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Anand P, Bravo L, Gutman S, McAllister A, Keddem S, Sonalkar S. "I Wasn't Expecting That Question": Responses to Requests for Abortion Referral at College Student Health Centers. Womens Health Issues 2024; 34:148-155. [PMID: 38246793 DOI: 10.1016/j.whi.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Women 18-24 years of age have the highest proportion of unintended pregnancies of any age group, and thus represent a significant population in need of abortion services. Prior research indicated that only half of college student health centers provide appropriate abortion referrals. Our objective was to better understand the referral experience and barriers to abortion referral at college student health centers. PROCEDURES We conducted a "secret caller" study at all 4-year colleges in Pennsylvania between June 2017 and April 2018, using a structured script requesting abortion referral. Calls were transcribed, coded using an iteratively developed codebook, and analyzed for themes related to barriers and facilitators of abortion referral. MAIN FINDINGS A total of 202 completed transcripts were reviewed. Themes that emerged were knowledge, experience, and comfort with abortion referral; support, empathy, and reassurance; coercion; misleading language; questioning the caller's autonomy; and institutional policy against referral. Most staff lacked knowledge and comfort with abortion referral. Although some staff members made supportive statements toward the caller, others used coercive language to try to dissuade the caller from an abortion. Many staff cited religious institutional policies against abortion referral and expressed a range of feelings about such policies. CONCLUSIONS Abortion referrals at student health centers lack consistency. Staff members frequently did not have the knowledge needed to provide appropriate abortion referrals, used coercive language in responding to requests for referrals, and perpetuated abortion stigma. Some health staff used coercive or evasive language that further stigmatized the caller's request for an abortion referral. College health centers should improve training and resources around abortion referral to ensure they are delivering appropriate, high-quality care.
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Affiliation(s)
- Priyanka Anand
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Licia Bravo
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Gutman
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arden McAllister
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Shimrit Keddem
- Department of Family Medicine & Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarita Sonalkar
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
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Vohra-Gupta S, Ela E, Vizcarra E, Petruzzi LJ, Hopkins K, Potter JE, White K. Evidence-based family planning services among publicly funded providers in Texas. BMC Health Serv Res 2022; 22:1498. [PMID: 36482413 PMCID: PMC9733229 DOI: 10.1186/s12913-022-08889-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Healthy Texas Women (HTW) is a fee-for-service family planning program that excludes affiliates of abortion providers. The HTW network includes providers who participate in Title X or the state Family Planning Program (FPP) and primary care providers without additional family planning funding (HTW-only). The objective of this study is to compare client volume and use of evidence-based practices among HTW providers. METHODS Client volume was determined from administrative data on unduplicated HTW clients served in fiscal year (FY) 2017. A sample of 114 HTW providers, stratified by region, completed a 2018 survey about contraceptive methods offered, adherence to evidence-based contraceptive provision, barriers to offering IUDs and implants, and counseling/referrals for pregnant patients. Differences by funding source were assessed using t-tests and chi-square tests. RESULTS Although HTW-only providers served 58% of HTW clients, most (72%) saw < 50 clients in FY2017. Only 5% of HTW providers received Title X or FPP funding, but 46% served ≥ 500 HTW clients. HTW-only providers were less likely than Title X providers to offer hormonal IUDs (70% vs. 92%) and implants (66% vs 96%); offer same-day placement of IUDs (21% vs 79%) and implants (21% vs 83%); and allow patients to delay cervical cancer screening when initiating contraception (58% vs 83%; all p < 0.05). There were few provider-level differences in counseling/referrals for unplanned pregnancy (p > 0.05). CONCLUSIONS HTW-only providers served fewer clients and were less likely to follow evidence-based practices. Program modifications that strengthen the provider network and quality of care are needed to support family planning services for low-income Texans.
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Affiliation(s)
- Shetal Vohra-Gupta
- grid.89336.370000 0004 1936 9924Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Elizabeth Ela
- grid.89336.370000 0004 1936 9924Population Research Center, University of Texas at Austin, 305 E. 23Rd Street, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Texas Policy Evaluation Project, The University of Texas at Austin, 116 Inner Campus Dr., Austin, TX 78712 USA
| | - Elsa Vizcarra
- grid.89336.370000 0004 1936 9924Population Research Center, University of Texas at Austin, 305 E. 23Rd Street, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Texas Policy Evaluation Project, The University of Texas at Austin, 116 Inner Campus Dr., Austin, TX 78712 USA
| | - Liana J. Petruzzi
- grid.89336.370000 0004 1936 9924Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Kristine Hopkins
- grid.89336.370000 0004 1936 9924Population Research Center, University of Texas at Austin, 305 E. 23Rd Street, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Texas Policy Evaluation Project, The University of Texas at Austin, 116 Inner Campus Dr., Austin, TX 78712 USA
| | - Joseph E. Potter
- grid.89336.370000 0004 1936 9924Population Research Center, University of Texas at Austin, 305 E. 23Rd Street, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Texas Policy Evaluation Project, The University of Texas at Austin, 116 Inner Campus Dr., Austin, TX 78712 USA
| | - Kari White
- grid.89336.370000 0004 1936 9924Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Population Research Center, University of Texas at Austin, 305 E. 23Rd Street, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Texas Policy Evaluation Project, The University of Texas at Austin, 116 Inner Campus Dr., Austin, TX 78712 USA
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Judge-Golden C, Kroll-Desrosiers A, Mattocks K, Borrero S. Prior Abortions and Barriers to Abortion Access Reported by Pregnant Women Veterans. J Gen Intern Med 2022; 37:816-818. [PMID: 36042077 PMCID: PMC9481818 DOI: 10.1007/s11606-022-07576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 04/01/2022] [Indexed: 10/28/2022]
Affiliation(s)
- Colleen Judge-Golden
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, USA.
| | - Aimee Kroll-Desrosiers
- Veterans Affairs Central Western Massachusetts Healthcare System, Northampton, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | - Kristin Mattocks
- Veterans Affairs Central Western Massachusetts Healthcare System, Northampton, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | - Sonya Borrero
- Center for Health Equity, Research, and Promotion (CHERP), Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA, USA.,Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, PA, USA
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Willing but unable: Physicians' referral knowledge as barriers to abortion care. SSM Popul Health 2022; 17:101002. [PMID: 34984221 PMCID: PMC8693343 DOI: 10.1016/j.ssmph.2021.101002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 11/20/2022] Open
Abstract
Abortion care is a crucial part of reproductive healthcare. Nevertheless, its availability is constrained by numerous forces, including care referrals within the larger healthcare system. Using a unique study of physician faculty across multiple specialties, we examine the factors associated with doctors' ability to refer patients for abortion care among those who were willing to consult in the care of a patient seeking an abortion (N = 674). Even though they were willing to refer a patient for an abortion, half (53%) of the physicians did not know how and whom to make those referrals, though they care for patients who may need them. Those with the least referral knowledge had not been taught abortion care during their medical training and were in earlier stages of their career than those who had more knowledge. This research exposes another obstacle for those seeking an abortion, a barrier that would be overcome with a clear and robust referral system within and across medical specialties.
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Obstetrician-gynecologist willingness to provide medication abortion with removal of the in-person dispensing requirement for mifepristone. Contraception 2021; 104:73-76. [DOI: 10.1016/j.contraception.2021.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 11/20/2022]
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