Perspectives on Sexual and Reproductive Health最新文献

Objectives: To measure knowledge of and experiences with self-managed abortion among abortion seekers in Indiana before the Supreme Court decision in Dobbs v. Jackson Women's Health Organization (Dobbs).

Study design: Between June 2021 and April 2022, we recruited a non-probability sample of Indiana residents of any age who were currently or recently pregnant and considering abortion via online advertisements, referrals from abortion funds, and flyers in abortion clinics. Participants completed two online surveys 1 month apart, and a subset completed in-depth interviews. We conducted descriptive and regression analyses of characteristics, methods, motivations, and knowledge of self-managed abortion.

Results: Among 434 total participants, 33 (7.6%, 95% CI: 5.5%-10.5%) reported a self-managed abortion attempt for their current/recent pregnancy; these participants were younger, less likely to be parents, more likely to be pregnant for the first time, and more likely to identify as a sexual and/or gender minority person than were participants who did not attempt to self-manage. Participants cited unaffordability of clinician-supported abortion care (n = 16/33, 49%) as the most common reason for attempting to self-manage. Those who reported challenges paying for abortion were three times more likely to attempt a self-managed abortion than those who did not (aRR: 3.0, 95% CI: 1.1, 8.2). Interviews (n = 40) highlighted low awareness of self-managed medication abortion.

Conclusions: Among people who faced financial barriers to clinician-supported abortion care in Indiana, financial distress motivated some residents to self-manage abortions. In the further restricted post-Dobbs period, financial support to obtain clinician-supported care and trusted, accessible information on safe and effective self-managed abortion options are imperative so that Indiana residents can access abortion care in accordance with their preferences.

Purpose: Experiences of gender-based discrimination against transgender and nonbinary people and racial discrimination against people of color in sexual healthcare settings serve as significant barriers to care. However, the sexual healthcare experiences of transgender young adults of color (TNYAC), who face intersecting forms of discrimination, are poorly understood.

Methods: We conducted a qualitative analysis of semi-structured interviews (n = 20) with TNYAC ages 20-30 years, residing across the United States. Interviews, conducted via Zoom from September 2021 to January 2022, focused on recent sexual healthcare experiences and potential discrimination based on gender or race. Researchers double-coded and, guided by intersectionality theory, analyzed transcripts using thematic analysis.

Results: Among 20 interviewees with diverse racial/ethnic identities (Black, Latine, Asian-American and Pacific Islander, and multiracial), we identified several themes. Participants described how interpersonal and systemic interactions related to their gender and race determined their sexual healthcare experiences, specifically experiences of gender discrimination, racial stereotyping, and racial segregation. Importantly, participants noted ways their sexual healthcare experiences were shaped by intersecting systems of both racial and gender oppression. Lastly, participants developed identity-affirming protective strategies to navigate discrimination, such as independent information seeking or choosing providers with shared gender and/or racial identities.

Discussion: The use of protective strategies in response to racial and gender discrimination in sexual healthcare highlights both the resilience of TNYAC and the need for equitable and inclusive healthcare services. Healthcare providers and practices can implement interventions like cultural humility training and co-located services to improve care for those who experience multiple forms of oppression.

Introduction: When positioned as part of a cluster of related social and political attitudes, abortion attitudes are characterized as somewhat fixed from a young age. The extent to which abortion attitudes are malleable, and can be shaped by experience, is under-researched in the United Kingdom (UK).

Methods: To address this gap, we conducted semi-structured interviews with individuals with (N = 12) and without (N = 16) abortion experience living in the United Kingdom, consisting of England, Scotland, Wales or Northern Ireland. Inductive thematic analysis was used to address the research question: How does experience and/or contact with abortion shape attitudes towards abortion?

Results: The theme From Abstract Idea to Reality illustrates participants' understanding of how abortion attitudes are developed by contact with real, lived experiences of abortion-someone's own and/or their friends' or acquaintances' abortions. Participants were clear that proximity to abortion helped them, and others, to see abortion as tangible, personal, and sensory ("reality") as opposed to intangible, imagined, and conceptual ("abstract"). Subthemes capture our participants' understanding of abortion as a reality as opposed to something imagined; abortion is a complex issue and abortion experiences are varied (Complexity of Abortion), attitudes towards abortion are largely stable (Consistency of Attitudes), and abortion, and the people who seek abortion in the United Kingdom, is still stigmatized (Persistent Stigma).

Conclusion: Our themes and discussion provide direction for future scholarship considering contact as a stigma reduction strategy, highlighting some potential benefits but also urging caution in oversimplifying a complicated social issue.

