Perspectives on Sexual and Reproductive Health最新文献

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.

Background: Transvaginal ultrasound (TVS) is used routinely in gynecological care in Australia to manage gynecological health concerns. Typically, TVS is well tolerated by patients, with low levels of discomfort reported. Trans and gender diverse people assigned female at birth may experience gender dysphoria or testosterone-related anatomical changes, which could make such intimate examinations physically difficult or emotionally distressing. However, to date, no studies have considered the impact of gender identity on individuals' experiences of TVS. To fill this research gap, we explored the experiences of TVS among trans and gender diverse individuals assigned female at birth within Australia.

Methods: We conducted semi-structured interviews with trans and gender diverse individuals assigned female at birth who have experienced TVS in Australia. We analyzed all interviews in line with Braun and Clarke's reflexive thematic analysis.

Results: Ten trans and gender diverse individuals aged between 18 and 50 years old participated in this study. From their interviews, we developed three overarching themes: (1) It's a bit like being a detective, (2) So I could properly say, "I don't want this done," and (3) I definitely felt like a novelty. Participants described a range of positive and negative experiences with TVS, with issues related to cisnormativity in documentation, staff attitudes, and inadequate informed consent consistently highlighted.

Conclusion: Trans and gender diverse people face challenges in accessing inclusive gynecological care in Australia. Our findings highlight a need for improved informed consent guidelines, better education and training for health professionals, and more inclusive clinic documentation to promote inclusive care.

Introduction: Qualitative research on miscarriage in the United States primarily draws on the experiences of participants recruited from healthcare settings which may fail to robustly illuminate how people navigate to care. We aimed to explore the miscarriage experiences of Indiana residents, identify barriers to access, and generate recommendations to improve comprehensive miscarriage management and information across the state.

Methodology: We used community-based recruitment methods and conducted semi-structured, in-depth interviews with 26 participants who had experienced at least one miscarriage in Indiana between 2018 and 2023. We audio-recorded and transcribed the interviews, and then we used Dedoose to manage our data and carried out content and thematic analysis.

Results: Participants described significant challenges locating both information and care about miscarriage. When they reached out to health care providers, women were instructed to "wait it out" or go to the emergency department (ED). These recommendations were inconsistent with participants' needs and desires. Participants reflected negatively on their experience at the ED, emphasizing the high financial and emotional costs associated with the visit. Only participants who discovered their pregnancy loss during prenatal care appointments reported being offered active intervention.

Discussion: Our findings suggest that some women in Indiana lack access to information and comprehensive treatment options for miscarriage. This funnels non-emergent patients to the ED where patients incur significant financial and emotional costs. Developing strategies to support miscarrying women inside and outside of the ED appears warranted.

Objective: We describe the origin, program design, and evaluation activities of Partners in Contraception Choice and Knowledge (PICCK), a statewide contraceptive access and quality initiative in Massachusetts, United States from 2018 to 2023.

Methods: PICCK primarily worked to improve contraceptive care at the state's birth hospitals and their affiliated outpatient practices using a champion model. In addition to hospital-level quality improvement activities, PICCK implemented statewide programming to engage audiences beyond the partnered sites, including a webinar series, annual conference, and resource development.

Results: Champions at each hospital led coordination and implementation of customized programming for their site with support from PICCK staff. We conducted presentations and trainings by videoconference when in-person activities were restricted during the COVID-19 pandemic. Implementation periods ranged from 56 to 1323 days (average = 517.5 days). At the statewide level, we conducted 31 webinars, hosted three virtual annual conferences, and created 97 patient- and clinician-facing resources.

Conclusion: PICCK was innovative in our dual approach to implementation, with both hospital-based and statewide activities. The structure of PICCK could be adapted to implement other public health quality improvement programs in clinical settings or statewide, given the adaptability and broad reach of the program.

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.

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.

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: 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.