1
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Bustin DJ, Simmons R, Galdo J, Kucek ME, Logan L, Cohn R, Smith H. Feasibility of a contraceptive-specific electronic health record system to promote the adoption of pharmacist-prescribed contraceptive services in community pharmacies in the United States. JAMIA Open 2024; 7:ooae071. [PMID: 39040536 PMCID: PMC11262636 DOI: 10.1093/jamiaopen/ooae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/12/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
Objectives Pharmacists in over half of the United States can prescribe contraceptives; however, low pharmacist adoption has impeded the full realization of potential public health benefits. Many barriers to adoption may be addressed by leveraging an electronic health records (EHR) system with clinical decision support tools and workflow automation. We conducted a feasibility study to determine if utilizing a contraceptive-specific EHR could improve potential barriers to the implementation of pharmacist-prescribed contraceptive services. Materials and Methods 20 pharmacists each performed two standardized patient encounter simulations: one on the EHR and one on the current standard of care paper-based workflow. A crossover study design was utilized, with each pharmacist performing encounters on both standardized patients with the modality order randomized. Encounters were timed, contraceptive outputs were recorded, and the pharmacists completed externally validated workload and usability surveys after each encounter, and a Perception, Attitude, and Satisfaction survey created by the research team after the final encounter. Results Pharmacists were more likely to identify contraceptive ineligibility using the EHR-based workflow compared to the paper workflow (P = .003). Contraceptive encounter time was not significantly different between the 2 modalities (P = .280). Pharmacists reported lower mental demand (P = .003) and greater perceived usefulness (P = .029) with the EHR-based workflow compared to the paper modality. Discussion and Conclusion Pharmacist performance and acceptance of contraceptive services delivery were improved with the EHR workflow. Pharmacist-specific contraceptive EHR workflows show potential to improve pharmacist adoption and provision of appropriate contraceptive care.
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Affiliation(s)
| | - Rebecca Simmons
- Division of Family Planning, University of Utah, Salt Lake City, UT 84132, United States
| | - Jake Galdo
- CPESN Health Equity, Nashville, TN 37217, United States
| | - Mary E Kucek
- OvaryIt, LLC, Lancaster, PA 17601, United States
| | | | - Rich Cohn
- Independent Consultant, Chapel Hill, NC 27516, United States
| | - Heather Smith
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI 02905, United States
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2
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Mandroiu A, Alsubahi N, Groot W, Pavlova M. Sexual and Reproductive Health Rights and Service Use among Undocumented Migrants in the EU: A Systematic Literature Review. Healthcare (Basel) 2024; 12:1771. [PMID: 39273795 PMCID: PMC11395426 DOI: 10.3390/healthcare12171771] [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: 07/06/2024] [Revised: 08/21/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024] Open
Abstract
Most EU member states fail to provide essential sexual and reproductive health services to undocumented migrants, a vulnerable population facing limited access, utilization, and worse health-related outcomes. This study systematically reviewed the literature on access to and use of these services, as well as related health, economic, and migratory outcomes for undocumented migrants in the EU-EFTA region. The systematic review is reported based on the PRISMA 2020 checklist and includes 37 studies published between 2017 and 2024. Included studies were based upon original quantitative, qualitative, or mixed-methods data; conducted in one or more European countries; and published in one or more of the following languages: English, Spanish, French, Portuguese, or Romanian. A quality assessment was conducted using the CASP checklist for qualitative studies and the NHLBI Study Quality Assessment Tools for quantitative studies. The findings revealed numerous access barriers, including refusal of care, lack of knowledge about national healthcare schemes, bureaucratic hurdles, and affordability issues. Even when care was available, stigma, fear of deportation, socio-economic precarity, and abuse further hindered utilization. These barriers contributed to generally worse reproductive health outcomes for undocumented migrants in Europe, though the findings may not generalize to all EU-EFTA countries.
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Affiliation(s)
- Alexandra Mandroiu
- Department of Health Services Research, Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), 1349-008 Lisbon, Portugal
| | - Nizar Alsubahi
- Department of Health Services Research, Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Health Service and Hospital Administration, Faculty of Economics and Administration, King Abdul Aziz University, Jeddah 21589, Saudi Arabia
| | - Wim Groot
- Department of Health Services Research, Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Maastricht Economic and Social Research Institute on Innovation and Technology, United Nations University, 6211 LK Maastricht, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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3
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Zell B, Effland K, Snyder M, Hays K, Gordon W. Prescriptive Authority for Direct Entry Midwives in Washington State: Increasing Client Access to Contraception. J Midwifery Womens Health 2024; 69:600-605. [PMID: 38229277 DOI: 10.1111/jmwh.13606] [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: 10/18/2023] [Indexed: 01/18/2024]
Abstract
Improving health and achieving health equity includes access to sexual and reproductive health care for all populations, especially those most in need. However, access to life-saving and life-affirming contraception with an individual's chosen perinatal provider can be impeded by restrictive regulations that limit scope and practice authority. This is especially true for the majority of community and direct entry midwives in the United States who have historically been unable to legally provide effective contraceptive methods. Recently, licensed midwives in Washington state were the first in the nation to achieve prescriptive authority, enabling their clients to directly obtain contraception and access to medications for common prenatal and postpartum conditions. Sustained advocacy efforts in the state's capitol enabled the Midwives' Association of Washington State to build relationships over time with legislators and government agencies to achieve this long-term goal. We present a successful midwifery-led innovation that achieved scope expansion for licensed midwives whose practice authority was limited by restrictive laws. Lessons learned are described and strategies offered to aid midwives and their advocates in other locales who want to improve health equity and access to contraception. Midwives are well positioned to provide this essential care to individuals living in underserved rural and urban areas and those from historically marginalized communities, but their ability to do so is limited by restrictive legislation.
