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Obern C, Morhe E, Gemzell-Danielsson K, Steinauer J. The importance of abortion training for obstetrician-gynecologists: A comparison of the United States, Sweden, and Ghana. Int J Gynaecol Obstet 2024; 167:598-603. [PMID: 38881231 DOI: 10.1002/ijgo.15733] [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: 02/06/2024] [Revised: 05/24/2024] [Accepted: 06/01/2024] [Indexed: 06/18/2024]
Abstract
Since 2020, World Health Organization guidelines state that universal access to abortion care is critical for individual and community health, and for the realization of human rights. Yet the right to access safe abortion care is severely restricted in many countries. This article outlines institutional and educational systems in the USA, Sweden, and Ghana, which all require obstetrics and gynecology (ob-gyn) training to include abortion care but vary in implementation. It argues that regardless of the political environment, the specialty should protect abortion training worldwide. In Sweden and Ghana, ob-gyn residents are required to participate in abortion training, while in the USA they are permitted to opt out. In Sweden, practicing ob-gyn specialists are required to provide abortion care, whereas in Ghana and the USA, this care is optional, leading to geographic disparities in abortion care access in these two countries. In the USA, the Supreme Court's Dobbs ruling jeopardizes programs' abilities to meet the training mandate, a requirement that was insufficiently implemented even before the ruling. It is critical that all clinicians are well-equipped to provide accurate information to their patients and provide pre- and post-abortion care. For this reason, we recommend that abortion is included in all undergraduate medical education programs in accordance with the recommendations of FIGO (the International Federation of Gynecology & Obstetrics). To meet WHO guidelines that require ob-gyn specialists to provide abortion care in an emergency, we urge FIGO to create a guideline about expectations for abortion training integration in obstetrics and gynecology.
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Affiliation(s)
- Cerisa Obern
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emmanuel Morhe
- Department of Obstetrics and Gynecology, University of Health and Allied Sciences, Ho, Ghana
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institute and Karolinska University, Stockholm, Sweden
| | - Jody Steinauer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
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Wallace ME, Vilda D, Dyer L, Johnson I, Funke L. Health care use and health consequences of geographic lack of access to abortion and maternity care. Birth 2024; 51:363-372. [PMID: 37968858 PMCID: PMC11093883 DOI: 10.1111/birt.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/05/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services. METHODS We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual-level and county-level characteristics. RESULTS In 2020, one third of counties in the US were comprehensive reproductive health care deserts (n = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13). CONCLUSIONS Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth.
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Affiliation(s)
- Maeve E Wallace
- Department of Social, Mary Amelia Center for Women's Health Equity Research, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Dovile Vilda
- Department of Social, Mary Amelia Center for Women's Health Equity Research, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Lauren Dyer
- Department of Social, Mary Amelia Center for Women's Health Equity Research, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Iman Johnson
- Department of Social, Mary Amelia Center for Women's Health Equity Research, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Newton-Hoe E, Lee A, Fortin J, Goldberg AB, Janiak E, Neill S. Mifepristone Use Among Obstetrician-Gynecologists in Massachusetts: Prevalence and Predictors of Use. Womens Health Issues 2024; 34:135-141. [PMID: 38129219 DOI: 10.1016/j.whi.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES We estimated the prevalence of mifepristone use for evidence-based indications among obstetrician-gynecologists in independent practice in Massachusetts and explored the demographic and practice-related factors associated with use. METHODS We used data from a cross-sectional survey administered to Massachusetts obstetrician-gynecologists identified from the American Medical Association Physician Masterfile. We measured the prevalence of mifepristone use for four clinical scenarios: early pregnancy loss, medication abortion, cervical preparation before dilation and evacuation procedures, and cervical preparation before induction of labor. Multivariate regression was used to calculate the odds of mifepristone use for these scenarios based on practice type, years in practice, physician sex, and history of medication abortion training. RESULTS A total of 198 obstetrician-gynecologists responded to the survey (response rate = 29.0%); this analysis was limited to 158 respondents who were not in residency or fellowship. Overall, 46.0% used mifepristone for early pregnancy loss and 38.6% for medication abortion. Fewer used mifepristone for cervical preparation before dilation and evacuation (26.0%) or before induction of labor (26.4%). Respondents in academic practice settings, with more years in practice, of female sex, and with sufficient medication abortion training were significantly more likely to use mifepristone for one or more evidence-based clinical indications. CONCLUSIONS Sufficient medication abortion training during residency significantly predicts whether obstetrician-gynecologists use mifepristone in practice. The U.S. Supreme Court's overturning of Roe v. Wade will allow state-level abortion bans and restrictions to be in effect, which will reduce exposure to abortion training during residency. Increasing training in and utilization of mifepristone are critical for equitable access to reproductive health services. Further interventions may need to be developed to increase mifepristone use in nonacademic practice settings.
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Affiliation(s)
- Emily Newton-Hoe
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital, Boston, Massachusetts.
| | - Alice Lee
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jennifer Fortin
- Planned Parenthood League of Massachusetts, Boston, Massachusetts
| | - Alisa B Goldberg
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital, Boston, Massachusetts; Planned Parenthood League of Massachusetts, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Janiak
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital, Boston, Massachusetts; Planned Parenthood League of Massachusetts, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Sara Neill
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Fleurant E, McCloskey L. Medication Abortion: A Comprehensive Review. Clin Obstet Gynecol 2023; 66:706-724. [PMID: 37910067 DOI: 10.1097/grf.0000000000000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
This chapter provides an overview of evidence-based guidelines for medication abortion in the first trimester. We discuss regimens, both FDA-approved and other clinical-based protocols, and will briefly discuss novel self-managed abortion techniques taking place outside the formal health care system. Overview of patient counseling and pain management are presented with care to include guidance on "no touch" regimens that have proven both feasible and effective. We hope that this comprehensive review helps the health care community make strides to increase access to abortion in a time when reproductive health care is continuously restricted.
