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Harris ST, Schieve LA, Drews-Botsch C, DiGuiseppi C, Tian LH, Soke GN, Bradley CB, Windham GC. Pregnancy Planning and its Association with Autism Spectrum Disorder: Findings from the Study to Explore Early Development. Matern Child Health J 2024; 28:949-958. [PMID: 38198102 PMCID: PMC11001519 DOI: 10.1007/s10995-023-03877-0] [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] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES To examine associations between pregnancy planning and autism spectrum disorder (ASD) in offspring. METHODS The Study to Explore Early Development (SEED), a multi-site case-control study, enrolled preschool-aged children with ASD, other DDs, and from the general population (POP). Some children with DDs had ASD symptoms but did not meet the ASD case definition. We examined associations between mother's report of trying to get pregnant (pregnancy planning) and (1) ASD and (2) ASD symptomatology (ASD group, plus DD with ASD symptoms group combined) (each vs. POP group). We computed odds ratios adjusted for demographic, maternal, health, and perinatal health factors (aORs) via logistic regression. Due to differential associations by race-ethnicity, final analyses were stratified by race-ethnicity. RESULTS Pregnancy planning was reported by 66.4%, 64.8%, and 76.6% of non-Hispanic White (NHW) mothers in the ASD, ASD symptomatology, and POP groups, respectively. Among NHW mother-child pairs, pregnancy planning was inversely associated with ASD (aOR = 0.71 [95% confidence interval 0.56-0.91]) and ASD symptomatology (aOR = 0.67 [0.54-0.84]). Pregnancy planning was much less common among non-Hispanic Black mothers (28-32% depending on study group) and Hispanic mothers (49-56%) and was not associated with ASD or ASD symptomatology in these two race-ethnicity groups. CONCLUSION Pregnancy planning was inversely associated with ASD and ASD symptomatology in NHW mother-child pairs. The findings were not explained by several adverse maternal or perinatal health factors. The associations observed in NHW mother-child pairs did not extend to other race-ethnicity groups, for whom pregnancy planning was lower overall.
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Affiliation(s)
- Shericka T Harris
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S106-4, Atlanta, GA, 30341, USA.
| | - Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S106-4, Atlanta, GA, 30341, USA
| | - Carolyn Drews-Botsch
- Department of Global and Community Health, College of Health and Human Services, George Mason University, 4400 University Drive, MS: 5B7, Fairfax, VA, 22030, USA
| | - Carolyn DiGuiseppi
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 80045, Aurora, CO, USA
| | - Lin H Tian
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S106-4, Atlanta, GA, 30341, USA
| | - Gnakub N Soke
- Center for Global Health, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Chyrise B Bradley
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Gayle C Windham
- California Department of Public Health, Environmental Health Investigations Branch, Richmond, CA, 94804, USA
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Hensel D, Helou NE, Zhang F, Stout MJ, Raghuraman N, Friedman H, Carter E, Odibo AO, Kelly JC. The Impact of a Multidisciplinary Opioid Use Disorder Prenatal Clinic on Breastfeeding Rates and Postpartum Care. Am J Perinatol 2024; 41:884-890. [PMID: 35668653 DOI: 10.1055/s-0042-1748526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To evaluate the hypothesis that patients with opioid use disorder (OUD), who receive prenatal care in a multidisciplinary, prenatal OUD clinic, have comparable postpartum breastfeeding rates, prenatal and postpartum visit compliance, and postpartum contraceptive use when compared with matched controls without a diagnosis of OUD. STUDY DESIGN This was a retrospective, matched, cohort study that included all patients who received prenatal care in a multidisciplinary, prenatal OUD clinic-Clinic for Acceptance Recovery and Empowerment (CARE)-between September 2018 and August 2020. These patients were maintained on opioid agonist therapy (OAT) throughout their pregnancy. CARE patients were matched to controls without OUD in a 1:4 ratio for mode of delivery, race, gestational age ± 1 week, and delivery date ± 6 months. The primary outcome was rate of exclusive breastfeeding at maternal discharge. Secondary outcomes included adherence with prenatal care (≥4 prenatal visits), adherence with postpartum care (≥1 postpartum visit), postpartum contraception plan prior to delivery, and type of postpartum contraceptive use. Conditional multivariate logistic regression was used to account for possible confounders in adjusted calculations. RESULTS A total of 210 patients were included (42 CARE and 168 matched controls). Despite having lower rates of adequate prenatal care, 40 CARE patients (95%) were exclusively breastfeeding at discharge resulting in CARE patients being significantly more likely to be breastfeeding at discharge (adjusted relative risk (aRR): 1.28, 95% confidence interval [CI]: 1.05-1.55). CARE patients and controls demonstrated no difference in postpartum visit compliance (86 vs. 81%, aRR: 1.03, 95% CI: 0.76-1.40) or effective, long-term contraception use (48 vs. 48%; aRR: 0.81, 95% CI: 0.36-1.84). CONCLUSION In the setting of multidisciplinary OUD prenatal care during pregnancy, patients with OUD were more likely to be breastfeeding at the time of discharge than matched controls, with no difference in postpartum visit compliance or effective, long-term contraception. KEY POINTS · Women with OUD are more likely to breastfeed when engaged in a multidisciplinary prenatal clinic.. · Women with OUD had no difference in LARC use when engaged in a multidisciplinary prenatal clinic.. · Women with OUD had no difference in postpartum visit rate in a multidisciplinary prenatal clinic..
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Affiliation(s)
- Drew Hensel
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Nicole El Helou
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Fan Zhang
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Molly J Stout
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Nandini Raghuraman
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Hayley Friedman
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Ebony Carter
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Anthony O Odibo
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jeannie C Kelly
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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SmithBattle L, Flick LH. Reproductive Justice as an Alternative to the Pregnancy Planning Paradigm for Teens. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00039-X. [PMID: 38575116 DOI: 10.1016/j.jogn.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Abstract
In this critical commentary, we describe the many limitations of the pregnancy planning paradigm as applied to pregnant and parenting teens. We describe how this paradigm, in characterizing pregnancies as intended or unintended, has shaped campaigns to prevent teen pregnancy and remains largely embedded in formal sex education and family planning programs in the United States. We argue that a paradigm shift is long overdue and describe how the reproductive justice framework addresses the limitations of the pregnancy planning paradigm. Although reproductive justice is endorsed by a growing number of organizations, recommended policies face formidable obstacles given that comprehensive sex education, contraception, and legal abortion are increasingly at risk in a post-Dobbs world.
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Lathan EC, Britt A, Ravi M, Ash MJ, McAfee E, Wallace S, Johnson CB, Woods-Jaeger B, Powers A, Michopoulos V. WHEN REPRODUCTION IS NO LONGER AUTONOMOUS: FEELING RESPECTED BY MATERNITY CARE PROVIDERS MODERATES THE ASSOCIATION BETWEEN AUTONOMY IN DECISION MAKING AND BIRTH-RELATED PTSD SYMPTOMS IN A COMMUNITY SAMPLE OF POSTPARTUM BLACK WOMEN. J Trauma Dissociation 2023; 24:520-537. [PMID: 37233983 PMCID: PMC10330569 DOI: 10.1080/15299732.2023.2212406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023]
Abstract
Black individuals are at particularly high risk for birth-related posttraumatic stress disorder (PTSD) symptoms, in part due to a lack of opportunity to lead maternity care decisions. Maternal care providers need evidence-based ways to reduce pregnant persons' risk for birth-related PTSD symptoms despite reduced autonomy in decision making resulting from heightened restrictions on reproductive rights. We investigated whether a potential relation between autonomy in decision making and birth-related PTSD symptoms would be moderated by being mistreated or feeling respected by maternity care providers in a community sample of Black women (N = 52; Mage = 28.2 years, SDage = 5.7 years) seeking maternity care at a public hospital in the southeastern United States. At six weeks postpartum, participants completed measures assessing autonomy in decision making, current birth-related PTSD symptoms, number of mistreatment events, and feelings of respect from providers during pregnancy, childbirth, and the postpartum period. Autonomy in decision making was negatively correlated with birth-related PTSD symptoms, r=-.43, p < .01. An interaction between autonomy in decision making and mistreatment by providers was trending toward significance, B=-.23, SE=.14, p = .10. Autonomy in decision making and feeling respected by maternity care provider interacted to predict birth-related PTSD symptoms, B = .05, SE=.01, p < .01. Feeling respected by providers may buffer against the negative effects of lack of autonomy in decision making on birth-related PTSD symptoms, highlighting the importance of providers' ability to convey respect to pregnant patients when they cannot lead care decisions.
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Affiliation(s)
- Emma C. Lathan
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Abby Britt
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Meghna Ravi
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Marcia J. Ash
- Dept of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Elizabeth McAfee
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Shimarith Wallace
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Colin B. Johnson
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Briana Woods-Jaeger
- Dept of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Abigail Powers
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasiliki Michopoulos
- Dept of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Emory National Primate Research Center, Atlanta, GA, USA
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Bell N, Hopla D, George T, Durham CO, Miller L, Kelley S. Evaluation of a Hands-On Graduate Training Curriculum in Contraception Care. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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Non-barrier contraceptive use patterns among Latina adolescents attending California reproductive health centers: A longitudinal study. Contraception 2023; 118:109897. [PMID: 36240905 DOI: 10.1016/j.contraception.2022.09.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To describe use of non-barrier contraceptives over a 9-month period, consistency in method use, and identify factors associated with method nonuse, switching, and consistency among Latina adolescents attending California sexual and reproductive health (SRH) centers. STUDY DESIGN We conducted a cohort study using data self-reported at baseline, and 3- and 9-months post-baseline. The analysis included 1162 sexually active adolescents aged 18 to 19 who self-identified as female and Latina, indicated that they were not currently pregnant or trying to become pregnant, and who attended California SRH centers between June 2016 and June 2020. We used binomial generalized multivariable linear models with a log link to assess the likelihood of nonbarrier method consistency, switching, and non-use. RESULTS At baseline, 453 of 1162 (39%) of respondents were using short-acting methods (pill, patch, ring, or injection), 113 of 1162 (9.7%) were using long-acting methods (implants or intrauterine devices [IUDs]), and 596 of 1162 (51.3%) reported using neither short- nor long-acting methods. Over a 9-month period, 22/33 (66.7%) of those using IUDs consistently used the method, which was a statistically greater frequency of consistency than individuals who selected other nonbarrier methods (270/530 [50.9%], aRR: 1.40; 95% CI: 1.11, 1.77). Implant users had rates of method consistency similar to users of other nonbarrier methods (aRR: 1.11; 95% CI: 0.89, 1.38). Factors independently associated with method consistency included being older, having never been pregnant, having greater perceived risk of pregnancy, and greater contraceptive knowledge. CONCLUSION Sexually active Latina adolescents attending California SRH centers who were not trying to become pregnant maintained consistent contraceptive use more frequently when using an IUD. Using a patient-centered approach, contraceptive counseling for Latina adolescents can describe the combined efficacy and contraceptive stability offered by IUDs should patients desire it. IMPLICATIONS This study addressees gaps in knowledge about U.S. Latina adolescents' contraceptive use patterns. We demonstrate that IUD users, and not implant users, appear more likely to consistently use their method than those using non-LARC methods. Patient-centered contraceptive counseling for Latina adolescents can describe the greater contraceptive stability that IUDs may offer.