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Affiliation(s)
| | - Kristin Effland
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
| | | | - Karen Hays
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
| | - Wendy Gordon
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
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4
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Lines LM, Fowler CI, Kaganova Y, Peacock K. Development and validation of a community risk score for sexual and reproductive health in the United States. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae048. [PMID: 39071108 PMCID: PMC11282459 DOI: 10.1093/haschl/qxae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/02/2024] [Accepted: 04/29/2024] [Indexed: 07/30/2024]
Abstract
Equitable access to sexual and reproductive health (SRH) care is key to reducing inequities in SRH outcomes. Publicly funded family-planning services are an important source of SRH care for people with social risk factors that impede their access. This study aimed to create a new index (Local Social Inequity in SRH [LSI-SRH]) to measure community-level risk of adverse SRH outcomes based on social determinants of health (SDoH). We evaluated the validity of the LSI-SRH scores in predicting adverse SRH outcomes and the need for publicly funded services. The data were drawn from more than 200 publicly available SDoH and SRH measures, including availability and potential need for publicly supported family planning from the Guttmacher Institute. The sample included 72 999 Census tracts (99.9%) in the 50 states and the District of Columbia. We used random forest regression to predict the LSI-SRH scores; 42 indicators were retained in the final model. The LSI-SRH model explained 81% of variance in the composite SRH outcome, outperforming 3 general SDoH indices. LSI-SRH scores could be a useful for measuring community-level SRH risk and guiding site placement and resource allocation.
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Affiliation(s)
- Lisa M Lines
- Center for the Health of Populations, RTI International, Research Triangle Park, NC 27709-2194, United States
- Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
| | - Christina I Fowler
- Center for the Health of Populations, RTI International, Research Triangle Park, NC 27709-2194, United States
| | - Yevgeniya Kaganova
- Center for the Health of Populations, RTI International, Research Triangle Park, NC 27709-2194, United States
| | - Karen Peacock
- Research and Evaluation, Essential Access Health, Los Angeles, CA 90025, United States
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5
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Espinosa M, Butler SA, Mengelkoch S, Prieto LJ, Russell E, Ramshaw C, Rose-Reneau Z, Remondino M, Nahavandi S, Hill SE. The Impact of a Digital Contraceptive Decision Aid on User Outcomes: Results of an Experimental, Clinical Trial. Ann Behav Med 2024; 58:463-473. [PMID: 38828482 DOI: 10.1093/abm/kaae024] [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] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Nearly 40% of unplanned pregnancies in the USA are the result of inconsistent or incorrect contraceptive use. Finding ways to increase women's comfort and satisfaction with contraceptive use is therefore critical to public health. One promising pathway for improving patient outcomes is through the use of digital decision aids that assist women and their physicians in choosing a contraceptive option that women are comfortable with. Testing the ability of these aids to improve patient outcomes is therefore a necessary first step toward incorporating this technology into traditional physician appointments. PURPOSE To evaluate the effectiveness of a novel contraceptive decision aid at minimizing decisional conflict and increasing comfort with contraception among adult women. METHODS In total, 310 adult women were assigned to use either the Tuune contraceptive decision aid or a control aid modeled after a leading online contraceptive prescriber's patient intake form. Participants then completed self-report measures of decisional conflict, contraceptive expectations, satisfaction, and contraceptive use intentions. Individual between-subjects analysis of variance (ANOVA) models were used to examine these outcomes. RESULTS Women using the Tuune decision aid (vs. those using the control aid) reported lower decisional conflict, more positive contraceptive expectations, greater satisfaction with the decision aid and recommendation, and more positive contraceptive use intentions. CONCLUSIONS Use of Tuune improved each of the predicted patient outcomes relative to a control decision aid. Online decision aids, particularly when used alongside physician consultations, may be an effective tool for increasing comfort with contraceptive use. CLINICAL TRIALS REGISTRATION # NCT05177783, ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT05177783.
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Affiliation(s)
- Matthew Espinosa
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
| | | | - Summer Mengelkoch
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
| | | | | | | | - Zak Rose-Reneau
- Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma, USA
| | - Molly Remondino
- Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma, USA
| | | | - Sarah E Hill
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
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López JD, Sriprasert I, Wilson ML. Editorial: Inequities and disparities in reproductive health: reproductive epidemiology. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1419178. [PMID: 38803453 PMCID: PMC11128666 DOI: 10.3389/frph.2024.1419178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Affiliation(s)
- Julia D. López
- Washington University School of Medicine, St. Louis, MO, United States
| | - Intira Sriprasert
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Melissa Lee Wilson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Quesada O, Crousillat D, Rodriguez F, Bravo-Jaimes K, Briller J, Ogunniyi MO, Mattina DJ, Aggarwal NR, Rodriguez CJ, De Oliveira GMM, Velarde G. Cardiovascular Disease in Hispanic Women: JACC Review Topic of the Week. J Am Coll Cardiol 2024; 83:1702-1712. [PMID: 38658109 PMCID: PMC11414578 DOI: 10.1016/j.jacc.2024.02.039] [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: 08/28/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 04/26/2024]
Abstract
Cardiovascular disease affects 37% of Hispanic women and is the leading cause of death among Hispanic women in the United States. Hispanic women have a higher burden of cardiovascular risk factors, are disproportionally affected by social determinants of health, and face additional barriers related to immigration, such as discrimination, language proficiency, and acculturation. Despite this, Hispanic women show lower rates of cardiovascular disease and mortality compared with non-Hispanic White women. However, this "Hispanic paradox" is challenged by recent studies that account for the diversity in culture, race, genetic background, country of origin, and social determinants of health within Hispanic subpopulations. This review provides a comprehensive overview of the cardiovascular risk factors in Hispanic women, emphasizing the role of social determinants, and proposes a multipronged approach for equitable care.
