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Smith H, Wilson M, Donovan B, Jones J, Butler T, Nathan S, Simpson P. Factors associated with unintended pregnancy and contraceptive practices in justice-involved adolescent girls in Australia. PLoS One 2024; 19:e0304825. [PMID: 38889164 PMCID: PMC11185493 DOI: 10.1371/journal.pone.0304825] [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: 05/04/2023] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Despite a decline in unintended teenage pregnancy in Australia, rates remain higher amongst justice-involved adolescent girls, who are more likely to be from disadvantaged socio-economic backgrounds, have histories of abuse, substance use and/or mental health issues. Furthermore, exposure to the criminal justice system may alter access to education and employment and opportunities, potentially resulting in distinct risk-factor profiles. We examine factors associated with unintended pregnancy, non-contraceptive use and Long-Acting Reversible Contraception (LARC) in a sample of sexually active, justice-involved adolescent girls from Western Australia and Queensland. METHODS Data from the Mental Health, Sexual Health and Reproductive Health of Young People in Contact with the Criminal Justice System (MeH-JOSH) Study was analysed on 118 sexually active adolescent girls. Participants were aged between 14 and 17 years, purposefully sampled based on justice-system involvement and completed an anonymous telephone survey. We constructed two multivariate models taking reproductive outcomes as the dependent variables. RESULTS Over one quarter (26%, 30/118) reported a past unintended pregnancy, 54 did not use any contraception at their last sexual encounter, and 17 reported LARC use. Following adjustments in the multivariate analysis, lifetime ecstasy use was associated with both unintended pregnancy (aOR 3.795, p = 0.022) and non-contraception use (aOR 4.562, p = 0.004). A history of physical abuse was also associated with both any contraception (aOR 3.024, p = 0.041) and LARC use (aOR 4.892, p = 0.050). Identifying as Aboriginal & Torres Strait Islander, education/employment status and geographic location appeared to have no association. CONCLUSION Our findings suggest that justice-involved adolescent girls have distinct risk factors associated with unplanned pregnancy and contraception use compared to the general population, but more research is required to understand the mechanisms and contexts underlying these risk factors. How exposure to physical violence may encourage contraception and LARC use, in particular, warrants further attention as does the association with ecstasy use.
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Affiliation(s)
- Helene Smith
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Mandy Wilson
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Jocelyn Jones
- National Drug & Research Institute, Curtin University, Perth, Australia
| | - Tony Butler
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Sally Nathan
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Paul Simpson
- School of Population Health, University of New South Wales, Sydney, Australia
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Stevenson M. Suggestions for political reparations for reproductive abuses against Black women. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 5:980828. [PMID: 38633480 PMCID: PMC11021574 DOI: 10.3389/frph.2023.980828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/31/2023] [Indexed: 04/19/2024] Open
Affiliation(s)
- Micaela Stevenson
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States
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Liese K, Stewart K, Pearson P, Lofton S, Mbande T, Patil C, Liu L, Geller S. Reply to: Comment on Melanated Group Midwifery Care: Centering the Voices of the Black Birthing Community. J Midwifery Womens Health 2023; 68:405-406. [PMID: 37254457 DOI: 10.1111/jmwh.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Kylea Liese
- Human Development Nursing Science, University of Illinois Chicago College of Nursing, Chicago, Illinois, USA
| | - Karie Stewart
- Department of Obstetrics and Gynecology, University of Illinois Chicago College of Medicine, Chicago, Illinois, USA
| | - Pam Pearson
- Human Development Nursing Science, University of Illinois Chicago College of Nursing, Chicago, Illinois, USA
| | - Saria Lofton
- Population Health Nursing Science, University of Illinois College of Nursing, Chicago, Illinois, USA
| | - Tayo Mbande
- Chicago Birthworks Collective, Chicago, Illinois, USA
| | - Crystal Patil
- Human Development Nursing Science, University of Illinois Chicago College of Nursing, Chicago, Illinois, USA
| | - Li Liu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Stacie Geller
- Center for Research on Women and Gender, Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
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Aguilar GA, Lundsberg LS, Stanwood NL, Gariepy AM. Exploratory study of race- or ethnicity-based discrimination among patients receiving procedural abortion care. Contraception 2023; 120:109949. [PMID: 36641096 DOI: 10.1016/j.contraception.2023.109949] [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: 06/01/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Explore relationships of race and ethnicity with experiences of race- or ethnicity-based discrimination during abortion care. STUDY DESIGN English- or Spanish-speaking individuals aged 18 to 50 completed cross-sectional, self-administered online surveys within 30 days of procedural abortion at 5 Northeastern U.S. reproductive health clinics from June 2020 toFebruary 2021. We considered any affirmative response on the Discrimination in Medical Settings (DMS) scale evidence of race- or ethnicity-based discrimination. We performed bivariate analyses and logistic regression examining discrimination among Black non-Latinx, Latinx any race, Other race non-Latinx compared to White non-Latinx participants. We assessed associations between discrimination and healthcare quality and satisfaction. RESULTS Participants (n = 163) averaged 27(±6) years and self-identified as Black non-Latinx (36.2%), White non-Latinx (28.8%), Latinx of any race (27.0%), and Other non-Latinx (8.0%). Most were publicly insured (52.8%) and <14 weeks gestation (90.8%).Overall, 15.3% reported race- or ethnicity-based discrimination