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Examination of the Public's Reaction on Twitter to the Over-Turning of Roe v Wade and Abortion Bans. Healthcare (Basel) 2022; 10:healthcare10122390. [PMID: 36553914 PMCID: PMC9777967 DOI: 10.3390/healthcare10122390] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022] Open
Abstract
The overturning of Roe v Wade reinvigorated the national debate on abortion. We used Twitter data to examine temporal, geographical and sentiment patterns in the public's reaction. Using the Twitter API for Academic Research, a random sample of publicly available tweets was collected from 1 May-15 July in 2021 and 2022. Tweets were filtered based on keywords relating to Roe v Wade and abortion (227,161 tweets in 2021 and 504,803 tweets in 2022). These tweets were tagged for sentiment, tracked by state, and indexed over time. Time plots reveal low levels of conversations on these topics until the leaked Supreme Court opinion in early May 2022. Unlike pro-choice tweets which declined, pro-life conversations continued with renewed interest throughout May and increased again following the official overturning of Roe v Wade. Conversations were less prevalent in some these states had abortion trigger laws (Wyoming, North Dakota, South Dakota, Texas, Louisiana, and Mississippi). Collapsing across topic categories, 2022 tweets were more negative and less neutral and positive compared to 2021 tweets. In network analysis, tweets mentioning woman/women, supreme court, and abortion spread faster and reached to more Twitter users than those mentioning Roe Wade and Scotus. Twitter data can provide real-time insights into the experiences and perceptions of people across the United States, which can be used to inform healthcare policies and decision-making.
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Quak XES, Sultana R, Aau WK, Goh CC, Tan NC. A 3-year retrospective study of unintended pregnancy in a developed multi-ethnic Asian community: A call for better healthcare system for family planning. Front Public Health 2022; 10:996696. [PMID: 36504963 PMCID: PMC9727312 DOI: 10.3389/fpubh.2022.996696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Women of childbearing age may face unintended pregnancy (UP). They are usually referred by primary care professionals (PCPs) to gynecologists to manage their UP in countries where abortion is legalized. The study aimed to determine the prevalence, demographic profiles, and associated factors of women in a developed community seeking referrals from PCPs for their UP. Methods The sociodemographic and clinical data were extracted from the electronic medical records of pregnant multi-ethnic Asian women at eight Singapore public primary care clinics from July 2017 to June 2020. Their demographic profiles were reviewed and compared among women of different age bands using appropriate statistical tests. Logistic regression was used to identify the factors associated with UP referrals. Results Among 9,794 gravid women, 974 of them requested gynecologist referrals to terminate UP over the 3-year period, constituting a prevalence of 9.94%. The mean age of women requesting such referrals was 29.7 ± 7 years. There were 10.7% with more than one prior unintended pregnancy and 15.7% were foreigners. The majority of these women were married, neither required social assistance nor had comorbidities. Only 2.9% of them were known to be prescribed contraceptives. A multivariable logistic regression analysis showed that women of Indian ethnicity, single, aged below 20 years and above 40 years, were more likely to request referrals for UP. Conclusion One in 10 gravid women had sought referrals for UP, especially adolescents and older women, and Indian ethnicity. An accessible community-based healthcare service to educate and counsel women on family planning is urgently needed to reduce the incidence of UP.
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Affiliation(s)
| | | | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore,SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore,*Correspondence: Ngiap Chuan Tan
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Eliason EL, Spishak-Thomas A, Steenland MW. Association of the affordable care act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy. Contraception 2022; 113:42-48. [PMID: 35259409 PMCID: PMC9378469 DOI: 10.1016/j.contraception.2022.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/23/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Before the Affordable Care Act (ACA), 55% of individuals giving birth with Medicaid lost insurance postpartum, potentially affecting their access to postpartum contraception. We evaluate the association of the ACA Medicaid expansions with postpartum contraceptive use and pregnancy at the time of the survey. METHODS We used 2012-2019 Pregnancy Risk Assessment Monitoring System data to estimate difference-in-difference models for the association of Medicaid expansions with the use of postpartum contraception (mean: 4 months postpartum): any contraception, long-acting reversible contraception, or LARC (contraceptive implant and intrauterine device), short-acting (contraceptive pill, patch, and ring), permanent, or non-prescription methods (condoms, rhythm method, and withdrawal), and pregnancy at the time of the survey. We examine low-income respondents overall and stratified by race and ethnicity. RESULTS We find that Medicaid expansion was associated with a 7.0 percentage point (95% CI: 3.0, 11.0) increase in postpartum LARC, a 3.1 percentage point (95% CI: -6.0, -0.2) decrease in short-acting contraception, and a 3.9 percentage point (95% CI: -6.2, -1.5) decrease in non-prescription contraceptive use overall. In stratified analyses, we find that increases in LARC use were concentrated among non-Hispanic White and Black respondents, with shifts in other postpartum contraceptives towards LARCs. Medicaid expansion was associated with a decrease in early postpartum pregnancy only among non-Hispanic Black respondents. CONCLUSIONS Medicaid expansions led to shifts from methods with a lower upfront out-of-pocket cost for people without insurance towards methods with the higher upfront out-of-pocket cost for people without insurance. These changes suggest that Medicaid expansion improved postpartum contraceptive access. IMPLICATIONS These findings indicate that postpartum uninsurance was a barrier to postpartum contraceptive access prior to Medicaid expansions under the Affordable Care Act. Medicaid expansions increased access to the full range of contraceptive methods.
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Affiliation(s)
- Erica L Eliason
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence RI, United States.
| | | | - Maria W Steenland
- Population Studies and Training Center, Brown University, Providence RI, United States
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Davis KM, Jones KA, Yee LM, Feinglass J. Modeling the Likelihood of Low Birth Weight: Findings from a Chicago-Area Health System. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01360-0. [PMID: 35799041 PMCID: PMC9823150 DOI: 10.1007/s40615-022-01360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study presents a statistical model of the incidence of low birth weight (LBW) births in a large, Chicago-area hospital system. The study was undertaken to provide a strategic framework for future health system interventions. METHODS Administrative and electronic health records were matched to census Zip Code Tabulation Area (ZCTA) household poverty data for 42,681 births in 2016-2019 at seven system hospitals, serving a diverse patient population. A logistic regression model of LBW incidence was estimated to test the independent significance of maternal sociodemographic characteristics after controlling for clinical risk factors. RESULTS The incidence of LBW was 6.3% overall but 11.3% among non-Hispanic Black patients as compared to 5.1% among non-Hispanic White patients. LBW incidence ranged from 9.2% for patients from the poorest ZCTA (20% + poor households) compared to 5.6% of patients from the most affluent (< 5% poor) ZCTA. Nulliparous patients, patients with pre-existing chronic conditions, and patients with hypertensive disorders of pregnancy were significantly more likely to have LBW births. After controlling for clinical risk factors and poverty level, non-Hispanic Black patients were still over 80% more likely and to have a LBW birth. DISCUSSION Study findings reveal the joint effects of social and clinical risk factors. Findings profile our highest-risk populations for targeted interventions. Promising prenatal care redesign programs include pregnancy patient navigators, home and group visits, eHealth telemonitoring, improved mental health screening, and diversification of the maternity care workforce. Decreasing LBW births should be a national public health policy priority and will require major investments in the most impacted communities.
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Affiliation(s)
- Ka’Derricka M. Davis
- Division of Maternal and Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Lynn M. Yee
- Division of Maternal and Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Northwestern Feinberg School of Medicine, Chicago, IL
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Nicolas SCA, Welling LLM. A Preliminary Investigation Into Women’s Sexual Risk-taking That Could Lead to Unintended Pregnancy. EVOLUTIONARY PSYCHOLOGICAL SCIENCE 2022. [DOI: 10.1007/s40806-022-00319-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dalessandro C, Kaiser J, Sanders JN. Reproductive autonomy and feelings of control over pregnancy among emerging adult clients in a Utah (USA) contraceptive initiative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 31:100688. [PMID: 34864316 PMCID: PMC8898276 DOI: 10.1016/j.srhc.2021.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/26/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Research has called for more exploration into how reproductive autonomy (which includes agency over pregnancy decisions) is related to structural, relational, and individual elements. Thus, we use surveys to investigate how one potential indicator of reproductive autonomy-feelings of control over pregnancy-may relate to structural, relational, and individual factors in emerging adults' (age 18-24) lives. METHODS Using survey data from 2594 emerging adult women participating in a contraceptive initiative in Utah (USA), we analyzed level of agreement with the statement: "I feel that I have control over whether or not I get pregnant," exploring relationships between sociodemographic characteristics and agreement with the statement. We used chi-square tests and multinomial logistic regression to investigate relationships between individual, relational, and structural factors and feelings of control. RESULTS Most participants (86%) agreed with the statement (n = 2231), while the remainder were neutral or disagreed. Participants reporting poverty-level incomes (RRR: 1.80; 95 %CI 1.25-2.59) and previous unwanted pregnancies (RRR: 2.74; 95 %CI: 1.56-4.81) were more likely to describe "neutral" feelings of control. CONCLUSION Findings indicate a relationship between feelings of control over pregnancy and several factors, and these results may help identify reproductive autonomy access gaps among emerging adults. More work should investigate these relationships as well as the meaning of "neutral" responses when it comes to assessments of control over pregnancy. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02734199, Registered 12 April 2016.