Objectives: Limiting abortion within the formal health care system is associated with more self-managed abortion (SMA). Reddit is a publicly available social networking site that allows users to create and join communities ("subreddits") around a specific topic. R/abortion is a subreddit dedicated to providing support and advice to people seeking or having an abortion. The purpose of this study is to analyze r/abortion data after the Dobbs leak in 2022 to explore SMA access and use experiences shared in the community.

Methods: We employed a hybrid qualitative thematic analysis approach to describe experiences, concerns, and questions related to SMA as shared in posts from r/abortion. A simple random sample of 10% of posts was obtained from those shared from May 2, 2022 through December 23, 2022 (n = 523).

Results: Among the analyzed posts, 111 described experiences with SMA. Four themes emerged during the analysis. First, some posters noted concerns and questions related to online ordering and receiving mailed medication abortion, including shipping delays, cost, and discreet packaging. The second theme was related to concerns and questions about the SMA process, such as when and how to take medication, bleeding amount, and abortion completion. The final two themes were related to seeking support/advice for SMA and sharing SMA experiences, with community members seeking and sharing support to combat isolation while self-managing.

Discussion: R/abortion is an important resource for some people self-managing abortions. This study provided key insights into areas that are commonly discussed, which can inform the provision of practical support for SMA.

Context: While the annual rate of vasectomy has dropped worldwide, we have little knowledge of its prevalence in France.

Objective: To describe the use of vasectomy in France from 2010 to 2022.

Methods: This population-based study relied on the French national health data system (SNDS, 99.5% of the population). We described the use of vasectomy in France (2010-2022) by men aged 18-70, and compared changes in sterilization practices for both genders. We then focused on men's characteristics, assessed incidence rates (Poisson distribution), and sought sperm preservation procedures, postvasectomy semen analyses (PVSA) and complications.

Results: In total, 109,544 vasectomies were performed from 2010 to 2022 on French men aged 18-70. There was a substantial rise in the number of vasectomies, which increased 15-fold (1,940 in 2010 vs. 30,288 procedures in 2022). In 2022, male sterilizations outnumbered female sterilizations by a ratio of 3:2. On average, men were younger over time and appeared to live in areas that are more privileged. Preoperatively, 6.8% of men opted for sperm cryopreservation. Post-vasectomy complications were rare (1.0%) and 64.7% of men underwent PVSA. We estimated the crude incidence of vasovasostomy was estimated at 0.56 [0.57-0.87] per 1000 person-years. The SNDS cannot provide information on the partners and the parity of the men in the study.

Conclusions: Our study shows that the practice of vasectomies performed in France has increased significantly over the last 12 years. Researchers will have to repeat this study in the coming years to confirm or refute this trend.

Background: Community-based doulas, who provide nonclinical perinatal support and are often from the same communities as the families they serve, are increasingly recognized as a strategy to ameliorate racialized perinatal health inequities. However, little is known about the successful implementation and sustainability of community-based doula programs.

Methods: Using an explanatory sequential mixed methods design, we examined the implementation and health outcomes of a community-based doula program serving low-income families and the barriers and facilitators that influence these outcomes. We analyzed programmatic and health outcome data among all families enrolled in the program from January 2016 through December 2022. Four in-depth listening sessions with the program's direct service providers were conducted and analyzed using thematic analysis.

Results: Among the over 1800 families served, the majority of whom identified as either Asian, Black, Indigenous, Latina/e/x, or multiracial, there were 14,672 total home visits that totaled 17,774 h. Over $87,000 in direct funds and 7000 tangible items (e.g., diapers) were dispersed to families. Preterm birth ranged from 4% to 9% across programs and most participants (> 94%) were breastfeeding/chestfeeding at birth. Direct service providers identified holistic, culturally-matched services and "doula-ing the doula" (organizational infrastructure to support doulas) as facilitators. Barriers included the intersecting systems of oppression that underlie the primary challenges faced by birthing families and direct service providers, including lack of community resources and power asymmetries within birth settings, that can lead to provider burnout.

Conclusions: These findings document the positive impact of community-based doula programs and bolster calls for increased compensation and structural supports for doulas.

Objective: To understand messaging about cycle syncing on TikTok, a trend that involves harmonizing daily activities and self-care rituals with various stages of the menstrual cycle.

Methods: We conducted a quantitative content analysis of TikTok videos (N = 100). In January 2023, we collected TikTok videos from content creators using the hashtag #cyclesyncing.

Results: About one-third of creators provided credentials. However, very few mentioned scientific evidence. More than half of the creators recommended aligning diet and exercise with the four menstrual cycle phases. Creators specifically recommended diets and exercises for each menstrual cycle phase.

