Perspectives on Sexual and Reproductive Health最新文献

Purpose: We sought to understand the relationship between Kentucky medical students' personal beliefs and values about the state's restrictive abortion climate and their considerations for residency training and/or post-residency practice in Kentucky.

Methods: We surveyed medical school students enrolled in two medical schools in Kentucky about their personal beliefs and values regarding the state's abortion climate and whether they were considering residency training and/or staying post-residency in Kentucky. We used descriptive statistics to examine differences in responses, stratified by consideration for residency training and staying. We further examined these relationships among the subset of students who were considering a residency in obstetrics and gynecology (OBGYN).

Results: The survey response rate was 17.9%. Overall, 77.8% (n = 210) of respondents indicated that the current anti-abortion climate in Kentucky did not align with their personal beliefs and values. Among all medical students, 51.1% (n = 138) indicated they were considering staying in Kentucky post-residency, including 29% of those considering an OBGYN residency. Among those considering an OBGYN residency (n = 74), 51.4% (n = 38) reported that they were considering staying in Kentucky for residency, compared with 48.6% (n = 69) of those who were not considering an OBGYN residency.

Conclusions: While most responding medical students reported their personal beliefs and values do not align with the state's anti-abortion climate, the majority are considering staying in Kentucky for residency and post-residency practice, regardless of their interest in an OBGYN residency. This suggests that opinions about the anti-abortion climate may not factor prominently in students' decisions about residency training and practice location.

Background: Current understanding of reproductive health content in medical school curricula is limited. This study explores abortion education offerings of osteopathic medical students (OMS) in the United States (US). After successfully completing their training, OMS receive a doctorate in osteopathic medicine (DO) rather than a Doctor of Medicine (MD). An increasing number of students are receiving DO medical education.

Methods: We developed and distributed a 19-item survey to OMS through social media and research offices at all US osteopathic medical schools. We used descriptive statistics and logistic regression models to analyze the data.

Results: Our survey resulted in 256 responses from 37 institutions (43% preclinical, n = 108; 57% clinical, n = 143). Approximately 72.1% of respondents (n = 137) were attending medical school in a state with limitations on abortion access. Over half (52.4%, n = 108) of respondents indicated their school was delivering abortion and/or contraception curriculum, with fewer schools having optional training (20%, n = 42) or no educational offerings (27%, n = 56). Of schools offering abortion education, the most frequent content included "both abortion and contraception education" (79.2%, n = 80); fewer reported "contraception education only" (17.8%, n = 18) or "abortion education only" (3%, n = 3) content. Half of respondents with optional abortion education participated, while 40.5% (n = 17) opted out. The most frequently reported time dedicated to abortion education was < 59 min (39.9%, n = 75). Clinical students were significantly more satisfied (p = 0.0458) with the time allotted to abortion content and perceived ability (p = 0.0256) to provide patient education on abortion.

Conclusion: Clinical students reported significantly increased satisfaction with abortion education received during their training as compared to preclinical students. Despite the majority supporting abortion education, most OMS received less than 1 h of dedicated instruction highlighting expansion opportunities.

Introduction: Statutory rape laws establish the age of consent to sex and related exceptions. To date, scholars have rarely examined statutory rape laws in the United States (US), in part because no comprehensive database of the laws exists.

Methods: We created a longitudinal database of statutory rape laws in each of the 50 US states and Washington, DC between 2000 and 2021. We coded laws according to age of consent to sex, close-in-age exceptions, and marital exemptions and examined how they have changed in the first two decades of the 21st century.

Results: In 2021, the age of consent varied between 16 (n = 32), 17 (n = 7), and 18 (n = 12) across states. Most states had exceptions to the age of consent for persons close-in-age (n = 39) and married couples (n = 39). From 2000 to 2021, one state increased its age of consent, two states removed close-in-age exceptions and four added them, six states removed marital exemptions, while two instated them.

Discussion: Statutory rape definitions and exceptions varied widely between states, but within states, the laws rarely changed in the past two decades. The variability of laws across states raises questions about how statutory rape laws should be structured. Our longitudinal database will facilitate research which may provide a stronger empirical basis for future policies.

