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MacCallum-Bridges CL, Kaestner R, Luo Z, Holzman C, Bruckner TA, Margerison CE. The Affordable Care Act Dependent Coverage Provision and Unintended Pregnancy. J Womens Health (Larchmt) 2024. [PMID: 39291314 DOI: 10.1089/jwh.2023.0956] [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: 09/19/2024] Open
Abstract
Background: Nearly half of all pregnancies in the United States are considered unintended (mistimed or unwanted), and this rate is even higher among younger and lower income women. The Affordable Care Act (ACA) dependent coverage provision may have influenced the frequency of unintended pregnancies by increasing accessibility to and affordability of family planning services among young adults. Furthermore, the impact of this provision may differ by young adult income level as those with lower income are less likely to be insured and thus more likely to benefit from this provision. Our objective was to estimate the association between the ACA dependent coverage provision and unintended pregnancy, overall, and by young adult income level. Methods: We applied a difference-in-differences approach to data from multiple cycles of the National Survey of Family Growth (n = 10,104) and compared trends in unintended pregnancy between those who were eligible to benefit (ages 18-25 years) and those who were ineligible to benefit (ages 26-33 years) from the provision, overall, and among income subgroups. Results: We found evidence that the dependent coverage provision was associated with a -7.4 percentage point reduction (95% CI: -13.5, -1.3) in the prevalence of unintended pregnancy among young adults with lower income (<100% of the federal poverty level). There was limited evidence, however, that the provision was associated with unintended pregnancy among young adults with higher income levels. Conclusions: These findings suggest the ACA dependent coverage provision may have reduced unintended pregnancy among a particularly high-risk group (i.e., young adults with lower income).
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Affiliation(s)
| | - Robert Kaestner
- Harris School of Public Policy, University of Chicago, Chicago, Illinois, USA
| | - Zhehui Luo
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Claudia Holzman
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Tim A Bruckner
- Department of Population Health & Disease Prevention, University of California, Irvine, California, USA
- Department of Health, Society, & Behavior, University of California, Irvine, California, USA
| | - Claire E Margerison
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, Michigan, USA
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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; 53:345-354. [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] [MESH Headings] [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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Zvavitch P, Rendall MS, Hurtado C, Shattuck RM. Contraceptive Consistency and Poverty after Birth. POPULATION RESEARCH AND POLICY REVIEW 2021; 40:1277-1311. [PMID: 34857977 PMCID: PMC8629354 DOI: 10.1007/s11113-020-09623-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
Unplanned pregnancies in the U.S. disproportionately occur among poor, less educated, and minority women, but it is unclear whether poverty following a birth is itself an outcome of this pregnancy planning status. Using the National Longitudinal Survey of Youth 1997 (n=2,101) and National Survey of Family Growth (n=778), we constructed two-year sequences of contraceptive use before a birth that signal an unplanned versus a planned birth. We regressed poverty in the year of the birth both on this contraceptive-sequence variable and on sociodemographic indicators including previous employment and poverty status in the year before the birth, race/ethnicity, education, partnership status, birth order, and family background. Compared to sequences indicating a planned birth, sequences of inconsistent use and non-use of contraception were associated with a higher likelihood of poverty following a birth, both before and after controlling for sociodemographic variables, and before and after additionally controlling for poverty status before the birth. In pooled-survey estimates with all controls included, having not used contraception consistently is associated with a 42% higher odds of poverty after birth. The positive association of poverty after birth with contraceptive inconsistency or non-use, however, is limited to women with low to medium educational attainment. These findings encourage further exploration into relationships between contraceptive access and behavior and subsequent adverse outcomes for the mother and her children.
