Womens Health Issues最新文献_第3页

Mistrust Limits Possibilities for Patient-Provider Discussions Regarding Cannabis Use During Pregnancy 不信任限制了患者与提供者讨论怀孕期间使用大麻的可能性。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-11-01 DOI: 10.1016/j.whi.2025.09.002

Heather Gould MPH , Claudia Zaugg MPH , Karen A. Scott MD, MPH, FACOG , Sarah C.M. Roberts DrPH

Background

Recent changes in cannabis policy and use among pregnant people have prompted recommendations that health care providers discuss cannabis use with pregnant patients. We explored pregnant people's perceptions of their interactions with health care providers regarding cannabis use during pregnancy.

Methods

We conducted in-depth interviews with 34 individuals who were either pregnant or had been pregnant within the past 2 years and who used cannabis before or during their pregnancy. The interviews explored people's experiences with and perspectives on communication with health care providers about cannabis use during pregnancy.

Results

Most participants reported an absence of provider-initiated inquiries about cannabis use and few disclosed their cannabis use to a provider. Participants expressed distrust in providers as sources of accurate cannabis information, as they understood providers as grouping cannabis with alcohol and other drugs, which they saw as conflicting with their perception of a lack of conclusive scientific evidence about health effects of cannabis use during pregnancy. They worried about providers judging and reporting them to child welfare if providers learned about their cannabis use. Participants described using cannabis for medical reasons, but only rarely recalled experiencing providers talking with them about risks and benefits of cannabis versus other treatments.

Conclusions

Although many pregnant people use cannabis as a medicine to manage pregnancy symptoms or health conditions, they perceive providers as viewing and treating cannabis as a harmful recreational drug. This disconnect, along with their fears of provider judgment and of providers reporting them to child welfare, appears to be limiting effective, person-focused discussions regarding risks and benefits of different approaches to treating the symptoms and health conditions for which pregnant people use cannabis.

背景：最近孕妇大麻政策和使用情况的变化促使人们建议卫生保健提供者与孕妇患者讨论大麻使用情况。我们探讨了孕妇对怀孕期间使用大麻与卫生保健提供者互动的看法。方法：我们对34名怀孕或在过去2年内怀孕并在怀孕前或怀孕期间使用大麻的人进行了深入访谈。这些访谈探讨了人们在怀孕期间使用大麻与保健提供者沟通的经验和观点。结果：大多数参与者报告没有提供者发起的关于大麻使用的询问，很少有人向提供者披露其大麻使用情况。与会者表示不相信供应商是大麻准确信息的来源，因为他们认为供应商将大麻与酒精和其他药物归为一类，这与他们认为缺乏关于怀孕期间使用大麻对健康影响的确凿科学证据的看法相矛盾。他们担心，如果提供者了解到他们使用大麻，他们会对他们进行判断并向儿童福利机构报告。参与者描述了出于医疗原因使用大麻，但很少回忆起有经验的提供者与他们谈论大麻与其他治疗相比的风险和益处。结论：尽管许多孕妇使用大麻作为治疗妊娠症状或健康状况的药物，但她们认为供应商将大麻视为一种有害的娱乐性药物。这种脱节，再加上他们对提供者的判断和提供者向儿童福利机构报告的恐惧，似乎限制了有关治疗孕妇使用大麻的症状和健康状况的不同方法的风险和益处的有效、以人为本的讨论。

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引用次数: 0

Contribution of Maternal Age to Increasing Severe Maternal Morbidity During Birth and Up to 1 Year Postpartum 产妇年龄对分娩期间和产后1年内严重产妇发病率增加的贡献。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-11-01 DOI: 10.1016/j.whi.2025.08.005

Samuel H. Nyarko PhD , Lucy T. Greenberg MS , Scott A. Lorch MD , Jeannette Rogowski PhD , Jeffrey S. Buzas PhD , Ciaran S. Phibbs PhD , George R. Saade MD , Molly Passarella MS , Nansi S. Boghossian MPH, PhD

Purpose

We examined whether increasing severe maternal morbidity (SMM) rates are driven by changes in maternal age distribution or age-specific SMM rates.

