We aimed to 1) characterize those who did and did not obtain an abortion and reasons why, and 2) evaluate the association between various facilitators, including financial and social support, and accessing an abortion.
Methods
Between June 2021 and April 2022, we recruited pregnant Indiana residents considering abortion through online posts, abortion funds, and abortion clinics. Respondents completed an online baseline survey and a follow-up survey 1 month later. Surveys collected information on sociodemographic characteristics, barriers and facilitators to abortion, and pregnancy outcome.
Results
Among 221 participants, 77% obtained an abortion within 1 month. Among online and abortion fund recruits, those who identified as Black or African American or Hispanic/Latinx and those without insurance were less likely to have had an abortion than were white and insured participants. Financial support from abortion funds and clinics and social support from peer networks were associated with higher odds of accessing abortion care 1 month later. Among participants still seeking abortion at 1 month or who had given birth, 64% reported that needing to gather money to pay for the abortion or travel expenses/lodging was a barrier to care. Among those who were no longer considering abortion at 1 month and planned to continue their pregnancy, 28% reported doing so because they did not have the money for an abortion.
Conclusions
In a restrictive state policy environment, receipt of financial and social support was associated with greater likelihood of obtaining abortion within a month of reporting considering or seeking it among a sample of pregnant people in Indiana.
{"title":"Financial, Social, and Demographic Factors Associated With Obtaining an Abortion: A Longitudinal Study in Indiana in 2021–2022","authors":"Alexandra Wollum PhD, MPH , Bria Goode MPH , Caitlin McKenna , Megan Jeyifo , Lizz Perkins , Meg Sasse Stern , Qudsiyyah Shariyf , Tracey A. Wilkinson MD, MPH , Heidi Moseson PhD, MPH","doi":"10.1016/j.whi.2025.03.001","DOIUrl":"10.1016/j.whi.2025.03.001","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to 1) characterize those who did and did not obtain an abortion and reasons why, and 2) evaluate the association between various facilitators, including financial and social support, and accessing an abortion.</div></div><div><h3>Methods</h3><div>Between June 2021 and April 2022, we recruited pregnant Indiana residents considering abortion through online posts, abortion funds, and abortion clinics. Respondents completed an online baseline survey and a follow-up survey 1 month later. Surveys collected information on sociodemographic characteristics, barriers and facilitators to abortion, and pregnancy outcome.</div></div><div><h3>Results</h3><div>Among 221 participants, 77% obtained an abortion within 1 month. Among online and abortion fund recruits, those who identified as Black or African American or Hispanic/Latinx and those without insurance were less likely to have had an abortion than were white and insured participants. Financial support from abortion funds and clinics and social support from peer networks were associated with higher odds of accessing abortion care 1 month later. Among participants still seeking abortion at 1 month or who had given birth, 64% reported that needing to gather money to pay for the abortion or travel expenses/lodging was a barrier to care. Among those who were no longer considering abortion at 1 month and planned to continue their pregnancy, 28% reported doing so because they did not have the money for an abortion.</div></div><div><h3>Conclusions</h3><div>In a restrictive state policy environment, receipt of financial and social support was associated with greater likelihood of obtaining abortion within a month of reporting considering or seeking it among a sample of pregnant people in Indiana.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 159-168"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.whi.2025.02.005
Suzan L. Carmichael PhD, MS , Peiyi Kan MS , Jonathan M. Snowden PhD
{"title":"Markers of Maternal Morbidity: Research Recommendations for Severe Perineal Lacerations, Severe Maternal Morbidity, and Other Complications","authors":"Suzan L. Carmichael PhD, MS , Peiyi Kan MS , Jonathan M. Snowden PhD","doi":"10.1016/j.whi.2025.02.005","DOIUrl":"10.1016/j.whi.2025.02.005","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 139-142"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.whi.2025.02.004
Sophia C. Garbarino MPH , Elizabeth Reisinger Walker PhD, MPH, MAT , Melissa J. Kottke MD, MPH, MBA , Hayat Mekonen BSPH , Jessica M. Sales PhD
Objectives
Georgia Title X sites serve over 160,000 patients per year, providing critical contraceptive access. The U.S. Medical Eligibility Criteria and Selected Practice Recommendations for Contraceptive Use (U.S. MEC SPR) are meant to increase contraception access, but few studies have explored U.S. MEC SPR implementation. This qualitative study aimed to understand Georgia Title X providers’ experiences with and attitudes toward U.S. MEC SPR implementation.
