Perspectives on Sexual and Reproductive Health最新文献

Context: Entertainment television can impact viewers' knowledge, attitudes, and reproductive health behaviors, yet little research has examined the impact of scripted abortion plotlines on viewers' abortion knowledge or social supportiveness for those having abortions. We examined the impact of an abortion storyline from Grey's Anatomy on US-based viewers.

Method: We conducted an online survey of likely Grey's Anatomy viewers prior to the episode's airing, assessing abortion ideology, knowledge, and support. After airing, we resurveyed respondents (including both those who had and had not viewed the target episode). We tested three hypotheses: episode exposure would (1) improve abortion knowledge and (2) increase support for medication abortion and decrease support for self-induced abortion, and (3) the effects on knowledge and supportive intention would be moderated by state support for abortion. We used independent samples t tests to examine hypotheses 1 and 2 and PROCESS macro to test the moderated effects (hypothesis 3).

Results: The results of the pretest/posttest analysis indicated that exposure to the episode significantly improved medication abortion knowledge. Increases in medication abortion knowledge were tied to explicit educational dialogue and did not translate into an increase in general abortion knowledge or social supportiveness. Notably, abortion-related state policy significantly moderated the influence of exposure for respondents in states with policies favorable to abortion access.

Conclusions: These findings suggest that entertainment television can contribute to meaningful increases in viewers' knowledge about abortion, but that the potential for impact of entertainment-education is closely linked to episode content and moderated by state-level abortion policy.

Context: Few qualitative findings have been published that explore and identify the challenges experienced by independent abortion providers during the COVID-19 pandemic in the United States (US). In this paper, we explore these themes while expanding the concept of "abortion exceptionalism" beyond its original legal meaning to address the impact of abortion stigma.

Methods: Twenty abortion providers from independent abortion clinics throughout the US South and Midwest participated in semi-structured interviews in June and July 2020. Interviews explored the challenges of providing abortion care in the wake of the COVID-19 pandemic and sought to identify how clinics strategized and amended their clinical practices to continue providing abortion care during this time.

Results: All providers we spoke to noted significant challenges to providing abortion care in the early days of COVID-19. In addition to experiencing the same concerns as other health care institutions, abortion clinics also faced additional, unique burdens that can only be attributed to the politics of abortion exceptionalism. Examples of this abortion exceptionalism include abrupt orders to close clinics, the need to rely on traveling physicians, legislature-imposed limits on telemedicine, heightened activities of protesters, and non-evidence-based regulation of medication abortion.

Conclusion: Despite major challenges and differential treatment, independent abortion clinics in the US persevered to continue to provide abortion care throughout the COVID-19 pandemic.

Context: Little is known about whether adolescents' risk-taking in areas other than sex is associated with the effectiveness of their contraceptive method use, or whether any such associations vary by race and ethnicity.

Methods: Data from the 2011, 2013 and 2015 National Youth Risk Behavior Surveys were used to examine nonsexual risk behaviors and contraceptive method choice among 5,971 sexually active females aged 13-18. Risk-taking profiles for White, Black and Hispanic adolescents were identified using latent class analysis. Multinomial logistic regression was used to estimate the associations between these risk profiles and use of less- or more-effective contraceptive methods at last sexual intercourse.

Results: Three distinct risk-taking profiles were identified for White and Hispanic adolescents and two for Black adolescents. Compared with their counterparts in the low-risk "abstainer" group, White adolescents in the "high substance use and violence" group were less likely to use condoms alone (relative risk, 0.4) or a prescription contraceptive paired with condoms (0.3) rather than no contraceptive at all, and more likely to use withdrawal or no method rather than condoms alone (2.4 each). However, higher risk-taking among Whites was positively associated with using prescription contraceptives rather than condoms (1.9). Among Black and Hispanic females, lower risk-taking was associated only with more condom use.

Conclusions: Future studies should examine whether interventions designed to reduce adolescent risk-taking improve the effectiveness of contraceptive use, particularly among White females. However, efforts to increase Black and Hispanic adolescents' use of more-effective contraceptives should target barriers other than risk-proneness. Perspectives on Sexual and Reproductive Health, 2020, 52(4):TK, doi:10.1363/psrh.12165.

The editors of Perspectives on Sexual and Reproductive Health were saddened to learn that Dr. Christine Kaestle died on July 16, 2020, in Blacksburg, Virginia. Dr. Kaestle was a professor in the Department of Human Development and Family Science at Virginia Tech College of Liberal Arts and Human Sciences, and was a longtime member of the journal's Editorial Advisory Committee. She could always be relied on to share her thoughtful insights in the areas of adolescent sexual and reproductive health, gender‐based violence and sexual behavior, and was a valued participant in our publishing community. The journal editors are deeply grateful for her years of friendly and professional support.

Context: Unintended pregnancy is common among young women. Understanding how such women use contraceptives- including method combinations-is essential to providing high-quality contraceptive care.

Methods: Data were from a representative cohort of 2,965 Australian women aged 18-23 who participated in the 2012-2013 Contraceptive Use, Pregnancy Intention and Decisions baseline survey, had been heterosexually active in the previous six months, and were not pregnant or trying to conceive. Latent class analysis was employed to characterize women's contraceptive choices; multinomial logistic regression was used to evaluate correlates of membership in the identified classes.