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Affiliation(s)
- Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA.
| | - Daniela Crousillat
- Division of Cardiovascular Sciences, Department of Medicine, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Joan Briller
- Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA; Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Modele O Ogunniyi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Grady Health System, Atlanta, Georgia, USA
| | - Deirdre J Mattina
- Department of Cardiovascular Medicine, Cleveland Clinic, Beachwood, Ohio, USA
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Gladys Velarde
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
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8
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Ross C, Smith JG, Gawel M, Walters TL, Song Y, Cong X, Shook NJ. "They're scared that somebody's gonna judge them": Female African American youth in foster care's perspectives on sexual and reproductive health communication with caregivers. J Pediatr Nurs 2024; 75:8-15. [PMID: 38091927 DOI: 10.1016/j.pedn.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Obtaining accurate information is critical for youth's sexual and reproductive health (SRH). Youth not in foster care often learn about SRH from their biological parents. Separated from their biological parents, youth in care depend on healthcare providers and caregivers for SRH information. However, they often receive insufficient information and feel unsupported in meeting their needs for SRH information. PURPOSE This study explored female African American adolescents in foster care's perspectives on effective SRH communication with caregivers to help them avoid sexual risks. METHODS A qualitative study was conducted using semi-structured interviews. We used purposive sampling to recruit 16 adolescents aged 18 to 20 years old with a history of foster care placement. The transcribed interviews underwent inductive thematic analysis. The Positive Youth Development theory underpinned this research. RESULTS Two prominent themes emerged: establishing a relationship and preferred communication approach. Youth reported that for caregivers to engage in effective SRH communication, they must first establish a relationship by being aware of the youth's childhood trauma, building trust, having patience, and being vulnerable. Youth also appreciated caregivers who ensured comfortability and were honest and straightforward. DISCUSSION Caregivers should be trained on adverse childhood experiences, trauma-informed approaches, SRH knowledge, and communication. IMPLICATIONS TO PRACTICE Healthcare providers should make use of the time spent with youth and discuss SRH topics during clinical encounters. This time spent with youth may be their only chance to obtain accurate SRH information. Youth's perspectives regarding communication about SRH should be implemented in future SRH communication interventions.
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Affiliation(s)
- Christina Ross
- University of Connecticut, School of Nursing, 231 Glenbrook Rd., Storrs, CT 06269, USA.
| | - Jessica G Smith
- University of Virginia, Department of Psychology, 485 McCormick Road, Gilmer Hall, Room 102, Charlottesville, VA 22903, USA.
| | - Marcie Gawel
- University of Connecticut, School of Nursing, 231 Glenbrook Rd., Storrs, CT 06269, USA.
| | - Tracy L Walters
- University of Connecticut, Department of Human Development and Family Sciences, 348 Mansfield Road, U-1058, Storrs, CT 06269, USA.
| | - Yutong Song
- University of Connecticut, School of Nursing, 231 Glenbrook Rd., Storrs, CT 06269, USA.
| | - Xiaomei Cong
- University of Connecticut, School of Nursing, 231 Glenbrook Rd., Storrs, CT 06269, USA.
| | - Natalie J Shook
- University of Connecticut, School of Nursing, 231 Glenbrook Rd., Storrs, CT 06269, USA.
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9
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Scott MA, Matt I, Tak CR. Access to on-campus contraception on college and university campuses in North Carolina. J Am Pharm Assoc (2003) 2024; 64:301-306. [PMID: 37844734 DOI: 10.1016/j.japh.2023.10.008] [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: 07/15/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Unintended pregnancies occur more frequently in college students and negatively affect health outcomes and educational attainment. This study examined access to on-campus contraceptives at all 4-year colleges and universities in North Carolina (NC). METHODS This institutional review board-exempt study evaluated availability of on-campus contraceptives including condoms; hormonal contraceptives including pills, patches, and vaginal rings; medroxyprogesterone injections; implants; intrauterine devices; and emergency contraception via website review. Institutions were stratified by characteristics including size, location, type (e.g., public, private, religious affiliation, historically black colleges and universities, women's colleges), and presence of a student health pharmacy. Comparisons were made using chi-square test or Fisher's exact test. RESULTS Fifty-four 4-year colleges and universities were identified. A plurality or the majority of schools were considered small (41%) and urban (48%) and had a religious affiliation (61%). Thirty-three percent of colleges and universities had an on-campus pharmacy. The most frequent contraceptives offered were condoms (43%), oral contraceptives (33%), and medroxyprogesterone injections (22%). Emergency contraception was available at approximately one-third of colleges and universities. Six percent of institutions provided a full range of contraceptive methods. Contraceptives were offered more frequently at large, public, urban institutions, whereas religious institutions and smaller institutions were less likely to offer contraceptives. CONCLUSION Access to on-campus contraception for college students in NC is lacking, and the vast majority of institutions did not provide a full range of contraceptives. Policy measures, such as enhancing reproductive health services at student health centers or increasing contraception availability directly through pharmacies, are needed to improve access for college students.
