Pub Date : 2024-09-04DOI: 10.1016/j.contraception.2024.110701
Gentry Carter, Misha Pangasa, Corinne D Sexsmith, Sarah Elliott, David K Turok, Lori M Gawron
Objectives: To describe long acting reversible contraception (LARC) initiation in emergency contraception (EC) visits.
Study design: EC clients age 18-35 years at four Utah family planning clinics between February 2021 and April 2023 chose between oral EC and three LARC options.
Results: Of 2106 EC clients approached, 306 (14.5%) requested LARC and 293 initiated a device: 160 (55%) an etonogestrel implant+ oral levonorgestrel (LNG), 72 (25%) a copper intrauterine device (IUD), and 61 (21%) a 52 mg levonorgestrel IUD (p < 0.001).
Conclusions: In this observational study, one in seven EC clients initiated a LARC method and more frequently selected the etonogestrel implant with oral levonorgestrel over an IUD.
{"title":"Selection of long acting reversible contraception methods by emergency contraception clients: A prospective observational study.","authors":"Gentry Carter, Misha Pangasa, Corinne D Sexsmith, Sarah Elliott, David K Turok, Lori M Gawron","doi":"10.1016/j.contraception.2024.110701","DOIUrl":"10.1016/j.contraception.2024.110701","url":null,"abstract":"<p><strong>Objectives: </strong>To describe long acting reversible contraception (LARC) initiation in emergency contraception (EC) visits.</p><p><strong>Study design: </strong>EC clients age 18-35 years at four Utah family planning clinics between February 2021 and April 2023 chose between oral EC and three LARC options.</p><p><strong>Results: </strong>Of 2106 EC clients approached, 306 (14.5%) requested LARC and 293 initiated a device: 160 (55%) an etonogestrel implant+ oral levonorgestrel (LNG), 72 (25%) a copper intrauterine device (IUD), and 61 (21%) a 52 mg levonorgestrel IUD (p < 0.001).</p><p><strong>Conclusions: </strong>In this observational study, one in seven EC clients initiated a LARC method and more frequently selected the etonogestrel implant with oral levonorgestrel over an IUD.</p><p><strong>Clinical trial registration: </strong>Clinicaltrials.gov NCT04678817; registered 12/16/20.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1016/j.contraception.2024.110698
Yan Che
{"title":"Response to Dr. Winter's letter.","authors":"Yan Che","doi":"10.1016/j.contraception.2024.110698","DOIUrl":"10.1016/j.contraception.2024.110698","url":null,"abstract":"","PeriodicalId":93955,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1016/j.contraception.2024.110699
Emily Freeman, Rachel Paul, Megan Dorsey, Adriana Nigaglioni Rivera, Jennifer A Reeves, Tessa Madden
Objective: To explore differences in demographic characteristics and telehealth usability between patients who chose video versus telephone for telehealth contraceptive counseling.
Study design: This was a secondary analysis of a prospective cohort comparing the interpersonal quality of contraceptive counseling between in-person and telehealth visits at a single Title X-funded clinic. Before the clinical visit, a non-clinician counselor provided structured contraceptive counseling based on patients' preferred modality. After counseling, respondents completed an electronic survey which included the Telehealth Usability Questionnaire (TUQ). Post-visit, the counselor evaluated perceived patient engagement. We calculated Area Deprivation Index (ADI) percentiles to characterize neighborhood environment. We compared characteristics between patients choosing video and telephone using Poisson regression and performed analyses stratified by ADI to test for effect modification.
Results: Between March 2021 and June 2022, we enrolled 149 patients in the telehealth group: 146 (98%) were included in the analysis. Seventy percent of respondents chose telephone. Higher ADI, Black race, and lower educational level (<4 years college) were associated with choosing telephone in the unadjusted analysis. However, after stratifying by ADI, only lower educational level remained associated with choice of telephone among respondents from more deprived neighborhoods (aRR 1.46, 95% CI 1.01-2.11). We observed no differences in TUQ scores between respondents choosing telephone and video.