Context: Previous studies of crisis pregnancy centers (CPCs) in the United States focused on clients who sought out CPCs for parenting resources. In contrast, this study focuses on the experiences of those who had already decided on abortion and describes how they avoided or selectively engaged with CPCs prior to obtaining abortion care.

Methods: I draw upon interviews with 16 abortion patients in Mississippi from June 2021 to March 2022. I recruited participants from social media and through Mississippi's lone abortion clinic. The semi-structured interviews focused on participants who were aware of CPCs' antiabortion mission at the time of the interview and why they avoided or engaged with these centers prior to their abortions. I analyzed transcripts for themes related to participants' experiences with CPCs.

Results: Participants described different strategies for interacting with CPCs, including deliberate avoidance based on prior knowledge of CPCs' antiabortion stance and strategic engagement to access ultrasounds or emotional support. Some participants interpreted stigmatizing practices as care, while others reported misinformation, deception, and attempted stigmatization that they explicitly resisted.

Conclusion: While CPCs remain a challenge to reproductive autonomy, many clients, including abortion patients, successfully bypassed or managed their CPC experiences in ways they found beneficial while circumventing CPCs' goals.

Introduction: Researchers have done limited empirical work to explore how healthcare providers are claiming conscientious objection to abortion care in Australia. Without this research, we cannot assess if existing mechanisms to regulate conscientious objection meet the needs of abortion seekers, abortion providers, and healthcare providers who conscientiously object to abortion care.

Methodology: We conducted semi-structured interviews with 41 interest-holders (including healthcare providers who provided or conscientiously objected to abortion care) across Australia about conscientious objection to abortion care and its regulation. We analyzed the data using framework analysis.

Results: We identified four themes describing how healthcare providers were claiming conscientious objection to abortion care. First, claims existed on a spectrum from "partial provision" to "refusal without referral." When healthcare providers refused to provide an abortion, they did not always refer the abortion seeker to a willing provider or service. Second, claims of conscientious objection could change over time. Third, the relationship between religion and conscientious objection was not necessarily direct. Finally, some healthcare providers refused to provide abortion for reasons other than conscience.

Conclusion: The findings demonstrated that conscientious objection provisions provided a flexible mechanism for healthcare providers to opt-out of providing abortion care at different times, in different contexts, and for different reasons (including reasons other than conscience). Education and guidelines may improve healthcare providers' understandings and interpretations of conscientious objection provisions. Destigmatizing interventions may also reduce the number of healthcare providers who refuse to participate in abortion care for conscience-based and non-conscience-based reasons.

Introduction: Over the last decade at the University Hospital of Nancy in Lorraine, France, we have observed an increasing number of people under 35 years old who receive consultation for gender incongruence, from an average of 7 new patients per year in 2002-2013 to an average of 27 per year in 2014-2017.

Methods: We conducted a mixed-methods study, including a retrospective quantitative analysis of medical records of youths who sought care for gender incongruence from 2004 to 2020, and a qualitative analysis of in-depth interviews with 11 patients identified through the medical records.

Results: The study included 235 participants (135 assigned female at birth, 100 assigned male at birth). Transgender men were younger than transgender women: mean age 20 (1.6, standard deviation, [SD]) years vs. 22.7 (4.3 SD) years; p = 0.01 at first referral. We observed no difference in age at the initiation of gender-affirming hormonal treatments. More than half of our participants chronologically situated their first questioning about their gender identity in the prepubertal period. Their life experiences revealed a lack of transgender representation in society, discomfort with the treatments offered, difficulties in becoming aware of and disclosing their gender identity, and the importance of peer/community support.

Conclusion: The present study provides insights into the growing population of transgender and gender nonconforming people receiving care in the University Hospital of Nancy which has coincided with the evolution of the national legal framework. Our results identify several priorities for transgender youth who are receiving gender-affirming care. Further research outside hospital networks appears warranted.

Introduction: China's one-child policy was implemented in 1980 primarily through mandatory intrauterine devices, tubal surgery, or abortion for "unauthorized pregnancies." While it was replaced in 2015, it affected millions of persons and its effects on reproductive decision making are not well known.

