Perspectives on Sexual and Reproductive Health最新文献

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.

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.