Methods

In a retrospective cohort study across three states, we analyzed data from two time points (2008–2009 to 2019–2020). We used Kitagawa decomposition analysis to determine the contributions of changes in maternal age distribution and age-specific SMM rates to SMM rates both with and without transfusion during birth and up to 1 year postpartum, stratified by race/ethnicity. We examined the following racial/ethnic groups: non-Hispanic white, non-Hispanic Black, Hispanic, and non-Hispanic Asian/Pacific Islander.

Results

Between 2008–2009 and 2019–2020, SMM and non-transfusion SMM rates increased from 213.6 to 260.5 and from 109.6 to 154.8 per 10,000 births, respectively. Across all racial and ethnic groups, the proportion of younger birthing individuals (<25 years) decreased and the proportion of older individuals (≥30 years) increased. The decomposition analysis showed that increases in SMM and non-transfusion SMM were primarily due to increases in age-specific SMM rates (100.0% and 94.6%, respectively), particularly among younger birthing individuals. Changes in maternal age distribution had a minimal overall contribution. However, when stratified by race/ethnicity, changes in maternal age distribution had a greater contribution to SMM (28.9%) and non-transfusion SMM (22.7%) rates among non-Hispanic Black individuals, with little to no contribution observed in the other groups.

Conclusion

The increasing rates of birth-related and postpartum SMM rates stem from increasing rates of SMM in every age group rather than shifts in maternal age distribution.

目的：我们研究了严重产妇发病率（SMM）的增加是否由产妇年龄分布或年龄特异性SMM率的变化驱动。方法：在一项横跨三个州的回顾性队列研究中，我们分析了两个时间点（2008-2009年至2019-2020年）的数据。我们使用Kitagawa分解分析来确定母亲年龄分布和年龄特异性SMM率的变化对分娩时和产后1年输血和不输血的SMM率的贡献，并按种族/民族分层。我们研究了以下种族/民族群体：非西班牙裔白人、非西班牙裔黑人、西班牙裔和非西班牙裔亚裔/太平洋岛民。结果：2008-2009年至2019-2020年期间，SMM和非输血SMM率分别从每万例新生儿213.6例上升到260.5例，从109.6例上升到154.8例。结论：出生相关和产后SMM率的上升源于每个年龄组SMM率的上升，而不是母亲年龄分布的变化。

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引用次数: 0

Factors Associated With Guideline-Concordant Cervical Cancer Screening Exit: A Mixed Methods Study 与指南一致的宫颈癌筛查退出相关的因素：一项混合方法研究。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-11-01 DOI: 10.1016/j.whi.2025.07.006

Abigael Olson MD , Lindsay Fuzzell PhD , Naomi C. Brownstein PhD , Holly B. Fontenot PhD, RN/NP , Alexandra Michel PhD, RN/CNM , Paige Lake MPH , Susan T. Vadaparampil PhD , Rebecca B. Perkins MD, MSc

Background

More than 20% of cervical cancers are diagnosed in women older than 65 years. Guidelines recommend screening exit at age 65 for average-risk patients only if certain criteria are met, yet most women aged 64–66 years in the United States are inadequately screened. In this mixed methods study, we explored clinician knowledge of exit criteria.

Methods

We explored factors associated with clinician-reported guideline-concordant screening exit, as well as facilitators and barriers to appropriate cervical cancer screening exit. Guideline concordance required that clinicians be aware that patients can exit screening if they have received a hysterectomy for benign reasons or had either three consecutive negative Pap tests or two consecutive negative human papilloma virus tests—and that they should not exit screening if they have a history of precancer treatment in the prior 25 years.

Results

In 2021, a national sample of 1,251 clinicians completed surveys; a subset (n = 55) completed qualitative interviews. Although most (>70%) correctly identified criteria related to hysterectomy and prior negative screening requirements, only 35% of participants (n = 434) responded correctly to all screening exit items. In logistic regression models, male clinicians, OB/GYNs, and those in academic or hospital-based practices were more likely to respond correctly. Interview responses indicated variable understanding of the nuances of exit criteria. Those who continued screening patients past age 65 cited concerns related to new sexual partners and missing cancers. Several providers noted difficulty accessing adequate records.