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Affiliation(s)
- Cristen Dalessandro
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT 84132, USA.
| | - Jennifer Kaiser
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT 84132, USA.
| | - Jessica N Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT 84132, USA.
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Grace KT, Decker MR, Alexander KA, Campbell J, Miller E, Perrin N, Glass N. Reproductive Coercion, Intimate Partner Violence, and Unintended Pregnancy Among Latina Women. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:1604-1636. [PMID: 32486886 PMCID: PMC8162928 DOI: 10.1177/0886260520922363] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Reproductive coercion (RC) describes a range of behaviors that restrict reproductive autonomy including pregnancy coercion, birth control sabotage, and controlling the outcome of a pregnancy. RC is associated with pregnancies that are mistimed and unwanted (i.e., unintended). Past research demonstrates that Latina women have higher risk for RC and for unintended pregnancy. This cross-sectional descriptive study with Latina women (n = 482) examined prevalence and risk factors for RC, evaluated the association of RC and unintended pregnancy among women with a past-year pregnancy, and explored use of safety and harm reduction strategies. A tablet survey was administered to women attending a community health center, between the ages of 15 and 45, who self-identified as Latina and who had a dating or sexual partner in the past year. Approximately one in six (16.8%) experienced past-year RC and risk factors included younger age (adjusted odds ratio [AOR] = 0.95, 95% confidence interval [CI] = [0.91, 1.00], p = .038) and concurrent intimate partner violence (IPV; AOR = 4.47, 95% CI = [2.06, 9.70], p < .001). IPV questions were specific to the partner involved with RC behaviors. For the 185 participants who reported a past-year pregnancy, RC was associated with lower pregnancy planning scores (β = -.27, 95% CI = [-0.41, -0.13], p < .001). The combination of experiencing RC and IPV appeared particularly potent in lowering pregnancy planning scores (β = -.15, 95% CI = [-0.29, 0.00], p = .052). Approximately 10.6% of participants engaged in harm reduction strategies, most commonly ending an unhealthy or abusive relationship (6.1%) and using less detectable methods of contraception so that partners would not find out (3.4%). The study articulates the risk of RC and its intersection with IPV and unintended pregnancy for Latina women. Providers working with racially and ethnically marginalized women have an important role in promoting safety and harm reduction strategies that include offering less detectable methods of contraception and support in leaving unhealthy and abusive relationships.
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Affiliation(s)
| | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Nancy Glass
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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14
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Poleon S, Thompson EL. Reasons for Intent to Discontinue and Remove Long-Acting Reversible Contraceptives: National Survey of Family Growth 2017-2019. J Womens Health (Larchmt) 2022; 31:733-740. [PMID: 35005999 DOI: 10.1089/jwh.2021.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Long-acting reversible contraceptives (LARCs) are highly effective forms of contraception, which can reduce the risk of unintended pregnancy. Despite LARC effectiveness, women may desire to discontinue this method. This study will examine reasons for intent to discontinue and remove LARCs among U.S. women 15-49 years of age from 2017 to 2019. Methods: The National Survey of Family Growth 2017-2019 was utilized with a sample of 6141 female respondents. Descriptive statistics for intention to discontinue LARCs, difficulty removing LARCs, and reasons for LARC discontinuation and removal were examined. Rao-Scott chi-square tests were conducted in SAS. Results: Overall, 22.9% of women reported ever using LARCs. Among LARC users, most women (81.2%) reported using LARC in the past 10 years. Among these women, 63.9% intended to discontinue LARCs, and 11.5% had difficulty removing LARCs. Reasons for wanting to discontinue LARCs include side effects (29.6%), LARC expiration (26.8%), LARC complications (19.3%), and decided to get pregnant (15.9%). Primary reasons reported for difficulty removing LARCs included: complications (68.3%), other reasons (13.4%), discouragement by provider (5.8%), and provider's inability to remove (4.9%). Conclusion: Given that women who use a LARC method rely on providers to remove this contraceptive method, understanding the reasons for discontinuation and difficulties encountered is needed. Findings from this nationally representative sample identified provider-level and system-level barriers for LARC removal. To respect the reproductive autonomy of LARC users' method for pregnancy prevention, these barriers must be overcome.
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Affiliation(s)
- Suprena Poleon
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Erika L Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
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15
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Hauck FR, Blackstone SR. Maternal Smoking, Alcohol and Recreational Drug Use and the Risk of SIDS Among a US Urban Black Population. Front Pediatr 2022; 10:809966. [PMID: 35620144 PMCID: PMC9127336 DOI: 10.3389/fped.2022.809966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/11/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Rates of sudden infant death syndrome (SIDS) are twice as high among Black infants compared to white infants in the US. While the contribution of sleep environment factors to this disparity is known, little is known about the risk of SIDS among Black infants in relation to maternal prenatal smoking, alcohol and drug use as well as infant smoke exposure. OBJECTIVE To assess the contribution of maternal substance use during pregnancy and the potential interactions with infant bedsharing in a high-risk, urban Black population. METHODS The Chicago Infant Mortality Study (CIMS) collected data on 195 Black infants who died of SIDS and 195 controls matched on race, age and birthweight. Risk of SIDS was calculated for maternal smoking, alcohol and drug use, adjusting for potential confounding variables and other risk factors for SIDS. Interactions between these substance use variables and bedsharing were also calculated. RESULTS Infants were more likely to die from SIDS if the mother smoked during pregnancy (aOR 3.90, 95% CI 1.37-3.30) and post-pregnancy (aOR 2.49, 95% CI 1.49-4.19). There was a dose response seen between amount smoked during pregnancy and risk of SIDS. Use of alcohol (aOR 2.89, 95% CI 1.29-6.99), cocaine (aOR 4.78, 95% CI 2.45-9.82) and marijuana (aOR 2.76, 95% CI 1.28-5.93) were associated with increased risk of SIDS. In the final, multivariable model controlling for sociodemographic factors and covariates, maternal smoking (aOR 3.03, 95% CI 1.03-8.88) and cocaine use (aOR 4.65, 95% CI 1.02-21.3) during pregnancy remained significant. There were significant, positive interactions between bedsharing and maternal smoking during pregnancy and post-pregnancy, alcohol use and cocaine use. CONCLUSION Maternal use of tobacco, alcohol and cocaine during pregnancy is associated with significantly increased risk of SIDS in a Black, urban population. Reducing substance use and eliminating disparities in SIDS, sudden unexpected infant death (SUID) (also known as sudden unexpected death in infancy or SUDI) and infant mortality need to involve more than individual level education, but instead will require a comprehensive examination of the role of social determinants of health as well as a multi-pronged approach to address both maternal and infant health and wellbeing.
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Affiliation(s)
- Fern R Hauck
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Sarah R Blackstone
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
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16
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Parker LA, Sullivan S, Cacho N, Krueger C, Mueller M. Effect of Postpartum Depo Medroxyprogesterone Acetate on Lactation in Mothers of Very Low-Birth-Weight Infants. Breastfeed Med 2021; 16:835-842. [PMID: 33913765 PMCID: PMC8817730 DOI: 10.1089/bfm.2020.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: This study examined the effect of postpartum administration of depo medroxyprogesterone acetate (DMPA) on milk production, time to onset of secretory activation, lactation duration, and infant consumption of mother's own milk (MOM) in mothers of preterm very low-birth-weight (VLBW) infants. Materials and Methods: We conducted a secondary analysis of data from mothers who delivered infants weighing ≤1,500 g and at ≤32 weeks' gestation. The volume of milk produced was measured on days 1-7, 14, and 21 by weighing all expressed milk on an electronic scale. Time to secretory activation was determined through self-report of a feeling of breast fullness. Information on lactation duration and the percent of feeds consisting of MOM consumed by infants was obtained from the medical records. Results: Mothers who received postpartum DMPA were more likely to be African American (72.4% versus 31.4%; p = 0.0006), unemployed (65.5% versus 44.5%; p = 0.027), and Medicaid eligible (89.7% versus 67.2%; p = 0.019). There were no differences in daily milk production between mothers who received DMPA before hospital discharge (n = 29) compared with those who did not (n = 141). When mothers who reached secretory activation before receiving DMPA were removed from analysis, receiving DMPA was associated with a later onset of secretory activation (103.7 versus 88.6 hours; p = 0.028). There were no statistically significant differences between the study groups in lactation duration or infant MOM consumption. Conclusions: DMPA, when administered postpartum to mothers of preterm VLBW infants, delayed secretory activation, but had no detrimental effect on milk production or lactation duration. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT01892085.
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Affiliation(s)
- Leslie A Parker
- Department of Biobehavioral Nursing Science in the College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Sandra Sullivan
- Department of Pediatrics at the College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Nicole Cacho
- Department of Pediatrics at the College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Charlene Krueger
- Department of Biobehavioral Nursing Science in the College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
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17
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Namkung EH, Mitra M. Birth intentions among US fathers with disabilities. Disabil Health J 2021; 14:101097. [PMID: 33865750 DOI: 10.1016/j.dhjo.2021.101097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/19/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Men's birth intention is an indicator of their sexual health and plays an important role for their child's health and development; however, birth intendedness in fathers with disabilities has been unknown. OBJECTIVE This study examines disparities in birth intendedness among fathers with and without disabilities and explores whether the differences vary by marital status or race/ethnicity. METHODS Data from the 2011-2017 National Survey of Family Growth (NSFG) were used to examine pregnancy intendedness for fathers with (n = 380) and without disabilities (n = 1,324) about their last birth in the five years preceding the interview. Multinomial regression models estimated the odds ratios of fathers' disability status on birth intention controlling for covariates. Interaction effects of disability status by marital status or race/ethnicity were also tested. RESULTS Fathers with disabilities were 1.89 (95% CI = 1.21, 2.95) times as likely to report their last birth as unwanted versus intended compared to those without disabilities after adjusting for covariates. Although married fathers without disabilities were less likely to report unintended birth than their unmarried counterparts, the protective effect of marriage was not evident among fathers with disabilities. CONCLUSIONS Disabled fathers are at a higher risk of unintended birth compared to nondisabled fathers. These findings highlight the need to increase access to family planning services for disabled men. Further research is needed to better understand the risk factors that contribute to disabled fathers' unintended birth and how these are linked to their child and family well-being.