during abortion care with Black non-Latinx more likely to report discrimination (23.7%; OR 7.00, 95% CI 1.50-32.59), while Latinx any race (15.9%, OR 4.26, 95% CI 0.83-21.74) and Other race non-Latinx participants (15.4%, OR 4.09, 95% CI 0.52-32.35) demonstrated statistically nonsignificant trend toward increased odds of discrimination compared to White non-Latinx (4.3%). Discrimination was associated with negative perceptions of: time with physician (p = 0.03), patient care involvement (p < 0.05), physician communication (p = 0.01), care quality (p = 0.02), and care satisfaction (p < 0.01). CONCLUSION Racially minoritized participants were more likely to report race- or ethnicity-based discrimination during abortion care; Black non-Latinx reported highest odds of discrimination compared to White non-Latinx. Discrimination was associated with unfavorable healthcare quality measures. IMPLICATIONS Race- or ethnicity-based discrimination during abortion care is disproportionately reported by racially minoritized populations, especially Black individuals, compared to White non-Latinx individuals. Discrimination is significantly associated with negative experiences of care. Future work should verify findings in different regions and larger studies, and design and test discrimination-reduction interventions.
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Affiliation(s)
- Gabriela A Aguilar
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States.
| | - Lisbet S Lundsberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Nancy L Stanwood
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Aileen M Gariepy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
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Wollum A, Zuniga C, Grindlay K, Grossman D. Who Accesses Birth Control Online? An Analysis of Requests for Contraception Submitted to an Online Prescribing Platform in the United States. Womens Health Issues 2023; 33:25-35. [PMID: 36182640 DOI: 10.1016/j.whi.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/14/2022] [Accepted: 08/05/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Telehealth has the potential to increase contraceptive access. Little is known about the characteristics of people using online prescribing platforms or whether these services help fill access gaps. METHODS We analyzed requests for contraception submitted between July 2015 and September 2017 to an online prescribing platform that offers sexual and reproductive care in the United States. We analyzed the characteristics of people seeking contraceptives, prevalence of contraindications to hormonal contraception among contraceptive seekers, and extent to which online prescribing may close contraceptive access gaps. RESULTS A total of 38,439 requests for prescription hormonal birth control were received during the study period, with requests increasing dramatically over this timeframe as the platform expanded operations to an increasing number of states. Methods were dispensed in response to 63% of requests. In this population seeking contraception, an estimated 1.2% had a contraindication to progestin-only pills, and an estimated 12.0% of patients who reported their blood pressure had a contraindication to combined hormonal methods. Few requests came from patients younger than 18 (1.2%). In multivariable negative binomial models, urban counties had a larger concentration of requests, whereas counties with higher rates of uninsurance and poverty had lower rates of requests. CONCLUSIONS Results suggest that the population seeking contraception from one online prescribing platform has similar levels of contraindications to hormonal contraceptives as found in prior research. Future research should seek to understand why utilization of this online prescribing platform was lower among young people, how to expand outreach to rural populations, and what underlies individuals' decisions about using these services.
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Affiliation(s)
| | | | | | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
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Downey MMB, Patteson Poehling C, O'Connell S. Measurement and Operationalization of the Social Determinants of Health and Long-Acting Reversible Contraception Use in the U.S.: A Systematic Scoping Review. AJPM FOCUS 2022; 1:100032. [PMID: 37791245 PMCID: PMC10546546 DOI: 10.1016/j.focus.2022.100032] [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] [Indexed: 10/05/2023]
Abstract
Introduction The objective of this review was to conduct a systematic evaluation of the measurement and operationalization of the social determinants of health in research on long-acting reversible contraception use in the U.S. To contribute to the ongoing refinement of the quality of social determinants of health and long-acting reversible contraception use research, this systematic scoping review examines how social determinants of health are measured and operationalized in studies that examine long-acting reversible contraception initiation and usage at the patient level. Methods A detailed search of 5 electronic databases (PubMed, Embase, Web of Science, CINAHL, and PsycINFO) was conducted between December 2020 and January 2021 according to PRISMA guidelines. Determinants were assessed using the Dahlgren and Whitehead model. The protocol and data extraction template were developed a priori. Results A total of 27 articles representing 26 studies were included in our study. A total of 12 studies were retrospective and cross-sectional in design; the remaining studies were a combination of designs. Healthcare services and health insurance were identified as the most frequently researched categories of determinants. There was wide variation in reported operationalization of race and ethnicity, limited engagement with sexuality, and uneven geographic representation across studies. Discussion This systematic scoping review is the first, to the best of our knowledge, to focus on the measurement and operationalization of social determinants of health and on current long-acting reversible contraception use research. Future research on the impact of social determinants of health on long-acting reversible contraception use must explore the full range of factors shaping contraceptive decision making and use and focus on equity-informed data collection methods and reporting.