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10
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Galvin AM, Garg A, Akpan IN, Spence EE, Thompson EL. Contraception-related knowledge, attitude, belief contexts among US women experiencing homelessness: A scoping review. Nurs Health Sci 2023; 25:290-301. [PMID: 37529965 DOI: 10.1111/nhs.13039] [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: 11/29/2022] [Revised: 06/29/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
Contraception provision may help reduce undesired pregnancies, but women experiencing homelessness may have low health literacy, specific attitudes, and certain beliefs that influence contraception uptake. This scoping review identifies what is known about pregnancy prevention and contraception knowledge, attitudes, and beliefs among US women experiencing homelessness. This review examined English articles that measured the context of knowledge, attitudes, and beliefs related to contraceptive use for avoiding pregnancy among US women experiencing homelessness. Using PRISMA-ScR guidelines, articles published before May 2022 were located via PubMed, EBSCOhost, and Embase. The initial search identified 1204 articles, and 10 met the inclusion criteria. There were five quantitative, four qualitative, and one mixed-methods study, published between 2000 and 2022, with samples of 15-764 women ranging from ages 15-51. Contraception knowledge, attitudes, and beliefs related to pregnancy prevention suggested several knowledge gaps (e.g., contraception efficacy), contraception preferences and past experiences, interpersonal relationship influences, and vulnerability to clinic and shelter-specific barriers. These findings may ultimately inform contraception interventions in partnership with the community of US women who experience homelessness and the health care and social service organizations who serve them.
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Affiliation(s)
- Annalynn M Galvin
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center (UTHealth) Houston, Houston, Texas, USA
| | - Ashvita Garg
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Idara N Akpan
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Emily E Spence
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Erika L Thompson
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
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11
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Cameron NA, Blyler CA, Bello NA. Oral Contraceptive Pills and Hypertension: A Review of Current Evidence and Recommendations. Hypertension 2023; 80:924-935. [PMID: 37075131 PMCID: PMC10852998 DOI: 10.1161/hypertensionaha.122.20018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Oral contraceptive pills (OCPs) have been used as effective and popular forms of contraception since the middle of the last century. By 2019, over 150 million reproductive-aged individuals were using OCPs to prevent unintended pregnancies worldwide. Safety concerns regarding the effects of OCPs on blood pressure were reported soon after these pills gained approval. Although OCP doses were subsequently reduced, epidemiologic evidence continued to support a smaller, but significant association between OCPs and hypertension. Given the rising prevalence of hypertension, as well as the adverse effects of cumulative exposure to blood pressure elevations on cardiovascular disease risk, understanding the nature of the association between OCPs and hypertension is important for clinicians and patients to assess the risks and benefits of use, and make individualized decisions regarding contraception. Therefore, this review summarizes the current and historical evidence describing the association between OCP use and blood pressure elevations. Specifically, it identifies the pathophysiologic mechanisms linking OCPs to hypertension risk, describes the magnitude of the association between OCPs and blood pressure elevations, and distinguishes the effects of various OCP types on blood pressure. Finally, it describes current recommendations regarding hypertension and OCP use, as well as identifies strategies, such as over-the-counter OCP prescribing, to safely and equitably improve access to oral contraception.
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Affiliation(s)
- Natalie A Cameron
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Chicago, Illinois
| | - Ciantel A. Blyler
- Department of Cardiology Smidt Heart Institute Cedars-Sinai Medical Center, Los Angeles, California
| | - Natalie A Bello
- Department of Cardiology Smidt Heart Institute Cedars-Sinai Medical Center, Los Angeles, California
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12
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Moseson H, Smith MH, Chakraborty P, Gyuras HJ, Foster A, Bessett D, Wilkinson TA, Norris AH. Abortion-Related Laws and Concurrent Patterns in Abortion Incidence in Indiana, 2010-2019. Am J Public Health 2023; 113:429-437. [PMID: 36795983 PMCID: PMC10003501 DOI: 10.2105/ajph.2022.307196] [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] [Accepted: 12/02/2022] [Indexed: 02/18/2023]
Abstract
Objectives. To analyze abortion incidence in Indiana concurrent with changes in abortion-related laws. Methods. Using publicly available data, we created a timeline of abortion-related laws in Indiana, calculated abortion rates by geography, and described changes in abortion occurrence coincident with changes in abortion-related laws between 2010 and 2019. Results. Between 2010 and 2019, Indiana's legislature passed 14 abortion-restricting laws, and 4 of 10 abortion-providing clinics closed. The Indiana abortion rate decreased from 7.8 abortions per 1000 women aged 15 to 44 years in 2010 to 5.9 in 2019. At all time points, the abortion rate was 58% to 71% of the Midwestern rate and 48% to 55% of the national rate. By 2019, nearly 1 in 3 (29%) Indiana residents who obtained abortion care did so outside the state. Conclusions. Access to abortion in Indiana over the past decade was low, required increases in interstate travel to obtain care, and co-occurred with the passage of numerous abortion restrictions. Public Health Implications. These findings preview unequal abortion access and increases in interstate travel as state-level restrictions and bans go into effect across the country. (Am J Public Health. 2023;113(4):429-437. https://doi.org/10.2105/AJPH.2022.307196).