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Affiliation(s)
- Erin Fleurant
- Department of Obstetrics and Gynecology, Northwestern McGaw Medical Center, Chicago, Illinois
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Brown C, Neerland CE, Weinfurter EV, Saftner MA. The Provision of Abortion Care via Telehealth in the United States: A Rapid Review. J Midwifery Womens Health 2023; 68:744-758. [PMID: 38069588 DOI: 10.1111/jmwh.13586] [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] [Revised: 09/11/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The recent Supreme Court decision Dobbs v. Jackson Women's Health that has overruled Roe v. Wade has resulted in severe limitations of abortion access throughout the United States. Telehealth has been put forth as one solution for improving access for reproductive health care, including abortion services. Telehealth has demonstrated safety and efficacy in several health care disciplines; however, its use for abortion care and services has not been explored and synthesized. METHODS As part of a larger review on telehealth and general reproductive health, our team identified a moderate amount of literature on telehealth and abortion care. We conducted a rapid review searching for eligible studies in MEDLINE, Embase, and CINAHL. Information was extracted from each included study to explore 4 key areas of inquiry: (1) clinical effectiveness, (2) patient and provider experiences, (3) barriers and facilitators, and (4) the impact of the coronavirus disease 2019 (COVID-19) pandemic. RESULTS Twenty-five studies on the use of telehealth for providing abortion services published between 2011 and 2022 were included. Telehealth for medical abortion increased during the COVID-19 pandemic and was found to be safe and clinically effective, with high patient satisfaction. Overall, telehealth improved access and removed barriers for patients including lack of transportation. Legal restrictions in certain states were cited as the primary barriers. Studies contained limited information on the perspectives and experiences of health care providers and diverse patient populations. DISCUSSION Abortion care via telehealth is safe and effective with high satisfaction and may also remove barriers to care including transportation and fear. Removing restrictions on telehealth for the provision of abortion services may further improve access to care and promote greater health equity.
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Affiliation(s)
- Camille Brown
- University of Minnesota School of Nursing, Minneapolis, Minnesota
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McNamara K, Poverman M, Nádas M, Mallow M, Gerber S. Privileging Midwives for Abortion Care. J Midwifery Womens Health 2023; 68:769-773. [PMID: 37850529 DOI: 10.1111/jmwh.13577] [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] [Revised: 09/11/2023] [Indexed: 10/19/2023]
Abstract
Since the US Supreme Court overturned Dobbs v Jackson, expanded access to abortion has been critical. Abortion is safe, and related complications are rare. The safety of abortion provision by advanced practice clinicians (APCs) is well documented. Despite the increase in targeted restrictions for patients and clinicians in many states post-Dobbs, in recent years there have been meaningful gains in recognition and codification of abortion as part of an expanded scope of practice for APCs. Thus, creating a formal written pathway for midwives to obtain privileges in abortion provision could also improve abortion access. In New York City's public health care system, the largest in the United States, midwives provide a significant portion of perinatal and gynecologic care. Yet, until recently, a process to privilege midwives in the provision of abortion services did not exist. In response, midwives and physicians at a large New York City hospital system sought key stakeholder support to develop a pathway for certified nurse-midwives and certified midwives, licensed midwives in New York state, to obtain the necessary training needed for independent abortion provision. This article describes the development of a midwifery-led pilot program to improve abortion access by increasing the availability of trained midwifery abortion providers, along with the results of staff meetings exploring attitudes toward abortion care by APCs. We report our safety statistics from this pilot program and share existing evidence for safety of abortion provision by midwives and other APCs.
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Affiliation(s)
- Keeley McNamara
- Obstetrics and Gynecology, New York Presbyterian-Hudson Valley Hospital, Cortlandt Manor, New York
| | - Marisa Poverman
- Obstetrics and Gynecology, NYC Health + Hospitals/Jacobi, Bronx, New York
| | - Marisa Nádas
- Obstetrics and Gynecology, NYC Health + Hospitals/Jacobi, Bronx, New York
- Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York
- NYC Health + Hospitals, New York, New York
| | | | - Sharon Gerber
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Miremberg H, Oduola O, Morrison JJ, O'Donoghue K. Fetal anomaly diagnosis and termination of pregnancy in Ireland: a service evaluation following implementation of abortion services in 2019. Am J Obstet Gynecol MFM 2023; 5:101111. [PMID: 37532025 DOI: 10.1016/j.ajogmf.2023.101111] [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: 06/09/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Approximately 3% of pregnancies are diagnosed with a fetal anomaly, of which a proportion is fatal or life-limiting. The introduction of legislation for termination of pregnancy in Ireland in 2019 for conditions "likely to lead to the death of the fetus" made termination of pregnancy for "fatal fetal anomaly" an option for pregnant women in Ireland. OBJECTIVE This study examined all cases of termination of pregnancy performed for major fetal anomaly over the first 3 years of service implementation, including cases that did not meet the legal criteria, resulting in women traveling outside Ireland for abortion care. STUDY DESIGN A retrospective service evaluation of tertiary fetal medicine clinics in 2 tertiary maternity hospitals between 2019 and 2021 was undertaken. We compared pregnancies of patients diagnosed with fatal fetal anomaly who underwent termination of pregnancy in Ireland with those of patients who did not meet the legal criteria and hence traveled outside Ireland for termination of pregnancy. RESULTS Overall, 139 pregnancies met the inclusion criteria; 83 (59.7%) patients had termination of pregnancy in the tertiary maternity hospital (local), and 56 (40.3%) traveled abroad, mainly to the United Kingdom. Demographic characteristics were similar between the 2 groups, as was gestation at diagnosis and delivery. All cases where termination of pregnancy was local were discussed at fetal medicine multidisciplinary meetings, as opposed to 34% of cases of patients who ultimately traveled outside Ireland for termination of pregnancy. The most common indication (25/83; 30.1%) for local termination of pregnancy was trisomy 18, followed by anencephaly. Traveling to obtain abortion care was mainly due to diagnosis of trisomy 21 (30/56; 53.6%), followed by other multiple structural anomalies/syndromes deemed locally as not meeting the legal criteria. CONCLUSION Legislation for termination of pregnancy for fetal anomaly, restricted to fatal diagnoses, is difficult to implement, requires significant multidisciplinary input, and can lead to limited services for pregnancies diagnosed with major fetal anomalies. Our findings emphasize the impact of legislative barriers to abortion care for fetal anomaly and the need for policies and services that support women's access to termination of pregnancy for fetal anomaly.
