Perspectives on Sexual and Reproductive Health最新文献

Context: The aim of this scoping review was to provide an overview of recent studies in peer reviewed journals investigating self-reported motivations to have an abortion or to continue an unwanted pregnancy in different countries and settings, including both qualitative and quantitative results.

Methods: We searched for English language publications published between 2008 and 2023 indexed in four scientific databases. We included studies if they captured people's own motivations for abortion and/ or for continuing an unwanted pregnancy.

Results: Of the included 19 studies, all focused on abortion, and four also included motivations to carry an initially unwanted pregnancy to term. Motivations for abortion often related to family planning (e.g., complete family, no desire for children, not the right time), the relationship with the person involved in the pregnancy, and life or material circumstances (such as financial resources, housing or future plans), and sometimes with stigma, shame, or expected negative reactions. Motivations to continue an unwanted pregnancy were having a supportive partner and personal beliefs about the pregnancy. Despite different settings, different methods, and methodological limitations, studies showed similar multifactorial and interrelated motivations in decision making around unwanted pregnancies.

Conclusions: This research showed that in different places throughout the world multiple interrelated motivations play a role in a decision to have an abortion or to continue an unwanted pregnancy. The findings mainly provide insight into retrospective explanatory accounts, which may be biased because respondents may feel the need to justify their choice. Future research should discontinue asking people to rationalize unwanted pregnancy decisions.

Context: According to Swedish law, abortion treatment should be carried out at an approved healthcare facility. All persons seeking medication abortions are obliged to attend an in-person visit, which includes a gynecological examination, an ultrasound scan, and administration of mifepristone at a hospital/clinic. However, some countries have implemented telemedicine abortion services without the requirement of in-person visits during and after the COVID-19 pandemic. The aim of this study is to (1) describe abortion seekers' experience of currently available abortion care; (2) explore abortion seekers' suggestions for improving medication abortion care; and (3) explore abortion seekers' views on an abortion care model that omits an in-person appointment and examination.

Methods: We interviewed 20 participants who sought early medication abortion at Sahlgrenska University Hospital, Gothenburg, Sweden, from March to April 2023. Systematic text-condensation of qualitative semi-structured interviews was used to explore abortion seekers' experience of the pre-abortion visit, including the gynecological and ultrasound examinations, thoughts about abortion care services, and telemedicine abortion.

Results: Three main findings emerged (1) The participants found it easy to contact the abortion clinic, but experienced undesired waiting time (2) Most participants appreciated the gynecological examination, but some found it distressing and uncomfortable (3) Participants considered telemedicine and taking mifepristone at home to be a good option in addition to in-person abortion care.

Conclusion: Offering both telemedicine and in-person consultations enhances abortion seekers' autonomy, reduces delays, and minimizes stress in abortion care.

Context: Over 40% of pregnancies in the United States are unintended. Women with unintended pregnancies may be less likely to receive timely prenatal care and engage in healthy behaviors immediately before and during pregnancy. Limited research suggests that women with disabilities are more likely to have an unintended pregnancy, but to date no studies have assessed whether intendedness varies by extent of disability.

Methods: We analyzed 2019-2020 PRAMS data from 22 sites that included the Washington Group Short Set of Questions on Disability (n = 37,832). We examined associations of extent of disability (none, some difficulty, or a lot of difficulty) with pregnancy intendedness (classified as intended, mistimed, unwanted, or unsure). We used multinomial logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) while controlling for sociodemographic characteristics.

Results: Overall, 60.1% of pregnancies were intended, 18.2% mistimed, 6.4% unwanted, and 15.3% unsure. Compared to respondents with no difficulty, respondents with some difficulty or a lot of difficulty were more likely to report a mistimed pregnancy (aOR = 1.55, 95%CI 1.40,1.71; aOR = 1.62, 95%CI 1.34,1.95), an unwanted pregnancy (aOR = 1.92, 95%CI 1.66,2.24; aOR = 2.20; 95%CI 1.72,2.82), and unsure intendedness (aOR = 1.61, 95%CI 1.45,1.79; aOR = 1.75, 95%CI 1.45,2.11), respectively.

Conclusions: People with disabilities who give birth, regardless of extent of disability, had elevated odds of mistimed and unwanted pregnancy and of being unsure of their pregnancy intendedness. Our findings support the use of more inclusive measures of disability and emphasize the need for equitable reproductive healthcare that respects the childbearing potential and choices of individuals with disabilities.