Methods: We designed, validated, and performed a cross-sectional survey of reproductive age Chinese-born or first-generation women of Chinese descent to describe the policy's impact on reproductive decision-making. Descriptive statistics and multivariate logistic regression were used to identify self-reported policy impact on contraceptive utilization and childbearing choices, and demographic associations.

Results: Between June 1 and October 31, 2021, 1098 people accessed the survey, and 838 were eligible. A total of 588 responded to questions pertaining to the primary outcome, yielding a response rate of 70.2%. Approximately 42% of participants lived under the policy and were affected by it in some way. 17.3% of participants stated their contraceptive utilization was affected and 23.3% stated their childbearing choices were affected. Those with low acculturation scores (OR = 2.27, 95% CI 1.35-3.85, p = 0.002) and those living in the United States for < 21 years (OR = 2.25, 95% CI 1.09-4.67, p < 0.01) were more likely to report their contraceptive plans were affected. 72.8% of participants self-reported high reproductive autonomy, whereas acculturation was mixed.

Conclusions: Although the one-child policy has had a large effect on people of the Chinese diaspora, its impact on reproductive decision-making may decrease with the duration of time in the United States and increasing acculturation.

Objective: The limited literature on family planning among Asian populations in the United States suggests that this group underutilizes contraception. We examined factors associated with contraceptive use, particularly among South Asians.

Methods: We used cross-sectional data from the 2013, 2014, and 2016 New York City Community Health Surveys and included women and men aged 18-44 years who engaged in sexual activity with a member of a different sex in the last year and did not intend to get pregnant, were not/partner was not pregnant, and could/partner could get pregnant (N = 7101). We conducted bivariate and multivariate logistic regressions with backward elimination to estimate the association between sociodemographic, behavioral, and health care-related factors with the use of any contraceptive at the last sexual encounter. The primary analysis included race as a key independent variable and the secondary analysis was restricted only to South Asians (n = 189).

Results: Two thirds of South Asians (67%) used a contraceptive at last sexual encounter. After full adjustment, compared to South Asians, other Asians showed a higher likelihood of using contraception (aOR 1.54; 95% CI: 1.05, 2.26). In the secondary analysis of South Asians, those who were married/living together (aOR 0.19; 95% CI: 0.08, 0.45) or divorced/separated/widowed (aOR 0.14; 95% CI: 0.03, 0.68) showed a lower likelihood of using any contraception compared to those who were never married.

Conclusion: Researchers need to conduct additional research to better understand contraceptive behavior among South Asians and identify if/what optimal interventions will increase access and help meet and support their reproductive goals and autonomy.

Introduction: Emergency contraception (EC) is essential for full-spectrum contraceptive care, preventing unintended pregnancies and promoting reproductive autonomy. Little is known about EC provision at safety-net clinics serving low-income people. This study examines EC provision at health department and federally qualified health center (FQHC) clinics in two United States (US) southeastern states at multiple points in time.

Methodology: We analyzed data from statewide surveys of publicly funded family planning clinics assessing the years 2016, 2019, and 2022 in Alabama and South Carolina and key informant interviews with staff at surveyed clinics to assess patterns of EC provision by clinic type over time.

Results: Almost all health departments across both states provided EC on-site compared to less than half of FQHCs. Advance provision of EC was less common, with health departments reporting significantly higher rates (2016 = 15.8%; 2019 = 28.7%; 2022 = 15.5%) than FQHCs (2016 = 0%; 2019 = 2.8%; 2022 = 4.3%) (2016, 2019 = p < 0.0001; 2022 p = 0.01). In 2022, 20% of health departments reported providing EC via telehealth compared to 5.1% of FQHCs (p = 0.002). Health department staff noted an increase in advance provision, and FQHC staff noted challenges to provision due to limitations in on-site stocking. EC provision did not change significantly across years.

Discussion: Access to EC varies across safety-net clinics in the US South and has not improved over time. Addressing barriers to EC access and providing accurate information about contraceptive methods is essential to empower informed family planning decisions. As reproductive health legislation continues to evolve, expanding access to EC remains critical for safeguarding reproductive health and autonomy.