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Affiliation(s)
- Polina Zvavitch
- Department of Sociology and Maryland Population Center, University of Maryland College Park, Maryland, USA
| | - Michael S. Rendall
- Department of Sociology and Maryland Population Center, University of Maryland College Park, Maryland, USA
| | - Constanza Hurtado
- Department of Sociology and Maryland Population Center, University of Maryland College Park, Maryland, USA
| | - Rachel M. Shattuck
- Maryland Population Research Center, University of Maryland, College Park, Maryland USA
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Gomez AM, Arteaga S, Freihart B. Structural Inequity and Pregnancy Desires in Emerging Adulthood. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2447-2458. [PMID: 33511506 PMCID: PMC8316486 DOI: 10.1007/s10508-020-01854-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 06/12/2023]
Abstract
Public health discourses often claim that delaying pregnancy is associated with social and economic benefits. Yet research suggests that, for young people, structural inequity is most influential in future outcomes, regardless of childbearing. We conducted in-depth interviews with 50 young women (ages 18-24) and their male partners (n = 100) and investigated the influence of structural inequity on pregnancy desires and plans. Three themes emerged, stratified by social advantage. In the "Things Will Be Different Later" theme, socially advantaged participants envisioned that their future lives would surely be different due to achievement of educational, professional, and economic goals; thus, their pregnancy plans aligned with their desires, often reflected in use of highly effective contraception. In the "I Don't Have Everything I Need" theme, participants expressed delaying desired pregnancies (primarily through condom use) until they could contend with structural barriers. Their pregnancy plans, shifted by way of structural inequity, were not aligned with their desires. Under the "I'll Never Have Everything I Need" theme, socially disadvantaged participants expressed significant doubt about ever realizing ideal circumstances for pregnancy preparedness; as pregnancy prevention was not salient, these participants used condoms or no contraception. This analysis indicates that structural inequities constrain reproductive self-determination in emerging adulthood, creating a chasm between desired and actual childbearing that was reflected in contraceptive decision-making. Public health narratives emphasizing the importance of pregnancy prevention for socially disadvantaged groups without addressing the manifestation of structural inequity in their lives perpetuate reproductive oppression vis-à-vis emphasis on contraceptive use to ensure future economic success.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, USA.
| | - Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, USA
| | - Bridget Freihart
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, USA
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Daundasekara SS, O’Connor DP, Berger Cardoso J, Ledoux T, Hernandez DC. Risk of Excess and Inadequate Gestational Weight Gain among Hispanic Women: Effects of Immigration Generational Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186452. [PMID: 32899746 PMCID: PMC7560227 DOI: 10.3390/ijerph17186452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022]
Abstract
There is a dearth of information on the risk of inadequate and excess gestational weight gain (GWG) among different generations of Hispanic women in the United States. Therefore, the objective of this study was to understand the relationship of GWG and immigration across three generations of Hispanic women. The study was conducted using data from National Longitudinal Survey of Youth 1979 (NLSY79). The study sample included 580 (unweighted count) women (148 first-generation, 117 second-generation, and 315 third-/higher-generation). Sociodemographic and immigration data were extracted from the main NLSY79 survey, and pregnancy data were extracted from the child/young adult survey following the biological children born to women in NLSY79. Covariate adjusted weighted logistic regression models were conducted to assess the risk of inadequate and excess GWG among the groups. Average total GWG was 14.98 kg, 23% had inadequate GWG, and 50% had excess GWG. After controlling for the covariates, there was no difference in the risk of inadequate GWG between the three generations. First-generation women (OR = 0.47, p = 0.039) and third-/higher-generation women (OR = 0.39, p = 0.004) had significantly lower risk of excess GWG compared to second-generation women. It is important to recognize the generational status of Hispanic women as a risk factor for excess GWG.
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Affiliation(s)
- Sajeevika S. Daundasekara
- Department of Health & Human Performance, The University of Houston, Houston, TX 77204, USA; (S.S.D.); (D.P.O.); (T.L.)
| | - Daniel P. O’Connor
- Department of Health & Human Performance, The University of Houston, Houston, TX 77204, USA; (S.S.D.); (D.P.O.); (T.L.)
- HEALTH Research Institute, The University of Houston, Houston, TX 77204, USA
| | - Jodi Berger Cardoso
- Graduate College of Social Work, The University of Houston, Houston, TX 77204, USA;
| | - Tracey Ledoux
- Department of Health & Human Performance, The University of Houston, Houston, TX 77204, USA; (S.S.D.); (D.P.O.); (T.L.)