Conclusion: When given the option, more patients selected telephone than video for telehealth contraceptive counseling. No demographic characteristics were associated with choice of telephone among patients with a higher ADI. Offering telephone-based telehealth may improve access for people seeking contraceptive services.
Implications: We found that telephone-based telehealth is preferable for some patients, which may reflect differences in access to or comfort with video technology. We observed that higher ADI, Black race, and lower education level were associated with choice of telephone, although not after stratifying by ADI. Utilization of telephone-based telehealth may improve access for some patients and lead to more equitable-based health care.
目的: 探讨选择视频和电话进行远程避孕咨询的患者的人口统计学特征和远程医疗可用性的差异:探讨选择视频与电话进行远程避孕咨询的患者在人口统计学特征和远程医疗可用性方面的差异:研究设计:这是一项前瞻性队列的二次分析,比较了在一家由 Title X 资助的诊所中,面对面就诊与远程医疗就诊之间避孕咨询的人际交往质量。在就诊前,一名非医师咨询师根据患者首选的方式提供结构化避孕咨询。咨询结束后,受访者填写了一份电子调查问卷,其中包括远程保健可用性问卷 (TUQ)。咨询结束后,咨询师对患者的参与度进行评估。我们计算了地区贫困指数 (ADI) 百分位数来描述社区环境。我们使用泊松回归法比较了选择视频和电话的患者的特征,并根据 ADI 进行了分层分析,以检验效果修正:在 2021 年 3 月至 2022 年 6 月期间,我们在远程医疗组招募了 149 名患者:146人(98%)被纳入分析。70%的受访者选择了电话。较高的 ADI、黑人种族和较低的教育水平(结论:在进行远程健康避孕咨询时,选择电话的患者多于选择视频的患者。在 ADI 较高的患者中,没有人口统计特征与选择电话有关。提供基于电话的远程保健服务可提高寻求避孕服务者的可及性。
{"title":"Demographic differences between patients selecting video or telephone for contraceptive counseling via telehealth.","authors":"Emily Freeman, Rachel Paul, Megan Dorsey, Adriana Nigaglioni Rivera, Jennifer A Reeves, Tessa Madden","doi":"10.1016/j.contraception.2024.110699","DOIUrl":"10.1016/j.contraception.2024.110699","url":null,"abstract":"<p><strong>Objective: </strong>To explore differences in demographic characteristics and telehealth usability between patients who chose video versus telephone for telehealth contraceptive counseling.</p><p><strong>Study design: </strong>This was a secondary analysis of a prospective cohort comparing the interpersonal quality of contraceptive counseling between in-person and telehealth visits at a single Title X-funded clinic. Before the clinical visit, a non-clinician counselor provided structured contraceptive counseling based on patients' preferred modality. After counseling, respondents completed an electronic survey which included the Telehealth Usability Questionnaire (TUQ). Post-visit, the counselor evaluated perceived patient engagement. We calculated Area Deprivation Index (ADI) percentiles to characterize neighborhood environment. We compared characteristics between patients choosing video and telephone using Poisson regression and performed analyses stratified by ADI to test for effect modification.</p><p><strong>Results: </strong>Between March 2021 and June 2022, we enrolled 149 patients in the telehealth group: 146 (98%) were included in the analysis. Seventy percent of respondents chose telephone. Higher ADI, Black race, and lower educational level (<4 years college) were associated with choosing telephone in the unadjusted analysis. However, after stratifying by ADI, only lower educational level remained associated with choice of telephone among respondents from more deprived neighborhoods (aRR 1.46, 95% CI 1.01-2.11). We observed no differences in TUQ scores between respondents choosing telephone and video.</p><p><strong>Conclusion: </strong>When given the option, more patients selected telephone than video for telehealth contraceptive counseling. No demographic characteristics were associated with choice of telephone among patients with a higher ADI. Offering telephone-based telehealth may improve access for people seeking contraceptive services.</p><p><strong>Implications: </strong>We found that telephone-based telehealth is preferable for some patients, which may reflect differences in access to or comfort with video technology. We observed that higher ADI, Black race, and lower education level were associated with choice of telephone, although not after stratifying by ADI. Utilization of telephone-based telehealth may improve access for some patients and lead to more equitable-based health care.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1016/j.contraception.2024.110700
Laura E Jacobson, Ruvani Jayaweera, Katy Footman, Julia M Goodman, Caitlin Gerdts, Blair G Darney
Objectives: To understand in-facility follow-up care-seeking behavior among both people who self-managed medication abortions and those who obtained facility-managed care in low-and-middle-income countries. We explore factors that contribute to meeting individual self-reported follow-up care needs, core to person-centered care.
