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Samari G, Wurtz HM, Desai S, Coleman-Minahan K. Perspectives from the pandemic epicenter: Sexual and reproductive health of immigrant women in New York City. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:136-146. [PMID: 38571367 DOI: 10.1111/psrh.12260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
CONTEXT The United States' response to COVID-19 created a policy, economic, and healthcare provision environment that had implications for the sexual and reproductive health (SRH) of racialized and minoritized communities. Perspectives from heterogenous immigrant communities in New York City, the pandemic epicenter in the United States (US), provides a glimpse into how restrictive social policy environments shape contraception, abortion, pregnancy preferences, and other aspects of SRH for marginalized immigrant communities. METHODS We conducted in-depth interviews in 2020 and 2021 with 44 cisgender immigrant women from different national origins and 19 direct service providers for immigrant communities in New York City to explore how immigrants were forced to adapt their SRH preferences and behaviors to the structural barriers of the COVID-19 pandemic. We coded and analyzed the interviews using a constant comparative approach. RESULTS Pandemic-related fears and structural barriers to healthcare access shaped shifts in contraceptive use and preferences among our participants. Immigrant women weighed their concerns for health and safety and the potential of facing discrimination as part of their contraceptive preferences. Immigrants also described shifts in their pregnancy preferences as rooted in concerns for their health and safety and economic constraints unique to immigrant communities. CONCLUSION Understanding how immigrant women's SRH shifted in response to the structural and policy constraints of the COVID-19 pandemic can reveal how historically marginalized communities will be impacted by an increasingly restrictive reproductive health and immigration policy landscape.
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Affiliation(s)
- Goleen Samari
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Heather M Wurtz
- Anthropology Department, University of Connecticut, Storrs, Connecticut, USA
- Research Program on Global Health & Human Rights, Human Rights Institute, University of Connecticut, Storrs, Connecticut, USA
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
| | - Sheila Desai
- Coalition to Expand Contraceptive Access, Oakland, California, USA
| | - Kate Coleman-Minahan
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Morris N, Biggs MA, Baba F, Seymour JW, White K, Grossman D. Interest in and Support for Alternative Models of Medication Abortion Provision Among Patients Seeking Abortion in the United States. Womens Health Issues 2024:S1049-3867(24)00023-9. [PMID: 38658288 DOI: 10.1016/j.whi.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Medication abortion is safe and effective, but restrictions still limit patients from accessing this method. Alternative models of medication abortion provision, namely advance provision, over-the-counter (OTC), and online, could help improve access to care for some, although there is limited evidence about abortion patients' interest in these models. METHODS Between 2017 and 2019, we administered a cross-sectional survey to abortion patients at 45 clinics across 15 U.S. states to explore their interest in and support for advance provision, OTC, and online abortion access. We assessed relationships between sociodemographic characteristics and interest in and support for each model using bivariate logistic regressions and present perceived advantages and disadvantages of each model, as described by a subset of participants. RESULTS Among 1,965 people enrolled, 1,759 (90%) initiated the survey. Interest in and support for advance provision was highest (72% and 82%, respectively), followed by OTC (63% and 72%) and online access (57% and 70%). In bivariate analyses, non-Hispanic Black and Asian/Pacific Islander respondents expressed lower interest and support for the online model and Alaska Native/Native American respondents expressed higher interest in an OTC model, as compared with white respondents. Among 439 participants naming advantages and disadvantages of each model, the most common advantages included convenience and having the abortion earlier. The most common disadvantages were not seeing a provider first and possibly taking pills incorrectly. CONCLUSIONS Although most abortion patients expressed interest in and support for alternative models of medication abortion provision, variation in support across race/ethnicity highlights a need to ensure that abortion care service models meet the needs and preferences of all patients, particularly people from historically underserved populations.
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Affiliation(s)
- Natalie Morris
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California.