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Affiliation(s)
| | - Catherine Patteson Poehling
- School of Social Work, College of Education and Human Sciences, the University of Southern Mississippi, Hattiesburg, Mississippi
| | - Samantha O'Connell
- Tulane University Office of Academic Affairs & Provost, New Orleans, Louisiana
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Callegari LS, Benson SK, Mahorter SS, Nelson KM, Arterburn DE, Hamilton AB, Taylor L, Hunter-Merrill R, Gawron LM, Dehlendorf C, Borrero S. Evaluating the MyPath web-based reproductive decision support tool in VA primary care: Protocol for a pragmatic cluster randomized trial. Contemp Clin Trials 2022; 122:106940. [PMID: 36179982 DOI: 10.1016/j.cct.2022.106940] [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: 04/13/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Counseling to identify and support individuals' desires for family formation is a key component of preventive health care that is often absent in primary care visits. This study evaluates a novel, web-based, person-centered intervention to increase the frequency and quality of communication about reproductive goals and healthcare needs in Veterans Health Administration (VA) primary care. METHODS We describe a hybrid type 1 effectiveness-implementation cluster randomized controlled trial in seven VA healthcare systems testing a web-based reproductive health decision support tool (MyPath). VA primary care providers are enrolled and randomized to intervention or usual care arms. Veterans scheduled to see intervention-arm providers receive a text message inviting them to use MyPath ahead of their appointment; Veterans scheduled to see control-arm providers receive usual care. Target enrollment is 36 providers and 456 Veterans. Outcomes are assessed by Veteran self-report after the visit and at 3- and 6-months follow-up. The primary outcome is occurrence of reproductive health discussions involving shared decision making; secondary outcomes include measures of communication, knowledge, decision conflict, contraceptive utilization, and receipt of services related to prepregnancy health. Data on implementation barriers, facilitators and cost are collected. RESULTS The trial is ongoing with no results to report. We have enrolled 36 primary care providers across 7 VA healthcare systems and recruitment of Veterans is ongoing. CONCLUSIONS Results will inform efforts to increase the quality and person-centeredness of reproductive healthcare delivery in primary care and to operationalize and scale up use of digital decision support tools in clinical settings. TRIAL REGISTRATION http://ClinicalTrials.gov Identifier: NCT04584294 Trial Status: Recruiting.
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Affiliation(s)
- Lisa S Callegari
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA; Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA.
| | - Samantha K Benson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Siobhan S Mahorter
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Karin M Nelson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA; Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Alison B Hamilton
- Health Services Research and Development, VA Greater Los Angeles Healthcare System, Los Angeles, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, USA
| | - Leslie Taylor
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Rachel Hunter-Merrill
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Lori M Gawron
- Health Services Research and Development, VA Salt Lake City Health Care System, Salt Lake City, USA; Department of Obstetrics & Gynecology, University of Utah School of Medicine, Salt Lake City, USA
| | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, USA
| | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, USA; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Callegari LS, Mahorter SS, Benson SK, Zhao X, Schwarz EB, Borrero S. Perceived Contraceptive Counseling Quality Among Veterans Using VA Primary Care: Data from the ECUUN Study. J Gen Intern Med 2022; 37:698-705. [PMID: 36042079 PMCID: PMC9481768 DOI: 10.1007/s11606-022-07586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND High-quality contraceptive counseling is critical to support Veterans' reproductive autonomy and promote healthy outcomes. OBJECTIVE To describe perceived quality of contraceptive counseling in Veterans Health Administration (VA) primary care and assess factors associated with perceived high- and low-quality contraceptive counseling. DESIGN Cross-sectional study using data from the Examining Contraceptive Use and Unmet Need in women Veterans (ECUUN) national telephone survey. PARTICIPANTS Veterans aged 18-44 who received contraceptive services from a VA primary care clinic in the past year (N=506). MAIN MEASURES Perceived quality of contraceptive counseling was captured by assessing Veterans' agreement with 6 statements regarding provider counseling adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. High-quality counseling was defined as a top score of strongly agreeing on all 6 items; low-quality counseling was defined as not agreeing (neutral, disagreeing, or strongly disagreeing) with >3 items. We constructed two multivariable models to assess associations between patient-, provider-, and system-level factors and perceived high-quality (Model 1) and perceived low-quality counseling (Model 2). KEY RESULTS Most participants strongly agreed that their providers listened carefully (74%), explained things clearly (77%), and spent enough time discussing things (71%). Lower proportions strongly agreed that their provider discussed more than one option (54%), discussed pros/cons of various methods (44%), or asked which choice they thought was best for them (62%). In Model 1, Veterans who received care in a Women's Health Clinic (WHC) had twice the odds of perceiving high-quality counseling (aOR=1.99; 95%CI=1.24-3.22). In Model 2, Veterans who received care in a WHC (aOR=0.49; 95%CI=0.25-0.97) or from clinicians who provide cervical cancer screening (aOR=0.49; 95%CI=0.26-0.95) had half the odds of perceiving low-quality counseling. CONCLUSIONS Opportunities exist to improve the quality of contraceptive counseling within VA primary care settings, including more consistent efforts to seek patients' perspectives with respect to contraceptive decisions.