| | - Daphne C. Hernandez
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center, Houston, TX 77030, USA
- Correspondence: ; Tel.: +713-500-2052
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Association between generational status and smoking behaviors before and during pregnancy among Hispanic women. Addict Behav 2020; 104:106310. [PMID: 31958708 DOI: 10.1016/j.addbeh.2020.106310] [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: 09/05/2019] [Revised: 12/02/2019] [Accepted: 01/07/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Evidence is limited on the risk of maternal smoking before and during pregnancy across generations of Hispanic immigrants. PURPOSE The aim of this study was to determine whether immigration generational status predicts maternal smoking behaviors before and during pregnancy among Hispanic women. METHODS Data on pregnancies in National Longitudinal Survey of Youth 1979 were used. Current study sample consists of Hispanic women (15-24 years) reporting pregnancy between 1979 and 2014 (n = 616). Data on birthplaces of the respondent and their parents were used to determine generation status. Maternal smoking behaviors before and during pregnancy were self-reported. Data were analyzed using weighted covariate-adjusted logistic regression models. RESULTS There were 24% first-generation, 20% second-generation, and 56% third or higher generation Hispanic women in the sample. Majority of participants were married (72%), with a high school degree or more (69%), and of Mexican origin (56%). After controlling for covariates, first generation Hispanic women had lower likelihood of smoking prior to (OR = 0.40, p = 0.009) and during pregnancy (OR = 0.35, p = 0.007) compared to third or higher generation women. The second-generation women had lower likelihood of smoking during pregnancy (OR = 0.46, p = 0.038) compared to third or higher generation women. CONCLUSIONS First generation Hispanic women are at lower risk of smoking both prior to and during pregnancy. Identification of cultural factors discouraging smoking during pregnancy among first/second generation Hispanic women and incorporating in smoking prevention interventions targeting Hispanic women could benefits the later generations of Hispanic immigrants.
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Lee W, Jung SW, Lim YM, Lee KJ, Lee JH. Spontaneous and repeat spontaneous abortion risk in relation to occupational characteristics among working Korean women: a cross-sectional analysis of nationally representative data from Korea. BMC Public Health 2019; 19:1339. [PMID: 31640649 PMCID: PMC6805676 DOI: 10.1186/s12889-019-7728-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
Background The association between spontaneous abortion (SA) and occupational characteristics among working women is not well-studied. This study aimed to assess the risk of SA and occupational factors such as occupational classification, working hours, and work schedules among working Korean women aged > 19 years. Methods In this cross-sectional study, 4078 working women were identified from among 25,534 workers in the Korea National Health and Nutrition Examination Surveys V (2010–2012) database, to obtain data on SA history and the number of SAs. Odds ratios (ORs) and 95% confidence intervals (CIs) for SA were calculated using multiple logistic regression models after adjusting for age, education, household income, cigarette smoking, alcohol consumption, and obesity status. The weighted prevalence for the number of SAs was calculated according to occupational characteristics to demonstrate the SA status among working Korean women. Results SA occurrence was reported in 5.7% of the study participants. The ORs (95% CIs) for SA were significantly higher in pink-, green-, and blue-collared workers than in white-collared workers. Regarding weekly working hours, compared with ≤50 h spent working, the ORs (95% CIs) for 51–60, 61–70, and > 70 h per week were 1.26 (0.87–1.84), 1.63 (1.04–2.56), and 1.73 (1.10–2.70), respectively. A significantly higher weighted prevalence of repeat SAs was observed in pink- and green-collared workers and in those who worked long hours. Conclusion We found a significant association between SA, repeat SA, and occupational characteristics among working Korean women.
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Affiliation(s)
- Wanhyung Lee
- Department of Occupational and Environmental Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Sung Won Jung
- Department of Occupational & Environmental Medicine, Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Young-Mee Lim
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Woman's University, Seoul, Republic of Korea
| | - Kyung-Jae Lee
- Department of Occupational & Environmental Medicine, Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - June-Hee Lee
- Department of Occupational & Environmental Medicine, Soonchunhyang University Hospital, Seoul, Republic of Korea.
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Manze MG, Watnick D, Romero D. A qualitative assessment of perspectives on getting pregnant: the Social Position and Family Formation study. Reprod Health 2019; 16:135. [PMID: 31488161 PMCID: PMC6729075 DOI: 10.1186/s12978-019-0793-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/16/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intentions-oriented approaches to measuring pregnancy do not necessarily align with how people view and approach pregnancy. Our objective was to obtain an in-depth understanding of the notions women and men hold regarding pregnancy. METHODS We conducted semi-structured in-depth interviews with 176 heterosexual women and men ages 18-35, in the United States. Data were analyzed using grounded theory methodology. RESULTS Participants described notions of getting pregnant in one of three ways. One group of participants used language that solely described pregnancy as a deliberate process, either premeditated or actively avoided. Another described pregnancy as a predetermined phenomenon, due to fate or something that 'just happens.' The third group represented a blending of both notions. CONCLUSIONS Our findings underscore the need to shift the current paradigm of deliberate intentions to one that recognizes that pregnancy can also be viewed as predetermined. These findings can be used to improve measurement, health services, and better direct public health resources.