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Affiliation(s)
- Hadas Miremberg
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland (Drs Miremberg and O'Donoghue).
| | - Oladayo Oduola
- Department of Obstetrics and Gynaecology, Galway University Hospital, University of Galway, Galway, Ireland (Drs Oduola and Morrison)
| | - John J Morrison
- Department of Obstetrics and Gynaecology, Galway University Hospital, University of Galway, Galway, Ireland (Drs Oduola and Morrison)
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland (Drs Miremberg and O'Donoghue); INFANT Research Centre, University College Cork, Cork, Ireland (Dr O'Donoghue)
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Ahrens KA, Palmsten K, Lipkind HS, Pfeiffer M, Gelsinger C, Ackerman-Banks C. Mental Health Within 24 Months After Delivery Among Women with Common Pregnancy Conditions. J Womens Health (Larchmt) 2023; 32:787-800. [PMID: 37192449 PMCID: PMC10354313 DOI: 10.1089/jwh.2022.0367] [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] [Indexed: 05/18/2023] Open
Abstract
Objective: The aim of this study is to estimate the risk of a new mental health diagnosis within the first 24 months postpartum among women with common pregnancy conditions, overall and by rurality. Materials and Methods: This longitudinal population-based study used the Maine Health Data Organization's All-Payer Claims Data to estimate the cumulative risk of a new mental health disorder diagnosis in the first 24 months postpartum among women with deliveries during 2007-2019 and who did not have a mental health diagnosis before pregnancy. Cox models were used to estimate hazard ratios for common pregnancy conditions (prenatal depression, gestational diabetes [GDM], and hypertensive disorders of pregnancy [HDP]) on the new diagnosis of five mental health conditions, separately. Models were adjusted for maternal demographics and pregnancy characteristics. Results: Of the 123,125 deliveries, the cumulative risk of being diagnosed in the first 24 months postpartum with depression was 28%, anxiety 25%, bipolar disorder 3%, post-traumatic stress disorder 6%, and schizophrenia/psychotic disorder 1%. Women with prenatal depression were at higher risk of having a postpartum mental health diagnosis compared with women without prenatal depression (adjusted hazard ratios [aHRs] ranged from 2.5 [for anxiety] to 4.1 [for postpartum depression]). Risk of having postpartum depression was modestly higher among women with HDP, as was the risk of postpartum bipolar disorder among those with GDM. Findings were generally similar between women living in rural versus urban areas. Conclusions: Effective interventions to prevent, screen, and treat mental health conditions among women with pregnancy complications for an extended time postpartum are warranted.
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Affiliation(s)
- Katherine A. Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Kristin Palmsten
- Pregnancy and Child Health Research Center, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Heather S. Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mariah Pfeiffer
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Catherine Gelsinger
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Christina Ackerman-Banks
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
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Bell LA, Tyler CP, Russell MR, Szoko N, Harrison EI, Kazmerski TM, Syed T, Kirkpatrick L. Preferences and Experiences Regarding Pregnancy Options Counseling in Adolescence and Young Adulthood: A Qualitative Study. J Adolesc Health 2023; 73:164-171. [PMID: 37032209 PMCID: PMC10330200 DOI: 10.1016/j.jadohealth.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE Perspectives of adolescents and young adults (AYAs) experiencing pregnancy options counseling (POC) are absent from the literature. This study explores AYA experiences and preferences related to POC to inform best practice guidelines. METHODS We conducted semistructured phone interviews in 2020-2021 among US-based individuals, 18-35 years old, who experienced a pregnancy less than 20 years of age. We performed qualitative descriptive analysis of positive and negative attributes of AYA's experiences with POC. RESULTS Fifty participants reported 59 pregnancies (16 parenting, 19 abortions, 18 adoptions, three miscarriages) between the ages of 13 and 19 years. Positive attributes of POC experienced included: (1) provider communication that was compassionate, respectful, supportive, and attentive to nonverbal cues; (2) provider neutrality; (3) discussion of all pregnancy options; (4) asking about feelings, choice, life plans, and additional supports; (5) provision of informational materials; and (6) warm handoffs/follow-up facilitation. Negative attributes of POC experienced included: (1) judgmental, impersonal, or absent communication; (2) lack of counseling on all options and/or coercive/directive counseling; (3) insufficient time and supportive resources; and (4) confidentiality concerns. We identified no differences in these perspectives across pregnancy outcomes reported. Participants generally desired counseling about all options, with rare exceptions of ambivalence. DISCUSSION Individuals who experienced an adolescent pregnancy described similar positive and negative attributes of POC regardless of preferred pregnancy outcome. Their perspectives highlight how crucial interpersonal communication skills are for effective POC for AYA. POC training across health care specialties should emphasize confidential, compassionate, and nonjudgmental care for AYA patients.
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Affiliation(s)
- Lauren A Bell
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Crystal P Tyler
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, University of Chicago, Chicago, Illinois
| | - Margaret R Russell
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicholas Szoko
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth I Harrison
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Traci M Kazmerski
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tahniat Syed
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laura Kirkpatrick
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
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Manning S, Kuhn D. Spontaneous and Complicated Therapeutic Abortion in the Emergency Department. Emerg Med Clin North Am 2023; 41:295-305. [PMID: 37024165 DOI: 10.1016/j.emc.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Pregnancy-related emergency department visits are common in the United States. Although typically managed safely in the outpatient setting, patients with spontaneous abortion may also present with life-threatening hemorrhage or infection. Management strategies for spontaneous abortion are similarly wide-ranging from expectant management to emergent surgical intervention. Surgical management of complicated therapeutic abortion is similar to that of spontaneous abortion. The dramatic changes in the legal status of abortion in the United States may have significant influence on the incidence of complicated therapeutic abortion, and we encourage emergency physicians to familiarize themselves with the diagnosis and management of these conditions.