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Affiliation(s)
- Heidi Moseson
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Mikaela H Smith
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Payal Chakraborty
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Hillary J Gyuras
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Abigail Foster
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Danielle Bessett
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Tracey A Wilkinson
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Alison H Norris
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
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13
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Healy AM. Better Preconception Glycemic Screening Guidelines Are Needed to Improve Pregnancy Outcomes. J Womens Health (Larchmt) 2023; 32:253-254. [PMID: 36637856 DOI: 10.1089/jwh.2022.0431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Amber M Healy
- Department of Specialty Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA.,Ohio Health Physicians Group Heritage College, Diabetes and Endocrinology, Athens, Ohio, USA
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14
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Smith MH, McGowan M, Chakraborty P, Hood RB, Field MP, Bessett D, Norwood C, Norris AH. Kentucky's abortion landscape, 2010 to 2019: an analysis of pre- Dobbs abortion disparities in a rural, restrictive state. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100441. [PMID: 36852333 PMCID: PMC9958464 DOI: 10.1016/j.lana.2023.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 02/17/2023]
Abstract
Background Since 2010, many US states have passed laws restricting abortion providers' ability to provide care. Such legislation has no demonstrated health benefits and creates inequitable barriers for patients. Methods To examine how Kentucky's abortion policies coincided with facility closures and abortion utilisation, we conducted a review of state abortion policies from 2010 to 2019 using newspapers and websites. We calculated abortion rates (abortions per 1000 women ages 15-44) by state of residence and provision for Kentucky, the South, and the US using data from the CDC and Kentucky Department of Health. We calculated percentages leaving and from out-of-state, and analysed abortions by race, pregnancy duration, and method. Findings Of 17 policies passed between 2010 and 2019, ten were enacted, including 20-week and telemedicine bans. One of Kentucky's two abortion facilities closed in 2017. The pooled average abortion rate in Kentucky (4.1) and for Kentuckians (5.8) was lower than national averages (11.8 and 11.1). An average of 38% of Kentuckians left their state for care, compared to 7% nationally. In 2019, the abortion rate in Kentucky was 5.8 times higher for Black patients than White patients (compared to 4.8 times nationally). The majority (62%) of abortions in Kentucky took place at 7-13 weeks' gestation. Interpretation Abortions in Kentucky were less frequent than in the South and US. The larger Black-White abortion rate gap reflects race- and class-based structural inequities in healthcare. Without federal protections, abortion access in Kentucky will continue waning. Funding This study was supported by a philanthropic foundation that makes grants anonymously.
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Affiliation(s)
- Mikaela H. Smith
- Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, OH, USA,Corresponding author.
| | - Michelle McGowan
- Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA,Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, OH, USA
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Robert B. Hood
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, OH, USA
| | - Carolette Norwood
- Department of Sociology and Criminology, Howard University, Washington, DC, USA
| | - Alison H. Norris
- Division of Epidemiology, The Ohio State University, College of Public Health, Columbus, OH, USA
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15
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Hadley M, Powell A. Severely Restricting Abortion Threatens Equitable Health Outcomes for People With Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:152-154. [PMID: 36062333 PMCID: PMC10202428 DOI: 10.1093/cid/ciac721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023] Open
Abstract
Equitable access to abortion is a critical component of reproductive care. Women with human immunodeficiency virus (HIV) in the United States are disproportionately Black and will be disproportionately affected by abortion bans following the Supreme Court's decision to overturn Roe v Wade. We argue that this decision is directly in conflict with the National HIV/AIDS Strategies and Centers for Disease Control and Prevention's goals to eliminate perinatal HIV transmission.
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Affiliation(s)
- Megan Hadley
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anna Powell
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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16
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Caballero TM, Miramontes-Valdes E, Polk S. Mi Plan: Using a Pediatric-Based Community Health Worker Model to Facilitate Obtainment of Contraceptives Among Latino Immigrant Parents with Contraceptive Needs. Jt Comm J Qual Patient Saf 2022; 48:591-598. [PMID: 36100556 DOI: 10.1016/j.jcjq.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/27/2022] [Accepted: 08/04/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Bilingual community health workers (CHWs) play an important role in helping Latino immigrants with limited English proficiency (LEP) access health care services and information. Contraceptive health care services and Spanish-language contraceptive information are particularly challenging to access for uninsured LEP immigrants. Contraceptive and reproductive care are longitudinal health needs, and pediatric settings pose a unique opportunity to address these needs among parents whose children access pediatric care. The purpose of this study was to pilot the feasibility of a CHW to support parental contraceptives needs within a pediatric setting serving a high number of Latino immigrant families. This article describes Mi Plan/My Plan, a CHW contraceptive counseling and resource navigation pilot program. METHODS The research team conducted a retrospective analysis of demographic and contraceptive use data from a 15-month CHW pilot within an urban, primary care pediatrics clinic. The CHW provided contraceptive counseling, referral, and appointment coordination. The outcome was desired contraceptive method obtainment within three months of counseling. RESULTS All 311 individuals counseled were Latina mothers with median child age of 3 months. At baseline, 64.3% were using contraception and 76.5% desired to start or change their current method. Among those who desired a change, 47.9% (114/238) obtained their desired method within three months of initial counselor contact. CONCLUSION Bilingual CHW contraceptive counseling and care coordination is feasible and acceptable in a pediatric setting serving a high number of Latino immigrant families. CHWs in pediatric settings support health care access equity and are relevant to optimal maternal and child health.