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Affiliation(s)
- Lisa S Callegari
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA, 98108, USA. .,Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, USA. .,Department of Health Services, University of Washington School of Public Health, Seattle, USA.
| | - Siobhan S Mahorter
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA, 98108, USA
| | - Sam K Benson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA, 98108, USA
| | - Xinhua Zhao
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, USA
| | | | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Hansen K, Boniface ER, Darney BG. Association of Title X clinic status with receipt of person-centered contraceptive counseling: a population-based study. Contraception 2022; 115:36-43. [PMID: 35995325 DOI: 10.1016/j.contraception.2022.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe receipt of person-centered contraceptive counseling among reproductive-aged women in the United States who sought contraceptive care at Title X clinics, non-Title X public clinics, and private clinics. STUDY DESIGN We conducted a secondary analysis of the 2017-2019 wave of the National Survey of Family Growth (NSFG). The sample included female respondents ages 15-49 who received contraceptive services in the past year and completed the Person-Centered Contraceptive Counseling (PCCC) measure, a quality metric evaluating interpersonal quality of the care received. We used multivariable logistic regression to estimate the predicted probability of receiving person-centered contraceptive counseling by source of care, adjusted for individual-level characteristics. RESULTS Of 2,225 (weighted N=26,599,620) eligible respondents, 6.9% received care at a Title X clinic, 8.2% at a non-Title X public clinic, and 84.9% at a private clinic. The adjusted predicted probability of receiving person-centered contraceptive counseling among respondents attending private clinics was 50.6% (95% CI 46.3-54.8%) compared with 51.3% (95% CI 40.4-62.3%) at Title X clinics and 52.4% (95% CI 44.0-60.7%) at other public clinics. Respondents with incomes ≥300% above the federal poverty level (FPL) had higher odds of reporting receipt of person-centered counseling compared to those with incomes below 100% of the FPL (aOR = 2.12; 95% CI 1.47-3.06). Non-Latina Black respondents had lower odds of receiving person-centered contraceptive counseling (aOR = 0.69; 95% CI 0.51-0.94), compared to non-Latina white respondents. CONCLUSION Title X clinics perform as well as the private sector in delivering person-centered contraceptive counseling. IMPLICATIONS Title X clinics provide quality person-centered contraceptive counseling on par with the private sector, despite serving populations that are often less likely to report high quality care. Broad implementation of the PCCC measure will permit tracking person-centered contraceptive care across diverse practice settings and populations.
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Affiliation(s)
- Katie Hansen
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, Oregon, 97239, United States.
| | - Emily R Boniface
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, Oregon, 97239, United States
| | - Blair G Darney
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, Oregon, 97239, United States; OHSU-Portland State University School of Public Health, 1810 SW 5(th) Avenue, Portland, Oregon, 97201, United States; Centro de Investigación en Salud Poblacional (CISP), Instituto Nacional de Salud Pública (INSP), Cuernavaca, México
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Thorburn S, Lindly OJ. A systematic search and review of the discrimination in health care measure, and its adaptations. PATIENT EDUCATION AND COUNSELING 2022; 105:1703-1713. [PMID: 34688522 PMCID: PMC9576001 DOI: 10.1016/j.pec.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/25/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Discrimination occurs in health care settings contributing to health inequities. Yet guidance on how best to measure discrimination in health care is still limited. OBJECTIVES We sought to (1) identify and describe the characteristics of published studies that used the Discrimination in Health Care Measure, a scale first published in 2001; (2) review how the measure has been used or adapted and summarize the measure's published psychometric properties and its variations; and (3) summarize associations between the measure and health-related variables. METHODS We performed a systematic search and review of the measure by searching PsycINFO, PubMed, Sociological Abstracts, and Web of Science from January 1, 2001 through January 31, 2017. We screened 260 unique articles, identified 22 eligible articles, and completed a narrative synthesis. RESULTS Most studies measured race or ethnicity-based discrimination. All studies made minor revisions to the measure, and most reported high reliabilities. Discrimination in health care, using this measure, was associated with adverse health outcomes. DISCUSSION AND PRACTICE IMPLICATIONS Study results indicate that the measure is easy to use and adapt. Researchers should consider using the Discrimination in Health Care Measure when designing studies that will examine individuals' discriminatory experiences when receiving health care.