Results: The vast majority of women (96%) reported using one or more contraceptives, most commonly short-acting hormonal methods (60%), barrier methods (38%), long-acting contraceptives (16%) and withdrawal (15%). In total, 32 combinations were reported. Four latent classes of method use were identified: no contraception (4% of women); short-acting hormonal methods with supplementation (59%, mostly the pill); high-efficacy contraceptives with supplementation (15%, all long-acting reversible contraceptive users); and low-efficacy contraceptive combinations (21%); supplementation usually involved barrier methods or withdrawal. Class membership differed according to women's characteristics; for example, women who had ever been pregnant were more likely than other women to be in the no-contraception, high-efficacy contraceptive or low-efficacy contraceptive combination classes than in the short-acting hormonal contraceptive class (odds ratios, 2.0-3.0).

Conclusions: The complexity of women's contraceptive choices and the associations between latent classes and such characteristics as pregnancy history highlight the need for individualized approaches to pregnancy prevention and contraceptive care.

Context: Although some family medicine residency programs include routine opt-out training in early abortion, little is known about abortion provision by trainees after residency graduation. A better understanding of the barriers to and enablers of abortion provision by trained family physicians could improve residency training and shape other interventions to increase abortion provision and access.

Methods: Twenty-eight U.S. family physicians who had received abortion training during residency were interviewed in 2017, between two and seven years after residency graduation. The doctors, identified using databases of abortion-trained physicians maintained by residency programs, were recruited by e-mail. In phone interviews, they described their postresidency abortion provision experiences. All interviews were transcribed, coded and analyzed using Dedoose, and a social-ecological framework was employed to guide investigation and analysis.

Results: Although many of the physicians were motivated to provide abortion care, only a minority did so. Barriers to and enablers of abortion provision were found on all levels of the social-ecological model-legal, institutional, social and individual-and included state-specific laws and restrictions on federal funding; religious affiliation or policies prohibiting abortion within particular health systems; mentorship, colleagues' support and the stigma of being an abortion provider; and geographic location, time management and individuals' prioritization of abortion provision.

Conclusions: Clinical training alone may not be sufficient for family medicine physicians to overcome the barriers to postresidency abortion provision. To increase abortion provision and access, organizations and advocates should work to strengthen enablers of provision, such as strong mentorship and support networks.

Context: Catholic hospitals represent a large and growing segment of U.S. health care. Because these facilities follow doctrines that restrict reproductive health services, including miscarriage management options when a fetal heartbeat is present, it is critical to understand whether and how women would want to learn about miscarriage treatment restrictions from providers.

Methods: From May 2018 to January 2019, semistructured interviews were conducted with 31 women aged 21-44 who had had exposure to religious-based health care; all were drawn from a nationally representative survey sample. Participants responded to a hypothetical scenario regarding the anticipatory disclosure of miscarriage management policy during routine prenatal care. Responses were inductively coded and thematically analyzed using modified grounded theory to understand women's attitudes and considerations related to receiving anticipatory miscarriage management information.

Results: Respondents supported the routine disclosure of miscarriage management policies during prenatal care. Some expressed concern that this might increase patient anxiety during pregnancy, but most felt that the information would serve to prepare and empower patients, and likened the topic to other anticipatory health information provided during prenatal care. Identified themes related to how providers can disclose this information (including the need for a precautionary framing to reduce patient stress), sharing the rationale for institutional policy, and the importance of provider neutrality to ensure patient autonomy.

Conclusions: To respect patient autonomy, health care providers working in Catholic hospitals should routinely discuss institutional miscarriage management policies with patients, and anticipatory counseling should give patients the balanced information they need to decide where to go for care should pregnancy complications arise.

Context: Research into the relationship between pregnancy intention and perinatal depression or low social support is limited. Women's perspectives on pregnancy and their associations with perinatal depression could help in developing targeted efforts for screening and intervention.

Methods: In 2014-2015, 161 women seeking pregnancy testing or abortion care at clinics in New Haven, Connecticut, were surveyed. They were asked about pregnancy context (intentions, planning, wantedness, desirability, timing and happiness), and the Edinburgh Depression Screen (EDS) and the Modified Kendler Social Support Index (MKSSI) were used to identify possible antenatal depression and low social support, respectively. Multivariable logistic regression analysis was employed to examine associations between pregnancy context and these outcomes.

Results: On average, participants were 27 years old and at nine weeks' gestation. One-fifth reported a previous diagnosis of depression or anxiety, and 22% and 33% screened positive for depression (EDS scores of 13 or higher and 10 or higher, respectively); 52% received low social support (MKSSI score of 3.2 or less). Regression analysis found that pregnancies described as unintended, poorly timed or undesired were associated with depression at the higher cutoff (odds ratios, 3.2-4.5); all unfavorable pregnancy measures were associated with depression at the lower cutoff. Ambivalence regarding pregnancy timing, intention, wantedness and desirability was associated with increased odds of depression by either EDS score. Unplanned pregnancies and those about which the woman was ambivalent were associated with low social support.

Conclusions: Findings support the need to screen women for depression early in pregnancy and to integrate assessments of pregnancy context into the evaluation of potential risk factors.