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17
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Watson K. The Ethics of Access: Reframing the Need for Abortion Care as a Health Disparity. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:22-30. [PMID: 35621314 DOI: 10.1080/15265161.2022.2075976] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The majority of U.S. abortion patients are poor women, and Black and Hispanic women. Therefore, this article encourages bioethicists and equity advocates to consider whether the need for abortion care should be considered a health disparity, and if yes, whether framing it this way would increase the ability of poor women and women of color to get the medical care they need. In order to engage with these critical questions, bioethicists must avoid abortion exceptionalism and respect patients as moral agents. Centering the conscience of pregnant people shifts our analysis away from the ethics of the act of abortion, and toward the ethics of access to abortion care. Because the Supreme Court is on the brink of shifting the question of abortion's legality to state legislatures, this is the moment for all bioethicists to clarify and strengthen their thinking, writing, and teaching in abortion ethics.
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18
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Clinician attitudes and practices on pregnancy planning and care in cystic fibrosis. J Cyst Fibros 2022; 22:201-206. [PMID: 35871973 DOI: 10.1016/j.jcf.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/17/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND People with cystic fibrosis (CF) are living longer and healthier lives as a result of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies, and are pursuing pregnancy. As the number of pregnancies in CF continue to increase, clinician attitudes and practices regarding care of pregnant people with CF remain largely unknown. OBJECTIVE To evaluate the current attitudes and practices of CF clinicians regarding pregnancy planning and care in CF. METHODS We conducted a national survey investigating practice patterns related to pregnancy care in CF. We used descriptive statistics to summarize responses and paired t-tests to compare population means. RESULTS A total of 93 clinicians completed the survey. Eighty-six percent of respondents believed family planning and pregnancy discussions should start before the age of 21 years, of which 67% believed these discussions should occur prior to age 18 years. Our results demonstrate variability in CF clinician comfort and management of various aspects of pregnancy care in CF including 1) potential complications of pregnancy 2) continuation of chronic CF therapies 3) continuation of CFTR modulators during pregnancy and lactation, and 4) approach to treatment of pulmonary exacerbation during pregnancy. CONCLUSIONS As more people with CF pursue pregnancy in the era of CFTR modulators, CF providers should be initiating discussions surrounding pregnancy early and often. Establishing best practices in the management of pregnancy in CF, expanding peri‑pregnancy expertise within the CF community, and future studies investigating the maternal-fetal effects of CF therapies are needed.
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Goldstein RL, Carlson JL, Tyson NA. Dobbs v. Jackson Decision: It's Time to Get Uncomfortable. Hosp Pediatr 2022; 12:e364-e366. [PMID: 35799327 DOI: 10.1542/hpeds.2022-006829] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The recently announced decision of the Supreme Court in the Dobbs v. Jackson case has left health care providers, researchers, and administrators struggling to defend reproductive health care against legal restrictions. Although some hospital-based providers may not consider reproductive health care as part of their "wheelhouse," anyone who cares for adolescents and young adults must see this as a call to action. Reproductive health screening is often missed in the primary care setting1 which has led to recommendations to provide this care wherever adolescents and young adults present for care.2 As adolescents are under the legal age of majority and typically have less experience, education, and resources to help them access reproductive health care when needed, these new abortion laws will create disproportionate burdens on the adolescent population. For low-income youth and adolescent and young adults of color, this will likely worsen the disparities that already exist with regard to access to reproductive health care.3 Adolescents have the highest rates of unintended pregnancy4 and these pregnancies are more likely to end in abortion than adult pregnancies.5,6 Adolescents younger than age 20 make up 12% of individuals who have abortions in the US; minors who are 17 years or younger account for about 4% of all abortions in the US.7.
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Affiliation(s)
- Rachel L Goldstein
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Jennifer L Carlson
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Nichole A Tyson
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA
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20
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The impact of coronavirus on reproduction: contraceptive access, pregnancy rates, pregnancy delay, and the role of vaccination. F&S REVIEWS 2022; 3:190-200. [PMID: 35663280 PMCID: PMC9150907 DOI: 10.1016/j.xfnr.2022.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Abstract
It is important to closely examine trends in reproduction during a pandemic because it provides not only the foundation for an improved future response but also crucial insights regarding the disparate impact across different races and socioeconomic classes. The coronavirus disease 2019 pandemic is a prime example of the impact a pandemic can have on a nation’s reproductive health. Contraception and abortion access became more difficult with more barriers to access, likely contributing to increasing unintended pregnancy rates. Underrepresented minorities and vulnerable populations were disproportionately affected by the virus on their reproductive health as well as by the virus itself. As the first ever messenger ribonucleic acid vaccine in conjunction with the lack of inclusion of pregnant and peripartum women in initial studies and conflicting and misinformation on social media, the initial role of the coronavirus disease 2019 vaccine in women of reproductive age was unclear. Further research inclusive of this group of women has led to the consensus by major medical societies to recommend vaccination of women regardless of pregnancy or lactating status. Examining these topics in depth will lead to the development of strategies that can be employed to mitigate the negative effects on reproductive health during the current pandemic and can also be applied to future strategic plans to prevent similar negative outcomes.