Study design: We conducted a qualitative, codebook thematic analysis of 67 in-depth interviews conducted with people who self-managed medication abortions or obtained facility-managed medication abortion care. We first classified individuals as having their follow-up care needs met (not seeking care when the participant felt confident that additional care was not warranted or desired or receiving care if it was desired) or not. Our a priori analytic domains came from the Anderson model of health services utilization - predisposing, enabling, or need factors (perceived and evaluated need for health services) that contributed to having follow-up care needs met or not. We also describe emergent themes within each domain.
Results: Most participants (n=59, 88%) had their follow-up care needs met; half (n=33, 49%) sought follow-up care in a facility. Prior birth or abortion experiences emerged as predisposing factors for having follow-up care needs met. Having accompaniment support (from activists or hotlines who provide abortion guidance outside of clinical settings), knowing what to expect, and information sources were key enabling factors for having follow-up care needs met. Need factors included flexible follow-up care guidelines. Those who did not have their follow-up care needs met described predisposing negative health system experiences; enabling factors including health system challenges, stigma from providers, and legal risk; and need factors of required follow-up care guidelines.
Conclusions: Medication abortion follow-up care experiences are diverse, and individual needs can be met both in and outside of health facilities. Understanding prior experiences, enabling accompaniment support, and considering flexible follow-up care guidelines can support meeting individual follow-up care needs, which is essential to person-centered abortion care.
Implications: Follow-up care needs, essential to ensuring access to high-quality abortion services, can be met in both self-managed and in-facility medication abortion models. Policies that require follow-up care when it is not needed or desired by the person can reinforce ideas that self-managed abortion is not safe or effective, despite existing evidence.
{"title":"Self-reported follow-up care needs can be met in both facility and self-managed abortion: Evidence from low- and middle-income countries.","authors":"Laura E Jacobson, Ruvani Jayaweera, Katy Footman, Julia M Goodman, Caitlin Gerdts, Blair G Darney","doi":"10.1016/j.contraception.2024.110700","DOIUrl":"10.1016/j.contraception.2024.110700","url":null,"abstract":"<p><strong>Objectives: </strong>To understand in-facility follow-up care-seeking behavior among both people who self-managed medication abortions and those who obtained facility-managed care in low-and-middle-income countries. We explore factors that contribute to meeting individual self-reported follow-up care needs, core to person-centered care.</p><p><strong>Study design: </strong>We conducted a qualitative, codebook thematic analysis of 67 in-depth interviews conducted with people who self-managed medication abortions or obtained facility-managed medication abortion care. We first classified individuals as having their follow-up care needs met (not seeking care when the participant felt confident that additional care was not warranted or desired or receiving care if it was desired) or not. Our a priori analytic domains came from the Anderson model of health services utilization - predisposing, enabling, or need factors (perceived and evaluated need for health services) that contributed to having follow-up care needs met or not. We also describe emergent themes within each domain.