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Madison AM, Powers D, Maslowsky J, Goyal V. Association Between Publicly Funded Contraceptive Services and the Abortion Rate in Texas, 2010-2015. Obstet Gynecol 2023; 141:361-370. [PMID: 36649327 PMCID: PMC9858333 DOI: 10.1097/aog.0000000000005057] [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: 07/04/2022] [Accepted: 10/20/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate how the availability of contraceptive services was associated with a change in the abortion rate before and after Texas' legislative changes to the family planning budget in 2011 and abortion access in 2013. METHODS In this cross-sectional study, we obtained 2010 and 2015 data on contraceptive provision (number of publicly funded clinics and number of contraceptive clients served per 1,000 reproductive-aged women) from the Guttmacher Institute and county-level abortion data from the Texas Department of State Health Services. We categorized counties as having an abortion rate that increased or declined less than the national rate between 2010 and 2015 ( low-decline counties ) compared with those having an abortion rate that declined equal to or greater than the national rate between 2010 and 2015 ( high-decline counties ). We evaluated differences in contraceptive provision between high-decline and low-decline counties and evaluated county characteristics (racial and ethnic composition, unemployment, poverty, uninsured, education, distance to an abortion clinic, deliveries covered by Medicaid, and Catholic hospital marketplace dominance) as potential confounders. RESULTS Of 157 counties that had at least one contraceptive clinic in either 2010 or 2015, 49 were low-decline counties and 108 were high-decline counties. Although the total number of publicly funded family planning clinics increased by 10.8%, there was a 4.7% decrease in the total number of contraceptive clients served statewide. Compared with low-decline counties, high-decline counties had a higher median number of contraceptive clients served per 1,000 women aged 18-44 years (31.9 vs 60.7, P <.05) in 2015. Between 2010 and 2015, the abortion rate decreased 19.7% for each 1.0% increase in contraceptive clients served. CONCLUSION Texas counties with higher abortion-rate declines had more publicly funded contraceptive clinics and served more contraceptive clients than counties with lower declines, which may indicate the importance of greater access to publicly funded contraceptive services.
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Affiliation(s)
- Anita M Madison
- Department of Obstetrics and Gynecology, Louisiana State University Health Science Center, Baton Rouge, Louisiana; the Population Research Center, University of Texas at Austin, Austin, Texas; and the School of Public Health, University of Illinois Chicago, Chicago, Illinois
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12
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Lambert VC, Hackworth EE, Billings DL. Qualitative analysis of anti-abortion discourse used in arguments for a 6-week abortion ban in South Carolina. Front Glob Womens Health 2023; 4:1124132. [PMID: 37066038 PMCID: PMC10098009 DOI: 10.3389/fgwh.2023.1124132] [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: 12/14/2022] [Accepted: 02/27/2023] [Indexed: 04/18/2023] Open
Abstract
Background On June 24, 2022, The U.S. Supreme Court overturned Roe v. Wade, leaving abortion legislation entirely up to states. However, anti-abortion activists and legislators have organized for decades to prevent abortion access through restrictive state-level legislation. In 2019, South Carolina legislators proposed a bill criminalizing abortion after 6 weeks gestation, before most people know they are pregnant. The current study examines the anti-abortion rhetoric used in legislative hearings for this extreme abortion restriction in South Carolina. By examining the arguments used by anti-abortion proponents, we aim to expose their misalignment with public opinion on abortion and demonstrate that their main arguments are not supported by and often are counter to medical and scientific evidence. Methods We qualitatively analyzed anti-abortion discourse used during legislative hearings of SC House Bill 3020, The South Carolina Fetal Heartbeat Protection from Abortion Act. Data came from publicly available videos of legislative hearings between March and November 2019, during which members of the public and legislators testified for and against the abortion ban. After the videos were transcribed, we thematically analyzed the testimonies using a priori and emergent coding. Results Testifiers (Anti-abortion proponents) defended the ban using scientific disinformation and by citing advances in science to redefine "life." A central argument was that a fetal "heartbeat" (i.e., cardiac activity) detected at 6 weeks gestation indicates life. Anti-abortion proponents used this to support their argument that the 6-week ban would "save lives." Other core strategies compared anti-abortion advocacy to civil rights legislation, vilified supporters and providers of abortion, and framed people who get abortions as victims. Personhood language was used across strategies and was particularly prominent in pseudo-scientific arguments. Discussion Abortion restrictions are detrimental to the health and wellbeing of people with the potential to become pregnant and to those who are pregnant. Efforts to defeat abortion bans must be grounded in a critical and deep understanding of anti-abortion strategies and tactics. Our results reveal that anti-abortion discourse is extremely inaccurate and harmful. These findings can be useful in developing effective approaches to countering anti-abortion rhetoric.
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Affiliation(s)
- Victoria C. Lambert
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, United States
- Correspondence: Victoria C. Lambert
| | - Emily E. Hackworth
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, United States
| | - Deborah L. Billings
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, United States
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Espey E, Haider S, Stone J, Gyamfi-Bannerman C, Steinauer J. Now is the time to stand up for reproductive justice and abortion access. Am J Obstet Gynecol 2023; 228:48-52. [PMID: 36008167 DOI: 10.1016/j.ajog.2022.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023]
Abstract
The ongoing assault on abortion care in the United States culminating in the Supreme Court decision that overturned Roe v Wade calls for concerted national action to address the major gaps in care and training that will ensue. We write this call to action to our community of obstetrician-gynecologists to prioritize advocacy for access to abortion care. Professional health organizations understand the importance of access to contraception and abortion care as the foundation for reproductive health, autonomy, and empowerment. As restrictions proliferate, patients are encountering significant challenges in accessing care; all in our community who provide obstetrical and gynecologic care need to step up to ensure adequate and equitable patient care and provider training. In this Clinical Opinion, we outline current professional organization evidence-based support for comprehensive reproductive health care including abortion care, without interference by politics, strategies to proactively prevent further restrictions, and actions to mitigate the harm that will be caused by further restrictions to abortion care. We must all speak up, be visible in our support, and take any and every opportunity to advocate for abortion care as an integral part of comprehensive reproductive medical care.
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Affiliation(s)
- Eve Espey
- Department of Obstetrics & Gynecology, School of Medicine, The University of New Mexico, Albuquerque, NM.
