Perspectives on Sexual and Reproductive Health最新文献

Context: Since March 2021, the Ohio legislature has been actively considering laws that would ban abortion if the United States Supreme Court overturns the Roe v. Wade decision that legalized abortion nationally in 1973.

Methods: We used a national database of publicly advertised abortion facilities to calculate driving distances for Ohioans before and after the activation of proposed abortion bans. Using a legal analysis of abortion laws following the overturn of Roe, we determined which states surrounding Ohio would continue providing abortion care. We calculated distances from each Ohio county centroid to the nearest open abortion facility in three scenarios: (1) as of February 2022, (2) the best-case post-Roe scenario (two of the five surrounding states continue to offer abortion care), and (3) worst-case post-Roe scenario (no surrounding states continue to offer abortion care). We calculated population-weighted distances using county-level data about women aged 15-44 years from the 2019 American Community Survey.

Results: In February 2022, all Ohio county centroids were at most 99 miles from an abortion facility (median = 50 miles). The best-case post-Roe scenario shows 62 of Ohio's 88 counties to be 115-279 miles away from the nearest facility (median = 146). The worst-case shows 85 counties to be 191-339 miles away from the nearest facility (median = 264). The current average population-weighted driving distance from county centroid to the nearest facility is 26 miles; the post-Roe scenarios would increase this to 157 miles (best-case) or 269 miles (worst-case).

Conclusions: Ohio's proposed abortion bans would substantially increase travel distances to abortion care, impacting over 2.2 million reproductive-aged Ohioans.

Objective: To document associations between socioeconomics and indicators of sexual wellbeing.

Methods: We obtained our data from the HER Salt Lake Initiative, a large, longitudinal cohort study of family planning clients in the United States who accessed free contraceptive services between March 2016 and March 2017. Baseline socioeconomic measures included Federal Poverty Level, receipt of public assistance, and difficulty paying for housing, food, and other necessities. Sexual wellbeing measures assessed sexual functioning and satisfaction, frequency of orgasm, and current sex-life rating. Among participants who had been sexually active in the last month (N = 2581), we used chi-square tests to examine bivariate associations between sexual and socioeconomic measures.

Results: We found strong and consistent relationships between sexual wellbeing and economic resources: those reporting more socioeconomic constraints also reported fewer signs of sexual flourishing.

Conclusions: Financial scarcity appears to constrain sexual wellbeing. To support positive sexual health, the public health field must continue to focus on economic reform, poverty reduction, and dismantling of structural classism as critical aspects of helping people achieve their full health and wellbeing potential. ClinialTrials.gov Identifier: NCT02734199.

Background: Scant research has examined latent and contextual dimensions of pregnancy intentions, conventionally classifying unintended pregnancies as mistimed (wanted later) or unwanted (not wanted at all). Being at risk of mistimed pregnancy likely encompasses a broad spectrum of emotions and expectations regarding pregnancy and merits further exploration.

Method: Using a national sample from GfK's online KnowledgePanel of women aged 15-39 considered at risk of mistimed pregnancy in 2017 (n = 1278), we conducted a latent class analysis to assess underlying patterns of current pregnancy orientation using three items: pregnancy desire, pregnancy acceptability, and expected pregnancy resolution. As class structure varied by relationship status (serious or not), we stratified analyses by relationship status.

Results: Among women in serious relationships, three classes emerged: "No," "Slightly okay," and "Acceptable." For those not in serious relationships, there were two classes: "Strong no" and "Ambiguous." Overall, the classes indicate varied patterns of wantedness, acceptability, and anticipated resolution to potential pregnancy.

Conclusions: This analysis reinforces that the construct of mistimed pregnancy is too restrictive to reflect the inherent diversity of prospective pregnancy orientation. The combination of relationship type as a grouping variable for stratified analyses, financial hardships' impact, and the overall effect of increasing age on increasing interest in pregnancy suggest the importance of locating pregnancy intentions within the broader reproductive life course. Scholars, clinicians, and public health programs should allow for multidimensionality of pregnancy perspectives, locate them within the broader life course, and acknowledge the potential impacts of stratified relationship formation on eventual pregnancy intentions.

Objectives: To evaluate whether the prevalence of postpartum contraceptive use was lower among people who delivered at a Catholic hospital compared to a non-Catholic hospital.

Methods: We linked 2015-2018 Pregnancy Risk Assessment Monitoring System (PRAMS) survey data from five states to hospital information from the corresponding birth certificate file. People with a live birth self-reported their use of contraception methods on the PRAMS survey at 2-6 months postpartum, which we coded into two dichotomous (yes vs. no) outcomes for use of female sterilization and highly-effective contraception (female/male sterilization, intrauterine device, implant, injectable, oral contraception, patch, or ring). We conducted multilevel log-binomial regression to examine the relationship between birth hospital type and postpartum contraception use adjusting for confounders.

Results: Prevalence of female sterilization for people who delivered at a Catholic hospital was 51% lower than that of their counterparts delivering at a non-Catholic hospital (adjusted prevalence ratio: 0.49; 95% confidence interval: 0.37-0.65).

Conclusion: We found lower use of postpartum female sterilization, but no difference in highly effective contraception overall, for people who delivered at a Catholic hospital compared to a non-Catholic hospital.

Introduction: Few interventions to improve contraceptive continuation are tailored to meet the developmental needs of young women under age 25 years. The Health Coaching for Contraceptive Continuation (HC3) intervention was designed to address this gap. In this special report, we describe the rationale for using health coaching, conceptual framework, intervention processes, and findings from a single-arm feasibility study of the intervention protocol.

Methodology: Health coaching is a person-centered behavioral change approach organized around five main strategies: providing education relevant to health goals, building health self-management skills, offering patient-centered counseling, identifying barriers to adherence, and fostering personal accountability for achieving health goals. We used these strategies to affect theory-driven mediators delineated in the Integrative Model of Behavioral Prediction (intentions, knowledge, attitudes, perceived social norms, and self-efficacy) and clinical mediators posited to change through program participation (shared contraceptive decision-making, method satisfaction, quality of life, distress tolerance, experiential avoidance, patient-coach alliance, and expectations of treatment effect). Experienced sexual health educators completed a manualized, 4-week health training program adapted from the National Society of Health Coaches. Between March and December 2017, we recruited a convenience sample of sexually-active women ages 14-21 years who initiated a new contraceptive in the prior 14 days from three urban pediatric clinics in Philadelphia, Pennsylvania. At baseline, participants completed a socio-demographic questionnaire, contraceptive needs assessment interview, and prioritized reproductive topics to learn more about. We synthesized these data into a coaching plan that guided the monthly coaching sessions which occurred for 6 months following contraceptive initiation. We assessed method adherence and continuation with monthly follow-up questionnaires and corroborated the findings through electronic medical record and pharmacy refill data review. Exit interviews assessed program acceptability. Feasibility outcomes measured throughout the protocol administration included recruitment and retention success. We used descriptive statistics to assess baseline and follow up questionnaire measures and audio-recorded and transcribed exit interviews verbatim. Two independent coders used deductive and inductive content analysis coding approaches to identify themes related to program acceptability.

Results: Of 92 women approached for the longitudinal intervention, 33 enrolled. Participants' mean age was 17.4 ± 2.1 years. Most were Black (n = 24), in high school (n = 23), and single/never-married (n = 31). Twenty-one completed ≥4 coaching sessions. Among the 23 for whom 6-month contraceptive continuation could be determined, 20 continued their baseli