Conclusions

Clinicians who routinely perform cervical cancer screening have knowledge gaps around exit criteria and also describe difficulty applying the criteria in practice. As fewer women undergo hysterectomy and life expectancy increases, the number of individuals older than 65 at risk for cervical cancer will continue to rise. Adjusting guidelines to decrease the complexity of exit criteria should be considered.

背景：超过20%的宫颈癌在65岁以上的妇女中被诊断出来。指南建议65岁的平均风险患者只有在满足某些标准的情况下才能退出筛查，然而在美国，大多数64-66岁的女性没有得到充分的筛查。在这项混合方法研究中，我们探讨了临床医生对退出标准的了解。方法：我们探讨与临床报告的指南相符的筛查退出相关的因素，以及适当的宫颈癌筛查退出的促进因素和障碍。指南一致性要求临床医生意识到，如果患者因良性原因接受了子宫切除术，或者连续三次宫颈涂片检查呈阴性或连续两次人乳头瘤病毒检查呈阴性，则可以退出筛查，如果他们在过去25年内有癌前治疗史，则不应该退出筛查。结果：2021年，全国1251名临床医生完成了调查；一个子集（n = 55）完成了定性访谈。虽然大多数（约70%）正确识别了与子宫切除术和既往阴性筛查要求相关的标准，但只有35%的参与者（n = 434）正确回答了所有筛查退出项目。在逻辑回归模型中，男性临床医生、妇产科医生和那些在学术或医院实践的医生更有可能做出正确的反应。访谈反应表明对退出标准的细微差别理解不一。那些65岁以上的患者继续接受筛查的人表示，他们担心会有新的性伴侣和遗漏癌症。一些供应商指出难以获得充分的记录。结论：常规进行宫颈癌筛查的临床医生在退出标准方面存在知识空白，并且在实践中应用标准也存在困难。由于接受子宫切除手术的妇女越来越少，而预期寿命增加，65岁以上有患子宫颈癌风险的人数将继续增加。应考虑调整指导方针，以降低退出标准的复杂性。

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引用次数: 0

Reproductive Health Services in Abortion-Providing Clinics: A Scoping Review of Provision and Policy Contexts 堕胎诊所的生殖健康服务：提供和政策背景的范围审查。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-11-01 DOI: 10.1016/j.whi.2025.07.007

Katherine M. Mahoney BA , Licia Bravo BS , Arden McAllister MPH , Kacie Bogar MS , Sean Hennessy PharmD, PhD , Courtney A. Schreiber MD, MPH , Alice Abernathy MD, MSHP

Objectives

Abortion-providing clinics often offer preventive reproductive health services. We conducted a scoping review to characterize provision of contraceptive care, sexually transmitted infection (STI) testing and/or treatment, and cervical cancer prevention and/or screening at U.S. abortion-providing clinics and to highlight policy drivers of variation in access to and provision of these services at the time of abortion by abortion-providing clinics.

Data Sources

Researchers screened articles and extracted data from PubMed, Embase, Scopus, and CINAHL from inception through March 2023.

Methods of Study Selection

Articles were eligible for review if they related contraceptive care, STI testing and/or treatment, or cervical cancer prevention and/or screening to abortion access, demand, or provision. Within these articles, we closely examined any discussion of health policy, conceptualized broadly based on existing literature describing policy associations with reproductive health care to identify policy drivers of reproductive health care provision in abortion care settings.

Tabulation, Integration, and Results

A total of 5,359 articles were screened; 74 were included in the review. Sixty-five were about contraceptive care, seven on STI testing and/or treatment, and two on cervical cancer prevention and/or screening. Drivers of variation in provision of preventive reproductive health services included insurance and billing policies and regulatory requirements on abortion-providing facilities and clinicians. Existing data on the association between policies that restrict or protect abortion access and provision of preventive health services by abortion-providing clinics on a national scale are limited.

Conclusion

Abortion-providing clinics are an access point for reproductive health services. Legislative trends to constrain abortion access may have spillover effects on provision of preventive reproductive health care such as contraceptive care, STI testing and/or treatment, and cervical cancer prevention and/or screening.