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Cárdenas-Suárez N, Ramirez-Santiago C, Zamora-Olivencia D, Romaguera J, Garcia Rivera EJ, Vale Moreno Y. Telehealth as a potential tool for outreach among women in Puerto Rico. AJOG GLOBAL REPORTS 2022; 3:100156. [PMID: 36691398 PMCID: PMC9860148 DOI: 10.1016/j.xagr.2022.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Access to the full spectrum of healthcare should be available to all individuals. After the revocation of the constitutional right to abortion, women have fewer alternatives to unplanned pregnancy. Telehealth provides an additional option for such pregnancies through its remote provision of services. This could benefit women of all social strata. However, data regarding telehealth among underserved populations are limited. OBJECTIVE This study aimed to evaluate the use of contraception, awareness of abortion services, and receptiveness to telehealth among women in Puerto Rico, a Spanish-speaking minority population. STUDY DESIGN This was a cross-sectional study of women living in Puerto Rico aged between 21 and 65 years. Data were collected with a self-administered survey via SurveyMonkey from March to December of 2021. Recruitment was done through social media and at the gynecology clinics of the University of Puerto Rico, Medical Sciences Campus and San Juan City Hospital. Analysis was done with Stata, version 14.2. Chi-square and Cochran-Armitage tests were used to evaluate the unadjusted relationship between variables. A P value ≤.05 was considered statistically significant. RESULTS A total of 286 women were recruited. Of these, 73.3% (189/258) were sexually active, 89.1% (229/257) were heterosexual, and 62.7% (163/260) were not using contraception. In addition, 63.3% (157/248) knew about emergency contraception, yet 42.4% (103/243) were unaware of any sources of access to it; 76.6% (197/257) were unaware of nearby abortion services. A higher education level was associated with knowing about emergency contraception (P<.05) and awareness of sources of access to it (P<.05). However, no significant association was found between a higher education level and awareness of nearby abortion services (P=.799). Regarding telehealth, 65.2% (176/270) were willing to use the service for future gynecologic visits, yet only 18.9% (51/269) were offered telehealth services. No association was found between previous telehealth experiences and willingness to use telehealth for future gynecologic visits (P=.325). CONCLUSION The lack of contraceptive use and unawareness of nearby abortion services place women at increased risk of unplanned pregnancy and unsafe practices. The gap between knowledge about and access to emergency contraception also calls for action. Telehealth may be of benefit given that most women showed interest in using it, and could be used for educating and providing women in Puerto Rico with contraception and medical abortions, further increasing their access to reproductive healthcare. Clarifying misconceptions and instructing women about safe practices is essential to our role as physicians. Ensuring women's access to adequate services is also vital for upholding their rights to healthcare.
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Affiliation(s)
- Natalia Cárdenas-Suárez
- Department of Obstetrics and Gynecology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (Drs Cárdenas-Suárez, Ramirez-Santiago, Romaguera, Garcia Rivera, and Vale Moreno)
- Department of Obstetrics and Gynecology, San Juan City Hospital, San Juan, Puerto Rico (Drs Cárdenas-Suárez, Zamora-Olivencia, Romaguera, and Vale Moreno)
- Corresponding author: Natalia Cárdenas-Suárez, MD.
| | - Cayra Ramirez-Santiago
- Department of Obstetrics and Gynecology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (Drs Cárdenas-Suárez, Ramirez-Santiago, Romaguera, Garcia Rivera, and Vale Moreno)
| | - Debora Zamora-Olivencia
- Department of Obstetrics and Gynecology, San Juan City Hospital, San Juan, Puerto Rico (Drs Cárdenas-Suárez, Zamora-Olivencia, Romaguera, and Vale Moreno)
- Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health, Bridgeport, CT (Dr Zamora-Olivencia)
| | - Josefina Romaguera
- Department of Obstetrics and Gynecology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (Drs Cárdenas-Suárez, Ramirez-Santiago, Romaguera, Garcia Rivera, and Vale Moreno)
- Department of Obstetrics and Gynecology, San Juan City Hospital, San Juan, Puerto Rico (Drs Cárdenas-Suárez, Zamora-Olivencia, Romaguera, and Vale Moreno)
| | - Enid J. Garcia Rivera
- Department of Obstetrics and Gynecology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (Drs Cárdenas-Suárez, Ramirez-Santiago, Romaguera, Garcia Rivera, and Vale Moreno)
| | - Yari Vale Moreno
- Department of Obstetrics and Gynecology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (Drs Cárdenas-Suárez, Ramirez-Santiago, Romaguera, Garcia Rivera, and Vale Moreno)
- Department of Obstetrics and Gynecology, San Juan City Hospital, San Juan, Puerto Rico (Drs Cárdenas-Suárez, Zamora-Olivencia, Romaguera, and Vale Moreno)
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15
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Bardhi O, Rizk PE. The Future of Medical Abortion Care: an Internal Medicine Obligation. J Gen Intern Med 2022; 37:4268-4269. [PMID: 36175756 PMCID: PMC9708975 DOI: 10.1007/s11606-022-07798-6] [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] [Received: 05/16/2022] [Accepted: 09/07/2022] [Indexed: 01/04/2023]
Abstract
Abortion care is an essential part of women's reproductive health. Due to increasing state restrictions on abortion care and the United States Supreme Court decision to overturn the landmark case of Roe v. Wade, it is becoming ever more important to increase medical abortion access for all women. Internal Medicine (IM) physicians are able to provide reproductive healthcare including medical abortions. As women in over 20 states are at risk of not having any access to abortion, it is our obligation as IM physicians to provide this care and help curb the effects of these restrictive laws and therefore train the next generation of internists to continue doing so.
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Affiliation(s)
- Olgert Bardhi
- Internal Medicine Residency Program, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
| | - Patrick E Rizk
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
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16
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Madera M, Johnson DM, Broussard K, Tello-Pérez LA, Ze-Noah CA, Baldwin A, Gomperts R, Aiken AR. Experiences seeking, sourcing, and using abortion pills at home in the United States through an online telemedicine service. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100075. [PMID: 37503356 PMCID: PMC10372773 DOI: 10.1016/j.ssmqr.2022.100075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
A growing number of people in the United States seek to self-manage their abortions by self-sourcing abortion medications online. Prior research focuses on people's motivations for seeking self-management of abortion and experiences trying to obtain medications. However, little is known about the experiences of people in the U.S. who actually complete a self-managed abortion using medications they self-sourced online. We conducted anonymous in-depth interviews with 80 individuals who sought abortion medications through Aid Access, the only online telemedicine service that provides abortion medications in all 50 U.S. states. Through grounded theory analysis we identified five key themes: 1) participants viewed Aid Access as a "godsend"; 2) Fears of scams, shipping delays, and surveillance made ordering pills online a "nerve-racking" experience; 3) a "personal touch" calmed fears and fostered trust in Aid Access; 4) participants were worried about the "what ifs" of the self-managed abortion experience; and 5) overall, participants felt that online telemedicine met their important needs. Our findings demonstrate that online telemedicine provided by Aid Access not only provided a critical service, but also offered care that participants deemed legitimate and trustworthy.
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Affiliation(s)
| | | | | | | | | | - Aleta Baldwin
- California State University, Sacramento, Sacramento, CA, USA
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17
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Weinmann AS. One degree of separation: urgent questions surrounding new USA laws in women's healthcare. Trends Immunol 2022; 43:851-854. [PMID: 36182546 DOI: 10.1016/j.it.2022.09.001] [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: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 01/12/2023]
Abstract
The criminalization of women's healthcare in many USA states has created uncertainty about women's access to evidence-based medical care and will affect the physical, mental, and emotional health and well-being of women. This article is intended to start a discussion on this complex topic in the immunology community.
