Perspectives on Sexual and Reproductive Health最新文献

Introduction: The United States (US) state of Texas uses two publicly funded programs to cover pregnant people-Medicaid for Pregnant Women and Children's Health Insurance Program (CHIP) Perinatal. While Medicaid offers more comprehensive coverage than CHIP Perinatal, it only includes US citizens and legally qualified residents. This tiered access to care, determined primarily by immigration status, generates stratified access. This paper explores how stratified access factors into reproductive experiences.

Methodology: Thirty-two pregnant and postpartum women who identified as first- or second-generation immigrants and had public insurance or no insurance coverage participated in a semi-structured in-depth interview. Interview questions explored topics related to immigration and border policies more broadly. This piece analyzes themes that emerged in relation to the type of healthcare coverage participants were able to access during pregnancy.

Results: Participants had a range of immigration statuses that factored into their eligibility for health programs. During pregnancy, 12 had CHIP Perinatal, 15 had Medicaid, and five had no coverage. Key themes shaping experiences of care included bureaucratic barriers in navigating health programs, inadequate coverage that reinforced health vulnerabilities, and feelings of limited autonomy.

Discussion: Women's narratives highlight the ways immigration status generates barriers to receiving health care coverage, including coverage for programs that individuals are entitled to regardless of immigration status. The type of coverage that a pregnant woman has dictates how comprehensive her care is and the degree to which she experiences coverage gaps outside of pregnancy.

Objective: To investigate the pathways that may elevate risks of desire for sterilization reversal, specifically through nonuse of long-acting reversible contraception (LARC), viewing abortion as unacceptable for oneself, and being economically disadvantaged.

Methods: We used chi-squared tests and binary logistic models to analyze data on 3422 women, including 299 sterilized women, from a population-representative sample of Delaware women aged 18-44 in 2021. We estimated models for female sterilization use and for desire for sterilization reversal.

Results: Among sterilized Delaware women aged 18-44, 28% report desiring sterilization reversal. In multivariate models, those who had never used LARC were more likely to have been sterilized (OR = 1.62; 95% CI = 1.09-2.40), although not more likely to desire sterilization reversal if sterilized. Women who viewed abortion as unacceptable for themselves were not more likely to be sterilized, but they were more likely to desire sterilization reversal if sterilized (OR = 2.42; 95% CI = 1.09-5.36). Economically disadvantaged women were both more likely to be sterilized (OR = 7.56; 95% CI = 4.51-12.68) and more likely, if sterilized, to desire sterilization reversal (OR = 3.88; 95% CI = 1.18-12.74).

Conclusion: We find varied pathways linking a woman's nonuse of LARC, her personal nonacceptability of abortion, and her economic disadvantage to increased risk of desiring sterilization reversal. Economic disadvantage is easily the greatest risk factor. We interpret these findings through a conceptual framework of constrained choice.

Objective: Intravaginal rings (IVRs) are marketed or in development for contraception and other indications. We sought to develop and validate the IVR Acceptability Scale (IVR-AS) as a multidimensional, standardized tool for assessing IVR acceptability among end-users in the United States.

Methods: Scale items reflect specific aspects of IVR acceptability for women and male partners. Response options range from 1 (not-at-all acceptable) to 5 (highly acceptable). We evaluated the IVR-AS within a randomized, crossover clinical trial of three nonmedicated silicone IVRs of differing external diameters (46, 56, 66 mm) in heterosexual couples who used each for ~30 days, then completed a self-administered survey. We conducted exploratory factor analysis and multivariable regression to assess convergent validity. Follow-up in-depth interviews with all participants explored scale salience.

Results: Twenty-four couples participated (mean age 27). The final 19-item women's scale (Cronbach's alpha = 0.93) included six subdimensions: ease of use; experience and sensation; effect on sexual desire/engagement, and effect on vaginal sex (all alphas > 0.78). The final eight-item men's scale comprised two subdimensions: effect on sexual desire/engagement and effect on vaginal sex (all alphas > 0.89). For both sexes, higher overall/subdimension scores were consistently associated with favorable assessments of the ring, for example, ease of insertion/removal; adherence (most p < 0.001). The 46/56 mm IVRs had higher overall and subdimension scores than the 66 mm IVR (most p < 0.001). Qualitative reports reinforced the salience of scale subdimensions and item content.

Conclusion: The IVR-AS captures multiple dimensions of IVR acceptability among women and their partners. The scales demonstrated excellent reliability and convergent validity. Further validation is warranted in future studies.

Trial registration: Clinical Trials.gov: NCT05128136. https://clinicaltrials.gov/study/NCT05128136?intr=non-medicated%20silicone%20ring&rank=2.

Objectives: Side-effects are often central to the decision to discontinue oral contraceptives. However, many oral contraceptive side-effects may be the result of a psychological nocebo effect. In this preliminary study, we investigate whether correlates of nocebo effects are associated with oral contraceptive side-effect experience.

Design: An exploratory online cross-sectional survey of 275 female, predominantly young, White respondents was conducted. Associations between psychological factors previously implicated in nocebo responses (beliefs about medicines, perceived sensitivity to medicines, side-effect expectations, medicine information seeking, anxiety and trust in medicines), and oral contraceptive side-effect experience were assessed using regression analyses.

Results: Increased side-effect expectations, stronger beliefs that medicines cause harm and are overused, increased perceived sensitivity to medicines, and decreased trust in medicine development were associated with increased attribution of symptoms to the oral contraceptive. Higher side-effect attribution scores were also associated with discontinued oral contraceptive use.

Conclusion: These preliminary findings demonstrate a potential role that nocebo-related factors may have in impacting oral contraceptive side-effect experience. Importantly, these factors are amenable to psychological interventions which could be employed to reduce oral contraceptive side-effect experience and, as a result, unnecessary discontinuation. Future research must first assess such relationships using a prospective design to confirm the direction of the associations identified using more diverse samples of oral contraceptive users to increase the generalisability of findings.

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.