</p><p><strong>Results: </strong>Most participants (n=59, 88%) had their follow-up care needs met; half (n=33, 49%) sought follow-up care in a facility. Prior birth or abortion experiences emerged as predisposing factors for having follow-up care needs met. Having accompaniment support (from activists or hotlines who provide abortion guidance outside of clinical settings), knowing what to expect, and information sources were key enabling factors for having follow-up care needs met. Need factors included flexible follow-up care guidelines. Those who did not have their follow-up care needs met described predisposing negative health system experiences; enabling factors including health system challenges, stigma from providers, and legal risk; and need factors of required follow-up care guidelines.</p><p><strong>Conclusions: </strong>Medication abortion follow-up care experiences are diverse, and individual needs can be met both in and outside of health facilities. Understanding prior experiences, enabling accompaniment support, and considering flexible follow-up care guidelines can support meeting individual follow-up care needs, which is essential to person-centered abortion care.</p><p><strong>Implications: </strong>Follow-up care needs, essential to ensuring access to high-quality abortion services, can be met in both self-managed and in-facility medication abortion models. Policies that require follow-up care when it is not needed or desired by the person can reinforce ideas that self-managed abortion is not safe or effective, despite existing evidence.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1016/j.contraception.2024.110695
Regine Sitruk-Ware, Jim Sailer, David Serfaty, Richard Anderson
{"title":"A new vision for male contraception research and development.","authors":"Regine Sitruk-Ware, Jim Sailer, David Serfaty, Richard Anderson","doi":"10.1016/j.contraception.2024.110695","DOIUrl":"https://doi.org/10.1016/j.contraception.2024.110695","url":null,"abstract":"","PeriodicalId":93955,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1016/j.contraception.2024.110696
Lindsay Burton, Rachel Perry, Janet Jacobson
Objectives: To compare medication abortion (MAB) success in very early pregnancy (VEP) with mifepristone followed by either one or two doses of misoprostol.
Study design: We performed a retrospective cohort analysis of VEP MABs from July 1, 2021 to May 31, 2022 treated with mifepristone 200 mg oral followed by a single dose of misoprostol 800 mcg buccal 24 to 48 hours later and MABs from June 21, 2022 to October 31, 2022 treated with mifepristone 200 mg oral followed by two doses of misoprostol 800 mcg buccal spaced 4 hours apart, with first dose taken 24 to 48 hours after mifepristone. Serum BhCG was collected at the time of mifepristone treatment with additional BhCG collected 48 to 72 hours after misoprostol treatment in both groups. Success was defined as a BhCG decline of ≥50%. MAB failure was defined as ongoing, viable pregnancy determined by follow-up ultrasound or procedural intervention with aspiration.
Results: There were 423 patients in the single-dose misoprostol group and 262 patients in the two-dose misoprostol group. There were no significant differences between the two groups in baseline characteristics. In the single-dose group, 372 (87.9%) were treated successfully; in the two-dose group, 224 (85.5%) were treated successfully. There was no significant difference in MAB success between the groups (p = 0.73).
Conclusions: The addition of a second dose of misoprostol does not improve the success of MAB in VEP.
Implications: Additional research is needed to identify interventions to improve the success of MAB in VEP.