目标：提供堕胎服务的诊所通常提供预防性生殖健康服务。我们对美国堕胎诊所提供的避孕护理、性传播感染（STI）检测和/或治疗、宫颈癌预防和/或筛查进行了范围审查，并强调堕胎诊所在堕胎时获得和提供这些服务的变化的政策驱动因素。数据来源：研究人员从PubMed， Embase， Scopus和CINAHL中筛选文章并提取数据，从成立到2023年3月。研究方法选择：如果文章涉及避孕护理、性传播感染检测和/或治疗、宫颈癌预防和/或筛查与人工流产的获取、需求或提供相关，则纳入综述。在这些文章中，我们仔细研究了任何关于健康政策的讨论，这些讨论的概念广泛地基于描述与生殖保健政策关联的现有文献，以确定堕胎护理机构中生殖保健提供的政策驱动因素。制表、整合和结果：共筛选了5359篇文献；74个被纳入审查。65项涉及避孕护理，7项涉及性传播感染检测和/或治疗，2项涉及宫颈癌预防和/或筛查。在提供预防性生殖健康服务方面造成差异的因素包括保险和计费政策以及对堕胎设施和临床医生的监管要求。关于限制或保护堕胎机会的政策与全国范围内提供堕胎服务的诊所提供预防性保健服务之间关系的现有数据有限。结论：人工流产门诊是生殖健康服务的一个接入点。限制堕胎机会的立法趋势可能对提供预防性生殖保健，如避孕护理、性传播感染检测和/或治疗以及宫颈癌预防和/或筛查产生溢出效应。

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引用次数: 0

Social Media Descriptions of Pain and Pain Management During Intrauterine Device Insertion: “Women's Pain is Not Taken Seriously” 社交媒体对宫内节育器插入过程中疼痛和疼痛管理的描述：“女性的疼痛没有被认真对待”。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-11-01 DOI: 10.1016/j.whi.2025.08.002

Gabrielle Schweitzer MD , Azza Elrashid , Lakshmi Sundaresan MD , Kathleen Mehari MD , Lauren Owens MD, MPH , Lauren D. Oshman MD, MPH

Introduction

Intrauterine devices (IUDs) are a highly effective and safe method of contraception, yet IUD insertion can be painful. Social media is a trusted source of health information for reproductive-age adults and accounts of painful and traumatic insertion are prevalent on social media. The aim of this study was to explore the experiences of social media users with pain, trauma, and pain management during IUD insertion.

Methods

We identified common IUD-related hashtags or search terms on TikTok, Instagram, and Twitter; identified the top posts (defined as the posts at the top of each search) and their comments for each hashtag or search term on each platform; performed directed qualitative content analysis; and summarized code frequency under each theme with descriptive statistics.

Results

Analysis of a total of 214 total posts and comments identified three major themes describing user experiences: 1) Severe pain experiences were more common than tolerable or mild experiences, 2) some participants shared traumatic and negative emotional responses, and 3) negative or dismissive health care professional responses to painful IUD insertion were more frequent than positive and supportive responses.

Conclusion

Health care professionals should be aware of common narratives on social media and provide trauma-informed pain management to ensure that all patients have appropriate counseling for IUDs.

导读：宫内节育器（IUD）是一种非常有效和安全的避孕方法，但宫内节育器的插入可能是痛苦的。社交媒体是育龄成年人健康信息的可靠来源，关于痛苦和创伤插入的描述在社交媒体上很普遍。本研究的目的是探讨社交媒体用户在宫内节育器插入过程中疼痛、创伤和疼痛管理的经历。方法：我们确定了TikTok、Instagram和Twitter上常见的宫内节育器相关标签或搜索词；识别每个平台上每个标签或搜索词的热门帖子（定义为每个搜索顶部的帖子）及其评论；进行定向定性含量分析；并对各主题下的代码频率进行了描述性统计。结果：对214篇帖子和评论的分析确定了描述用户体验的三个主要主题：1)重度疼痛体验比可忍受或轻度体验更常见；2)一些参与者分享创伤性和负面情绪反应；3)对痛苦的宫内节育器插入的负面或轻蔑的医疗专业人员反应比积极和支持的反应更频繁。结论：卫生保健专业人员应了解社交媒体上的常见叙述，并提供创伤知情的疼痛管理，以确保所有患者都有适当的宫内节育器咨询。