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Affiliation(s)
- Sheryl Thorburn
- School of Social and Behavioral Health Sciences, Oregon State University, United States
| | - Olivia J Lindly
- Department of Health Sciences, Northern Arizona University, United States.
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Manlove J, Parekh J, Whitfield B, Griffith I, Garg A, Fasula AM. A Mixed-Methods Pilot Evaluation of Manhood 2.0, a Program to Reduce Unintended Pregnancy Among Young Men. Am J Mens Health 2022; 16:15579883221104895. [PMID: 35723069 PMCID: PMC9344189 DOI: 10.1177/15579883221104895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
One promising though understudied approach to addressing race/ethnic disparities in teen pregnancy rates is through sexual and reproductive health (SRH) programming for young men. This pilot study assessed the feasibility, quality, and preliminary efficacy of Manhood 2.0-a group-based, after-school SRH program for young Black and Latino men, which examines gender norms. This mixed-methods study describes program attendance and quality; participant experiences and engagement in the program; and changes in participant gender norms, knowledge, attitudes, self-efficacy, and social support. Quantitative data from baseline and post-intervention surveys (n = 51) were analyzed using paired t-tests and McNemar's tests. Qualitative data from five post-intervention focus groups (n = 27) were transcribed, coded, and analyzed for themes. At baseline, participants were ages 15 to18 years (M = 16.4 years), 30% were Latino, 66% were Black, 34% ever had sex, and 44% of sexually active participants had sex without any contraceptive method or condom. Quality ratings by program observers were high. The majority of participants (61%) attended at least 75% of sessions, and 96% rated Manhood 2.0 as "very good" or "excellent." Pre-post comparisons showed increases in receipt of SRH information; contraception knowledge; positive attitudes about supporting partners in pregnancy prevention; self-efficacy in partner communication about sex; discussing program content with friends and family; and social competence and support. Focus group participants described benefits from the Manhood 2.0 content (i.e., full range of contraceptive methods, sexual consent, gender norms) and delivery (i.e., reflective discussion, nonjudgmental facilitators). Findings suggest that Manhood 2.0 is a promising SRH program for young men.
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Affiliation(s)
| | | | | | | | | | - Amy M Fasula
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Seidman D, Logan R, Weber S, Gandhi A, Blackstock O. Reimagining Preexposure Prophylaxis Provision for Women in the United States. Clin Infect Dis 2022; 74:2243-2248. [PMID: 35482659 PMCID: PMC9890470 DOI: 10.1093/cid/ciab959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Indexed: 02/05/2023] Open
Abstract
Structural determinants of health drive inequities in the acquisition of human immunodeficiency virus (HIV) and the use of preexposure prophylaxis (PrEP) for HIV prevention among cisgender women in the United States. However, current PrEP clinical guidance and implementation paradigms largely focus on individual behaviors and characteristics, resulting in missed opportunities to improve PrEP access, and the implicit transferring of prevention work from health systems to individuals. In this viewpoint article, we outline ways to apply a structural lens to clinical guidance and PrEP implementation for women and propose areas for future work.
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Affiliation(s)
- Dominika Seidman
- Correspondence: Dominika Seidman, 1001 Potrero Ave, Ward 6D, San Francisco, CA 94110, USA ()
| | - Rachel Logan
- Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Anisha Gandhi
- Racial Equity and Social Justice Initiatives, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
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Eysenbach G, Leung T, Callegari LS, Kazmerski TM, Borrero S. A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States. J Med Internet Res 2022; 24:e36338. [PMID: 35482371 PMCID: PMC9100540 DOI: 10.2196/36338] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/14/2022] [Accepted: 04/01/2022] [Indexed: 01/21/2023] Open
Abstract
The United States has abysmal reproductive health indices that, in part, reflect stark inequities experienced by people of color and those with preexisting medical conditions. The growth of "femtech," or technology-based solutions to women's health issues, in the public and private sectors is promising, yet these solutions are often geared toward health-literate, socioeconomically privileged, and/or relatively healthy white cis-women. In this viewpoint, we propose a set of guiding principles for building technologies that proactively identify and address these critical gaps in health care for people from socially and economically marginalized populations that are capable of pregnancy, as well as people with serious chronic medical conditions. These guiding principles require that such technologies: (1) include community stakeholders in the design, development, and deployment of the technology; (2) are grounded in person-centered frameworks; and (3) address health disparities as a strategy to advance health equity and improve health outcomes.