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Finley Baba
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Jane W Seymour
- Collaborative for Reproductive Equity, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kari White
- Resound Research for Reproductive Health, Austin, Texas
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
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Tilstra AM, Polizzi A, Wagner S, Akimova ET. Projecting the long-term effects of the COVID-19 pandemic on U.S. population structure. Nat Commun 2024; 15:2409. [PMID: 38499539 PMCID: PMC10948855 DOI: 10.1038/s41467-024-46582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
The immediate, direct effects of the COVID-19 pandemic on the United States population are substantial. Millions of people were affected by the pandemic: many died, others did not give birth, and still others could not migrate. Research that has examined these individual phenomena is important, but fragmented. The disruption of mortality, fertility, and migration jointly affected U.S. population counts and, consequently, future population structure. We use data from the United Nations World Population Prospects and the cohort component projection method to isolate the effect of the pandemic on U.S. population estimates until 2060. If the pandemic had not occurred, we project that the population of the U.S. would have 2.1 million (0.63%) more people in 2025, and 1.7 million (0.44%) more people in 2060. Pandemic-induced migration changes are projected to have a larger long-term effect on future population size than mortality, despite comparable short-term effects.
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Affiliation(s)
- Andrea M Tilstra
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford, Oxford, OX1 1JD, UK.
- Department of Sociology, University of Oxford, Oxford, OX1 1JD, UK.
| | - Antonino Polizzi
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford, Oxford, OX1 1JD, UK
- Department of Sociology, University of Oxford, Oxford, OX1 1JD, UK
| | - Sander Wagner
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford, Oxford, OX1 1JD, UK
| | - Evelina T Akimova
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford, Oxford, OX1 1JD, UK
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Pickering S, Manze M, Losch J, Romero D. Delays in Obtaining Abortion and Miscarriage Care Among Pregnant Persons in New York State During the COVID-19 Pandemic: The CAP Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:30-39. [PMID: 38249936 PMCID: PMC10797165 DOI: 10.1089/whr.2023.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
Background We sought to investigate delays obtaining abortion and miscarriage care during the COVID-19 pandemic, compared with before the pandemic, among pregnant persons in New York State (NYS). Methods We administered a cross-sectional survey in June-July 2020 to NYS residents aged 18-44 years who identified as female or transgender male (N = 1,525). This analysis focused on a subsample who had an abortion or miscarriage during COVID-19, were seeking an abortion at the time of the survey, or had an abortion or miscarriage before COVID-19 (n = 116). We conducted bivariate analyses to determine differences in delays to seeking or obtaining an abortion or miscarriage during versus before the pandemic, as well as consideration of abortion among those pregnant during versus before the pandemic. We also asked open-ended questions about miscarriage and abortion experiences. Main Findings Of the 21 respondents who sought or were seeking an abortion during the COVID-19 pandemic, 76.2% (n = 16) reported experiencing a delay in obtaining abortion care, compared with 18.2% (n = 4) of those who experienced a delay before the pandemic (p < 0.001). A significantly higher proportion of respondents who were pregnant during the pandemic considered abortion, compared with those who gave birth before the pandemic (39.1% vs. 7.6%; p < 0.001). Of the 39 respondents who miscarried during the pandemic, 35.9% (n = 14) delayed care, compared with 5.9% (n = 2) before the pandemic (p < 0.01). Some respondents also commented on the difficulty of accessing miscarriage services during COVID-19 in open-ended responses. Principal Conclusions Those who sought abortion or miscarriage care during the COVID-19 pandemic experienced significant delays in getting care. These are essential services that must be available during public health emergencies, and yet access to these services is now severely limited in many states due to the Dobbs vs. Jackson Women's Health Organization decision.
