl":"10.1016/j.contraception.2024.110629","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to assess the impact of state and institutional policies in managing pregnancies of unknown location (PUL) at US Ryan residency programs.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional electronic survey of all US Ryan residency program directors (n=113) in March–April 2024. Using Guttmacher state abortion restriction classifications, we compared the perceived influence of institutional and state policies on PUL management among Ryan programs in restrictive vs. non-restrictive abortion climates. Provision of diagnostic uterine aspiration (UA) for undesired PUL was a secondary outcome. We compared response proportions with Fisher’s exact tests.</div></div><div><h3>Results</h3><div>Sixty-eight (60%) Ryan program directors responded from 31 states. Of these, 26 (38.2%) were from states with restrictive abortion policies. Six programs (8.8%) changed PUL management after the <em>Dobbs v Jackson Women’s Health Organization</em> decision. Compared to programs in protective states, programs in restrictive states were more likely to report that state policy “severely” or “somewhat” inhibits their ability to care for patients with PULs (50% vs. 2.4%, p<0.001), rarely or never offer diagnostic uterine aspiration (30.8% vs. 7.1%, p=0.02), and identify institutional leadership as a barrier to offering diagnostic UAs (19.2% vs. 2.4%, p=0.03). The most frequently cited institutional barriers to providing diagnostic UA were staffing and faculty comfort/willingness, which did not differ significantly by state abortion climate.</div></div><div><h3>Conclusions</h3><div>State abortion policy may impact the options available to patients with PULs. Programs should work to address barriers to providing diagnostic uterine aspiration in the setting of undesired PULs.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110629"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426201","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

A POST-DOBBS ANALYSIS OF IN- VS. OUT-OF-STATE ABORTION TRAVEL EXPERIENCE IN MASSACHUSETTS AND ILLINOIS 对马萨诸塞州和伊利诺伊州州内与州外堕胎旅行经历的后多布斯分析马萨诸塞州和伊利诺伊州的州内与州外堕胎旅行经验分析

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110580

OL Thornton, IR Fulcher, J Ospina, P Kumar, H Dismer, M Landeau, AB Goldberg, E Janiak

Objectives

We aimed to describe differences in demographics and travel-related costs between in-state residents and out-of-state travelers who received abortion care after Dobbs v Jackson Women’s Health Organization.

Methods

We conducted a multi-site cross-sectional survey of patients who received abortion care at three clinics in Massachusetts and Illinois in 2023. Survey questions were derived from validated measures and included demographics, state of residence, and out-of-pocket expenses. Participants were recruited and surveyed on-site during their appointment. We compared characteristics between in-state and out-of-state participants using chi-squared tests.

Results

The overall enrollment rate in the study was 81%, with 148 in-state residents and 111 out-of-state travelers. A plurality of participants (35%) were between 18 and 24 years old, 32% identified as Black, 35% as White, and 75% as heterosexual or straight. There were no demographic differences between in-state residents and out-of-state travelers. However, out-of-state participants were more likely to lose at least one day of wages due to abortion-related travel (56.7% vs 40.6%, p<0.001). The average out-of-pocket travel cost for abortion care was $33.32 for in-state individuals compared to $294.50 for out-of-state travelers (p<0.001). For out-of-state travelers, airfare contributed to the largest share of expenses (41.3%), followed by accommodations (17.5%) and gas and parking (16.6%).

Conclusions

People traveling from out-of-state for abortion care missed more days of work and spent significantly more out-of-pocket on travel-related expenses compared to in-state individuals. Our findings highlight financial barriers to abortion access faced by people in abortion ban states. Abortion funds, clinics, and policymakers must urgently support initiatives to reduce prohibitive travel costs for abortion care.

我们旨在描述在 Dobbs 诉杰克逊妇女健康组织案之后，州内居民和州外旅行者在接受人工流产护理时在人口统计学和旅行相关费用方面的差异。方法我们对 2023 年在马萨诸塞州和伊利诺伊州的三家诊所接受人工流产护理的患者进行了一项多站点横断面调查。调查问题来自有效的测量方法，包括人口统计学、居住州和自付费用。我们在预约期间现场招募并调查了参与者。我们使用卡方检验比较了州内和州外参与者的特征。结果该研究的总体注册率为 81%，其中州内居民 148 人，州外旅行者 111 人。大多数参与者（35%）的年龄在 18-24 岁之间，32% 的人认为自己是黑人，35% 的人认为自己是白人，75% 的人认为自己是异性恋或异性恋者。州内居民和州外旅行者在人口统计学上没有差异。然而，州外参与者更有可能因为与堕胎有关的旅行而损失至少一天的工资（56.7% vs 40.6%，p<0.001）。州内个人因堕胎护理而自付的旅行费用平均为 33.32 美元，而州外旅行者则为 294.50 美元（p<0.001）。对于州外旅行者而言，机票是最大的支出（41.3%），其次是住宿（17.5%）以及汽油和停车费（16.6%）。结论与州内旅行者相比，州外旅行者因堕胎护理而缺勤的天数更多，自付的旅行相关费用也更高。我们的研究结果突显了禁止堕胎州的人们在获得堕胎服务方面所面临的经济障碍。人工流产基金、诊所和政策制定者必须紧急支持降低人工流产护理所需的高昂旅行费用的倡议。

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引用次数: 0