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Affiliation(s)
- Meredith G. Manze
- Graduate School of Public Health and Health Policy, City University of New York (CUNY), 55 W. 125th St., New York, NY 10027 USA
| | - Dana Watnick
- Graduate School of Public Health and Health Policy, City University of New York (CUNY), 55 W. 125th St., New York, NY 10027 USA
- Center for AIDS Research, Albert Einstein College of Medicine, New York, NY USA
| | - Diana Romero
- Graduate School of Public Health and Health Policy, City University of New York (CUNY), 55 W. 125th St., New York, NY 10027 USA
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Nandi P, Kramer M, Kottke M. Changing disparities in teen birth rates and repeat birth rates in Georgia: implications for teen pregnancy prevention. Contraception 2018; 99:175-178. [PMID: 30471260 DOI: 10.1016/j.contraception.2018.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/23/2018] [Accepted: 11/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To understand teen birth trends in Georgia by racial and geographic factors. STUDY DESIGN We analyzed overall birth and repeat teen birth rates by race, urban/rural status and adequacy of obstetric care from 2008 to 2016 using vital records from all Georgia counties. RESULTS Overall birth rates among teens analyzed decreased dramatically in Georgia, from 45.63 births per 1000 teens in 2008-2010 to 26.28 per 1000 teens in 2014-2016. Repeat birth rates followed a similar decline, from 9.40 to 4.53 repeat births per 1000 teens over the same time period. These rates decreased in all subgroups of teens but to varying degrees. The difference in birth and repeat birth rates between black and white teens decreased fourfold during this time period, whereas the declines in these rates for teens living in rural versus urban counties and with inadequate versus adequate obstetric care were less pronounced. CONCLUSION While remarkable reductions in teen birth and repeat birth rates have occurred since 2008, these declines have not been equally experienced by all groups of teens. IMPLICATIONS Our analysis suggests that persistent disparities in teen birth and repeat birth rates exist, particularly in areas with limited or threatened access to reproductive health care. Applying targeted teen pregnancy prevention initiatives to these areas could help ensure equitable health and social outcomes for teens.
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Affiliation(s)
- Preetha Nandi
- Emory University School of Medicine, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Michael Kramer
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Melissa Kottke
- Jane Fonda Center, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
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Dannefer D. Systemic and Reflexive: Foundations of Cumulative Dis/Advantage and Life-Course Processes. J Gerontol B Psychol Sci Soc Sci 2018; 75:1249-1263. [DOI: 10.1093/geronb/gby118] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Indexed: 11/12/2022] Open
Abstract
AbstractCumulative dis/advantage has been defined as the systemic tendency for interindividual divergence in a given characteristic to increase with the passage of time. Over recent decades, evidence supporting cumulative dis/advantage (CDA) as a cohort-based process that produces inequalities on a range of life-course outcomes has steadily increased. This paper reviews this growing body of work, grounding the discussion in CDA’s foundation as a general sociological construct with broad relevance. I emphasize the distinction between outcome and process, and then distinguish multiple levels of social analysis at which CDA operates. From this review, I extract two principles, endogenous system dynamics and life-course reflexivity, that can be cross-classified to provide a framework for analyzing contemporary research frameworks and initiatives relevant to CDA. I argue that the full sociological impact and implications of CDA research has been unevenly developed and applied, and conclude by suggesting some possible directions for further building on CDA’s insights.
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Affiliation(s)
- Dale Dannefer
- Department of Sociology, Case Western Reserve University, Cleveland, Ohio
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Estrada F, Suárez-López L, Hubert C, Allen-Leigh B, Campero L, Cruz-Jimenez L. Factors associated with pregnancy desire among adolescent women in five Latin American countries: a multilevel analysis. BJOG 2018; 125:1330-1336. [DOI: 10.1111/1471-0528.15313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- F Estrada
- CONACYT - National Institute of Public Health-Reproductive Health Division; Mexico
| | - L Suárez-López
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| | - C Hubert
- CONACYT - National Institute of Public Health-Reproductive Health Division; Mexico
| | - B Allen-Leigh
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| | - L Campero
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| | - L Cruz-Jimenez
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
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