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Affiliation(s)
- Eun Ha Namkung
- Lurie Institute for Disability Policy, Heller School for Social Policy & Management, Brandeis University, 415 South Street (MS035), Waltham, MA, 02453, USA.
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy & Management, Brandeis University, 415 South Street (MS035), Waltham, MA, 02453, USA.
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18
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Barber JS, Guzzo KB, Budnick J, Kusunoki Y, Hayford SR, Miller W. Black-White Differences in Pregnancy Desire During the Transition to Adulthood. Demography 2021; 58:603-630. [PMID: 33834223 DOI: 10.1215/00703370-8993840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article explores race differences in the desire to avoid pregnancy or become pregnant using survey data from a random sample of 914 young women (ages 18-22) living in a Michigan county and semi-structured interviews with a subsample of 60 of the women. In the survey data, desire for pregnancy, indifference, and ambivalence are very rare but are more prevalent among Black women than White women. In the semi-structured interviews, although few women described fatalistic beliefs or lack of planning for future pregnancies, Black and White women did so equally often. Women more often described fatalistic beliefs and lack of planning when retrospectively describing their past than when prospectively describing their future. Using the survey data to compare prospective desires for a future pregnancy with women's recollections of those desires after they conceived, more Black women shifted positive than shifted negative, and Black women were more likely to shift positive than White women-that is, Black women do not differentially retrospectively overreport prospectively desired pregnancies as having been undesired before conception. Young women's consistent (over repeated interviews) prospective expression of strong desire to avoid pregnancy and correspondingly weak desire for pregnancy, along with the similarity of Black and White women's pregnancy plans, lead us to conclude that a "planning paradigm"-in which young women are encouraged and supported in implementing their pregnancy desires-is probably appropriate for the vast majority of young women and, most importantly, is similarly appropriate for Black and White young women.
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Affiliation(s)
- Jennifer S Barber
- Department of Sociology and Kinsey Institute, Indiana University, Bloomington, IN, USA
| | | | - Jamie Budnick
- Population Studies Center and Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Yasamin Kusunoki
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Sarah R Hayford
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Warren Miller
- Transnational Family Research Institute, Aptos, CA, USA
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19
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Manso-Córdoba S, Pickering S, Ortega MA, Asúnsolo Á, Romero D. Factors Related to Seeking Help for Postpartum Depression: A Secondary Analysis of New York City PRAMS Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249328. [PMID: 33322171 PMCID: PMC7763494 DOI: 10.3390/ijerph17249328] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
Postpartum depression (PPD) affects 13% of mothers and can have a major impact on their lives and those of their children. However, most cases go undiagnosed, and the risk factors for this underdiagnosis are not yet fully known. We intended to analyze the influence of different sociodemographic and health factors associated with symptoms of postpartum depression. Data from the New York City Pregnancy Risk Assessment Monitoring System (PRAMS) for 2016–2017 were analyzed. 618 women met the inclusion criterion of recurring depressive symptoms. Most women who experienced PPD symptoms did not seek help. Seeking help was a much better predictor of the diagnosis of PPD when compared to questions regarding symptoms. The most important factors related to a decreased risk of not asking for help were having a previous mental health history and having doctor visits for a chronic illness. The racial group most at risk of not asking for help were Asian/Pacific Islander (API) women. Interventions aimed at reducing the stigma and increasing knowledge of PPD should be incorporated into the antenatal education of expectant mothers, particularly among women who may not have previously sought care for mental or chronic illnesses.
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Affiliation(s)
- Silvia Manso-Córdoba
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain;
| | - Sarah Pickering
- Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, NY 10010, USA;
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain;
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain
- University Center for the Defense of Madrid (CUD-ACD), 28047 Madrid, Spain
| | - Ángel Asúnsolo
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain;
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY 10010, USA
- Correspondence: (Á.A.); (D.R.); Tel.: +34-619587458 (Á.A.); +1-646-364-9522 (D.R.)
| | - 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, NY 10010, USA
- Correspondence: (Á.A.); (D.R.); Tel.: +34-619587458 (Á.A.); +1-646-364-9522 (D.R.)
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20
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Malat J, Johns-Wolfe E, Smith T, Shields GS, Jacquez F, Slavich GM. Associations between lifetime stress exposure, race, and first-birth intendedness in the United States. J Health Psychol 2020; 27:765-777. [PMID: 33111552 DOI: 10.1177/1359105320963210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This study examined how lifetime stress exposure and race are associated with first-birth intendedness, and whether these associations differ based on stress exposure timing. Greater lifetime stress exposure was related to increased first-birth intendedness for black women but was unrelated or even associated with decreased first-birth intendedness for white women, depending on stress exposure timing. These effects were robust while controlling for age, partner status, household income, and education, and they differed based on the timing of participants' stress exposure. These data thus provide evidence that first-birth intendedness is influenced by both lifetime stress exposure and race in the United States.
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21
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Cruz-Bendezú AM, Lovell GV, Roche B, Perkins M, Blake-Lamb TL, Taveras EM, Simione M. Psychosocial status and prenatal care of unintended pregnancies among low-income women. BMC Pregnancy Childbirth 2020; 20:615. [PMID: 33046003 PMCID: PMC7552564 DOI: 10.1186/s12884-020-03302-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/30/2020] [Indexed: 11/14/2022] Open
Abstract
Background Nearly half of all pregnancies in the United States are reported as unintended and rates are highest among women of low socioeconomic status. The purpose of this study was to examine the associations between unintended pregnancies and maternal mental health and timing of prenatal care among low-income women. Methods In this cross-sectional study, 870 women, whom were participating in the First 1000 Days program in three community health centers in the Boston area, were enrolled at their first prenatal visit from August 2016 – September 2017. We assessed pregnancy intention by self-report using the Pregnancy Risk Assessment Monitoring System. We used self-reported survey information and electronic health record data to assess the following outcomes: current stress, current depression, and timing of initial prenatal visit. We used multivariable logistic regression models to examine associations and adjusted for sociodemographic factors. Results Women were a mean (SD) age of 29.3 (6.1), and 39.2% reported that their pregnancy was unintended. 50.6% of women were Hispanic, 28.4% were White, 10.1% were Black, and 10.9% were other races. 78.9% of women reported an annual household income <$50,000. Overall, 26.7% of women reported current stress, 8.2% reported current depression, and 18.3% of women initiated prenatal care after their first trimester. In multivariable analyses, women with unintended pregnancies had higher odds of experiencing current stress (OR: 1.72; 95% CI: 1.22, 2.41), current depression (OR: 1.83; 95% CI: 1.04, 3.20), and initiation of prenatal care post-first trimester (OR: 1.84; 95% CI: 1.23, 2.74). Conclusions Unintended pregnancies were associated with current stress and depression, and delayed prenatal care in this sample of low-income women suggesting the importance of identifying high-risk women and tailoring interventions to support women’s needs. Trial registration ClinicalTrials.gov (NCT03191591; Retrospectively registered on June 19, 2017).
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Affiliation(s)
- Alanna M Cruz-Bendezú
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA
| | - Grace V Lovell
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA
| | - Brianna Roche
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA
| | - Tiffany L Blake-Lamb
- Department of Obstetrics and Gynecology, MGH, Boston, MA, USA.,Kraft Center for Community Health Leadership, Partners Healthcare, Boston, MA, USA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA.,Kraft Center for Community Health Leadership, Partners Healthcare, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Meg Simione
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA. .,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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22
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Troutman M, Rafique S, Plowden TC. Are higher unintended pregnancy rates among minorities a result of disparate access to contraception? Contracept Reprod Med 2020; 5:16. [PMID: 33014415 PMCID: PMC7527248 DOI: 10.1186/s40834-020-00118-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 07/30/2020] [Indexed: 11/25/2022] Open
Abstract
Abstract Unintended pregnancy is a major global issue. Women who experience an unintended pregnancy have a significant risk of morbidity and mortality. Additionally, these women also experience substantial financial hardships. Many women, particularly women of color, do not have adequate access to reliable and affordable contraception resulting in major health disparities among this group. This review explores the relationship between unintended pregnancy and inadequate access to contraception and is divided into 5 sections: addressing problems associated with unintended pregnancies, unintended pregnancy rate in the US, disparities of unintended pregnancy rates and access to care, addressing potential solutions, and finally conclusions. Keyterms unintended pregnancy, healthcare disparities, contraception, access to care.
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Affiliation(s)
- Michele Troutman
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA
| | | | - Torie Comeaux Plowden
- Department of Obstetrics and Gynecology, Womack Army Medical Center, Ft Bragg, NC USA
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23
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Quinn DA, Sileanu FE, Zhao X, Mor MK, Judge-Golden C, Callegari LS, Borrero S. History of unintended pregnancy and patterns of contraceptive use among racial and ethnic minority women veterans. Am J Obstet Gynecol 2020; 223:564.e1-564.e13. [PMID: 32142832 PMCID: PMC7528209 DOI: 10.1016/j.ajog.2020.02.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/31/2020] [Accepted: 02/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nearly half of all pregnancies in the United States each year are unintended, with the highest rates observed among non-Hispanic black and Hispanic women. Little is known about whether variations in unintended pregnancy and contraceptive use across racial and ethnic groups persist among women veteran Veterans Affairs users who have more universal access than other populations to health care and contraceptive services. OBJECTIVES The objectives of this study were to identify a history of unintended pregnancy and describe patterns of contraceptive use across racial and ethnic groups among women veterans accessing Veterans Affairs primary care. STUDY DESIGN Cross-sectional data from a national random sample of women veterans (n = 2302) aged 18-44 years who had accessed Veterans Affairs primary care in the previous 12 month were used to assess a history of unintended pregnancy (pregnancies reported as either unwanted or having occurred too soon). Any contraceptive use at last sex (both prescription and nonprescription methods) and prescription contraceptive use at last sex were assessed in the subset of women (n = 1341) identified as being at risk for unintended pregnancy. Prescription contraceptive methods include long-acting reversible contraceptive methods (intrauterine devices and subdermal implants), hormonal methods (pill, patch, ring, and injection), and female or male sterilization; nonprescription methods include barrier methods (eg, condoms, diaphragm), fertility-awareness methods, and withdrawal. Multivariable logistic regression models were used to examine the relationship between race/ethnicity with unintended pregnancy and contraceptive use at last sex. RESULTS Overall, 94.4% of women veterans at risk of unintended pregnancy used any method of contraception at last sex. Intrauterine devices (18.9%), female surgical sterilization (16.9%), and birth control pills (15.9%) were the 3 most frequently used methods across the sample. Intrauterine devices were the most frequently used method for Hispanic, non-Hispanic white, and other non-Hispanic women, while female surgical sterilization was the most frequently used method among non-Hispanic black women. In adjusted models, Hispanic women (adjusted odds ratio, 1.60, 95% confidence interval, 1.15-2.21) and non-Hispanic black women (adjusted odds ratio, 1.84, 95% confidence interval, 1.44-2.36) were significantly more likely than non-Hispanic white women to report any history of unintended pregnancy. In the subcohort of 1341 women at risk of unintended pregnancy, there were no significant racial/ethnic differences in use of any contraception at last sex. However, significant differences were observed in the use of prescription methods at last sex. Hispanic women (adjusted odds ratio, 0.51, 95% confidence interval, 0.35-0.75) and non-Hispanic black women (adjusted odds ratio, 0.69, 95% confidence interval, 0.51-0.95) were significantly less likely than non-Hispanic white women to have used prescription contraception at last sex. CONCLUSION Significant racial and ethnic differences exist in unintended pregnancy and contraceptive use among women veterans using Veterans Affairs care, suggesting the need for interventions to address potential disparities. Improving access to and delivery of patient-centered reproductive goals assessment and contraceptive counseling that can address knowledge gaps while respectfully considering individual patient preferences is needed to support women veterans' decision making and ensure equitable reproductive health services across Veterans Affairs.