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Affiliation(s)
- Sarah Pickering
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Meredith Manze
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Jessie Losch
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Diana Romero
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, New York, USA
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Darney BG, Biel FM, Oakley J, Coleman-Minahan K, Cottrell EK. Contraceptive Method Switching and Long-Acting Reversible Contraception Removal in U.S. Safety Net Clinics, 2016-2021. Obstet Gynecol 2023; 142:669-678. [PMID: 37535965 PMCID: PMC10424816 DOI: 10.1097/aog.0000000000005277] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To describe patterns of contraceptive method switching and long-acting reversible contraception (LARC) removal in a large network of community health centers. METHODS We conducted a retrospective cohort study using individual-level electronic health record data from 489 clinics in 20 states from 2016 to 2021. We used logistic regression models, including individual-, clinic-, and state-level covariates, to calculate adjusted odds ratios and predicted probabilities of any observed contraceptive method switching and LARC removal among those with baseline incident LARC, both over 4-year time periods. RESULTS Among 151,786 patients with 513,753 contraceptive encounters, 22.1% switched to another method at least once over the 4-year observation period, and switching patterns were varied. In patients with baseline LARC, the adjusted predicted probability of switching was 19.0% (95% CI 18.0-20.0%) compared with patients with baseline moderately effective methods (16.2%, 95% CI 15.1-17.3%). The adjusted predicted probability of switching was highest among the youngest group (28.6%, 95% CI 25.8-31.6% in patients aged 12-14 years) and decreased in a dose-response relationship by age to 8.4% (95% CI 7.4-9.4%) among patients aged 45-49 years. Latina and Black race and ethnicity, public or no insurance, and baseline Title X clinic status were all associated with higher odds of switching at least once. Among baseline LARC users, 19.4% had a removal (to switch or discontinue) within 1 year and 30.1% within 4 years; 97.6% of clinics that provided LARC also had evidence of a removal. CONCLUSION Community health centers provide access to method switching and LARC removal. Contraceptive switching and LARC removal are common, and clinicians should normalize switching and LARC removal among patients.
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Affiliation(s)
- Blair G Darney
- Oregon Health & Science University, the OHSU-PSU School of Public Health, and OCHIN, Portland, Oregon; the National Institute of Public Health, Center for Population Health, Cuernavaca, Morelos, Mexico; and the College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, and the University of Colorado Population Center and the Population Program and Geography Department, University of Colorado Boulder, Boulder, Colorado
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Hall JA, Barrett G, Stephenson JM, Edelman NL, Rocca C. Desire to Avoid Pregnancy scale: clinical considerations and comparison with other questions about pregnancy preferences. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:167-175. [PMID: 36717217 PMCID: PMC10359540 DOI: 10.1136/bmjsrh-2022-201750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Clinicians and women of reproductive age would benefit from a reliable way to identify who is likely to become pregnant in the next year, in order to direct health advice. The 14-item Desire to Avoid Pregnancy (DAP) scale is predictive of pregnancy; this paper compares it with other ways of assessing pregnancy preferences to shortlist options for clinical implementation. METHODS A cohort of 994 UK women of reproductive age completed the DAP and other questions about pregnancy preferences, including the Attitude towards Potential Pregnancy Scale (APPS), at baseline and reported on pregnancies quarterly for a year. For each question, DAP item and combinations of DAP items, we examined the predictive ability, sensitivity, specificity, area under the receiver operating curve (AUROC), and positive and negative predictive values. RESULTS The AUROCs and predictive ability of the APPS and DAP single items were weaker than the full DAP, though all except one had acceptable AUROCs (>0.7). The most predictive individual DAP item was 'It would be a good thing for me if I became pregnant in the next 3 months', where women who strongly agreed had a 66.7% chance of pregnancy within 12 months and the AUROC was acceptable (0.77). CONCLUSION We recommend exploring the acceptability to women and healthcare professionals of asking a single DAP item ('It would be a good thing for me if I became pregnant in the next 3 months'), possibly in combination with additional DAP items. This will help to guide service provision to support reproductive preferences.