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Affiliation(s)
- Amy S Weinmann
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA.
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18
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Miles C, Weidner A, Summit AK, Thomson CJ, Zhang Y, Cole AM, Shih G. Patient opinions on sexual and reproductive health services in primary care in rural and urban clinics. Contraception 2022; 114:26-31. [PMID: 35489391 DOI: 10.1016/j.contraception.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Primary care providers are a major source of sexual and reproductive health care in the United States, particularly in rural areas, and not all providers offer the same services. This study aimed to understand patient preferences and expectations around reproductive health services including abortion care in a primary care setting and if those expectations differed by urban or rural setting. STUDY DESIGN An anonymous survey was distributed to all patients 18 years or older in 4 primary care clinics in Idaho, Washington, and Wyoming over a 2-week period. The survey asked patients about which reproductive health services should be available in primary care. RESULTS The overall response rate was 69% (745/1086). For all queried reproductive health services except for aspiration abortion, the majority of respondents reported that primary care clinics should have that service available. Forty-two percent of respondents reported that aspiration abortion should be available in primary care. Overall, most respondents reported that medication abortion (58%) and miscarriage management (65%) should be available in primary care. More respondents in urban clinics thought IUD services (84% vs 71%), medication abortion (74% vs 37%), and aspiration abortion (52% vs 28%) should be accessible in primary care compared to those in rural-serving clinics. CONCLUSIONS This study of 4 primary care clinics in Idaho, Washington, and Wyoming, spanning urban and rural settings, highlights that most patients desire contraception services and miscarriage management to be available in primary care. IMPLICATIONS Increasing training may help meet patient desires for access to reproductive services in primary care, however, further exploration of barriers to this care is warranted. High rates of respondents desiring miscarriage management access highlights the need to train more primary care clinicians to provide full spectrum miscarriage management options.
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Affiliation(s)
- Christina Miles
- University of Washington, Department of Family Medicine, Seattle, WA, United States.
| | - Amanda Weidner
- University of Washington, Department of Family Medicine, Seattle, WA, United States
| | - Aleza K Summit
- RHEDI, Montefiore Medical Center (Department of Family and Social Medicine), Bronx, NY, United States
| | - Claire J Thomson
- Swedish First Hill Family Medicine Residency, Seattle, WA, United States
| | - Ying Zhang
- University of Washington, Department of Family Medicine, Seattle, WA, United States
| | - Allison M Cole
- University of Washington, Department of Family Medicine, Seattle, WA, United States
| | - Grace Shih
- University of Washington, Department of Family Medicine, Seattle, WA, United States
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19
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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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20
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Abstract
The American Academy of Pediatrics reaffirms its position that the rights of adolescents under 18 years of age to confidential care when considering legal medical and surgical abortion therapies should be protected. Most adolescents voluntarily involve parents and other trusted adults in decisions regarding pregnancy termination and should be encouraged to do so when safe and appropriate. The legal climate surrounding abortion law is rapidly becoming more restrictive and threatens to adversely impact adolescents. Mandatory parental involvement, the judicial bypass procedure, and general restrictive abortion policies pose risks to adolescents' health by causing delays in accessing medical care, increasing volatility within a family, and limiting their pregnancy options. These harms underscore the importance of adolescents' access to confidential abortion care. This statement presents a summary of pertinent current information related to the impact of legislation requiring mandatory parental involvement in an adolescent's decision to obtain abortion services.
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21
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King B, Shpiegel S, Grinnell-Davis C, Smith R. The Importance of Resources and Relationships: An Introduction to the Special Issue on Expectant and Parenting Youth in Foster Care. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2022; 39:651-656. [PMID: 35992615 PMCID: PMC9375089 DOI: 10.1007/s10560-022-00878-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Bryn King
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, M5S 1V4 Toronto, ON Canada
| | - Svetlana Shpiegel
- Department of Social Work and Child Advocacy, Montclair State University, Montclair, United States
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22
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Baca M, Harrison ME, Grubb L, Hoopes A, Hwang L, Maslowsky J, Romano M, Tebb K, Tyson N. SAHM/NASPAG Statement on Leaked Draft SCOTUS Opinion Regarding Mississippi v Jackson Women's Health. J Pediatr Adolesc Gynecol 2022; 35:417-419. [PMID: 35618232 DOI: 10.1016/j.jpag.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie Baca
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Megan E Harrison
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600.
| | - Laura Grubb
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Andrea Hoopes
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Loris Hwang
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Julie Maslowsky
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Mary Romano
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Kathleen Tebb
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
| | - Nichole Tyson
- Children's Hospital of Eastern Ontario, Pediatrics, 401 Smyth Rd, Ottawa, ON, Canada K1H8L1, Phone: 613 737 7600
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23
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Ohio Abortion Regulations and Ethical Dilemmas for Obstetrician–Gynecologists. Obstet Gynecol 2022; 140:253-261. [DOI: 10.1097/aog.0000000000004870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
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Seymour JW, Thompson TA, Milechin D, Wise LA, Rudolph AE. Potential Impact of Telemedicine for Medication Abortion Policy and Programming Changes on Abortion Accessibility in the United States. Am J Public Health 2022; 112:1202-1211. [PMID: 35830676 PMCID: PMC9342822 DOI: 10.2105/ajph.2022.306876] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To quantify the impact of telemedicine for medication abortion (TMAB) expansion or ban removal on abortion accessibility. Methods. We included 1091 facilities from the 2018 Advancing New Standards in Reproductive Health facility database and Planned Parenthood Web site, among which 241 did not offer abortion as sites for TMAB expansion. Accessibility was defined as the proportion of reproductive-aged women living within a 30-, 60-, or 90-minute drive time from an abortion-providing facility. We calculated accessibility differences between 3 scenarios: (1) facilities offering abortion in 2018 (reference), (2) the reference scenario in addition to all facilities in states without TMAB bans (TMAB expansion), and (3) all facilities (TMAB ban removal). We also stratified by state and urban-rural status. Results. In 2018, 65%, 81%, and 89% of women lived within a 30-, 60-, or 90-minute drive time from an abortion-providing facility, respectively. Expansion and ban removal expanded abortion accessibility relative to the current accessibility scenario (range: 1.25-5.66 percentage points). Women in rural blocks experienced greater increases in accessibility than those in urban blocks. Conclusions. TMAB program and policy changes could expand abortion accessibility to an additional 3.5 million reproductive-aged women. Public Health Implications. Our findings can inform where to invest resources to improve abortion accessibility. (Am J Public Health. 2022;112(8):1202-1211. https://doi.org/10.2105/AJPH.2022.306876).