Objective: We explored awareness of and attitudes about the safety of various methods people use to attempt to end a pregnancy without medical assistance, which we refer to in this study collectively as self-managed abortion (SMA).

Methods: In 2020, we invited individuals living in eight United States (US) states considered "hostile" to abortion rights or with a history of criminalizing abortions performed outside the formal healthcare system to participate in semi-structured telephone interviews regarding their attitudes toward these practices. We analyzed coded transcripts for content and themes.

Results: We interviewed 54 individuals. Participants perceived methods of ending a pregnancy on one's own to have a high potential for complications, often evoking "coat hanger" abortions. Participants also frequently referenced methods such as physical trauma, herbs, teas, alcohol, or other drugs. Very few participants reported awareness of medication abortion pills. When asked about the safety of SMA in the context of self-sourcing these medications, participants considered pills safer and more acceptable than other SMA methods, while still fearing incorrect use and complications. Others believed that SMA could offer greater reproductive autonomy, less stigma, and a safer physical and psychological experience than facility-based abortion care.

Conclusion: In 2020, most participants perceived SMA as involving unsafe practices and did not include use of medication abortion pills. Future research should document how beliefs and attitudes have been influenced by the expansion in telemedicine provision of medication abortion, the implementation of new state abortion bans, and the promulgation of Shield Laws.

Introduction: Affective-sexual education is essential for all people, regardless of their intellectual capacity. However, people with intellectual disabilities, and especially those with conceptual, social, and practical limitations, may face additional challenges. In this study, we evaluate the effectiveness of the Saludiversex-M affective-sexual education program for people with moderate intellectual disabilities using a controlled trial design.

Methodology: A total of 99 Spanish participants with moderate intellectual disabilities completed a battery of instruments before and after the intervention. Overall, 30 support staff professionals hetero-evaluated participants before and after the program.

Results: Multilevel analyses showed that knowledge about sexuality significantly increased among those who received the intervention compared to those who did not. Support staff observed an increase in knowledge about sexuality and reported decreased concern about uninhibited behaviors among those who participated in the program.

Discussion: The Saludiversex-M program is effective in improving knowledge about sexuality, which is essential for promoting behavioral change. The program is a pioneering and effective educational strategy for sexual health promotion for people with moderate intellectual disabilities and empowers support staff working with these populations.

On January 30, 2024, over 300 researchers filed an amicus brief in FDA v. Alliance for Hippocratic Medicine, a United States (US) Supreme Court case that could have severely impacted access to mifepristone, one of the two drugs commonly used in medication abortion. The researchers summarize the legal challenges to the US Food and Drug Administration's (FDA's) original approval of mifepristone in 2000 and its 2016 and 2021 decisions modifying mifepristone's Risk Evaluation and Mitigation Strategy (REMS) Program and label, the responses from the FDA and drug manufacturer to the challenges, and the potential implications of the Court's decision on access to mifepristone in the US. The researchers detail how the FDA relied on a robust scientific record analyzing tens of thousands of patient experiences that conclusively demonstrated the safety and effectiveness of the changes to the mifepristone REMS Program and label and urge the Supreme Court to rely on the clear scientific record and preserve access to mifepristone without reimposing restrictions. What follows is a reprint of this brief.

Introduction: Intimate partner violence (IPV) involves an individual committing acts intended to harm or intimidate a current or former romantic partner. The COVID-19 pandemic and subsequent stay-at-home orders often trapped victims with perpetrators and intensified IPV. Although sexual and gender diverse people disproportionately experience IPV compared to cisgender, heterosexual people, their experiences are not well documented in the Canadian context. This study aimed to explore the experiences of Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender diverse (2S/LGBTQIA+) people with IPV in Ontario and how the COVID-19 pandemic affected their IPV experiences.

Methods: We conducted in-depth, semi-structured interviews with self-identified 2S/LGBTQIA+ people who experienced IPV on/after March 15, 2020. We audio-recorded and transcribed all interviews and coded the transcripts for content and themes using inductive and deductive techniques.

Results: Our 20 participants experienced physical, psychological, sexual, and financial abuse. Technology-facilitated violence extended abuse geographically and temporally. IPV experiences were associated with negative mental health outcomes that were intensified by the COVID-19 pandemic. Participants struggled to see themselves as legitimate victims of IPV. Although participants regretted being victims of violence, many saw their abusive relationship(s) as a learning experience to inform future relationships.