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引用次数: 0

“Am I Truly Invisible?”: A Qualitative Study on Black Women's Experiences of and Coping With Intersectional Invisibility in Uterine Fibroid Treatment “我真的隐形吗？”黑人妇女在子宫肌瘤治疗中交叉性隐形的经历与应对。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.05.005

Arianne N. Malekzadeh MA , Ami R. Zota ScD, MS , Myla Lyons BA , Tamara Taggart PhD, MPH

Background

Black women are disproportionately burdened by uterine leiomyomas (fibroids) and face intersectional invisibility wherein their needs are ignored in health care settings due to sexism and racism. Our objective was to elucidate Black women's experiences in fibroid treatment and the strategies they use to protect their health and counter their intersectional invisibility.

Methods

We recruited participants from the Fibroids Observational Research on Genes and the Environment (FORGE) Study. We conducted semistructured individual interviews (average length 45 minutes) on Black women's experiences in fibroid treatment. We analyzed the transcripts using a thematic analytical approach and intersectionality, a critical analytical framework that allows for the examination of how sexism and racism intersect to influence health inequities.

Results

Participants were 16 Black women aged 30–52 years who were seeking fibroid treatment in Washington, DC. Our analysis revealed that participants experience gendered racism (the intersection of sexism and racism) in fibroid treatment, mirroring a historical and ongoing pattern of how Black women are treated in health care settings, and that they manage their intersectional invisibility by engaging in strategies characteristic of the superwoman schema: projecting strength, suppressing emotions, resisting being dependent, and striving to succeed despite limited resources. Participants also highlighted that their ideal fibroid-related care would include a holistic approach and social support.

Conclusions

Our findings emphasize that Black women's intersectional invisibility extends to fibroid treatment, reflecting the social-structural inequities that they face in health care settings more broadly. Attendance to Black women's voices in research and practice can help decrease their intersectional invisibility and subsequently improve their fibroid treatment and related health outcomes.

背景：由于性别歧视和种族歧视，黑人妇女的子宫平滑肌瘤（肌瘤）负担过重，她们的需求在卫生保健机构中被忽视。我们的目的是阐明黑人妇女在子宫肌瘤治疗中的经验，以及她们用来保护自己的健康和对抗交叉隐形的策略。方法：我们招募了来自子宫肌瘤基因与环境观察研究（FORGE）研究的参与者。我们对黑人妇女的肌瘤治疗经历进行了半结构化的个人访谈（平均时长45分钟）。我们使用主题分析方法和交叉性分析了转录本，交叉性是一种关键的分析框架，可以检查性别歧视和种族主义如何交叉影响健康不平等。结果：参与者是16名年龄在30-52岁的黑人女性，她们在华盛顿特区寻求肌瘤治疗。我们的分析显示，参与者在子宫肌瘤治疗中经历了性别种族主义（性别歧视和种族主义的交集），这反映了黑人妇女在医疗保健机构中如何被对待的历史和持续模式，并且他们通过参与超人模式特征的策略来管理交叉隐形：投射力量，压抑情绪，抵制依赖，尽管资源有限但仍努力取得成功。参与者还强调，他们理想的肌瘤相关护理将包括整体方法和社会支持。结论：我们的研究结果强调，黑人妇女的交叉性不可见性延伸到肌瘤治疗，反映了她们在更广泛的医疗保健环境中面临的社会结构不平等。在研究和实践中关注黑人妇女的声音可以帮助减少她们在交叉领域的不可见性，并随后改善她们的肌瘤治疗和相关的健康结果。

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引用次数: 0

Experiences and Perspectives of Sexual and Reproductive Health Among Women in Recovery From Opioid Use Disorder 从阿片类药物使用障碍中恢复的妇女性健康和生殖健康的经验和观点。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.07.003

Nicole M. Mattson PhD, RN, CNS-BC, Aleigha Barry RN, BSN, Jessica Zemlak PhD, MSN, RN

Background

Women in recovery from opioid use disorder (OUD) have unmet sexual and reproductive health (SRH) needs resulting in health disparities such as unintended pregnancy and sexually transmitted infections/HIV infection compared with women without OUD. The purpose of this qualitative descriptive study was to explore the perceptions and experiences of co-occurring multiple social-ecologic influences (individual, interpersonal, community, society) on SRH among women in recovery from OUD.