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Affiliation(s)
- Jane W Seymour
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
| | - Terri-Ann Thompson
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
| | - Dennis Milechin
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
| | - Lauren A Wise
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
| | - Abby E Rudolph
- Jane W. Seymour is with the Department of Epidemiology, School of Public Health, Boston University, Boston, MA, and Ibis Reproductive Health, Cambridge, MA. Terri-Ann Thompson is with Ibis Reproductive Health. Dennis Milechin is with Research Computing Services, Information Services and Technology, Boston University. Lauren A. Wise is with the Department of Epidemiology, School of Public Health, Boston University. Abby E. Rudolph is with the Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
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25
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Grimstad F, Boskey E. More than Just Abortion: How Attacks on Privacy Threaten Gynecology. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.29005.commentary] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Frances Grimstad
- Division of Pediatric and Adolescent Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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26
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Hughes LD, Kidd KM, Gamarel KE, Operario D, Dowshen N. "These Laws Will Be Devastating": Provider Perspectives on Legislation Banning Gender-Affirming Care for Transgender Adolescents. J Adolesc Health 2021; 69:976-982. [PMID: 34627657 PMCID: PMC9131701 DOI: 10.1016/j.jadohealth.2021.08.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/14/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The standards of care for transgender and gender diverse youth (TGDY) experiencing gender dysphoria are well-established and include gender-affirming medical interventions. As of July 2021, 22 states have introduced or passed legislation that bans the provision of gender-affirming medical care to anyone under the age of 18 even with parent or guardian consent. The purpose of this study is to understand what providers who deliver gender-affirming medical care to TGDY think about this legislation. METHODS In March 2021, we recruited participants via listservs known to be frequented by providers of gender-affirming medical care. Eligible participants were over the age of 18, currently working as a physician, nurse practitioner, or physician's assistant, and providing gender-affirming care to TGDY under the age of 18 in the U.S. RESULTS We analyzed the responses of 103 providers from all 50 states and DC. Most participants identified as white (77%), cisgender women (70%), specializing in pediatric care (52%). The most salient theme, described by nearly all participants, was the fear that legislation banning gender-affirming care would lead to worsening mental health including increased risk for suicides among TGDY. Other themes included the politicization of medical care, legislation that defies the current standards of care for TGDY, worsening discrimination toward TGDY, and adverse effects on the providers. CONCLUSIONS Providers of gender-affirming care overwhelmingly opposed legislation that bans gender-affirming care for TGDY citing the severe consequences to the health and well-being of TGDY along with the need to practice evidence-based medicine without fear.
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Affiliation(s)
- Landon D Hughes
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, 1 Medical Center Dr, Morgantown, West Virginia
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Nadia Dowshen
- Colonial Penn Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Influence of the Coronavirus Disease 2019 (COVID-19) Pandemic on Delays in and Barriers to Abortion. Obstet Gynecol 2021; 138:805-808. [PMID: 34619741 PMCID: PMC8522335 DOI: 10.1097/aog.0000000000004569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is associated with delays in and barriers to accessing abortion, which are associated with higher gestational ages at the time of abortion.
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28
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Merz AA, Janiak E, Mokashi M, Allen RH, Jackson C, Berkowitz L, Steinauer J, Bartz D. "We're called upon to be nonjudgmental": A qualitative exploration of United States medical students' discussions of abortion as a reflection of their professionalism. Contraception 2021; 106:57-63. [PMID: 34529953 DOI: 10.1016/j.contraception.2021.09.004] [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] [Received: 02/26/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Medical educators may assess learners' professionalism through clinical scenarios eliciting value conflicts - situations in which an individual's values differ from others' perceived values. We examined the extent to which United States (US) medical students' discussion of abortion highlights their professionalism according to the 6 American Association of Medical Colleges (AAMC) professionalism competencies. STUDY DESIGN We conducted anonymous, semistructured qualitative interviews with 74 US medical students applying to OB/GYN residency. Interviews explored attitudes toward abortion and abortion case vignettes. We analyzed interview transcripts using directed content analysis for alignment with the AAMC professionalism competencies: humanism, patient needs superseding self-interest, patient autonomy, physician accountability, sensitivity to diverse populations, and commitment to ethical principles. RESULTS Students' genders, races, religions, and geographic regions were diverse. Attitudes toward abortion varied, but all students commented on themes related to at least 1 AAMC professionalism competency when discussing abortion care. Statements demonstrating students' humanism, prioritization of patient autonomy, and sense of physician accountability were common. Most comments reflected positive professionalism practices, regardless of personal views on abortion or provision intentions; very few students made statements that were not aligned with the AAMC professionalism competencies. CONCLUSIONS All students in this study exhibited professionalism when discussing abortion, regardless of personal views on abortion or intention to provide this care. Case-based discussions involving abortion could be used to explore professionalism competencies among medical learners. IMPLICATIONS Discussing abortion has the potential to elicit values conflict, which enables learners to exhibit professionalism. Case-based abortion education should be included in medical school curricula to measure medical professionalism in future physicians, and to serve as a tool for teaching professionalism in medical school.
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Affiliation(s)
| | - Elizabeth Janiak
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, United States
| | | | - Rebecca H Allen
- Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Providence, RI, United States
| | - Courtney Jackson
- Department of Strategic Planning and Institutional Effectiveness, Massachusetts Bay Community College, Framingham, MA, United States
| | - Lori Berkowitz
- Harvard Medical School, Boston, MA, United States; Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA, United States
| | - Jody Steinauer
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States; Bixby Center for Global Reproductive Health, San Francisco, CA, United States
| | - Deborah Bartz
- Harvard Medical School, Boston, MA, United States; Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, United States.