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Affiliation(s)
- Deirdre A Quinn
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA.
| | - Florentina E Sileanu
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA
| | - Xinhua Zhao
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA
| | - Maria K Mor
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Colleen Judge-Golden
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Lisa S Callegari
- Departments of Obstetrics and Gynecology and Health Services, University of Washington, Seattle, WA; Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA
| | - Sonya Borrero
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA; Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA; Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA
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24
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Hernandez ND, Chandler R, Nava N, Tamler I, Daley EM, Baldwin JA, Buhi ER, O’Rourke K, Romero-Daza N, Grilo S. Young adult US-born Latina women's thoughts, feelings and beliefs about unintended pregnancy. CULTURE, HEALTH & SEXUALITY 2020; 22:920-936. [PMID: 31382840 PMCID: PMC7002175 DOI: 10.1080/13691058.2019.1642517] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Abstract
Current measures of unintended pregnancy underestimate the co-occurring, complex set of social, cultural, economic and structural factors that influence how women interpret unintended pregnancy. The purpose of this study was to prospectively explore young adult US-born Latinas' thoughts, feelings and beliefs about pregnancy, specifically unintended pregnancies and the sociocultural factors identified as contributors to those beliefs. In-depth interviews (n = 20) were conducted with US-born, English-speaking Latinas aged 18-25 years in south Florida. Seventeen participants did not intend to get pregnant, while the remaining participants (n = 3) reported that their intentions kept changing. Participants' beliefs regarding their unintended pregnancy were influenced by social and economic hardship and cultural factors such as fatalism and familismo. Ideas and the meaning of pregnancy differed based on the woman's pregnancy resolution decision. Many women felt the term 'unintended pregnancy' placed blame on women and was stigmatising. When discussing pregnancy planning, most participants felt that women should not plan their pregnancies and doing so was going against fate. Findings suggest that salient influences such as culture and the social determinants related to unintended pregnancy should be incorporated into measurements examining unintended pregnancy.
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Affiliation(s)
- Natalie D. Hernandez
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Nancy Nava
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Ilyssa Tamler
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ellen M. Daley
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Julie A. Baldwin
- Northern Arizona University, Department of Health Sciences, College of Health and Human Services, Flagstaff, AZ, USA
| | - Eric R. Buhi
- San Diego State University, Graduate School of Public Health, San Diego, CA, USA
| | - Kathleen O’Rourke
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Nancy Romero-Daza
- Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Stephanie Grilo
- Chronic Disease Epidemiology, Yale School of Public Heath, New Haven, CT, USA
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Townes A, Rosenberg M, Guerra-Reyes L, Murray M, Herbenick D. Inequitable Experiences Between Black and White Women Discussing Sexual Health With Healthcare Providers: Findings From a U.S. Probability Sample. J Sex Med 2020; 17:1520-1528. [PMID: 32622764 DOI: 10.1016/j.jsxm.2020.04.391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the United States, efforts to achieve health equity and reduce sexual health disparities remain a national priority; however, limited research has focused on understanding racial differences in patient/provider discussions about sexual health. AIM To quantify racial differences between black and white women (aged 18-49 years) in the United States discussing sexual health with a healthcare provider in the past year. METHODS Data were analyzed from a subset of 1,654 women aged 18-49 years who participated in the 2018 National Survey of Sexual Health and Behavior. Measures of interest included visiting a healthcare provider and discussing sexual health with the provider in the past year. Log binomial models were developed to estimate risk ratios for the likelihood of sexual health topics encountered by black women; models were adjusted for age, marital status, education level, and annual income. MAIN OUTCOME Black women were significantly more likely to report having a healthcare visit in the past year compared to white women and were more likely to have discussed their sexual health activities. RESULTS The adjusted risk ratio (ARR) for black women who reported discussing sex or sexual health with a healthcare provider was 1.16 (95% CI: 1.06-1.26). The ARR for black women who were asked if they were sexually active was 1.16 (95% CI: 1.06-1.26) and about their condom use was 1.49 (95% CI: 1.27-1.74). Black women were nearly 2 times more likely to be offered sexually transmitted disease testing (ARR: 1.72, 95% CI: 1.46-2.02) and to report that they were provided condoms for future use (ARR: 1.94, 95% CI: 1.12-3.36). CLINICAL TRANSLATION Healthcare providers are encouraged to have routine sexual health discussions with all patients; however, we found that there are differences among black and white women in discussing their sexual health activities. STRENGTHS & LIMITATIONS The present study utilized a nationally representative probability survey, including an oversample of black women. The study focused on sexual health discussions of black and white women with a healthcare provider, and therefore, women who did not have a healthcare visit in the past year were excluded from the analysis. CONCLUSION Black women reported having conversations about their sexual activities (eg, condom use) and were offered sexually transmitted disease testing more often than white women. These data provide insights that will impact patient/provider communication and aid in improving the delivery of sexual healthcare for all women. Townes A, Rosenberg M, Guerra-Reyes L, et al. Inequitable Experiences Between Black and White Women Discussing Sexual Health With Healthcare Providers: Findings From a U.S. Probability Sample. J Sex Med 2020;17:1520-1528.
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Affiliation(s)
- Ashley Townes
- Department of Applied Health Science, School of Public Health, Indiana University-Bloomington and Center for Sexual Health Promotion, Indiana University-Bloomington, Bloomington, IN, USA.
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University-Bloomington, Bloomington, IN, USA
| | - Lucia Guerra-Reyes
- Department of Applied Health Science, School of Public Health, Indiana University-Bloomington, Bloomington, IN, USA
| | - Maresa Murray
- Department of Applied Health Science, School of Public Health, Indiana University-Bloomington, Bloomington, IN, USA
| | - Debby Herbenick
- Department of Applied Health Science, School of Public Health, Indiana University-Bloomington and Center for Sexual Health Promotion, Indiana University-Bloomington, Bloomington, IN, USA
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Racial Disparities in Reproductive Healthcare among Parous and Nulliparous Women in Mississippi. J Racial Ethn Health Disparities 2020; 8:304-314. [PMID: 32495305 DOI: 10.1007/s40615-020-00783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/16/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Long-standing racial disparities exist in reproductive healthcare and have been associated with negative health outcomes among minority women. This study aimed to analyze the racial disparities in reproductive healthcare among Mississippi women, particularly as it related to contraception access, usage, setting, provider type, and payer. METHODS A two-stage stratified probability design was employed - 95 of the 1500 licensed childcare facilities across the state were randomly selected, and then two to three classrooms were randomly selected within each facility. The children were the means to obtaining a weighted sample of parous women of childbearing age (15-44). Once a parous woman completed the study, she could invite a nulliparous friend of similar age, race, and socioeconomic background to also participate in the study. RESULTS Racial disparities were found in the reproductive healthcare of both the parous and nulliparous groups. Overall, black women were less likely to receive services from an obstetrics and gynecology. Parous and nulliparous black women were more likely to receive their reproductive healthcare at the health department and less likely to use the most effective methods of contraception. CONCLUSION Low use of the most effective methods of contraception, despite high levels of general contraceptive use and high insurance coverage, hints at additional barriers to full access for black women in Mississippi. More equitable access to effective family planning counseling and contraception can have meaningful impact on the lives of black women in our state.
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Montgomery TM, Stephens-Shields AJ, Schapira MM, Akers AY. Dual-Method Contraception Use Among Young Women Pre- and Post-ACA Implementation. Policy Polit Nurs Pract 2020; 21:140-150. [PMID: 32397804 DOI: 10.1177/1527154420923747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The 2012 implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive coverage mandate removed financial barriers to contraception access for many insured women. Since that time, increases in sexually transmitted disease (STD) rates have been noted, particularly among Black adolescent and young adult women aged 15 to 24 years. It is unclear whether changes in dual-method contraception use (simultaneous use of nonbarrier contraceptive methods and condoms) are associated with the increase in STD rates. A repeated cross-sectional analysis was conducted among adolescent and young adult women to compare pre-ACA data from the 2006-2010 cohort and post-ACA data from the 2013-2015 cohort of the National Survey for Family Growth. A significant decrease in short-acting reversible contraception use (SARC; 78.2% vs. 67.5%; p < .01) and a significant increase in long-acting reversible contraception use (LARC; 8.9% vs. 21.8%; p < .01) were found, but no significant change in dual-method contraception use was found among pre- versus post-ACA SARC users and SARC nonusers (odds ratio [OR]: 1.88, 95% confidence interval [CI]: 0.64-5.46, p = .25), LARC users and LARC nonusers (adjusted odds ratio [AOR]: 1.62, 95% CI: 0.42-6.18, p = .48), or White and Black women (AOR: 1.45, 95% CI: 0.66-3.18, p = .35). There was no direct association between changes in contraception use and decreased condom use and therefore no indirect association between changes in contraception use and increased STD rates. Health care providers should continue promoting consistent condom use. Additional research is needed to understand recent increases in STD rates among Black women in the post-ACA era.
