BMJ Sexual & Reproductive Health最新文献

Background: Many factors contribute to the decision to provide abortion in the United States. We aim to describe pre-residency experiences and decisions that contribute to choosing a career as an abortion provider in the United States.

Methods: We conducted 60-min semi-structured telephone interviews with 34 current abortion care providers about their career trajectories, decision-making and planning. Interviews were transcribed and coded by three members of the research team using thematic analysis.

Results: A majority of the participants considered (73.5%, n=25) and firmly committed (62.8%, n=22) to providing abortion care prior to entering residency. They described important professional experiences with women's health and reproductive rights, as well as personal experiences with abortion care, all of which inspired them to seek out abortion training during medical school and residency. Participants also described a dearth of mentors or role models until late in training, especially for family physicians.

Conclusions: Our study suggests that the decision to provide abortion care is often made prior to residency training, before or during medical school, so additional support may be needed to promote exposure to abortion care during undergraduate medical education or even before. Further, there is a need for improved mentorship and role modelling during these periods, especially for family physicians. This may be especially critical after the overturn of Roe v Wade, as medical schools in restrictive states may not be able to provide abortions to patients, depriving students of role models who are abortion providers.

BackgroundEthnic minorities in high-income countries have higher rates of unintended pregnancies but are less likely to use highly efficacious long-acting reversible contraception (LARC). The reasons for this are unclear.

Aim: To understand the views and experiences of ethnic minorities within high-income countries about LARC.

Methodology: Medline, CINAHL, EMBASE and Sociological Abstracts were searched systematically to find qualitative articles about views on LARC. Titles and abstracts were screened to select qualitative studies about LARC whose participants were mainly from ethnic minorities in high-income countries. Quality assessment was conducted using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis was conducted.

Results: Seventeen studies (19 articles) met the inclusion criteria, 14 of which were from the USA (227 participants identified as Latina, 222 Black, 15 multiracial, 4 Asian). Two studies included 32 Chinese women in the UK and Australia and one included 20 Aboriginal women in Australia. Factors influencing uptake of LARC included side effects, convenience, and perceived efficacy of LARC compared with other methods; women's ideas, concerns and expectations; and external influences (partner, family/friends, health professionals and society). Convenience of LARC, control over reproductive decisions, and desire to prevent pregnancy were the main facilitators. Barriers included specific cultural concerns about irregular bleeding, concerns about racial discrimination, and family/friends having negative views on LARC.

Conclusions: Ethnic minority women often have additional needs and concerns about LARC compared with the White majority. Further research is needed to develop and evaluate customised respectful counselling on contraception options for ethnic minority women and their partners.

Background: Short birth intervals and unintended pregnancy are associated with poorer maternal and infant outcomes. There is a risk of pregnancy during the immediate postpartum period unless contraception is initiated. This retrospective cohort study aimed to capture the current patterns of hormonal contraceptive provision within 12 months postpartum in a high-income country.

Methods: We used a linked administrative dataset comprising all women who gave birth in Queensland, Australia between 1 July 2012 and 30 June 2018 (n=339 265 pregnancies). We described our cohort by whether they were provided with government-subsidised hormonal contraception within 12 months postpartum. The associations between hormonal postpartum contraceptive provision and demographic and clinical characteristics were examined using univariate and multivariate logistic regression and presented in terms of crude and adjusted odds ratios with 95% confidence intervals.

Results: A majority of women (60.2%) were not provided with government-subsidised hormonal postpartum contraception within 12 months postpartum. Women who were younger (<25 years), were overweight or obese, smoked, were born in Australia, were non-Indigenous, gave birth in a public hospital, or were in the lowest socioeconomic status group were more likely to be provided with postpartum contraception after adjusting for other covariates, compared with their counterparts.

Conclusions: Strategies to increase the provision and uptake of contraception in the immediate postpartum period are needed to prevent short birth intervals and unintended pregnancy and ensure women's fertility intentions are enacted. Ongoing research is needed to examine the factors influencing women's access to contraceptive services and, further, the types of contraception provided.