Methods

Purposive sampling was used to recruit cis-gender women aged 18–49 who self-identify as being in recovery from OUD and speak English. We conducted one 45- to 60-minute audio-recorded semistructured telephone interview with each participant.

Results

In our sample (N = 22), 59% identified as white and the mean age was 34.7 years (SD = 6.8). We identified themes related to SRH across social-ecological levels. Holistic Definition of SRH: Participants described an evolution of their knowledge and behaviors related to SRH during recovery to include preventive health, emotional well-being, and healthy relationships. Reevaluation of Relationships: Participants described undergoing a critical appraisal of their relationships and identified relationships that strengthened or threatened their recovery. Built and Lived Community: Participants described a rebuilding and restructuring of both social and physical domains of community. Shadow of Stigma: Participants described experiencing stigmatizing behaviors related to the interconnectedness of their childbearing capacity, SRH, and recovery.

Conclusions

Women's expansive descriptions of SRH in recovery extend beyond access to contraception and sexually transmitted infection/HIV screening. Interventions focused on SRH must account for the complex multilevel influences on the health of women in recovery from OUD.

背景：与没有阿片类药物使用障碍的妇女相比，从阿片类药物使用障碍（OUD）中恢复的妇女的性健康和生殖健康（SRH）需求未得到满足，导致意外怀孕和性传播感染/艾滋病毒感染等健康差异。本定性描述性研究的目的是探讨多重社会生态影响（个人、人际、社区、社会）共同发生对OUD康复妇女SRH的感知和体验。方法：采用目的抽样方法，招募年龄在18-49岁、自我认同为OUD恢复期、会说英语的顺性女性。我们对每个参与者进行了一次45到60分钟的录音半结构化电话采访。结果：本组22例患者中，59%为白种人，平均年龄34.7岁（SD = 6.8）。我们在社会生态层面确定了与SRH相关的主题。性健康和生殖健康的整体定义：参与者描述了他们在康复期间与性健康和生殖健康相关的知识和行为的演变，包括预防健康、情绪健康和健康的关系。关系的重新评估：参与者描述了对他们的关系进行的批判性评估，并确定了加强或威胁他们恢复的关系。建立和生活的社区：参与者描述了社区的社会和物理领域的重建和重组。污名化的阴影：参与者描述了与生育能力、性生殖健康和康复相关的污名化行为。结论：恢复期女性对性健康生殖健康的广泛描述超出了获得避孕和性传播感染/艾滋病毒筛查的范围。以性健康和生殖健康为重点的干预措施必须考虑到对妇女产后康复健康的复杂多层次影响。

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引用次数: 0

Demand for Medication Abortion Through Telehealth Before and After the Dobbs v. Jackson Supreme Court Decision in States Where Abortion Is Legal 在堕胎合法的州，多布斯诉杰克逊案最高法院判决前后，远程医疗对药物流产的需求。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.06.003

Anna E. Fiastro PhD, MPH, MEM , Elissa Brown MPH , Rebecca Gomperts MD, MPP, PhD , Emily M. Godfrey MD, MPH

Objective

The provision of medication abortion through telehealth accounts for an increasing share of total abortions in the United States, offering a private and affordable option for patients in both restrictive and supportive states. This study compares demand for telehealth medication abortion before and after the U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization (Dobbs) in states where abortion access is protected, to understand how patients seeking care in supportive states may have been impacted by the landmark decision.

Methods

We compared the volume of patients receiving medication abortion from a U.S.-based telehealth service in 18 states, the sociodemographic characteristics of patients, and self-reported reasons for choosing telehealth before and after the Dobbs decision using electronic medical records from March 24, 2022–September 24, 2022. All states examined support legal access to abortion; results were stratified to compare two levels of protective abortion policies.