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21
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Dehlendorf C, Perritt J. Statewide Contraceptive Access Initiatives: A Critical Perspective. Am J Public Health 2022; 112:S490-S493. [PMID: 35767799 PMCID: PMC10490307 DOI: 10.2105/ajph.2022.306930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Christine Dehlendorf
- Christine Dehlendorf is with the Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco. Jamila Perritt is president and CEO of Physicians for Reproductive Health, Washington, DC
| | - Jamila Perritt
- Christine Dehlendorf is with the Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco. Jamila Perritt is president and CEO of Physicians for Reproductive Health, Washington, DC
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22
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Thompson TA, Northcraft D, Carrión F. Addressing Structural Inequities, a Necessary Step Toward Ensuring Equitable Access to Telehealth for Medication Abortion Care During and Post COVID-19. Front Glob Womens Health 2022; 3:805767. [PMID: 35368993 PMCID: PMC8967978 DOI: 10.3389/fgwh.2022.805767] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Telehealth, one of the newest health innovations, has been promoted as a tool to enhance access to health care services in ways that center patient needs. However, integrating telehealth within an inequitable health system undermines its potential. This perspective highlights policies and practices that foster structural inequities and names their impact on the use and acceptability of telehealth for medication abortion among specific communities of color. Communities of color have a higher prevalence of abortion use but face many barriers, including financial and geographic barriers, to abortion access. Preliminary evidence on telehealth for medication abortion shows that it is highly acceptable, accommodating of patient needs, and may allow patients to access abortion care at earlier gestational ages. However, evidence during the COVID-19 pandemic shows that utilization of telehealth is lower among communities of color. We describe how systemic barriers, including regulations on or laws banning telehealth for medication abortion, disinvestments in digital access, and restrictions on public insurance coverage, could perpetuate lower utilization of telehealth for medication abortion care among communities of color. We call for systems changes that will remove these barriers and make this health care innovation available to all who may desire it.
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Affiliation(s)
| | - Dana Northcraft
- Expanding Medication Abortion Access (EMAA) Project, Washington, DC, United States
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23
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Qasba N, Wallace KF, Sopko J, Czajka J, Capoccia KL, Shcherbakova N, Goff SL, Qasba N. Twelve-month supply of short-acting contraception methods: Pharmacists’ perspectives on implementation of new state law. J Am Pharm Assoc (2003) 2022; 62:1296-1303.e2. [DOI: 10.1016/j.japh.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/28/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
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24
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Poleon S, Thompson EL. Reasons for Intent to Discontinue and Remove Long-Acting Reversible Contraceptives: National Survey of Family Growth 2017-2019. J Womens Health (Larchmt) 2022; 31:733-740. [PMID: 35005999 DOI: 10.1089/jwh.2021.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Long-acting reversible contraceptives (LARCs) are highly effective forms of contraception, which can reduce the risk of unintended pregnancy. Despite LARC effectiveness, women may desire to discontinue this method. This study will examine reasons for intent to discontinue and remove LARCs among U.S. women 15-49 years of age from 2017 to 2019. Methods: The National Survey of Family Growth 2017-2019 was utilized with a sample of 6141 female respondents. Descriptive statistics for intention to discontinue LARCs, difficulty removing LARCs, and reasons for LARC discontinuation and removal were examined. Rao-Scott chi-square tests were conducted in SAS. Results: Overall, 22.9% of women reported ever using LARCs. Among LARC users, most women (81.2%) reported using LARC in the past 10 years. Among these women, 63.9% intended to discontinue LARCs, and 11.5% had difficulty removing LARCs. Reasons for wanting to discontinue LARCs include side effects (29.6%), LARC expiration (26.8%), LARC complications (19.3%), and decided to get pregnant (15.9%). Primary reasons reported for difficulty removing LARCs included: complications (68.3%), other reasons (13.4%), discouragement by provider (5.8%), and provider's inability to remove (4.9%). Conclusion: Given that women who use a LARC method rely on providers to remove this contraceptive method, understanding the reasons for discontinuation and difficulties encountered is needed. Findings from this nationally representative sample identified provider-level and system-level barriers for LARC removal. To respect the reproductive autonomy of LARC users' method for pregnancy prevention, these barriers must be overcome.