{"title":"Success of medication abortion with mifepristone followed by two doses of misoprostol in very early pregnancy.","authors":"Lindsay Burton, Rachel Perry, Janet Jacobson","doi":"10.1016/j.contraception.2024.110696","DOIUrl":"10.1016/j.contraception.2024.110696","url":null,"abstract":"<p><strong>Objectives: </strong>To compare medication abortion (MAB) success in very early pregnancy (VEP) with mifepristone followed by either one or two doses of misoprostol.</p><p><strong>Study design: </strong>We performed a retrospective cohort analysis of VEP MABs from July 1, 2021 to May 31, 2022 treated with mifepristone 200 mg oral followed by a single dose of misoprostol 800 mcg buccal 24 to 48 hours later and MABs from June 21, 2022 to October 31, 2022 treated with mifepristone 200 mg oral followed by two doses of misoprostol 800 mcg buccal spaced 4 hours apart, with first dose taken 24 to 48 hours after mifepristone. Serum BhCG was collected at the time of mifepristone treatment with additional BhCG collected 48 to 72 hours after misoprostol treatment in both groups. Success was defined as a BhCG decline of ≥50%. MAB failure was defined as ongoing, viable pregnancy determined by follow-up ultrasound or procedural intervention with aspiration.</p><p><strong>Results: </strong>There were 423 patients in the single-dose misoprostol group and 262 patients in the two-dose misoprostol group. There were no significant differences between the two groups in baseline characteristics. In the single-dose group, 372 (87.9%) were treated successfully; in the two-dose group, 224 (85.5%) were treated successfully. There was no significant difference in MAB success between the groups (p = 0.73).</p><p><strong>Conclusions: </strong>The addition of a second dose of misoprostol does not improve the success of MAB in VEP.</p><p><strong>Implications: </strong>Additional research is needed to identify interventions to improve the success of MAB in VEP.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1016/j.contraception.2024.110697
Aliza Adler, M Antonia Biggs, Shelly Kaller, Rosalyn Schroeder, Ndola Prata, Karen Scott, Lauren Ralph
Objective: To assess the prevalence of ever considering self-managing an abortion (SMA) and its associations with experiences of medical mistrust and mistreatment in a nationally representative sample.
Study design: In 2021-22, we conducted a national, cross-sectional, online probability-based survey of US people assigned female at birth ages 15-49. Among those who had ever been pregnant, we ran weighted multivariable logistic regressions to examine whether having had difficulty trusting medical providers and/or experiencing medical mistreatment was associated with SMA consideration.
Results: Of 4260 participants who had ever been pregnant, 5.2% (95% CI, 4.3%-6.3%) ever considered SMA. Additionally, 38.8% (95% CI, 36.8%-40.9%) reported prior moderate medical mistrust; 17.0% (15.4%-18.6%) experienced neglect of symptoms only, and 22.2% (20.6%-24.0%) experienced ridicule or humiliation in a previous healthcare encounter. In multivariable analyses, those who reported prior high medical mistrust had increased odds of considering SMA (aOR=5.2, [95% CI, 2.9-9.2]), compared to those who had no prior medical mistrust. Those who had experienced ridicule or humiliation by healthcare providers had increased odds of considering SMA (aOR=3.8, [95% CI, 2.3-6.1]), compared to those without such experiences. Participants who believed others perceived them as Black or Arab/Middle Eastern, were poor in their youth, or identified as Lesbian, Gay, Bisexual, Transgender, Queer, and other had higher proportions of considering SMA (p-values<0.01).
Conclusions: Experiences of medical mistrust and mistreatment are common and are associated with increased likelihood of considering SMA. Those who identified with a structurally minoritized group were more likely to consider SMA, and those whose "street race" was Arab/Middle Eastern had the highest likelihood.
Implications: If restrictions on abortion continue to increase, individuals may further consider SMA. Our findings suggest a need to create healthcare environments that foster trust and respect, as well as to ensure people have access to safe options for SMA.