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Affiliation(s)
| | | | - Lisa S Callegari
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, United States.,Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Traci M Kazmerski
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sonya Borrero
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Health Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, United States
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14
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Pérez AE, Agénor M. Racial/Ethnic and Sexual Orientation Identity Differences in the Receipt of a Sexual History Assessment from a Health Care Provider among Women in the United States. Womens Health Issues 2022; 32:156-164. [PMID: 34924267 DOI: 10.1016/j.whi.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Differential sexual history assessment, whereby certain groups are more or less likely to be asked questions about their sexual behavior by a health care provider, may lead to differential sexual health care and counseling. METHODS Using nationally representative data from the 2013 through 2019 waves of the National Survey of Family Growth, we examined racial/ethnic and sexual orientation identity differences in receiving a sexual history assessment from a health care provider in the last 12 months among U.S. women aged 15-44 years (N = 14,019). RESULTS Adjusting for survey wave, Black and Latina heterosexual women; White, Black, and Latina bisexual women; and Black or Latina lesbian women had higher odds (odds ratio range, 1.47 [Latina heterosexual] to 2.71 [Black bisexual]) of having received a sexual history assessment in the last 12 months compared with White heterosexual women. All differences except for those among Black or Latina lesbian women persisted after controlling for demographic, socioeconomic, and health care factors (odds ratio range, 1.43 [Latina heterosexual] to 2.14 [Black bisexual]). Of note, Black bisexual women, about whom providers may hold biased assumptions of promiscuity rooted in both racism and biphobia, had the highest predicted probability of being asked about their sexual behavior by a provider. CONCLUSIONS Person-centered, structurally competent, and anti-oppressive practices and programs aimed at combating bias, stigma, and discrimination in the health care system and facilitating an inclusive clinic environment for all patients are needed to address differences in the provision of sexual health services and promote sexual health equity.
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Affiliation(s)
- Ashley E Pérez
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California.
| | - Madina Agénor
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
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15
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Thompson TAM, Young YY, Bass TM, Baker S, Njoku O, Norwood J, Simpson M. Racism Runs Through It: Examining The Sexual And Reproductive Health Experience Of Black Women In The South. Health Aff (Millwood) 2022; 41:195-202. [PMID: 35130060 DOI: 10.1377/hlthaff.2021.01422] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Few studies have illustrated how racism influences Black women's use of reproductive health care services. This article presents findings of a collaborative study conducted by a research team and a reproductive justice organization to understand Black women's concerns with sexual and reproductive health services. The qualitative research was conducted with Black women living in Georgia and North Carolina, using a community-based participatory research approach. Themes were developed from participant accounts that highlight how racism, both structural and individual, influenced their reproductive health care access, utilization, and experience. Structural racism affected participants' finances and led some to forgo care or face barriers to obtaining care. Individual racism resulted in some women electing to receive care only from same-race medical providers. These findings suggest a need for policies and practices that address structural barriers to reproductive health care access and improve the reproductive health experience of Black women.
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Affiliation(s)
| | | | - Tanya M Bass
- Tanya M. Bass North Carolina Central University, Durham, North Carolina
| | | | - Oriaku Njoku
- Oriaku Njoku, Access Reproductive Care-Southeast, Atlanta, Georgia
| | | | - Monica Simpson
- Monica Simpson, SisterSong Women of Color Reproductive Justice Collective, Atlanta, Georgia
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16
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Loder C, Hall K, Kusunoki Y, Harris LH, Dalton V. Associations between perceived discrimination and contraceptive method use: why we need better measures of discrimination in reproductive healthcare. Women Health 2021; 61:461-469. [PMID: 33938402 DOI: 10.1080/03630242.2021.1919816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Discrimination has historically contributed to coercive contraceptive in the United States. We investigated associations between perceived discrimination, or the perception of unequal treatment in everyday life, and contraceptive method use among U.S. women. We analyzed population-based data from a 2013 study of U.S. women who were premenopausal, age 18-50, sexually active with a male partner in the last year and were not attempting pregnancy. Perceived discrimination was measured using the Everyday Discrimination Scale. Contraceptive method use was categorized into five method categories: permanent, highly effective reversible, moderately effective, barrier and no method. We analyzed relationships between perceived discrimination and contraceptive method use with several regression models, controlling for covariates. Among 539 women in our analytic sample, those with high perceived discrimination had lower incomes, less educational attainment and were less likely to be insured. Perceived discrimination was associated with a reduced odds of using any contraceptive method (aOR 0.43, CI 0.21-0.87, p < .001). Contraceptive method users with high perceived discrimination had an increased odds of using highly effective reversible methods versus moderately effective methods (aOR 5.28, CI 1.63-17.07 p = < .001). Women who perceived discrimination were at risk for contraceptive nonuse; however, among contraceptive users, perceived discrimination was associated with the use of more effective reversible methods.