Study Design
From March 2023 to December 2023, we conducted semi-structured interviews with 20 Georgia Title X providers. Participants also completed a short demographic survey. Transcripts were first assessed using rapid analysis techniques in Google Sheets, then analyzed more thoroughly with a thematic analysis approach in Dedoose. We calculated demographic descriptive statistics using SAS.
Results
The sample was diverse in race but not gender; all participants identified as cisgender women. Interviews revealed that most participants learned about the guidelines in medical or nursing school. Notable benefits of using the U.S. MEC SPR included facilitating patient contraceptive education and building providers’ confidence in their prescribing skills. The only reported challenges were limited user-friendliness and limited information about certain medical conditions in the U.S. MEC. Participants had mixed experiences with clinic leadership prioritizing U.S. MEC SPR use but reported similar perceived patient barriers to care.
Conclusions
This study suggests that the U.S. MEC SPR can help Title X providers serve clients seeking contraception, but barriers to widespread implementation remain. Efforts to increase guidelines use should consider providers’ needs and preferences along with factors impacting patient access to contraceptive care.
{"title":"Title X Provider Experiences With and Perceptions of Contraception Guidelines Implementation in Georgia: A Qualitative Study","authors":"Sophia C. Garbarino MPH , Elizabeth Reisinger Walker PhD, MPH, MAT , Melissa J. Kottke MD, MPH, MBA , Hayat Mekonen BSPH , Jessica M. Sales PhD","doi":"10.1016/j.whi.2025.02.004","DOIUrl":"10.1016/j.whi.2025.02.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Georgia Title X sites serve over 160,000 patients per year, providing critical contraceptive access. The U.S. Medical Eligibility Criteria and Selected Practice Recommendations for Contraceptive Use (U.S. MEC SPR) are meant to increase contraception access, but few studies have explored U.S. MEC SPR implementation. This qualitative study aimed to understand Georgia Title X providers’ experiences with and attitudes toward U.S. MEC SPR implementation.</div></div><div><h3>Study Design</h3><div>From March 2023 to December 2023, we conducted semi-structured interviews with 20 Georgia Title X providers. Participants also completed a short demographic survey. Transcripts were first assessed using rapid analysis techniques in Google Sheets, then analyzed more thoroughly with a thematic analysis approach in Dedoose. We calculated demographic descriptive statistics using SAS.</div></div><div><h3>Results</h3><div>The sample was diverse in race but not gender; all participants identified as cisgender women. Interviews revealed that most participants learned about the guidelines in medical or nursing school. Notable benefits of using the U.S. MEC SPR included facilitating patient contraceptive education and building providers’ confidence in their prescribing skills. The only reported challenges were limited user-friendliness and limited information about certain medical conditions in the U.S. MEC. Participants had mixed experiences with clinic leadership prioritizing U.S. MEC SPR use but reported similar perceived patient barriers to care.</div></div><div><h3>Conclusions</h3><div>This study suggests that the U.S. MEC SPR can help Title X providers serve clients seeking contraception, but barriers to widespread implementation remain. Efforts to increase guidelines use should consider providers’ needs and preferences along with factors impacting patient access to contraceptive care.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 188-195"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1016/j.whi.2025.02.002
Amar D. Mandavia MA, PhD , Anne N. Banducci PhD , Tracy L. Simpson PhD , Brian P. Marx PhD , Sage E. Hawn PhD , Justeen Hyde PhD , Victoria E. Ameral PhD , Rebecca E. Sistad Hall PhD , Clara E. Roth BA , Alexis A. Sarpong MPH , Michael Davenport MA , Frank Meng PhD , Michael D. Stein MD , Nicholas A. Livingston PhD
Background
Veterans with substance use disorders (SUDs) are at elevated risk of dying by suicide. We examined sex and age differences in rates and means of suicide death among veterans with alcohol (AUD) and/or opioid use disorder (OUD) diagnoses.