Results

A total of 6,296 patients received medication abortion through telehealth during the study period. Daily demand increased by 74%, from an average of 25.0 patients per day in the pre-Dobbs period to 43.4 patients per day post-Dobbs (difference 18.4; 95% confidence interval [15.4, 21.5]; p < .001). No sociodemographic differences were observed between patient populations before and after the Dobbs decision. Comfort and privacy were the most frequently selected reasons for choosing telehealth in both time periods. Concern over legal restrictions was more frequently cited after the Dobbs decision. A larger increase in demand (88%) was observed in states with fewer protections post-Dobbs compared with states with the most protective policies (68%) (p < .001).

Conclusions

Demand for telehealth medication abortion increased after the Dobbs decision in states where abortion remained legal. Telehealth provides an essential pathway to access safe and effective abortion care for a broad range of patients across different policy environments.

目的：通过远程保健提供药物流产在美国流产总数中所占的份额越来越大，为限制性和支持性州的患者提供了一种私人和负担得起的选择。本研究比较了美国最高法院在多布斯诉杰克逊妇女健康组织（多布斯）一案中堕胎权受到保护的各州对远程医疗药物堕胎的需求，以了解在支持州寻求护理的患者如何受到具有里程碑意义的决定的影响。方法：从2022年3月24日至2022年9月24日，我们比较了美国18个州的远程医疗服务中接受药物流产的患者数量，患者的社会人口统计学特征，以及在多布斯决定前后使用电子病历报告选择远程医疗的原因。所有被调查的州都支持合法堕胎；将结果分层比较两个级别的保护性堕胎政策。结果：研究期间共6296例患者通过远程医疗接受了药物流产。每日需求增加了74%，从多布斯之前的平均每天25.0名患者增加到多布斯之后的每天43.4名患者(差异18.4；95%置信区间[15.4,21.5]；P < 0.001)。在Dobbs决定之前和之后，没有观察到患者群体之间的社会人口统计学差异。在这两个时期，舒适和隐私是选择远程保健的最常见原因。在多布斯案判决之后，人们更频繁地提到了对法律限制的担忧。在多布斯之后，与保护政策最多的州（68%）相比，在保护较少的州（88%）观察到更大的需求增长（p < 0.001）。结论：在堕胎仍然合法的州，对远程医疗药物流产的需求在多布斯判决后增加。远程保健为不同政策环境下的广大患者提供了获得安全有效堕胎护理的重要途径。

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引用次数: 0

Use of Preabortion Ultrasonography Among Telehealth Medication Abortion Patients 远程医疗药物流产患者人工流产前超声检查的应用。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.06.002

Sylvie T. Wilson MSPH , Lisa Peters MPH , Leah R. Koenig PhD, MSPH , Suzanne O. Bell PhD, MPH , Ushma D. Upadhyay PhD, MPH

Background

Since 2020, some clinicians have offered telehealth medication abortion care that does not require ultrasonographic screening for eligible patients. However, some telehealth medication abortion patients nonetheless obtain ultrasonography.

Objective

This study aims to understand which patients obtain ultrasonography before telehealth medication abortion, their reasons for ultrasonography, and where they obtain it.

Study Design

Using data from the California Home Abortion by Telehealth (CHAT) Study, a cohort study of patients using telehealth abortion services in 2021 and 2022, participants were asked whether they had pre-abortion ultrasonographic imaging, reasons for the ultrasonography, and where they obtained it. We analyzed these responses using chi-squared tests, Fisher's exact tests, and multivariable logistic regression.

Results

Among 1,775 participants, 11% (n = 194) obtained ultrasonography before their abortion. In the multivariable model, participants who were younger, were food insecure, had a pregnancy duration of 35 days (5 weeks) or more, or were unsure of their pregnancy duration were significantly more likely to obtain pre-abortion ultrasonography. The most common reason for ultrasonography was to assess pregnancy duration (69%). Most participants obtained imaging at a clinic (41%) or at an emergency room or hospital (27%), although some obtained imaging at crisis pregnancy centers (14%). Of those who obtained ultrasonography, 8% were referred by their telehealth provider; the remainder sought ultrasonography on their own initiative.

Conclusion

Hospitals, clinics, and imaging facilities can create policies to increase the accessibility of ultrasonography for those who desire or require pre-abortion ultrasonography.