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Uhm S, Mastey N, Baker CC, Chen MJ, Matulich MC, Hou MY, Melo J, Wilson SF, Creinin MD. Mifepristone prior to osmotic dilators for dilation and evacuation cervical preparation: A randomized, double-blind, placebo-controlled pilot study. Contraception 2021; 107:23-28. [PMID: 34464634 DOI: 10.1016/j.contraception.2021.08.013] [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] [Received: 05/29/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate mifepristone impact on osmotic dilator placement and procedural outcomes when given 18 to 24 hours before dilator placement for dilation and evacuation (D&E) at 18 weeks 0 days to 23 weeks 6 days gestation. STUDY DESIGN We performed a randomized, double-blind, placebo-controlled trial from April 2019 through February 2021, enrolling participants undergoing osmotic dilator (Dilapan) placement for a planned, next-day D&E. Participants took mifepristone 200 mg or placebo orally 18 to 24 hours before dilator placement. We used a gestational age-based protocol for minimum number of dilators. Our primary outcome was the proportion of participants for whom 2 or more additional dilators could be placed compared to the minimum gestational age-based standard. We secondarily evaluated cervical dilation after dilator removal in the operating room, subjective procedure ease, and complication rates (cervical laceration, uterine perforation, blood transfusion, infection, hospitalization, or extramural delivery). RESULTS Of the planned 66 participants, we enrolled 44 (stopped due to coronavirus disease 2019-related obstacles), and 41 (19 mifepristone; 22 placebo) completed the study. We placed 2 or more additional dilators compared to standard in 7 (36.8%) and 3 (13.6%) participants after mifepristone and placebo, respectively (p = 0.14). We measured greater median initial cervical dilation in the mifepristone (3.2 cm[2.6-3.6]) compared to placebo (2.6 cm[2.2-3.0]) group, p = 0.03. Surgeon's perception of procedure being "easy" (8/19[42.1] vs 9/22[40.9], respectively, p = 1.00) and complication rate (3/19[15.8%] vs 3/22[13.6], respectively, p = 1.00) did not differ. CONCLUSION Our underpowered study did not demonstrate a difference in cervical dilator placement, but mifepristone 18 to 24 hours prior to dilators increases cervical dilation without increasing complications. IMPLICATIONS Mifepristone 18 to 24 hours prior to cervical dilator placement may be a useful adjunct to cervical dilators based on increased cervical dilation at time of procedure; however, logistical barriers, such as an additional visit, may preclude routine adoption without definite clinical benefit.
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Affiliation(s)
- Suji Uhm
- Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine; Pittsburgh, PA, United States.
| | - Namrata Mastey
- Department of Obstetrics and Gynecology, University of California, Davis; Sacramento, CA, United States
| | - Courtney C Baker
- Department of Obstetrics and Gynecology, University of California, Davis; Sacramento, CA, United States
| | - Melissa J Chen
- Department of Obstetrics and Gynecology, University of California, Davis; Sacramento, CA, United States
| | - Melissa C Matulich
- Department of Obstetrics and Gynecology, University of California, Davis; Sacramento, CA, United States
| | - Melody Y Hou
- Department of Obstetrics and Gynecology, University of California, Davis; Sacramento, CA, United States
| | - Juliana Melo
- Department of Obstetrics and Gynecology, University of California, Davis; Sacramento, CA, United States
| | | | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis; Sacramento, CA, United States
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Society for Maternal-Fetal Medicine Special Statement: Maternal-fetal medicine subspecialist survey on abortion training and service provision. Am J Obstet Gynecol 2021; 225:B2-B11. [PMID: 33845031 DOI: 10.1016/j.ajog.2021.04.220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Following a collaborative workshop at the 39th Annual Pregnancy Meeting, the Society for Maternal-Fetal Medicine Reproductive Health Advisory Group identified a need to assess the attitudes of maternal-fetal medicine subspecialists about abortion services and the available resources at the local and regional levels. The purpose of this study was to identify trends in attitudes, beliefs, and behaviors of practicing maternal-fetal medicine subspecialists in the United States regarding abortion. An online survey was distributed to associate and regular members of the Society for Maternal-Fetal Medicine to assess their personal training experience, abortion practice patterns, factors that influence their decision to provide abortion care, and their responses to a series of scenarios about high-risk maternal or fetal medical conditions. Frequencies were analyzed and univariable and multivariable analyses were conducted on the survey responses. Of the 2751 members contacted, 546 Society for Maternal-Fetal Medicine members completed all (448 of 546, 82.1%) or some (98 of 546, 17.9%) of the survey. More than 80% of the respondents reported availability of abortion services in their state, 70% reported availability at their primary institution, and 44% reported provision as part of their personal medical practice. Ease of referral to family planning subspecialists or other abortion providers, institutional restrictions, and the lack of training or continuing education were identified as the most significant factors contributing to the respondents' limited scope of abortion services or lack of any abortion services offered. In the univariable analysis, exposure to formal family planning training programs, fewer years since the completion of residency, current practice setting not being religiously affiliated, and current state categorized as supportive by the Guttmacher Institute's abortion policy landscape were factors associated with abortion provision (all P values <.01). After controlling for these factors in a multivariable regression, exposure to formal family planning training programs was no longer associated with current abortion provision (P=.20; adjusted odds ratio, 1.34; 95% confidence interval, 0.85-2.10), whereas a favorable state policy environment and fewer years since the completion of residency remained associated with abortion provision. The results of this survey suggest that factors at the individual, institutional, and state levels affect the provision of abortion care by maternal-fetal medicine subspecialists. The subspecialty of maternal-fetal medicine should be active in ensuring adequate training and education to create a community of maternal-fetal medicine physicians able to provide comprehensive reproductive healthcare services.
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Affiliation(s)
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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Informed Consent and Shared Decision Making in Obstetrics and Gynecology: ACOG Committee Opinion, Number 819. Obstet Gynecol 2021; 137:e34-e41. [PMID: 33481530 DOI: 10.1097/aog.0000000000004247] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Meeting the ethical obligations of informed consent requires that an obstetrician-gynecologist gives the patient adequate, accurate, and understandable information and requires that the patient has the ability to understand and reason through this information and is free to ask questions and to make an intentional and voluntary choice, which may include refusal of care or treatment. Shared decision making is a patient-centered, individualized approach to the informed consent process that involves discussion of the benefits and risks of available treatment options in the context of a patient's values and priorities. Some informed consent challenges are universal to medicine, whereas other challenges arise more commonly in the practice of obstetrics and gynecology than in other specialty areas. This Committee Opinion focuses on informed consent for adult patients in clinical practice and provides new guidance on the practical application of informed consent through shared decision making. The principles outlined in this Committee Opinion will help support the obstetrician-gynecologist in the patient-centered informed consent process.
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