Methods
We studied a cohort of veterans with AUD and/or OUD diagnoses who received Veterans Health Administration care and died of any cause between January 2016 and December 2020. We assessed the risk of suicide death and lethal means by sex, age, and their interaction.
Results
Among veterans with AUD and/or OUD, 119,693 died of any cause during the study period. Suicides represented 4.5% of all deaths (n = 5,419), with women being 2.25 times (95% confidence interval [CI], 1.97–2.55) more likely to die by suicide than men and dying at significantly younger ages than men. Suicide deaths accounted for 21.28 and 32.25 years of potential life lost for men (mean age, 52.92 ± 14.81 years) and women (mean age, 47.65 ± 11.52 years), respectively. Intentional poisoning was the most common means of suicide death for both men and women. Women were 2.08 times (95% CI, 1.61–2.71) more likely to die by poisoning-related suicide than men. Men were 1.73 times (95% CI, 1.13–2.77) more likely to die by firearms-related suicide than women.
Conclusion
Among veterans diagnosed with AUD and/or OUD, women were more likely to die by suicide, at a younger age, than men. Poisoning was the primary means of suicide death for men and women. These national-level data highlight the urgency of suicide risk assessment and prevention among women veterans with substance use disorder.
{"title":"Sex Differences in Suicide, Lethal Means, and Years of Potential Life Lost Among Veterans With Substance Use Disorder","authors":"Amar D. Mandavia MA, PhD , Anne N. Banducci PhD , Tracy L. Simpson PhD , Brian P. Marx PhD , Sage E. Hawn PhD , Justeen Hyde PhD , Victoria E. Ameral PhD , Rebecca E. Sistad Hall PhD , Clara E. Roth BA , Alexis A. Sarpong MPH , Michael Davenport MA , Frank Meng PhD , Michael D. Stein MD , Nicholas A. Livingston PhD","doi":"10.1016/j.whi.2025.02.002","DOIUrl":"10.1016/j.whi.2025.02.002","url":null,"abstract":"<div><h3>Background</h3><div>Veterans with substance use disorders (SUDs) are at elevated risk of dying by suicide. We examined sex and age differences in rates and means of suicide death among veterans with alcohol (AUD) and/or opioid use disorder (OUD) diagnoses.</div></div><div><h3>Methods</h3><div>We studied a cohort of veterans with AUD and/or OUD diagnoses who received Veterans Health Administration care and died of any cause between January 2016 and December 2020. We assessed the risk of suicide death and lethal means by sex, age, and their interaction.</div></div><div><h3>Results</h3><div>Among veterans with AUD and/or OUD, 119,693 died of any cause during the study period. Suicides represented 4.5% of all deaths (<em>n</em> = 5,419), with women being 2.25 times (95% confidence interval [CI], 1.97–2.55) more likely to die by suicide than men and dying at significantly younger ages than men. Suicide deaths accounted for 21.28 and 32.25 years of potential life lost for men (mean age, 52.92 ± 14.81 years) and women (mean age, 47.65 ± 11.52 years), respectively. Intentional poisoning was the most common means of suicide death for both men and women. Women were 2.08 times (95% CI, 1.61–2.71) more likely to die by poisoning-related suicide than men. Men were 1.73 times (95% CI, 1.13–2.77) more likely to die by firearms-related suicide than women.</div></div><div><h3>Conclusion</h3><div>Among veterans diagnosed with AUD and/or OUD, women were more likely to die by suicide, at a younger age, than men. Poisoning was the primary means of suicide death for men and women. These national-level data highlight the urgency of suicide risk assessment and prevention among women veterans with substance use disorder.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 196-204"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We sought to understand the extent to which the contraceptive care provided at publicly supported family planning clinics in the United States aligns with aspects of person-centered care.
Materials and Methods
We conducted a descriptive study with a national sample of U.S. family planning clinics between November 2022 and December 2023. We measured person-centeredness by the scope of services offered, including the extent to which providers solicit and prioritize patients’ contraceptive intentions, preferences, and goals; the dispensing protocols for various contraceptive methods; and the availability of social services such as intimate partner violence screening and housing insecurity support. We fielded an online survey to a sample of 2,146 clinics, and our analytic sample was 422 clinics.