背景：自2020年以来，一些临床医生为符合条件的患者提供了不需要超声筛查的远程医疗药物流产护理。然而，一些远程医疗药物流产患者仍然接受超声检查。目的：了解远程医疗药物流产患者术前超声检查情况、超声检查原因及超声检查地点。研究设计：使用加州远程医疗家庭堕胎（CHAT）研究的数据，这是一项针对2021年和2022年使用远程医疗堕胎服务的患者的队列研究，参与者被问及他们是否有堕胎前超声成像，超声成像的原因，以及他们在哪里获得的超声成像。我们使用卡方检验、Fisher精确检验和多变量逻辑回归分析这些反应。结果：在1775名参与者中，11% （n = 194）在流产前进行了超声检查。在多变量模型中，年龄较小、食物不安全、怀孕持续时间为35天（5周）或更长，或不确定其怀孕持续时间的参与者更有可能获得流产前超声检查。超声检查最常见的原因是评估妊娠期（69%）。大多数参与者在诊所（41%）或急诊室或医院（27%）接受了影像学检查，尽管有些人在危重妊娠中心（14%）接受了影像学检查。在接受超声检查的人中，8%是由远程保健提供者介绍的；其余的则主动寻求超声检查。结论：医院、诊所和影像机构可以制定政策，为希望或需要进行流产前超声检查的患者增加超声检查的可及性。

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引用次数: 0

Differences in Contraceptive Method Discontinuation and Contraceptive Method Preferences by Disability Status 残疾状况对避孕方法停药和避孕方法偏好的影响。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-09-01 DOI: 10.1016/j.whi.2025.06.004

Zoe H. Pleasure MPH , Laura D. Lindberg PhD

Background

Contraceptive care delivery to people with disabilities must be contextualized within the U.S. history of stratified reproduction and eugenics. Significant sexual and reproductive health inequities have been documented between people with disabilities and those without disabilities in family planning service receipt and contraceptive method use. Little research has examined how discontinuation of contraception or dissatisfaction with contraceptive methods may differ for people with disabilities.

Objective

This study assesses differences in contraceptive desires and experiences between disabled and nondisabled individuals.

Methods

Our sample included self-identified female respondents from the 2011–2019 National Survey of Family Growth. We examined demographic and sexual and reproductive health differences between disabled and nondisabled respondents based on self-report of disabilities. Unadjusted and adjusted logistic regression models estimated differences in contraceptive method discontinuation due to dissatisfaction and method choice based on cost.

Results

Differences by disability status were found for reports of fecundity and the contraceptive method used in the past 12 months. In both unadjusted and adjusted models, significantly more disabled people than nondisabled people reported having discontinued their method because of dissatisfaction and having wanted to use a different method if cost were not an issue.

Conclusions

Self-reported disabilities are associated with contraceptive method dissatisfaction and unmet contraceptive preferences. Efforts are needed to tailor person-centered clinical care that is responsive to this population's reproductive wants and needs.

背景：向残疾人提供避孕护理必须在美国分层生殖和优生学的历史背景下进行。有记录表明，残疾人和非残疾人在接受计划生育服务和使用避孕方法方面存在严重的性健康和生殖健康不平等。很少有研究调查停止避孕或对避孕方法不满意对残疾人有何不同。目的：本研究评估残疾人和非残疾人在避孕欲望和体验方面的差异。方法：我们的样本包括2011-2019年全国家庭增长调查中自我认定的女性受访者。我们根据残疾自我报告检查了残疾和非残疾受访者之间的人口统计学和性健康和生殖健康差异。未调整和调整的逻辑回归模型估计了由于不满意和基于成本的方法选择而停止避孕方法的差异。结果：在过去12个月的生育能力和使用的避孕方法的报告中发现残疾状况的差异。在未调整和调整的模型中，残疾人比非残疾人报告说，由于不满意而停止使用他们的方法，并且如果成本不是问题，他们想使用不同的方法。结论：自我报告的残疾与避孕方法不满意和未满足的避孕偏好有关。需要努力调整以人为本的临床护理，以满足这一人群的生殖需求。

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引用次数: 0