目的:在全国具有代表性的样本中,评估曾经考虑自我管理人工流产(SMA)的发生率及其与医疗不信任和虐待经历的关联:在一个具有全国代表性的样本中,评估曾经考虑自我管理人工流产(SMA)的流行率及其与医疗不信任和虐待经历的关联:研究设计:2021-22 年,我们对 15-49 岁出生时即被指定为女性的美国人进行了一次全国性、横断面、在线概率调查。在曾经怀孕的人群中,我们进行了加权多变量逻辑回归,以研究难以信任医疗服务提供者和/或遭受医疗虐待是否与考虑 SMA 有关:在 4260 名曾经怀孕的参与者中,5.2%(95% CI,4.3%-6.3%)曾经考虑过 SMA。此外,38.8%(95% CI,36.8%-40.9%)的受试者表示曾有过中度的医疗不信任;17.0%(15.4%-18.6%)的受试者仅有过忽视症状的经历,22.2%(20.6%-24.0%)的受试者在之前的医疗经历中受到过嘲笑或羞辱。在多变量分析中,与之前没有医疗不信任经历的人相比,之前报告过高度医疗不信任经历的人考虑 SMA 的几率更高(aOR=5.2,[95% CI,2.9-9.2])。经历过医疗服务提供者嘲笑或羞辱的参与者与无此类经历者相比,考虑 SMA 的几率增加(aOR=3.8,[95% CI,2.3-6.1])。认为他人认为自己是黑人或阿拉伯/中东人、年轻时贫穷或被认定为 LGBTQ+ 的参与者考虑 SMA 的比例更高(p 值 < 0.01):医疗不信任和虐待的经历很常见,与考虑接受 SMA 的可能性增加有关。那些被认定为结构上属于少数群体的人更有可能考虑 SMA,而那些 "街头种族 "为阿拉伯/中东人的人考虑 SMA 的可能性最大:如果对堕胎的限制继续增加,人们可能会进一步考虑 SMA。我们的研究结果表明,有必要营造一种促进信任和尊重的医疗环境,并确保人们能够获得安全的 SMA 选择。
{"title":"The association of experiences of medical mistrust and mistreatment and ever considering self-managing an abortion.","authors":"Aliza Adler, M Antonia Biggs, Shelly Kaller, Rosalyn Schroeder, Ndola Prata, Karen Scott, Lauren Ralph","doi":"10.1016/j.contraception.2024.110697","DOIUrl":"10.1016/j.contraception.2024.110697","url":null,"abstract":"<p><strong>Objective: </strong>To assess the prevalence of ever considering self-managing an abortion (SMA) and its associations with experiences of medical mistrust and mistreatment in a nationally representative sample.</p><p><strong>Study design: </strong>In 2021-22, we conducted a national, cross-sectional, online probability-based survey of US people assigned female at birth ages 15-49. Among those who had ever been pregnant, we ran weighted multivariable logistic regressions to examine whether having had difficulty trusting medical providers and/or experiencing medical mistreatment was associated with SMA consideration.</p><p><strong>Results: </strong>Of 4260 participants who had ever been pregnant, 5.2% (95% CI, 4.3%-6.3%) ever considered SMA. Additionally, 38.8% (95% CI, 36.8%-40.9%) reported prior moderate medical mistrust; 17.0% (15.4%-18.6%) experienced neglect of symptoms only, and 22.2% (20.6%-24.0%) experienced ridicule or humiliation in a previous healthcare encounter. In multivariable analyses, those who reported prior high medical mistrust had increased odds of considering SMA (aOR=5.2, [95% CI, 2.9-9.2]), compared to those who had no prior medical mistrust. Those who had experienced ridicule or humiliation by healthcare providers had increased odds of considering SMA (aOR=3.8, [95% CI, 2.3-6.1]), compared to those without such experiences. Participants who believed others perceived them as Black or Arab/Middle Eastern, were poor in their youth, or identified as Lesbian, Gay, Bisexual, Transgender, Queer, and other had higher proportions of considering SMA (p-values<0.01).</p><p><strong>Conclusions: </strong>Experiences of medical mistrust and mistreatment are common and are associated with increased likelihood of considering SMA. Those who identified with a structurally minoritized group were more likely to consider SMA, and those whose \"street race\" was Arab/Middle Eastern had the highest likelihood.</p><p><strong>Implications: </strong>If restrictions on abortion continue to increase, individuals may further consider SMA. Our findings suggest a need to create healthcare environments that foster trust and respect, as well as to ensure people have access to safe options for SMA.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1016/j.contraception.2024.110693
Maarten De Winter
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Pub Date : 2024-08-23DOI: 10.1016/j.contraception.2024.110692
Elizabeth Kravitz, Jessica Chen, Jessica Wu, Kira Bromwich, Nathanael Koelper, Arden McAllister, Sarita Sonalkar
Objective: Analyze changes in abortion practices during the early coronavirus disease 2019 (COVID-19) pandemic.