Results
Our results highlight that most publicly supported family planning clinics provide contraception using counseling protocols that support patient-centeredness, such as assessing patients’ contraceptive preferences during contraceptive counseling. However, we found statistically significant variation by clinic type within many of these measures, with a higher proportion of Planned Parenthood clinics following patient-centered protocols than other clinic types, particularly federally qualified health centers and community health centers.
Conclusions
Publicly supported family planning clinics provide contraception using some person-centered care protocols, although there is room for improvement. Furthermore, person-centered practices vary by clinic type. More research should be done with patients to assess additional elements of person-centered contraceptive care.
{"title":"Assessing the Provision of Person-Centered Contraceptive Care at Publicly Supported Clinics Providing Contraceptive Services in the United States","authors":"Jennifer Mueller MPH, Priscille Osias BA, Madeleine Haas BA, Alicia VandeVusse PhD","doi":"10.1016/j.whi.2025.03.003","DOIUrl":"10.1016/j.whi.2025.03.003","url":null,"abstract":"<div><h3>Introduction</h3><div>We sought to understand the extent to which the contraceptive care provided at publicly supported family planning clinics in the United States aligns with aspects of person-centered care.</div></div><div><h3>Materials and Methods</h3><div>We conducted a descriptive study with a national sample of U.S. family planning clinics between November 2022 and December 2023. We measured person-centeredness by the scope of services offered, including the extent to which providers solicit and prioritize patients’ contraceptive intentions, preferences, and goals; the dispensing protocols for various contraceptive methods; and the availability of social services such as intimate partner violence screening and housing insecurity support. We fielded an online survey to a sample of 2,146 clinics, and our analytic sample was 422 clinics.</div></div><div><h3>Results</h3><div>Our results highlight that most publicly supported family planning clinics provide contraception using counseling protocols that support patient-centeredness, such as assessing patients’ contraceptive preferences during contraceptive counseling. However, we found statistically significant variation by clinic type within many of these measures, with a higher proportion of Planned Parenthood clinics following patient-centered protocols than other clinic types, particularly federally qualified health centers and community health centers.</div></div><div><h3>Conclusions</h3><div>Publicly supported family planning clinics provide contraception using some person-centered care protocols, although there is room for improvement. Furthermore, person-centered practices vary by clinic type. More research should be done with patients to assess additional elements of person-centered contraceptive care.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 169-179"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Women's smoking and cessation behaviors are influenced by various sex- and gender- (SaG) related factors; however, most smoking cessation programs that do not target pregnant women follow a gender-neutral approach. We aimed to systematically review the literature on smoking cessation programs for women outside reproductive contexts to assess their effectiveness and how they address SaG-related barriers.
Methods
We selected experimental studies published between June 1, 2009, and June 7, 2023, that describe smoking cessation interventions designed exclusively for women. Two independent reviewers extracted study characteristics, intervention effectiveness, strategies to address SaG-related factors, and the studies’ approach to gender equity using the gender integration continuum. We searched multiple databases to comprehensively identify relevant studies for inclusion. The protocol was registered with PROSPERO #CRD42023429054.
Results
Twenty-five studies were selected and summarized using a narrative synthesis. Of these, nine (36%) found a greater reduction in smoking in the intervention group relative to the comparison group. Nine studies addressed women's concerns about post-cessation weight gain; however, in only one of these did the intervention group show a greater likelihood of quitting smoking relative to the comparison group. In contrast, three of four studies tailored for women facing socioeconomic disadvantage, and three of four studies designed for women with medical comorbidities, reported a greater reduction in smoking behaviors in the intervention relative to the comparison group. Ten studies relied solely on counseling and did not provide participants with smoking cessation pharmacotherapy. Overall, studies addressed individual and community-level barriers to quitting, including post-cessation weight gain, lack of social support, psychological distress, and cultural influences. All but one study avoided using harmful gender norms to promote cessation.
Conclusions
Strategies that address SaG-related barriers to quitting may improve cessation outcomes among women, particularly when tailored to meet the unique needs of specific groups such as those facing socioeconomic disadvantage. Future studies should combine best practices in smoking cessation treatment—behavioral counseling and pharmacotherapy—with new knowledge on how SaG factors influence motives for smoking and barriers to quitting. Such an approach could lead to more effective and equitable smoking cessation interventions for women.
