BMJ Sexual & Reproductive Health最新文献

Background: Interconception, the time between pregnancies, is an opportunity to improve the health outcomes of women, infants and subsequent pregnancies. Interconception care involves the assessment of previous pregnancy outcomes, management of maternal risk factors, advice regarding optimal pregnancy spacing, and postpartum contraception provision. However, there is no consistent provision of interconception care, and limited understanding of consumer perspectives. This study aims to describe Australian women's perceptions and experiences of interconception care.

Methods: A qualitative descriptive semi-structured interview study was undertaken in July 2022 with women of reproductive age who had given birth to at least one child with intention to have another child. Reflexive thematic analysis was conducted and the standards for reporting qualitative research informed the writing of this study.

Results: From 15 participants, analysis identified two major themes: (1) women's lack of engagement with interconception care services; and (2) difficulties accessing interconception care. All participants were unfamiliar with interconception terminology, but most perceived it as a distinct care need, largely accessed in primary healthcare settings. Participants wanted further support to be initiated by healthcare professionals about issues such as breastfeeding, postpartum care and lifestyle risk reduction. Interconception care availability and content was perceived as inconsistent, ineffective and provided opportunistically. Participants outlined the need for improved consumer and healthcare professional interconception care awareness, education, and woman-centred continuity of care.

Conclusions: Interconception care awareness is needed by women and healthcare professionals to better meet the needs of women during this life stage.

Background: Advance provision of medication abortion, or the prescription of mifepristone and misoprostol before pregnancy occurs, is an unexplored care model aimed at expanding abortion access. We examine motivations for obtaining advance provision from the online telemedicine service, Aid Access, which supports people in the United States.

Methods: Between May and November 2023, we conducted semi-structured, in-depth interviews with 39 people who obtained advance provision between January 2022 and April 2023. Interviews were transcribed and we conducted a thematic analysis to assess individual motivations.

Results: Participants were motivated to obtain medications because of the Dobbs v Jackson Women's Health Organization (Dobbs) draft opinion leak and eventual decision. Participants expressed concerns about access to abortion under current and future abortion restrictions. Concerns about restrictions prompted people to make a backup plan for themselves and loved ones, and participants compared advance provision to other emergency medications and practices. Some participants were motivated to have medications on hand because pregnancy would be either unsafe or difficult. Others were trying to become pregnant, but because of their health histories they were cognisant of the health risks of a desired pregnancy. Overall, participants were motivated to take back control of their reproductive autonomy in the face of inevitable abortion bans.

Conclusions: The need for autonomy, resistance and reassurance were woven throughout participant's motivations for obtaining advance provision. The Dobbs decision acted as a catalyst for action to take back reproductive autonomy and prepare for a lack of access to abortion care.

Background: Access to post-abortion contraception (PAC) is critical for reducing unintended pregnancies and supporting reproductive decision-making. Patients often face challenges in identifying, accessing and initiating their preferred contraceptive methods post-abortion. This may be particularly so with telemedicine models of care with absence of in-person appointments, and reduced opportunities to provide some contraceptive methods. This qualitative service evaluation explored patients' perspectives on PAC consultations and decision-making to inform future PAC service models in the era of telemedicine.

Methods: Qualitative interviews with 15 patients who had telemedicine medical abortion at home up to 12 weeks' gestation. Data were analysed using reflexive thematic analysis.

Results: Contraceptive discussions during pre-abortion consultations were valued for supporting informed choices about future contraceptive use. Decision-making was influenced by previous contraception experiences, emotional state at the time of abortion and concerns about contraceptive 'failure'. Some preferred non-hormonal methods due to past negative experiences with hormonal contraceptives. However, limited information about 'natural' contraceptive methods and concerns about discussing these with healthcare professionals were described. Barriers to accessing preferred methods, particularly long-acting reversible contraception (LARC), included reduced availability of appointments and caring responsibilities. Fast-tracked appointments for LARC fitting post-abortion were valued. The need for flexible PAC consultations and access after abortion, for example, remote consultations complemented by personalised interactions with sexual and reproductive health experts, was emphasised.

Conclusion: The findings highlight the need for flexible and more accessible PAC service models in the era of telemedicine care to ensure timely access to preferred contraceptive methods.