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Affiliation(s)
- Tiffany M Montgomery
- Drexel University, College of Nursing and Health Professions, Philadelphia, Pennsylvania, USA
| | | | | | - Aletha Y Akers
- Children's Hospital of Philadelphia, Division of Adolescent Medicine, USA
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Reproductive Coercion and Relationship Abuse Among Adolescents and Young Women Seeking Care at School Health Centers. Obstet Gynecol 2020; 134:351-359. [PMID: 31306331 PMCID: PMC6687410 DOI: 10.1097/aog.0000000000003374] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reproductive coercion and female relationship abuse are prevalent and associated with poor sexual health; health care providers should assess for harmful partner behaviors among all patients who are adolescents or young women. OBJECTIVE: To investigate demographic differences and evaluate how reproductive coercion and relationship abuse influences young females' care-seeking and sexual health behaviors. METHODS: We conducted a secondary analysis of cross-sectional baseline survey data from sexually active female students (aged 14–19 years) who sought care from school health centers. Outcomes included recent (previous 3 months) reproductive coercion, physical or sexual adolescent relationship abuse, and nonpartner sexual violence victimization. Cluster-adjusted χ2 tests compared demographics and generalized linear mixed models estimated associations among reproductive coercion, adolescent relationship abuse (physical and sexual abuse in romantic relationships), and care-seeking and sexual health behaviors. RESULTS: Of 550 sexually active high school females, 12% reported recent reproductive coercion and 17% reported physical or sexual adolescent relationship abuse, with no significant demographic differences. Prevalence of recent nonpartner sexual violence was 17%. There were no observed significant differences in care-seeking behaviors among those with recent reproductive coercion compared with those without. Physical or sexual adolescent relationship abuse was associated with increased odds of seeking testing or treatment for sexually transmitted infections (adjusted odds ratio [aOR] 2.08, 95% CI 1.05–4.13). Females exposed to both adolescent relationship abuse and reproductive coercion had higher odds of having a partner who was 5 or more years older (aOR 4.66, 95% CI 1.51–14.4), having two or more recent sexual partners (aOR 3.86, 95% CI 1.57–9.48), and using hormonal contraception only (aOR 3.77, 95% CI 1.09–13.1 vs hormonal methods with condoms). CONCLUSION: Almost one in eight females experienced recent reproductive coercion. We did not observe significant demographic differences in reproductive coercion. Partner age and number of sexual partners may elevate risk for abusive relationships. Relationship abuse is prevalent among high school students seeking care, with no clear pattern for case identification. By failing to identify factors associated with harmful partner behaviors, our results support universal assessment for reproductive coercion and relationship abuse among high school–aged adolescents, involving education, resources, and harm-reduction counseling to all patients. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01678378.
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Grace KT, Alexander KA, Jeffers NK, Miller E, Decker MR, Campbell J, Glass N. Experiences of Reproductive Coercion Among Latina Women and Strategies for Minimizing Harm: "The Path Makes Us Strong". J Midwifery Womens Health 2020; 65:248-256. [PMID: 31994835 PMCID: PMC7152557 DOI: 10.1111/jmwh.13061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/26/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Latina women disproportionately report experiencing reproductive coercion (RC), a set of behaviors that interfere with autonomous reproductive decision making. Given RC's associations with intimate partner violence (IPV) and unintended pregnancy, it is critical to identify and address RC to assist women to achieve safety, autonomy, and reproductive life plans. The purpose of this study was to describe and understand the context of RC and the use of RC safety strategies among Latina women receiving services at an urban clinic, through listening to the experiences of the women in their own words. METHODS Qualitative descriptive methodology was used. Semistructured interviews were conducted with a purposive sample of 13 Latina women recruited from a Federally Qualified Health Center in the Washington, DC, area. RESULTS Data were organized into 3 a priori categories: (1) RC behaviors, (2) co-occurrence of RC and IPV, and (3) RC harm reduction strategies. New RC behaviors emerged, and immigration status was used as a method of coercive control. From these a priori categories emerged 4 themes: impact of immigrant and citizenship status, machismo, strength and bravery, and importance of family. Harm reduction strategies included less detectable contraception; some sought community services, but others resorted to deception and stalling as the only tools available to them. DISCUSSION Less detectable methods of contraception remained useful harm reduction strategies for women experiencing RC. Midwives should inquire about method fit and be mindful of honoring the request when patients ask to change methods. Women's strength and resilience emerged as a vital source of power and endurance. This diverse sample and the powerful voices of the women who participated make a significant contribution to the understanding of RC experienced by Latina women in the United States.
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Affiliation(s)
- Karen Trister Grace
- John Hopkins University School of Nursing, Baltimore, Maryland. Dr. Grace is currently at the Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michele R Decker
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Nancy Glass
- Johns Hopkins University School of Nursing, Baltimore, Maryland
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Rodriguez AL, Arcara J, Deardorff J, Gomez AM. The association between religiosity and pregnancy acceptability among Latino/a young adults: does generational status matter? CULTURE, HEALTH & SEXUALITY 2020; 22:184-200. [PMID: 30931805 PMCID: PMC7607687 DOI: 10.1080/13691058.2019.1581260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Abstract
The US Latino/a population is considered to be at high risk for unintended pregnancy; some research indicates that Latino/a parents are more likely to express happiness about an unintended pregnancy than other racial/ethnic groups. Associations between pregnancy attitudes and factors such as religiosity and nativity have also been documented in the Latino/a population, but existing research is sparse, dated and primarily focused on women of Mexican heritage. This study sought to expand this literature by examining the relationship between religiosity and pregnancy acceptability and assessing effect modification by generational status and gender in a national sample of young Latino/a cisgender women and men of various ancestral backgrounds currently in relationships. In multivariable logistic regression models, there was a positive association between importance of religion and pregnancy acceptability for both men and women; being highly or moderately religious was associated with elevated odds of finding a pregnancy acceptable. Effect modification by generational status was significant for women, but not for men. Results suggest that religiosity, gender and generational status have differential influences on and relationships to pregnancy orientations for Latina women and Latino men and should be considered in the design and delivery of family planning care for Latino/a clients.
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Affiliation(s)
- Allison L. Rodriguez
- Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley, USA
- Department of Maternal, Child and Adolescent Health, School of Public Health, University of California, Berkeley, CA, USA
| | - Jennet Arcara
- Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley, USA
| | - Julianna Deardorff
- Department of Maternal, Child and Adolescent Health, School of Public Health, University of California, Berkeley, CA, USA
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity (SHARE) Program, School of Social Welfare, University of California, Berkeley, USA
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31
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Dongarwar D, Ajewole VB, Oduguwa E, Ngujede A, Harris K, Ofili TU, Olaleye OA, Salihu HM. Role of Social Determinants of Health in Widening Maternal and Child Health Disparities in the Era of Covid-19 Pandemic. Int J MCH AIDS 2020; 9:316-319. [PMID: 32765962 PMCID: PMC7397329 DOI: 10.21106/ijma.398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We present a conceptual model that describes the social determinants of health (SDOH) pathways contributing to worse outcomes in minority maternal and child health (MCH) populations due to the current COVID-19 pandemic. We used International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) codes in the categories Z55-Z65 to identify SDOH that potentially modulate MCH disparities. These SDOH pathways, coupled with pre-existing comorbidities, exert higher-than-expected burden of maternal-fetal morbidity and mortality in minority communities. There is an urgent need for an increased infusion of resources to mitigate the effects of these SDOH and avert permanent truncation in quality and quantity of life among minorities following the COVID-19 pandemic.
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Affiliation(s)
- Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Veronica B Ajewole
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | - Emmanuella Oduguwa
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Ahone Ngujede
- College of Business, Columbia Southern University, Orange Beach, AL, USA
| | - Kiydra Harris
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | - Theresa U Ofili
- College of Business, Columbia Southern University, Orange Beach, AL, USA
| | - Omonike A Olaleye
- Maternal and Child Health Student Training Program, Texas Southern University, Houston, TX, USA.,College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.,Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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Behn M, Pace LE, Ku L. The Trump Administration's Final Regulations Limit Insurance Coverage of Contraception. Womens Health Issues 2019; 29:103-106. [DOI: 10.1016/j.whi.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
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Upadhyay UD, Johns NE, Cartwright AF, Franklin TE. Sociodemographic Characteristics of Women Able to Obtain Medication Abortion Before and After Ohio's Law Requiring Use of the Food and Drug Administration Protocol. Health Equity 2018; 2:122-130. [PMID: 30283858 PMCID: PMC6071907 DOI: 10.1089/heq.2018.0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: In 2011, a law went into effect in Ohio that regulates how abortion care providers can offer medication abortion to their patients. We sought to evaluate changes in sociodemographic characteristics of Ohio medication abortion patients before and after the implementation of this law. Methods: We used a retrospective cohort design, comparing characteristics of women obtaining a medication abortion at four abortion facilities before and after the law. We used chart data from January 2010 to January 2011 and February 2011 to October 2014. For any significant changes in sociodemographics found before and after the law, we used stratified cross-tabulations to disentangle whether they were likely related to the restricted gestational limit imposed by the law (lowered from 9 to 7 weeks gestation), or whether they were likely related to other burdens brought on by the law, such as increased costs and visits. Results: Women obtaining a medication abortion after the law were more likely to be older (p=0.01), have higher levels of education (p<0.001), be of white race (p<0.001), have private insurance (p=0.001), have no children (p=0.002), and reside in a higher income zip code (p=0.03). Both the reduced gestational limit and the increased costs and visits likely contributed to declines among black women and women with lower levels of education. The reduced gestational limit for medication abortion likely contributed to a decline among younger women and Medicaid recipient groups. The increased costs and visits imposed by the law likely contributed to the decline in medication abortion among women with no insurance and women with children. Conclusion: The lower gestational limit, higher cost, and time and travel burdens exacted by Ohio's medication abortion law were associated with disproportionate reductions in medication abortion among the most disadvantaged groups. The law was associated with reduced access among women who were younger, of black race, less educated, and in lower socioeconomic groups.