{"title":"Smoking Cessation Programs for Women in Non-reproductive Contexts: A Systematic Review","authors":"Alexa Gruber BHSc , Alexa Braverman BSc , Wayne K. deRuiter PhD , Terri Rodak MA, MISt , Lorraine Greaves PhD , Nancy Poole PhD , Monica Parry MEd, MSc, NP-Adult, PhD , Monika Kastner PhD , Diana Sherifali RN, PhD, CDE , Carly Whitmore RN, PhD , Andrew Sixsmith PhD , Sabrina Voci PhD , Nadia Minian PhD , Laurie Zawertailo PhD , Peter Selby MBBS, MHSc , Osnat C. Melamed MD, MSc","doi":"10.1016/j.whi.2025.01.003","DOIUrl":"10.1016/j.whi.2025.01.003","url":null,"abstract":"<div><h3>Background</h3><div>Women's smoking and cessation behaviors are influenced by various sex- and gender- (SaG) related factors; however, most smoking cessation programs that do not target pregnant women follow a gender-neutral approach. We aimed to systematically review the literature on smoking cessation programs for women outside reproductive contexts to assess their effectiveness and how they address SaG-related barriers.</div></div><div><h3>Methods</h3><div>We selected experimental studies published between June 1, 2009, and June 7, 2023, that describe smoking cessation interventions designed exclusively for women. Two independent reviewers extracted study characteristics, intervention effectiveness, strategies to address SaG-related factors, and the studies’ approach to gender equity using the gender integration continuum. We searched multiple databases to comprehensively identify relevant studies for inclusion. The protocol was registered with PROSPERO #CRD42023429054.</div></div><div><h3>Results</h3><div>Twenty-five studies were selected and summarized using a narrative synthesis. Of these, nine (36%) found a greater reduction in smoking in the intervention group relative to the comparison group. Nine studies addressed women's concerns about post-cessation weight gain; however, in only one of these did the intervention group show a greater likelihood of quitting smoking relative to the comparison group. In contrast, three of four studies tailored for women facing socioeconomic disadvantage, and three of four studies designed for women with medical comorbidities, reported a greater reduction in smoking behaviors in the intervention relative to the comparison group. Ten studies relied solely on counseling and did not provide participants with smoking cessation pharmacotherapy. Overall, studies addressed individual and community-level barriers to quitting, including post-cessation weight gain, lack of social support, psychological distress, and cultural influences. All but one study avoided using harmful gender norms to promote cessation.</div></div><div><h3>Conclusions</h3><div>Strategies that address SaG-related barriers to quitting may improve cessation outcomes among women, particularly when tailored to meet the unique needs of specific groups such as those facing socioeconomic disadvantage. Future studies should combine best practices in smoking cessation treatment—behavioral counseling and pharmacotherapy—with new knowledge on how SaG factors influence motives for smoking and barriers to quitting. Such an approach could lead to more effective and equitable smoking cessation interventions for women.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 123-137"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.whi.2024.12.002
Laura B. Attanasio PhD , Kimberley H. Geissler PhD
Objective
More than 40% of U.S. birthing people are covered by Medicaid. Accountable Care Organizations (ACOs) are increasingly common in state Medicaid programs and may influence maternal health, quality of care, and outcomes. However, there has been limited examination of how Medicaid ACOs operate in the context of perinatal care. Our objective was to explore how individuals in ACO leadership have approached program design to address maternal health and how these programs have shaped health care utilization and maternal health from the perspective of postpartum ACO beneficiaries and clinicians.
Methods
We conducted virtual semi-structured interviews with three key stakeholder groups in Massachusetts (ACO leaders, maternity care clinicians, and Medicaid ACO members who had given birth within the past 6–24 months) between November 2021 and May 2023. Purposive sampling aimed to achieve variation in geographic location (members and clinicians) and race/ethnicity (members). Interviews were recorded, professionally transcribed, and analyzed iteratively using thematic analysis.
Principal Findings
Thirty-three interviews were conducted: four with ACO leaders, 15 with maternity care clinicians, and 14 with ACO members. Maternity care clinicians did not perceive that ACO implementation had substantially impacted perinatal health care. Interviews with ACO leadership suggested that the lack of perceived impact may be partially explained by competing priorities; the Massachusetts Medicaid ACOs generally did not focus on maternal health during the initial implementation period. Postpartum ACO members were largely unaware of ACOs.