Study design: Sites recruited by Society of Family Planning participated in a longitudinal descriptive analysis comprising three surveys between February and October 2020. Average monthly total and medication abortion volume was analyzed by χ2 and linear regression.
Results: Total average volume of abortion services did not change among participating sites (p = 0.79). Volume and proportion of medication abortion increased over the study period (p = 0.02, p < 0.01).
Conclusions: The early COVID-19 pandemic marked a shift toward medication abortion.
Implications: Our findings are interlaced in a national trend predating the Dobbs ruling, likely accelerated by the COVID-19 pandemic.
{"title":"Adaptations to COVID-19 by US abortion clinics: Analysis of Society of Family Planning survey data.","authors":"Elizabeth Kravitz, Jessica Chen, Jessica Wu, Kira Bromwich, Nathanael Koelper, Arden McAllister, Sarita Sonalkar","doi":"10.1016/j.contraception.2024.110692","DOIUrl":"10.1016/j.contraception.2024.110692","url":null,"abstract":"<p><strong>Objective: </strong>Analyze changes in abortion practices during the early coronavirus disease 2019 (COVID-19) pandemic.</p><p><strong>Study design: </strong>Sites recruited by Society of Family Planning participated in a longitudinal descriptive analysis comprising three surveys between February and October 2020. Average monthly total and medication abortion volume was analyzed by χ<sup>2</sup> and linear regression.</p><p><strong>Results: </strong>Total average volume of abortion services did not change among participating sites (p = 0.79). Volume and proportion of medication abortion increased over the study period (p = 0.02, p < 0.01).</p><p><strong>Conclusions: </strong>The early COVID-19 pandemic marked a shift toward medication abortion.</p><p><strong>Implications: </strong>Our findings are interlaced in a national trend predating the Dobbs ruling, likely accelerated by the COVID-19 pandemic.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1016/j.contraception.2024.110691
Divya Dethier, Reni Soon, Taylor Ronquillo, Zarina Wong, Mary Tschann
Objectives: To compare outcomes and characteristics of two cohorts of patients: those receiving medication abortion (MAB) at ≤42 days gestation and those at 43 to 56 days gestation.
Study design: We conducted a retrospective cohort study in 2022, comparing 142 patients accessing MAB at ≤42 days with 200 patients at 43 to 56 days. We sought to detect a 7% difference in MAB success with 80% power and alpha of 0.05. We assessed follow-up responses and unscheduled contacts with the health care system.
Results: Abortion success rates were similar between the ≤42-day and 43 to 56-day groups (94.3% vs 97%, p = 0.226). Those ≤42 days had more unscheduled office visits (13% vs 6%, p = 0.01) but no difference in phone calls or emergency room visits. More patients with successful MAB in the ≤42-day group answered that bleeding (11.7% vs 1.9%, p = 0.006) and cramping (10.5% vs 2.9%, p = 0.035) were not heavier or worse than a period and that they had no pregnancy symptoms prior to the abortion (15.8% vs 6.0%, p = 0.034). Patients ≤42 days gestation less often had a pretreatment ultrasound (48% vs 64%, p = 0.004). Patients without prior ultrasound more often needed uterine aspiration to complete the abortion (6.8% vs 2%, p = 0.027).
Conclusions: Patients undergoing MAB at ≤42 days have similar success rates but more unscheduled office visits, and more ambiguous symptoms when using standardized questions for evaluating abortion success. Clinicians should adapt anticipatory guidance and counseling for this population.