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Affiliation(s)
- Ushma D. Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Nicole E. Johns
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Alice F. Cartwright
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Tanya E. Franklin
- Department of Obstetrics, Gynecology, and Women's Health, University of Louisville School of Medicine, Louisville, Kentucky
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Holliday CN, Miller E, Decker MR, Burke JG, Documet PI, Borrero SB, Silverman JG, Tancredi DJ, Ricci E, McCauley HL. Racial Differences in Pregnancy Intention, Reproductive Coercion, and Partner Violence among Family Planning Clients: A Qualitative Exploration. Womens Health Issues 2018; 28:205-211. [PMID: 29631975 DOI: 10.1016/j.whi.2018.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/17/2018] [Accepted: 02/07/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Unintended pregnancy (UIP) is a persistent public health concern in the United States disproportionately experienced by racial/ethnic minorities and women of low socioeconomic status. UIP often occurs with experiences of reproductive coercion (RC) and intimate partner violence (IPV). The purpose of the study was to qualitatively describe and compare contexts for UIP risk between low-income Black and White women with histories of IPV/RC. STUDY DESIGN Semistructured interviews were conducted with low-income Black and White women with histories of IPV or RC, ages 18 to 29 years, recruited from family planning clinics in Pittsburgh, Pennsylvania. RESULTS Interviews with 10 non-Hispanic Black women and 34 non-Hispanic White women (N = 44) were included in the analysis. Differences between White and Black women emerged regarding IPV/RC experiences, gender roles in intimate relationships, and trauma histories, including childhood adversity. Fatal threats and IPV related to childbearing were most influential among White women. Among Black women, pregnancy was greatly influenced by RC related to impending incarceration, subfertility, and condom nonuse, and decisions about contraception were often dependent on the male. Sexual abuse, including childhood sexual assault, in the context of sexual/reproductive health was more prominent among White women. Childhood experiences of neglect impacted pregnancy intention and love-seeking behaviors among Black women. CONCLUSIONS Racial differences exist in experiences of IPV/RC with regard to UIP even among women with similar economic resources and health care access. These findings provide much-needed context to the persistent racial/ethnic disparities in UIP and illustrate influences beyond differential access to care and socioeconomic status.
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Affiliation(s)
- Charvonne N Holliday
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Patricia I Documet
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Sonya B Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jay G Silverman
- Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla, California
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California
| | - Edmund Ricci
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Heather L McCauley
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan
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McKenney KM, Martinez NG, Yee LM. Patient navigation across the spectrum of women's health care in the United States. Am J Obstet Gynecol 2018; 218:280-286. [PMID: 28844825 PMCID: PMC5826769 DOI: 10.1016/j.ajog.2017.08.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/10/2017] [Accepted: 08/16/2017] [Indexed: 12/12/2022]
Abstract
Patient navigation is a patient-centered intervention that uses trained personnel to identify patient-level barriers, including financial, cultural, logistical, and educational obstacles to health care and then mitigate these barriers to facilitate complete and timely access to health services. For example, to assist a woman with Medicaid who is seeking postpartum care, a patient navigator could help her schedule an appointment before her insurance benefits change, coordinate transportation and child care, give her informational pamphlets on contraception options, and accompany her to the appointment to ensure her questions are answered. Existing studies examining the efficacy of patient navigation interventions show particularly striking benefits in the realm of cancer care, including gynecological oncology; patient navigation has been demonstrated to increase access to screening, shorten time to diagnostic resolution, and improve cancer outcomes, particularly in health disparity populations, such as women of color, rural populations, and poor women. Because of the successes in cancer care at reducing disparities in health care access and health outcomes, patient navigation has the potential to improve care and reduce disparities in obstetric and benign gynecological care. We review the concept of patient navigation, offer potential roles for patient navigation in obstetrics and gynecology, and discuss areas for further investigation.
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Affiliation(s)
- Kathryn M McKenney
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Noelle G Martinez
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Valero-Elizondo J, Hong JC, Spatz ES, Salami JA, Desai NR, Rana JS, Khera R, Virani SS, Blankstein R, Blaha MJ, Nasir K. Persistent socioeconomic disparities in cardiovascular risk factors and health in the United States: Medical Expenditure Panel Survey 2002–2013. Atherosclerosis 2018; 269:301-305. [DOI: 10.1016/j.atherosclerosis.2017.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/23/2017] [Accepted: 12/07/2017] [Indexed: 11/15/2022]
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Robbins C, Boulet SL, Morgan I, D’Angelo DV, Zapata LB, Morrow B, Sharma A, Kroelinger CD. Disparities in Preconception Health Indicators -
Behavioral Risk Factor Surveillance System, 2013-2015, and Pregnancy Risk Assessment Monitoring System, 2013-2014. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2018; 67:1-16. [PMID: 29346340 PMCID: PMC5829866 DOI: 10.15585/mmwr.ss6701a1] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM/CONDITION Preconception health is a broad term that encompasses the overall health of nonpregnant women during their reproductive years (defined here as aged 18-44 years). Improvement of both birth outcomes and the woman's health occurs when preconception health is optimized. Improving preconception health before and between pregnancies is critical for reducing maternal and infant mortality and pregnancy-related complications. The National Preconception Health and Health Care Initiative's Surveillance and Research work group suggests ten prioritized indicators that states can use to monitor programs or activities for improving the preconception health status of women of reproductive age. This report includes overall and stratified estimates for nine of these preconception health indicators. REPORTING PERIOD 2013-2015. DESCRIPTION OF SYSTEMS Survey data from two surveillance systems are included in this report. The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing state-based, landline and cellular telephone survey of noninstitutionalized adults in the United States aged ≥18 years that is conducted by state and territorial health departments. BRFSS is the main source of self-reported data for states on health risk behaviors, chronic health conditions, and preventive health services primarily related to chronic disease in the United States. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing U.S. state- and population-based surveillance system administered collaboratively by CDC and state health departments. PRAMS is designed to monitor selected maternal behaviors, conditions, and experiences that occur before, during, and shortly after pregnancy that are self-reported by women who recently delivered a live-born infant. This report summarizes BRFSS and PRAMS data on nine of 10 prioritized preconception health indicators (i.e., depression, diabetes, hypertension, current cigarette smoking, normal weight, recommended physical activity, recent unwanted pregnancy, prepregnancy multivitamin use, and postpartum use of a most or moderately effective contraceptive method) for which the most recent data are available. BRFSS data from all 50 states and the District of Columbia were used for six preconception health indicators: depression, diabetes (excluded if occurring only during pregnancy or if limited to borderline/prediabetes conditions), hypertension (excluded if occurring only during pregnancy or if limited to borderline/prehypertension conditions), current cigarette smoking, normal weight, and recommended physical activity. PRAMS data from 30 states, the District of Columbia, and New York City were used for three preconception health indicators: recent unwanted pregnancy, prepregnancy multivitamin use, and postpartum use of a most or moderately effective contraceptive method by women or their husbands or partners (i.e., male or female sterilization, hormonal implant, intrauterine device, injectable contraceptive, oral contraceptive, hormonal patch, or vaginal ring). Heavy alcohol use during the 3 months before pregnancy also was included in the prioritized set of 10 indicators, but PRAMS data for each reporting area are not available until 2016 for that indicator. Therefore, estimates for heavy alcohol use are not included in this report. All BRFSS preconception health estimates are based on 2014-2015 data except two (hypertension and recommended physical activity are based on 2013 and 2015 data). All PRAMS preconception health estimates rely on 2013-2014 data. Prevalence estimates of indicators are reported for women aged 18-44 years overall, by age group, race-ethnicity, health insurance status, and reporting area. Chi-square tests were conducted to assess differences in indicators by age group, race/ethnicity, and insurance status. RESULTS During 2013-2015, prevalence estimates of indicators representing risk factors were generally highest and prevalence estimates of health-promoting indicators were generally lowest among older women (35-44 years), non-Hispanic black women, uninsured women, and those residing in southern states. For example, prevalence of ever having been told by a health care provider that they had a depressive disorder was highest among women aged 35-44 years (23.1%) and lowest among women aged 18-24 years (19.2%). Prevalence of postpartum use of a most or moderately effective method of contraception was lowest among women aged 35-44 years (50.6%) and highest among younger women aged 18-24 years (64.9%). Self-reported prepregnancy multivitamin use and getting recommended levels of physical activity were lowest among non-Hispanic black women (21.6% and 42.8%, respectively) and highest among non-Hispanic white women (37.8% and 53.8%, respectively). Recent unwanted pregnancy was lowest among non-Hispanic white women and highest among non-Hispanic black women (5.0% and 11.6%, respectively). All but three indicators (diabetes, hypertension, and use of a most or moderately effective contraceptive method) varied by insurance status; for instance, prevalence of current cigarette smoking was higher among uninsured women (21.0%) compared with insured women (16.1%), and prevalence of normal weight was lower among women who were uninsured (38.6%), compared with women who were insured (46.1%). By reporting area, the range of women reporting ever having been told by a health care provider that they had diabetes was 5.0% (Alabama) to 1.9% (Utah), and women reporting ever having been told by a health care provider that they had hypertension ranged from 19.2% (Mississippi) to 7.0% (Minnesota). INTERPRETATION Preconception health risk factors and health-promoting indicators varied by age group, race/ethnicity, insurance status, and reporting area. These disparities highlight subpopulations that might benefit most from interventions that improve preconception health. PUBLIC HEALTH ACTION Eliminating disparities in preconception health can potentially reduce disparities in two of the leading causes of death in early and middle adulthood (i.e., heart disease and diabetes). Public health officials can use this information to provide a baseline against which to evaluate state efforts to improve preconception health.