Conclusions
Lack of explicit attention to the perinatal population in Medicaid financing and delivery system reforms may reduce the potential impact in improving outcomes.
{"title":"“On the OB Side of Things, It's Completely Disconnected”: Early Implementation of Medicaid Accountable Care Organizations and Health Care in the Perinatal Period","authors":"Laura B. Attanasio PhD , Kimberley H. Geissler PhD","doi":"10.1016/j.whi.2024.12.002","DOIUrl":"10.1016/j.whi.2024.12.002","url":null,"abstract":"<div><h3>Objective</h3><div>More than 40% of U.S. birthing people are covered by Medicaid. Accountable Care Organizations (ACOs) are increasingly common in state Medicaid programs and may influence maternal health, quality of care, and outcomes. However, there has been limited examination of how Medicaid ACOs operate in the context of perinatal care. Our objective was to explore how individuals in ACO leadership have approached program design to address maternal health and how these programs have shaped health care utilization and maternal health from the perspective of postpartum ACO beneficiaries and clinicians.</div></div><div><h3>Methods</h3><div>We conducted virtual semi-structured interviews with three key stakeholder groups in Massachusetts (ACO leaders, maternity care clinicians, and Medicaid ACO members who had given birth within the past 6–24 months) between November 2021 and May 2023. Purposive sampling aimed to achieve variation in geographic location (members and clinicians) and race/ethnicity (members). Interviews were recorded, professionally transcribed, and analyzed iteratively using thematic analysis.</div></div><div><h3>Principal Findings</h3><div>Thirty-three interviews were conducted: four with ACO leaders, 15 with maternity care clinicians, and 14 with ACO members. Maternity care clinicians did not perceive that ACO implementation had substantially impacted perinatal health care. Interviews with ACO leadership suggested that the lack of perceived impact may be partially explained by competing priorities; the Massachusetts Medicaid ACOs generally did not focus on maternal health during the initial implementation period. Postpartum ACO members were largely unaware of ACOs.</div></div><div><h3>Conclusions</h3><div>Lack of explicit attention to the perinatal population in Medicaid financing and delivery system reforms may reduce the potential impact in improving outcomes.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 89-96"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.whi.2025.02.008
Liz Borkowski MPH, Karen A. McDonnell PhD
{"title":"Remembering Susan F. Wood, a Champion of Evidence-Based Policy for Women's Health","authors":"Liz Borkowski MPH, Karen A. McDonnell PhD","doi":"10.1016/j.whi.2025.02.008","DOIUrl":"10.1016/j.whi.2025.02.008","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 63-64"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.whi.2025.02.001
Elizabeth R. Boskey PhD, MPH, MSSW , Emile Redwood MD , Til Parsa MD , Frances W. Grimstad MS, MD
Background
As more transgender adolescents and young adults seek gender-affirming care, questions persist about how their desire for potentially fertility-affecting treatment intersects with their fertility intentions.
Methods
We surveyed 125 individuals born with a uterus and ovaries, living in the United States, initially prescribed gender-affirming testosterone at or before age 18, about their interest in genetically related children and history of fertility preservation and fertility-affecting procedures.
Results
Twenty-two percent of respondents did not want children, and 47% wanted children but did not think a genetic relationship was important. Another 8% indicated having genetically related children was important and 17% indicated they did not know. Only 47% recalled counseling about fertility preservation. Those who might want genetically related children were less satisfied when they did not recall counseling (p = .001). Significantly more people in the group who might want genetically related children still had one or both ovaries (100% vs. 86%; p = .03), desired to carry a pregnancy in the future or were unsure (30% vs. 8%; p = .01), and either desired to use their eggs for genetically related children or were unsure (93% vs. 26%; p < .001).
Conclusions
More than one-half of individuals prescribed gender-affirming testosterone as adolescents had no interest in genetically related children. Those who were interested in genetically related children were more likely to have other fertility-preserving interests and behaviors, including potentially desiring a pregnancy and still having one or both ovaries. This finding suggests that fertility-related behaviors of individuals prescribed gender-affirming testosterone are in line with their stated goals.