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Affiliation(s)
- Suprena Poleon
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Erika L Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
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25
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Mi Familia Entera: Contraceptive Use Among Spanish-Speaking Mothers of Young Children. Matern Child Health J 2021; 26:139-148. [PMID: 34845572 DOI: 10.1007/s10995-021-03300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To characterize contraceptive method use and satisfaction among Spanish-speaking Latina immigrants who attend their child's well care visit. METHODS Spanish-speaking women whose youngest child was ≤ 4 years old completed an orally-administered Spanish-language survey in a pediatric clinic (N = 194). Survey items were based on previously published contraceptive use assessments among diverse populations. We used chi-square and Fisher exact test to describe maternal characteristics by contraceptive method effectiveness categories: Tier 1, most effective methods (hormonal implant, intrauterine device, tubal ligation, and vasectomy); Tier 2, very effective methods (hormonal injection, oral contraceptive pill, hormonal patch, and hormonal ring); Tier 3, effective methods (condoms), and no method. RESULTS 34% of women were using a Tier 1 method, 40% were using a Tier 2 method, and 17% had unmet contraceptive need (no pregnancy intention, no birth control); 84% were satisfied with their current method and 82% of women were uninsured. Tier 2 method or no method users were more likely than women using a Tier 1 method to have children < 9 months old (X2 (6, N = 190) = 20.4, p = .002). CONCLUSIONS Latina immigrants with young children who attend their child's pediatric visit are mostly using effective contraceptives and are satisfied with their method. A culturally supportive medical home and access to no-cost long-acting reversible contraceptives through a temporary private grant likely contributed to high contraceptive use and satisfaction in our study. Describing maternal contraceptive use among Latina immigrant mothers can inform future equitable, culturally tailored, approaches to pediatric maternal contraceptive need screening.
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26
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Mahony H, Spinner C, Vamos CA, Daley EM. Social Network Influences on Young Women's Choice to Use Long-Acting Reversible Contraception: A Systematic Review. J Midwifery Womens Health 2021; 66:758-771. [PMID: 34491002 DOI: 10.1111/jmwh.13280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Long-acting reversible contraception (LARC; including intrauterine devices and implants) is recommended as the first-line contraceptive choice by several professional organizations (eg, American College of Obstetricians and Gynecologists); however, rates of uptake are lower than those of other contraceptive methods. A young woman's social network may influence the decision to use LARC. The purpose of this review was to determine the role of health care providers (HCPs), family, peers, and sexual partner(s) on young women's decisions to initiate LARC. METHODS Several databases (PubMed, CINAHL, and PsycINFO) were searched for articles published between 2000 and 2020 that studied the social network influences of HCPs, family, peers, and sexual partner(s) on LARC initiation among women in the United States aged 18 to 25. A narrative synthesis of the included articles was conducted. RESULTS Twenty-nine articles met the inclusion criteria (21 qualitative, 6 quantitative, 2 mixed methods). HCPs are an important influence on a young woman's LARC decision-making. Peers and family also have a role but were often sources of negative or inaccurate information. Gaps in the literature were identified, including a lack of data on implant users and a dearth of studies on the role of sexual partner influence; most studies were not guided by theory. DISCUSSION HCPs are integral to LARC initiation and may be more influential than other social network members. Future research should focus on understanding how social network members interact to result in LARC initiation. Gaining insight into these influences may improve existing interventions or contribute to the development of new interventions and ultimately promote LARC use among young women.
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Affiliation(s)
- Helen Mahony
- College of Public Health, University of South Florida, Tampa, Florida
| | - Chelse Spinner
- College of Public Health, University of South Florida, Tampa, Florida
| | - Cheryl A Vamos
- College of Public Health, University of South Florida, Tampa, Florida
| | - Ellen M Daley
- College of Public Health, University of South Florida, Tampa, Florida
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Sait M, Aljarbou A, Almannie R, Binsaleh S. Knowledge, attitudes, and perception patterns of contraception methods: Cross-sectional study among Saudi males. Urol Ann 2021; 13:243-253. [PMID: 34421259 PMCID: PMC8343273 DOI: 10.4103/ua.ua_42_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 12/01/2020] [Indexed: 11/09/2022] Open
Abstract
Purpose: The aim of this study is to assess the knowledge, attitude, and perception pattern of contraception and family planning among males in Saudi Arabia. Methods: A cross-sectional study was conducted using a self-administered questionnaire. Study sample were Saudi males who presented to the urology clinics in one tertiary center. Beside demographic data, we evaluate the responders’ knowledge about types of contraceptive methods, usage of one or more methods, reasons for using contraceptives, knowledge of contraception complications, awareness of religious opinion on contraception, the ideal number of children, and birth interval between them. Statistical analysis was performed using the Chi-square and Fisher's exact tests. A value of P < 0.05 was considered statistically significant. Results: Two hundred and forty-three subjects filled the questioner. The participants’ mean age was 42.7 years (range, 19–81); 227 (93.4%) were married. The majority of the participants were aware of the concept of contraception (79%). However, only 54% of the cohort reported using at least one type of contraception. A high percentage of the participants wanted a limited number of children with longer birth intervals. Many factors are responsible for increasing awareness and practice of contraception, additionally; there is limited knowledge and practice regarding male contraception, particularly vasectomy. Withdrawal technique and oral contraceptive pills for females were the most commonly used contraceptive methods for Saudi family planning. The most common reason for using birth control methods was having a lot of children. More than two-thirds of males believed that birth control methods are not prohibited by Islamic law. Conclusions: Younger age, shorter duration of marriage, governmental employee, less number of children, higher education degree, and higher monthly income had higher impact on contraception awareness and utilization. Couples still prefer noninvasive methods for contraception. Despite the relatively low use of contraceptive methods, particularly the male methods, the majority of the participants know about contraception. Efforts to advocate and promote the effective use of reproductive and sexual health services among newly married couples are warranted.
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Affiliation(s)
- Moataz Sait
- Department of Surgery, Division of Urology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Aljarbou
- Department of Surgery, Division of Urology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Raed Almannie
- Department of Surgery, Division of Urology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saleh Binsaleh
- Department of Surgery, Division of Urology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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