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Affiliation(s)
- Cheryl Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Sheree L. Boulet
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Isabel Morgan
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Denise V. D’Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Lauren B. Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
- U.S. Public Health Service Commissioned Corps
| | - Brian Morrow
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Andrea Sharma
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
- U.S. Public Health Service Commissioned Corps
| | - Charlan D. Kroelinger
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Race and ethnicity may not be associated with risk of unintended pregnancy. Contraception 2017; 97:313-318. [PMID: 29288654 DOI: 10.1016/j.contraception.2017.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/29/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective was to use improved measures and methodology to investigate whether race and ethnicity are associated with unintended pregnancy. STUDY DESIGN Cross-sectional study of English- or Spanish-speaking women, aged 16-44, with pregnancies <24weeks' gestation recruited from pregnancy testing and abortion care sites in New Haven, CT, between June 2014 and June 2015. Participants completed self-assessments of race, ethnicity and multidimensional measures of pregnancy "context," including timing, intention, wantedness, desirability, happiness and planning (measured with the London Measure of Unplanned Pregnancy). Multivariable analysis was performed, adjusting for maternal demographics, language, recruitment site, substance use and medical conditions including history of depression. RESULTS Among 161 participants (mean age=27.2±6.6years), mean gestational age was 9±4.6weeks. Overall, 14% self-identified as White non-Hispanic, 37% Black non-Hispanic, 42% Hispanic and 7% multiracial. Most (85%) were unmarried, and 75% had at least one child. After adjustment, happiness about new pregnancies was more likely among Black non-Hispanic than White non-Hispanic women OR=5.66 (95%CI: 1.51-21.20). Neither race nor ethnicity was significantly associated with pregnancy intention, wantedness, planning, timing or desirability. CONCLUSION In a diverse cohort with multiple, antenatal measures of pregnancy context, neither race nor ethnicity is significantly associated with unintended pregnancy, as previous studies reported. Black non-Hispanic women were more likely to report happiness about new pregnancies than White non-Hispanic women. This study improves upon previous analyses that used retrospective and limited assessments of pregnancy intention, excluded women with miscarriages or abortions, and lacked adjustment for confounding. IMPLICATIONS Evaluation of multidimensional pregnancy contexts assessed antenatally is important and may capture the experiences of women more accurately, especially Black and Hispanic women.
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Socioeconomic Status As a Risk Factor for Unintended Pregnancy in the Contraceptive CHOICE Project. Obstet Gynecol 2017; 130:609-615. [PMID: 28796678 DOI: 10.1097/aog.0000000000002189] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the association of low socioeconomic status as an independent risk factor for unintended pregnancy. METHODS We performed a secondary analysis of data from the Contraceptive CHOICE project. Between 2007 and 2011, 9,256 participants were recruited and followed for up to 3 years. The primary outcome of interest was unintended pregnancy; the primary exposure variable was low socioeconomic status, defined as self-report of either receiving public assistance or having difficulty paying for basic necessities. Four contraceptive groups were evaluated: 1) long-acting reversible contraceptive method (hormonal or copper intrauterine device or subdermal implant); 2) depot medroxyprogesterone acetate injection; 3) oral contraceptive pills, a transdermal patch, or a vaginal ring; or 4) other or no method. Confounders were adjusted for in the multivariable Cox proportional hazard model to estimate the effect of socioeconomic status on risk of unintended pregnancy. RESULTS Participants with low socioeconomic status experienced 515 unintended pregnancies during 14,001 women-years of follow-up (3.68/100 women-years; 95% CI 3.37-4.01) compared with 200 unintended pregnancies during 10,296 women-years (1.94/100 women-years; 95% CI 1.68-2.23) among participants without low socioeconomic status. Women with low socioeconomic status were more likely to have an unintended pregnancy (unadjusted hazard ratio [HR] 1.8, 95% CI 1.5-2.2). After adjusting for age, education level, insurance status, and history of unintended pregnancy, low socioeconomic status was associated with an increased risk of unintended pregnancy (adjusted HR 1.4, 95% CI 1.1-1.7). CONCLUSION Despite the removal of cost barriers, low socioeconomic status is associated with a higher incidence of unintended pregnancy.
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Hughey KL, Llanes M, Plegue M, Kruger DJ, Waller A, Ledón C, Chang T. Risk for Unintended Pregnancy Among Latino Men and Women in a Nonmetropolitan County in Michigan. PRIMER (LEAWOOD, KAN.) 2017; 1:21. [PMID: 32944707 PMCID: PMC7490188 DOI: 10.22454/primer.2017.651218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION This study characterizes the risk for unintended pregnancy among Latino men and women within a racially and ethnically diverse county in Michigan. METHODS Latino respondents aged 18 to 50 years who reported no intention to become pregnant in the next year and no contraception use were defined as "at risk" for unintended pregnancy. Any associations between risk for unintended pregnancy and sociodemographic factors was determined through multivariate logistic regression. RESULTS Risk for unintended pregnancy was higher among men (67%) than women (59%; P=0.046; n=341). In multivariate logistic regression analysis, English speaking ability was associated with lower odds for risk of unintended pregnancy (OR=0.73; P=0.004). Having a high school degree or less was associated with higher odds for risk of unintended pregnancy (OR=4.15, P<0.001 and OR=2.74, P=0.026, respectively). CONCLUSION Among Latinos in a nonmetropolitan community, both men and women were at high risk for unintended pregnancy. Future studies that address the reasons behind this elevated risk may inform potential interventions among this at-risk group.
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Affiliation(s)
| | - Mikel Llanes
- University of Michigan Department of Family Medicine
| | - Melissa Plegue
- University of Michigan School of Medicine, Department of Family Medicine
| | | | | | - Charo Ledón
- Accion Buenos Vecinos Community Coalition, Ann Arbor, MI
| | - Tammy Chang
- University of Michigan Department of Family Medicine and Institute for Healthcare Policy and Innovation, Ann Arbor, MI
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Holliday CN, McCauley HL, Silverman JG, Ricci E, Decker MR, Tancredi DJ, Burke JG, Documét P, Borrero S, Miller E. Racial/Ethnic Differences in Women's Experiences of Reproductive Coercion, Intimate Partner Violence, and Unintended Pregnancy. J Womens Health (Larchmt) 2017; 26:828-835. [PMID: 28402692 PMCID: PMC5576208 DOI: 10.1089/jwh.2016.5996] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To explore racial/ethnic differences in reproductive coercion (RC), intimate partner violence (IPV), and unintended pregnancy (UIP). MATERIALS AND METHODS We analyzed cross-sectional, baseline data from an intervention that was conducted between August 2008 and March 2009 in five family planning clinics in the San Francisco, California area, to examine the association of race/ethnicity with RC, IPV, and UIP among female patients aged 16-29 (n = 1234). RESULTS RC was significantly associated with race/ethnicity, p < 0.001, [prevalence estimates: Black (37.1%), multiracial (29.2%), White (18.0%), Hispanic/Latina (24.0%), and Asian/Pacific Islander/other (API/other) (18.4%)]. Race/ethnicity was not associated with IPV. UIP was more prevalent among Black (50.3%) and multiracial (47.2%) women, with an overall range of 37.1%-50.3% among all racial/ethnic groups (p < 0.001). In adjusted analyses, factors associated with UIP were RC [adjusted odds ratio (AOR) = 1.59, 95% confidence interval (95% CI) = 1.26-2.01] and Black (AOR = 1.63, 95% CI = 1.02-2.60) and API/other (AOR = 1.41, 95% CI = 1.15-1.73) race/ethnicity, which remained significant in the presence of RC. Race-stratified models revealed that RC increased odds of UIP for White (AOR = 2.06, 95% CI = 1.45-2.93) and Black women (AOR = 1.72, 95% CI = 1.14-2.60). CONCLUSIONS Black and multiracial women seeking care in family planning clinics have a disproportionately high prevalence of RC and UIP. RC may partially explain differences in UIP prevalence, with the effect of race/ethnicity slightly attenuated in RC-adjusted models. However, the impact of RC on risk for UIP was similar for White and Black women. Findings from this study support the need to understand and prevent RC, particularly among women of color. Results are foundational in understanding disparities in RC and UIP that may have implications for refinement of clinical care.
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Affiliation(s)
- Charvonne N. Holliday
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Heather L. McCauley
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan
| | - Jay G. Silverman
- Division of Global Public Health, Department of Medicine, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, California
| | - Edmund Ricci
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Michele R. Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California
| | - Jessica G. Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Patricia Documét
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Nelson DB, Zhao H, Corrado R, Mastrogiannnis DM, Lepore SJ. Preventing Unintended Pregnancy Among Young Sexually Active Women: Recognizing the Role of Violence, Self-Esteem, and Depressive Symptoms on Use of Contraception. J Womens Health (Larchmt) 2017; 26:352-360. [PMID: 28045570 DOI: 10.1089/jwh.2016.5753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Ineffective contraceptive use among young sexually active women is extremely prevalent and poses a significant risk for unintended pregnancy (UP). Ineffective contraception involves the use of the withdrawal method or the inconsistent use of other types of contraception (i.e., condoms and birth control pills). This investigation examined violence exposure and psychological factors related to ineffective contraceptive use among young sexually active women. MATERIALS AND METHODS Young, nonpregnant sexually active women (n = 315) were recruited from an urban family planning clinic in 2013 to participate in a longitudinal study. Tablet-based surveys measured childhood violence, community-level violence, intimate partner violence, depressive symptoms, and self-esteem. Follow-up surveys measured type and consistency of contraception used 9 months later. Multivariate logistic regression models assessed violence and psychological risk factors as main effects and moderators related to ineffective compared with effective use of contraception. RESULTS The multivariate logistic regression model showed that childhood sexual violence and low self-esteem were significantly related to ineffective use of contraception (adjusted odds ratio [aOR] = 2.69, confidence interval [95% CI]: 1.18-6.17, and aOR = 0.51, 95% CI: 0.28-0.93; respectively), although self-esteem did not moderate the relationship between childhood sexual violence and ineffective use of contraception (aOR = 0.38, 95% CI: 0.08-1.84). Depressive symptoms were not related to ineffective use of contraception in the multivariate model. CONCLUSIONS Interventions to reduce UP should recognize the long-term effects of childhood sexual violence and address the role of low self-esteem on the ability of young sexually active women to effectively and consistently use contraception to prevent UP.
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Affiliation(s)
- Deborah B Nelson
- 1 Department of Epidemiology, Biostatistics, and Ob/Gyn, Temple University , Philadelphia, Pennsylvania
| | - Huaqing Zhao
- 2 Department of of Biostatistics and Epidemiology, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Rachel Corrado
- 3 Applied Public Health Informatics Fellow, Division of Informatics, Information Technology and Telecommunication Centers for Disease Control , New York, New York
| | | | - Stephen J Lepore
- 5 Department of Social and Behavioral Sciences, Temple University , Philadelphia, Pennsylvania
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Multiple Types of Factors May Explain Racial Gaps In Unintended Pregnancy. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2016; 48:102-103. [PMID: 27303866 DOI: 10.1363/48e9416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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