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Affiliation(s)
- Charisse Loder
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - K Hall
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yasamin Kusunoki
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.,School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa Hope Harris
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Vanessa Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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17
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Logan RG, Daley EM, Vamos CA, Louis-Jacques A, Marhefka SL. "When Is Health Care Actually Going to Be Care?" The Lived Experience of Family Planning Care Among Young Black Women. QUALITATIVE HEALTH RESEARCH 2021; 31:1169-1182. [PMID: 33622078 PMCID: PMC8114454 DOI: 10.1177/1049732321993094] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
While family planning care (FPC) visits may serve as opportunities to address gaps in knowledge and access to limited resources, young Black women may also face structural barriers (i.e., racism, discrimination, bias) to engaging in care due to the intersections of racial identity, age, and socioeconomic status. Findings from interviews with 22 Black women, ages 18 to 29 years, about the lived experience of FPC highlighted dynamic patient-provider encounters. Women's narratives uncovered the following essences: silence around sex impedes engagement in care, patient-provider racial concordance as protection from harm, providers as a source of discouragement and misinformation, frustration as a normative experience, decision making excludes discussion and deliberation, medical mistrust is pervasive and a part of Black consciousness, and meaningful and empathic patient-provider encounters are elusive. Health systems should prioritize developing and enhancing young Black women's relationship with FPC providers to help mitigate persistent inequities that perpetuate disadvantage among this population.
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18
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Riggan KA, Gilbert A, Allyse MA. Acknowledging and Addressing Allostatic Load in Pregnancy Care. J Racial Ethn Health Disparities 2021; 8:69-79. [PMID: 32383045 PMCID: PMC7647942 DOI: 10.1007/s40615-020-00757-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/18/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022]
Abstract
The USA is one of the few countries in the world in which maternal and infant morbidity and mortality continue to increase, with the greatest disparities observed among non-Hispanic Black women and their infants. Traditional explanations for disparate outcomes, such as personal health behaviors, socioeconomic status, health literacy, and access to healthcare, do not sufficiently explain why non-Hispanic Black women continue to die at three to four times the rate of White women during pregnancy, childbirth, or postpartum. One theory gaining prominence to explain the magnitude of this disparity is allostatic load or the cumulative physiological effects of stress over the life course. People of color disproportionally experience social, structural, and environmental stressors that are frequently the product of historic and present-day racism. In this essay, we present the growing body of evidence implicating the role of elevated allostatic load in adverse pregnancy outcomes among women of color. We argue that there is a moral imperative to assign additional resources to reduce the effects of elevated allostatic load before, during, and after pregnancy to improve the health of women and their children.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Anna Gilbert
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.
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19
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Quinn DA, Sileanu FE, Zhao X, Mor MK, Judge-Golden C, Callegari LS, Borrero S. History of unintended pregnancy and patterns of contraceptive use among racial and ethnic minority women veterans. Am J Obstet Gynecol 2020; 223:564.e1-564.e13. [PMID: 32142832 PMCID: PMC7528209 DOI: 10.1016/j.ajog.2020.02.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/31/2020] [Accepted: 02/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nearly half of all pregnancies in the United States each year are unintended, with the highest rates observed among non-Hispanic black and Hispanic women. Little is known about whether variations in unintended pregnancy and contraceptive use across racial and ethnic groups persist among women veteran Veterans Affairs users who have more universal access than other populations to health care and contraceptive services. OBJECTIVES The objectives of this study were to identify a history of unintended pregnancy and describe patterns of contraceptive use across racial and ethnic groups among women veterans accessing Veterans Affairs primary care. STUDY DESIGN Cross-sectional data from a national random sample of women veterans (n = 2302) aged 18-44 years who had accessed Veterans Affairs primary care in the previous 12 month were used to assess a history of unintended pregnancy (pregnancies reported as either unwanted or having occurred too soon). Any contraceptive use at last sex (both prescription and nonprescription methods) and prescription contraceptive use at last sex were assessed in the subset of women (n = 1341) identified as being at risk for unintended pregnancy. Prescription contraceptive methods include long-acting reversible contraceptive methods (intrauterine devices and subdermal implants), hormonal methods (pill, patch, ring, and injection), and female or male sterilization; nonprescription methods include barrier methods (eg, condoms, diaphragm), fertility-awareness methods, and withdrawal. Multivariable logistic regression models were used to examine the relationship between race/ethnicity with unintended pregnancy and contraceptive use at last sex. RESULTS Overall, 94.4% of women veterans at risk of unintended pregnancy used any method of contraception at last sex. Intrauterine devices (18.9%), female surgical sterilization (16.9%), and birth control pills (15.9%) were the 3 most frequently used methods across the sample. Intrauterine devices were the most frequently used method for Hispanic, non-Hispanic white, and other non-Hispanic women, while female surgical sterilization was the most frequently used method among non-Hispanic black women. In adjusted models, Hispanic women (adjusted odds ratio, 1.60, 95% confidence interval, 1.15-2.21) and non-Hispanic black women (adjusted odds ratio, 1.84, 95% confidence interval, 1.44-2.36) were significantly more likely than non-Hispanic white women to report any history of unintended pregnancy. In the subcohort of 1341 women at risk of unintended pregnancy, there were no significant racial/ethnic differences in use of any contraception at last sex. However, significant differences were observed in the use of prescription methods at last sex. Hispanic women (adjusted odds ratio, 0.51, 95% confidence interval, 0.35-0.75) and non-Hispanic black women (adjusted odds ratio, 0.69, 95% confidence interval, 0.51-0.95) were significantly less likely than non-Hispanic white women to have used prescription contraception at last sex. CONCLUSION Significant racial and ethnic differences exist in unintended pregnancy and contraceptive use among women veterans using Veterans Affairs care, suggesting the need for interventions to address potential disparities. Improving access to and delivery of patient-centered reproductive goals assessment and contraceptive counseling that can address knowledge gaps while respectfully considering individual patient preferences is needed to support women veterans' decision making and ensure equitable reproductive health services across Veterans Affairs.