Discussion: Our findings suggest that 2S/LGBTQIA+ people may experience unique forms of identity abuse and may have difficulty recognizing their IPV experiences as abuse. Ensuring that comprehensive sexual health education is trauma-informed, anti-oppressive, and includes information about healthy relationship dynamics, 2S/LGBTQIA+ relationships, and IPV is critical.

Objective: We describe the experiences and preferences of women who switched from clinic-administered intramuscular depot medroxyprogesterone acetate (DMPA-IM) to self-administered subcutaneous DMPA (DMPA-SC) in the context of the COVID-19 pandemic.

Methods: We conducted interviews with women in California and Washington about their experiences with self-administered DMPA-SC. We interviewed women after their first or second self-administered DMPA-SC injection and conducted follow-up interviews after their third or fourth injection. We performed both thematic and descriptive content analyses.

Results: We completed 29 interviews with 15 women. Most participants (n = 10) were between the ages of 20 and 39 and the majority (n = 12) used DMPA primarily for contraception. Most (n = 13) described self-administered DMPA-SC as "very easy" or "somewhat easy" to use and reported greater convenience, decreased pain, fewer logistical and financial challenges, increased privacy, and improved comfort with injection compared to DMPA-IM. Participants identified difficulties obtaining DMPA-SC from pharmacies and safe needle disposal as barriers. Most (n = 13) would recommend DMPA-SC to a friend and desired to continue self-administration beyond the COVID-19 pandemic. Participants recommended counseling all patients about this option alongside other contraceptive methods, and offering clinician supervision, if desired.

Conclusion: Women who switched from in-clinic DMPA-IM to self-administered DMPA-SC during the COVID-19 pandemic preferred the latter and intended to continue self-administration. Self-administration of DMPA-SC should be routinely offered and easily accessible to patients.

Introduction: Although menstruation is a natural biological process, many people feel embarrassed of their menses and struggle to discuss it. To mitigate menstrual communication stigma, it is necessary to first elucidate communication experiences and perceptions. Thus, we qualitatively explore menstrual communication among cisgender women who menstruate and their family, friends, healthcare providers, and community.

Methodology: In partnership with No More Secrets (NMS), a Philadelphia menstrual health non-profit, we conducted a community-based participatory research (CBPR) project in Fall 2020. Cisgender, menstruating individuals ages 18-45 recruited from NMS' catchment in Philadelphia participated in semi-structured interviews about their menstrual experiences and communication (N = 20). A deductive, theory-driven approached based on the social-ecological model was used to analyze the data.

Results: Varying emotional responses arose across social-ecological levels: communication was awkward and simplistic with family; positive and supportive with friends and community members; and uncomfortable and frustrating with healthcare providers. Participants echoed the importance of menstrual communication as a means of sharing information, feeling less alone, and decreasing menstrual stigma.

Discussion: Findings can inform future CBPR workshops that address stigma in familial, healthcare, and community-based discussions to improve menstrual health and experiences for cisgender girls and women, transgender men, and gender non-binary individuals who menstruate.

Background: Adolescent contraceptive decision-making is influenced by a number of patient and clinician-driven factors. Although the AAP continues to endorse an efficacy-based model of contraceptive counseling, many professional organizations are shifting to a shared decision-making model as the optimal approach for providing unbiased and patient-driven contraceptive counseling. While SDM is intended to reduce the influence of clinician bias, it can exacerbate inequity if a clinician tailors a conversation based on their assumptions of a patient's goals or preferences. In this qualitative study, we explored self-reported contraceptive counseling practices among US-based clinicians who see adolescent patients to assess how these practices create barriers or facilitators to SDM and person-centered contraceptive care.

Methods: We interviewed 16 clinicians at the 2022 AAP Annual Meeting who counsel adolescent patients about contraception. We used thematic content analysis to analyze interview transcripts using Dedoose.

Results: We identified six aspects of contraceptive counseling that clinicians commonly employed with adolescent patients. These were: (1) sociodemographic characteristics driving counseling, (2) reliance on tiered effectiveness counseling, (3) initiating counseling conversations using "ask then explain" or "explain then ask" approaches, (4) emphasis on teen pregnancy prevention, (5) the influence of method accessibility on counseling, and (6) parental involvement in decision-making and patient confidentiality. We describe how these themes align with or diverge from each component of the SDM framework.

Conclusion: Clinicians in this study frequently engaged in non-patient-centered techniques during contraceptive counseling with adolescents. These findings can inform practice recommendations to support clinicians in providing high-quality contraceptive counseling using shared decision-making.