Perspectives on Sexual and Reproductive Health最新文献

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.

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.

Background: The COVID-19 pandemic reshaped people's healthcare experiences and access to healthcare, including abortion. In response to the COVID-19 outbreak, some policymakers claimed that abortion is a nonessential service and should be restricted. In contrast, other policymakers contended that abortion is time-sensitive essential healthcare, and access to it should be protected. These efforts put access to abortion into the public arena during the onset of the pandemic. We examined whether people perceived the pandemic changed their attitudes toward abortion and their rationale for whether their support for abortion increased, decreased, or remained the same.

Method: We administered a web-based survey to US-based English and Spanish-speaking adults (n = 1583) to assess their abortion beliefs. Participants answered open and close-ended questions about abortion, including whether they believe the COVID-19 outbreak changed their views about abortion and why. Because our sample was not representative of the US population, we weighted the data and present weighted results.

Results: As expected, most participants (91.7%) indicated that the COVID-19 outbreak did not change their abortion views. Many of these participants did not see a relationship between the COVID-19 pandemic and abortion. Participants who became more supportive (5.2%) cited well-being and financial concerns as reasons. Participants who became less supportive (3.1%) cited excessive death associated with the COVID-19 outbreak as their reason.

Conclusion: Most participants perceived that the COVID-19 pandemic did not change their views about abortion, suggesting the pandemic may not be a context linked to abortion attitudes.

Introduction: Complete ectogenesis through artificial womb technology (AWT) would enable fertilization, embryonic development, and fetal development outside of the human body. In 2004, Canada's Assisted Human Reproduction Act established a 14-day legal limit on the in vitro cultivation of human embryos, stymying the domestic development of AWT. Given recent scientific advancements, we aimed to explore Canadians' perspectives on the 14-day rule and AWT development.

Methods: In September 2020-February 2021, we conducted an online English-French survey and semi-structured in-depth interviews with a subset of respondents to solicit Canadian citizens' perspectives on AWT. We audio-recorded and transcribed the telephone/Zoom/Skype interviews and used ATLAS.ti to manage our data. We analyzed survey data using descriptive statistics and interviews for content and themes using inductive and deductive techniques.

Results: We received 343 completed surveys and conducted 41 interviews. Although overall knowledge of AWT, in general, and the 14-day rule, in particular, was limited, our participants felt that AWT had the potential to improve lives. Participants also perceived the 14-day rule as an outdated limitation on technological progress and a barrier to AWT development. Participants suggested revisiting the legislation and emphasized centering science, technology, and medicine in any update.

Discussion: In 2021, the International Society for Stem Cell Research released updated guidelines which recommended relaxing the 14-day rule, depending on the research objectives. Given the changing domestic and international landscape, Canadian policymakers should revisit the 14-day rule limit imposed by the Assisted Human Reproduction Act and seek input from Canadians when embarking on this reform process.

Background: Medication abortion has accounted for an increasing share of abortions in the United States (US) since the Food and Drug Administration's approval of mifepristone in 2000. This study offers updated estimates of medication abortions provided within the formal healthcare system in 2023 in US states without total abortion bans as well as a discussion of recent trends in medication abortion provision.

Methods: The Guttmacher Institute's Monthly Abortion Provision Study employs data from monthly samples of providers in a Bayesian hierarchical model to produce estimates of abortions provided within the formal healthcare system. We estimate the number and share of medication abortions provided in 2023 in states without total abortion bans and the share of abortions provided through telemedicine-only clinics.

Results: Clinicians provided 648,500 medication abortions within the formal healthcare system in 2023 in states without total bans (90% uncertainty interval: 640,720-657,860), representing 63% of all abortions. Ten percent of all abortions were provided by telemedicine-only clinics. The number of medication abortions provided in US states without total abortion bans increased by 19% between 2019 and 2020, and by 32% between 2020 and 2023.

Discussion: Medication abortion plays a critical role in the US abortion access landscape. Medication abortion provision has accelerated since 2019, likely due to COVID-era policies that facilitated the expansion of telemedicine medication abortion provision. This shift has created essential access for individuals navigating abortion bans and other barriers to care since the removal of federal abortion protections.

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.

Background: Given the history of coercion in the provision of sterilization, it is important that patients who desire permanent contraception receive patient-centered care that respects their preferences. Recent literature examining the provision of postpartum permanent contraception has not explored whether patients who desire permanent contraception feel supported by their clinical teams.

Methods: We interviewed patients from four medical centers around the United States with a documented desire for postpartum permanent contraception. We audio-recorded, transcribed, and analyzed interviews using rapid qualitative methods and thematic content analysis.

Results: Of the 81 patients interviewed, most (n = 64) felt supported by their clinician throughout their prenatal care and delivery hospitalization. Seventeen patients shared stories of feeling unsupported. Patients recalled feeling dismissed when they initiated conversations about permanent contraception. Additionally, they felt they had received incomplete counseling on permanent contraception and felt discouraged from getting the procedure during prenatal care encounters. During delivery hospitalization, patients discussed not being informed about barriers to permanent contraception as they surfaced, facing lack of prioritization of the procedure by clinicians, recognizing communications errors among the clinical team, and feeling pressured to undergo or not undergo permanent contraception.

Conclusion: Most patients felt supported by their clinicians throughout permanent contraception decision-making and provision. Patients who did not feel supported reported a spectrum of experiences ranging from rushed appointments, perceived clinician bias in counseling, and communications barriers to the provision of permanent contraception after delivery. Patient-centered care that prioritizes patient experiences, values, and desires is necessary to ensure that all people can achieve their reproductive goals.

Background: The reversal of the federal right to abortion through the 2022 US Supreme Court ruling in Dobbs v. Jackson Women's Health Organization is changing the landscape for medication abortion access. Several states with supportive abortion laws are expanding access to medication abortion by mandating that university Student Health Centers (SHCs) provide this service. Meanwhile, other states are limiting even the information that medical providers can give to patients. In this environment, we document changing information on medication abortion on university SHC websites.

Methods: We conducted thematic content analysis for medication abortion-related information on 549 SHC websites at 4-year bachelor's degree granting public universities/colleges across the United States. We examined information on medication abortion at four timepoints: March 2022, August 2022, February 2023, and February 2024 using computer-assisted software.

Results: Only 1% of the SHC websites detailed information on access to medication abortion in March 2022. By February 2024, 7.5% of SHC websites provided some information on how to access medication abortion. This increase was driven primarily by SHC websites of public colleges in California, New York, and Massachusetts, where legislation required SHC to provide medication abortion services on campuses. For universities that provided any information on medication abortion, the websites had varying details on access and responses to changing state-level legislation and federal regulations.

Conclusions: Overall, university SHC websites are increasingly mentioning medication abortion, though mostly in states with supportive abortion laws. We anticipate more SHCs will post such information on their websites in response to legal requirements set by state legislatures.

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.