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Affiliation(s)
- Jennifer Anne Hall
- Research Department of Reproductive Health, UCL Institute for Women's Health, London, UK
| | - Geraldine Barrett
- Research Department of Reproductive Health, UCL Institute for Women's Health, London, UK
| | - Judith M Stephenson
- Research Department of Reproductive Health, UCL Institute for Women's Health, London, UK
| | - Natalie Lois Edelman
- School of Sport & Health Sciences, University of Brighton, Brighton, UK
- Primary Care & Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Corinne Rocca
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco (UCSF) School of Medicine, Oakland, San Francisco, California, USA
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Adelman S, Charifson M, Seok E, Mehta-Lee SS, Brubaker SG, Liu M, Kahn LG. State-specific fertility rate changes across the USA following the first two waves of COVID-19. Hum Reprod 2023; 38:1202-1212. [PMID: 37038265 PMCID: PMC10233281 DOI: 10.1093/humrep/dead055] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/02/2023] [Indexed: 04/12/2023] Open
Abstract
STUDY QUESTION How did the first two coronavirus disease 2019 (COVID-19) waves affect fertility rates in the USA? SUMMARY ANSWER States differed widely in how their fertility rates changed following the COVID-19 outbreak and these changes were influenced more by state-level economic, racial, political, and social factors than by COVID-19 wave severity. WHAT IS KNOWN ALREADY The outbreak of the COVID-19 pandemic contributed to already declining fertility rates in the USA, but not equally across states. Identifying drivers of differential changes in fertility rates can help explain variations in demographic shifts across states in the USA and motivate policies that support families in general, not only during crises. STUDY DESIGN, SIZE, DURATION This is an ecological study using state-level data from 50 US states and the District of Columbia (n = 51). The study period extends from 2020 to 2021 with historical data from 2016 to 2019. We identified Wave 1 as the first apex for each state after February 2020 and Wave 2 as the second apex, during Fall/Winter 2020-2021. PARTICIPANTS/MATERIALS, SETTING, METHODS State-level COVID-19 wave severity, defined as case acceleration during each 3-month COVID-19 wave (cases/100 000 population/month), was derived from 7-day weekly moving average COVID-19 case rates from the US Centers for Disease Control and Prevention (CDC). State-level fertility rate changes (change in average monthly fertility rate/100 000 women of reproductive age (WRA)/year) were derived from the CDC Bureau of Vital Statistics and from 2020 US Census and University of Virginia 2021 population estimates 9 months after each COVID-19 wave. We performed univariate analyses to describe national and state-level fertility rate changes following each wave, and simple and multivariable linear regression analyses to assess the relation of COVID-19 wave severity and other state-level characteristics with fertility rate changes. MAIN RESULTS AND THE ROLE OF CHANCE Nationwide, fertility dropped by 17.5 births/month/100 000 WRA/year following Wave 1 and 9.2 births/month/100 000 WRA/year following Wave 2. The declines following Wave 1 were largest among majority-Democrat, more non-White states where people practiced greater social distancing. Greater COVID-19 wave severity was associated with steeper fertility rate decline post-Wave 1 in simple regression, but the association was attenuated when adjusted for other covariates. Adjusting for the economic impact of the pandemic (hypothesized mediator) also attenuated the effect. There was no relation between COVID-19 wave severity and fertility rate change following Wave 2. LIMITATIONS, REASONS FOR CAUTION Our study harnesses state-level data so individual-level conclusions cannot be inferred. There may be residual confounding in our multivariable regression and we were underpowered to detect some effects. WIDER IMPLICATIONS OF THE FINDINGS The COVID-19 pandemic initially impacted the national fertility rate but, overall, the fertility rate rebounded to the pre-pandemic level following Wave 2. Consistent with prior literature, COVID-19 wave severity did not appear to predict fertility rate change. Economic, racial, political, and social factors influenced state-specific fertility rates during the pandemic more than the severity of the outbreak alone. Future studies in other countries should also consider whether these factors account for internal heterogeneity when examining the impact of the COVID-19 pandemic and other crises on fertility. STUDY FUNDING/COMPETING INTEREST(S) L.G.K. received funding from the National Institute of Environmental Health Sciences (R00ES030403), M.C. from the National Science Foundation Graduate Research Fellowship Program (20-A0-00-1005789), and M.L. and E.S. from the National Institute of Environmental Health Sciences (R01ES032808). None of the authors have competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Sarah Adelman
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Mia Charifson
- Vilcek Institute of Biomedical Graduate Sciences, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Eunsil Seok
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Shilpi S Mehta-Lee
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sara G Brubaker
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Mengling Liu
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Linda G Kahn
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Koenig LR, Smith Hughes C, Gemmill A, Diamond-Smith N. Unequal impacts of the COVID-19 pandemic on women's fertility preferences: Evidence from a longitudinal cohort in the United States. SSM Popul Health 2022; 20:101305. [PMID: 36467514 PMCID: PMC9705005 DOI: 10.1016/j.ssmph.2022.101305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022] Open
Abstract
•The COVID-19 pandemic suppressed fertility desires among US women.•Impacts on fertility preferences persisted from summer 2020 to early 2021.•The fertility preferences of younger women, women of color and those facing financial stress were most impacted.
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Affiliation(s)
- Leah R. Koenig
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Carolyn Smith Hughes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Alison Gemmill
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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