背景：随着越来越多的跨性别青少年和年轻人寻求性别确认治疗，关于他们对可能影响生育的治疗的渴望与他们的生育意图如何交叉的问题仍然存在。方法：我们调查了125名出生时就有子宫和卵巢的人，他们生活在美国，在18岁或18岁之前开始使用性别确认睾酮，了解他们对遗传相关儿童的兴趣以及生育能力保存和生育影响手术的历史。结果：22%的受访者不想要孩子，47%的人想要孩子，但认为遗传关系并不重要。另有8%的人表示有基因相关的孩子很重要，17%的人表示他们不知道。只有47%的人回忆起关于保留生育能力的咨询。那些可能想要有遗传关系的孩子的人，当他们不记得咨询时，满意度较低（p = .001）。在那些可能想要有遗传关系的孩子的人群中，明显更多的人仍然有一个或两个卵巢(100%比86%；P = .03)，希望将来怀孕或不确定(30% vs. 8%；P = 0.01)，或者希望将其卵子用于遗传相关的儿童，或者不确定(93% vs. 26%；结论：超过一半的人在青少年时期服用了性别确认睾酮，他们对有基因关系的孩子没有兴趣。那些对有遗传关系的孩子感兴趣的人更有可能有其他保持生育能力的兴趣和行为，包括潜在地希望怀孕，但仍然拥有一个或两个卵巢。这一发现表明，服用性别确认睾酮的个体的生育相关行为符合他们的既定目标。
{"title":"Fertility Intentions and Histories Among Transgender Adults Who Started Gender-Affirming Testosterone Before Adulthood","authors":"Elizabeth R. Boskey PhD, MPH, MSSW , Emile Redwood MD , Til Parsa MD , Frances W. Grimstad MS, MD","doi":"10.1016/j.whi.2025.02.001","DOIUrl":"10.1016/j.whi.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>As more transgender adolescents and young adults seek gender-affirming care, questions persist about how their desire for potentially fertility-affecting treatment intersects with their fertility intentions.</div></div><div><h3>Methods</h3><div>We surveyed 125 individuals born with a uterus and ovaries, living in the United States, initially prescribed gender-affirming testosterone at or before age 18, about their interest in genetically related children and history of fertility preservation and fertility-affecting procedures.</div></div><div><h3>Results</h3><div>Twenty-two percent of respondents did not want children, and 47% wanted children but did not think a genetic relationship was important. Another 8% indicated having genetically related children was important and 17% indicated they did not know. Only 47% recalled counseling about fertility preservation. Those who might want genetically related children were less satisfied when they did not recall counseling (<em>p</em> = .001). Significantly more people in the group who might want genetically related children still had one or both ovaries (100% vs. 86%; <em>p</em> = .03), desired to carry a pregnancy in the future or were unsure (30% vs. 8%; <em>p</em> = .01), and either desired to use their eggs for genetically related children or were unsure (93% vs. 26%; <em>p</em> < .001).</div></div><div><h3>Conclusions</h3><div>More than one-half of individuals prescribed gender-affirming testosterone as adolescents had no interest in genetically related children. Those who were interested in genetically related children were more likely to have other fertility-preserving interests and behaviors, including potentially desiring a pregnancy and still having one or both ovaries. This finding suggests that fertility-related behaviors of individuals prescribed gender-affirming testosterone are in line with their stated goals.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 74-82"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.whi.2025.01.005
Maureen K. Galindo MS, RN , Scott E. Klewer MD , Karrie F. Downing MPH , Chelsea L. Takamatsu MD , Michael D. Seckeler MD, MSc , Matthew E. Oster MD, MPH , R. Thomas Collins II MD , Wendy N. Nembhard PhD, MPH , Elijah H. Bolin MD , Sherry L. Farr PhD, MSPH
Background
Guidelines recommend tailored reproductive health counseling for women with congenital heart defects (CHDs) beginning in adolescence, yet provider adherence to recommendations remains understudied, particularly outside specialized cardiac care settings.