Implications: Access to very early abortion is increasingly relevant as legal restrictions on abortion increase. Earlier gestations may have different responses to standard follow-up questions despite a successful MAB and may have more interactions with the health care system.
目的:比较两组患者的结果和特征:比较两组患者的预后和特征:妊娠≤42天和妊娠43-56天接受药物流产(MAB)的患者:我们进行了一项回顾性队列研究,比较了2022年所有142名妊娠≤42天接受药物流产的患者与200名妊娠43-56天接受药物流产的患者的特征和结果。我们力图在80%的功率和0.05的α值条件下检测出人流手术成功率7%的差异。我们比较了随访反应和与医疗系统的计划外联系:≤42天组和43-56天组的人工流产成功率相似(94.3% vs 97%,p=0.226)。≤42天组的非计划门诊频率更高(13% vs 6%,p=0.01),但电话或急诊就诊率没有差异。妊娠≤42 天组有更多的人流成功患者回答出血量(11.7% 对 1.9%,P=0.006)和痉挛(10.5% 对 2.9%,P=0.035)不比月经量多或严重,而且流产前没有怀孕症状(15.8% 对 6.0%,P=0.034)。妊娠不足 42 天的患者较少在治疗前进行超声波检查(48% 对 64%,P=0.004)。未事先进行超声波检查的患者更常需要吸宫术来完成流产(6.8% vs 2%,p=0.027):结论:使用标准化问题评估人工流产成功率时,≤42 天接受人流手术的患者成功率相似,但计划外就诊次数更多,症状更模糊。临床医生应考虑针对这一人群调整预期指导和咨询:启示:随着法律对人工流产的限制越来越多,尽早进行人工流产变得越来越重要。尽管人流手术成功了,但较早妊娠者对标准随访问题的反应可能不同,与医疗保健系统的互动也可能更多。
{"title":"Comparison of medication abortion outcomes at less than and greater than 6 weeks gestation.","authors":"Divya Dethier, Reni Soon, Taylor Ronquillo, Zarina Wong, Mary Tschann","doi":"10.1016/j.contraception.2024.110691","DOIUrl":"10.1016/j.contraception.2024.110691","url":null,"abstract":"<p><strong>Objectives: </strong>To compare outcomes and characteristics of two cohorts of patients: those receiving medication abortion (MAB) at ≤42 days gestation and those at 43 to 56 days gestation.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study in 2022, comparing 142 patients accessing MAB at ≤42 days with 200 patients at 43 to 56 days. We sought to detect a 7% difference in MAB success with 80% power and alpha of 0.05. We assessed follow-up responses and unscheduled contacts with the health care system.</p><p><strong>Results: </strong>Abortion success rates were similar between the ≤42-day and 43 to 56-day groups (94.3% vs 97%, p = 0.226). Those ≤42 days had more unscheduled office visits (13% vs 6%, p = 0.01) but no difference in phone calls or emergency room visits. More patients with successful MAB in the ≤42-day group answered that bleeding (11.7% vs 1.9%, p = 0.006) and cramping (10.5% vs 2.9%, p = 0.035) were not heavier or worse than a period and that they had no pregnancy symptoms prior to the abortion (15.8% vs 6.0%, p = 0.034). Patients ≤42 days gestation less often had a pretreatment ultrasound (48% vs 64%, p = 0.004). Patients without prior ultrasound more often needed uterine aspiration to complete the abortion (6.8% vs 2%, p = 0.027).</p><p><strong>Conclusions: </strong>Patients undergoing MAB at ≤42 days have similar success rates but more unscheduled office visits, and more ambiguous symptoms when using standardized questions for evaluating abortion success. Clinicians should adapt anticipatory guidance and counseling for this population.</p><p><strong>Implications: </strong>Access to very early abortion is increasingly relevant as legal restrictions on abortion increase. Earlier gestations may have different responses to standard follow-up questions despite a successful MAB and may have more interactions with the health care system.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}