Conclusion: Cycle syncing content on TikTok oversimplifies a complex literature involving tailoring diet and exercise to the menstrual cycle. Our findings also have implications for previous research pointing to negative discourse about hormonal contraception on social media and problematic messaging about women's reproductive health. More expert voices surrounding women's reproductive health are needed in the evolving social media landscape.

Context: Testosterone, which some transgender and non-binary (TGNB) individuals born with a uterus will use for gender affirmation, is not a form of contraception. Gaps remain in understanding how well clinicians address contraceptive needs with individuals initiating testosterone.

Methodology: This was an IRB-approved retrospective analysis of TGNB individuals on testosterone for gender affirmation. Charts were evaluated for whether or not sexual activity that could result in pregnancy was assessed, and whether contraceptive counseling was performed for those at risk of pregnancy.

Results: Of the 280 individuals included, almost all (232, 83%) had documentation of whether or not they were engaging in penile-vaginal intercourse. Nineteen percent (45) were currently engaging in penile-vaginal intercourse at the time of testosterone initiation, and 17% (39) had a history of penile-vaginal intercourse. The majority of those currently engaging in penile-vaginal sex had contraceptive counseling when initiating testosterone (39/45, 87%), and the majority were documented as using a form of contraception (40/45, 89%), with condoms being the most frequently documented form (24/40, 53%). Those who previously engaged in penile-vaginal sex were less likely to have documentation of counseling (16/39, 41%) or contraceptive use (19/39, 49%), with condoms being the most frequently documented form (9/19, 23%).

Conclusion: In this cohort of TGNB individuals who initiated testosterone, the majority had an assessment of penile-vaginal sexual activity documented. The majority of those who had engaged in penile-vaginal sexual activity had documentation of both contraceptive counseling and use of a form of contraception, with condoms being the most common.

Objective: Rural women are significantly more likely than urban women to be sterilized. This study aims to understand why rural women depend so heavily on this method of fertility control, whether they are more likely than suburban and urban women to desire sterilization reversal, and the impact of female sterilization on rural women's ability to achieve their fertility goals.

Methods: Data from 10,081 sexually active women aged 15 to 49, who participated in the National Survey of Family Growth (2015-2019), were analyzed using binary and multinomial logistic regression analyses. Unadjusted and adjusted predicted probabilities were calculated to estimate the prevalence of (1) female sterilization, (2) desire for sterilization reversal or wanting a(nother) child if sterilized, and (3) unwanted infecundity among rural, suburban, and urban women.

Results: Rural women (24.2%) are substantially more likely than suburban (15.3%) or urban (13.9%) women to receive tubal ligation. These disparities are not explained by women's demographic, reproductive, religious, and socioeconomic characteristics. Rural women who are sterilized are not more likely than suburban or urban women to desire sterilization reversal or to want to have (more) children. However, because more rural women rely on tubal ligation, a significantly higher fraction of rural women (34.8%) than urban women (23.8%) who want to have a(nother) child are infecund. Roughly, 40% of infecund rural women who wish to conceive had tubal ligation.

Conclusions: Limited contraceptive choice undermines rural women's ability to conceive wanted births. These results highlight another important reason for expanded reproductive health care in rural America.

Objective: In the last 15 years, the United States has seen a surge in anti-abortion legislation enacted at the state level. Many of these pieces of legislation utilize anatomical and embryological details to justify the necessity of abortion bans. In this study, we evaluated the level to which these statements are accurate and/or misleading, if at all, as determined by experts in anatomy and embryology.

Methods: Experts evaluated statements of anatomical and embryological fact included in Legislative Findings (or equivalent) sections of state-level abortion ban legislation passed between January 2016 and January 2023 on their level of accuracy and misleadingness. We investigated 56 pieces of legislation from 23 states, which resulted in 57 testable statements common to 13 pieces of legislation across 12 states. Forty-one experts in anatomy and embryology rated each statement from 1 (completely inaccurate/misleading) to 5 (completely accurate/non-misleading).

Results: Mean accuracy for all 57 statements was 3.0 ± 1.2 (range: 1.4-4.3) and the overall level of misleadingness was 2.5 ± 1.2 (range: 1.3-3.8).

Conclusion: All 57 statements were significantly different from a null expectation of completely accurate and completely non-misleading. Statements made about anatomy and embryology aim to justify abortion bans but contain, to varying extents, inaccurate and misleading information, thereby contributing to the detrimental effects of restrictive abortion legislation on the health and well-being of pregnancy-capable people.