Study Design
We conducted a cross-sectional cohort study among women aged 19 to 38 with CHDs, identified from active population-based birth defects registries in three states. Participants completed surveys from 2016 to 2019, including questions about contraception, pregnancy counseling, concerns, and experiences. Multivariable Poisson regression, adjusted for sociodemographic and health characteristics, assessed associations between CHD severity, counseling, and reproductive health outcomes.
Results
Of 765 women, those with severe CHDs, compared with non-severe, were more likely to report receiving clinician counseling about safe contraceptive methods (44.0% and 13.7%; adjusted prevalence ratio [aPR] = 3.0; 95% confidence interval [95% CI] [2.2, 4.0]), pregnancy, (63.3% and 16.5%; aPR = 3.6; 95% CI [2.7, 4.6]), and pregnancy avoidance (32.0% and 6.4%; aPR = 4.3; 95% CI [2.9, 6.6]); be concerned about ability to have children (40.9% and 31.2%; aPR = 1.4; 95% CI [1.1, 1.8]), and delay/avoid pregnancy (26.6% and 10.7%; aPR = 2.2; 95% CI [1.5, 3.2]). No disparity was found in ever being pregnant (30.0% vs. 37.2%; aPR = 1.0; 95% CI [0.7, 1.2]). One-third of the respondents with any CHD reported concerns about their ability to have children (33.6%).
Conclusion
We found that only a minority of women with CHDs reported receiving counseling on safe contraception and pregnancy, and about a third reported concerns about their ability to have children. These findings highlight a gap between guideline recommendations and clinical practice, underscoring the need for improved reproductive health discussions for women with CHDs.
{"title":"Reproductive Health Counseling and Outcomes Among Women With Congenital Heart Defects: Results From the Congenital Heart Survey to Recognize Outcomes, Needs, and Well-Being, 2016–2019","authors":"Maureen K. Galindo MS, RN , Scott E. Klewer MD , Karrie F. Downing MPH , Chelsea L. Takamatsu MD , Michael D. Seckeler MD, MSc , Matthew E. Oster MD, MPH , R. Thomas Collins II MD , Wendy N. Nembhard PhD, MPH , Elijah H. Bolin MD , Sherry L. Farr PhD, MSPH","doi":"10.1016/j.whi.2025.01.005","DOIUrl":"10.1016/j.whi.2025.01.005","url":null,"abstract":"<div><h3>Background</h3><div>Guidelines recommend tailored reproductive health counseling for women with congenital heart defects (CHDs) beginning in adolescence, yet provider adherence to recommendations remains understudied, particularly outside specialized cardiac care settings.</div></div><div><h3>Study Design</h3><div>We conducted a cross-sectional cohort study among women aged 19 to 38 with CHDs, identified from active population-based birth defects registries in three states. Participants completed surveys from 2016 to 2019, including questions about contraception, pregnancy counseling, concerns, and experiences. Multivariable Poisson regression, adjusted for sociodemographic and health characteristics, assessed associations between CHD severity, counseling, and reproductive health outcomes.</div></div><div><h3>Results</h3><div>Of 765 women, those with severe CHDs, compared with non-severe, were more likely to report receiving clinician counseling about safe contraceptive methods (44.0% and 13.7%; adjusted prevalence ratio [aPR] = 3.0; 95% confidence interval [95% CI] [2.2, 4.0]), pregnancy, (63.3% and 16.5%; aPR = 3.6; 95% CI [2.7, 4.6]), and pregnancy avoidance (32.0% and 6.4%; aPR = 4.3; 95% CI [2.9, 6.6]); be concerned about ability to have children (40.9% and 31.2%; aPR = 1.4; 95% CI [1.1, 1.8]), and delay/avoid pregnancy (26.6% and 10.7%; aPR = 2.2; 95% CI [1.5, 3.2]). No disparity was found in ever being pregnant (30.0% vs. 37.2%; aPR = 1.0; 95% CI [0.7, 1.2]). One-third of the respondents with any CHD reported concerns about their ability to have children (33.6%).</div></div><div><h3>Conclusion</h3><div>We found that only a minority of women with CHDs reported receiving counseling on safe contraception and pregnancy, and about a third reported concerns about their ability to have children. These findings highlight a gap between guideline recommendations and clinical practice, underscoring the need for improved reproductive health discussions for women with CHDs.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 65-73"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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