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Affiliation(s)
- Deirdre A Quinn
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA.
| | - Florentina E Sileanu
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA
| | - Xinhua Zhao
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA
| | - Maria K Mor
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Colleen Judge-Golden
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Lisa S Callegari
- Departments of Obstetrics and Gynecology and Health Services, University of Washington, Seattle, WA; Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA
| | - Sonya Borrero
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA; Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA; Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA
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20
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Arora KS, Ponsaran R, Morello L, Katabi L, Behmer Hansen RT, Zite N, White K. Attitudes and beliefs of obstetricians-gynecologists regarding Medicaid postpartum sterilization - A qualitative study. Contraception 2020; 102:376-382. [PMID: 32858053 DOI: 10.1016/j.contraception.2020.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the attitudes and beliefs of obstetrician-gynecologists in the United States (US) regarding the Medicaid postpartum sterilization policy. STUDY DESIGN We recruited obstetrician-gynecologists practicing in ten geographically diverse US states for a qualitative study using the American College of Obstetricians and Gynecologists directory. We conducted semi-structured interviews via telephone, professionally transcribed, and analyzed using the constant comparative method and principles of grounded theory. RESULTS We interviewed thirty obstetrician-gynecologists (63.3% women, 76.7% non-subspecialized, and 53.3% academic setting). Participants largely described the consent form as unnecessary, paternalistic, an administrative hassle, a barrier to desired patient care, and associated with worse health outcomes. Views on the waiting period's utility and impact were mixed. Many participants felt the sterilization policy was discriminatory. However, some participants noted the policy's importance in terms of the historical basis, used the form as a counseling tool to remind patients of the permanence of sterilization, felt the policy prompted them to counsel regarding sterilization, and protected patients in contemporary medical practice. CONCLUSION Many physicians shared concerns about the ethics and clinical impact of the Medicaid sterilization policy. Future revisions to the Medicaid sterilization policy must balance prevention of coercion with reduction in barriers to those desiring sterilization in order to maximize reproductive autonomy. IMPLICATIONS Obstetrician-gynecologists are key stakeholders of the Medicaid sterilization policy. Obstetrician-gynecologists largely believe that revision to the Medicaid sterilization policy is warranted to balance reduction of external barriers to desired care with a process that enforces the need for counseling regarding contraception and reviewing patient preference for sterilization throughout pregnancy in order to minimize regret.
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Affiliation(s)
- Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, United States; Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States.
| | - Roselle Ponsaran
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States
| | - Laura Morello
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States
| | - Leila Katabi
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States
| | | | - Nikki Zite
- Department of Obstetrics and Gynecology, University of Tennessee, Knoxville, TN, United States
| | - Kari White
- Steve Hicks School of Social Work and Department of Sociology, University of Texas at Austin, Austin, TX, United States
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21
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Kathawa CA, Arora KS. Implicit Bias in Counseling for Permanent Contraception: Historical Context and Recommendations for Counseling. Health Equity 2020; 4:326-329. [PMID: 32775942 PMCID: PMC7410277 DOI: 10.1089/heq.2020.0025] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2020] [Indexed: 11/13/2022] Open
Abstract
We provide an overview of the causes, manifestations, and potential mitigating steps regarding implicit bias in counseling for permanent contraception. The historical context of sterilization abuses and the implications of these on society's notions of fitness for parenthood are reviewed. We present contemporary examples of contraceptive coercion and discuss the impact of implicit bias from health care providers. Finally, we outline steps for ensuring a patient-centered shared decision-making ethical approach to permanent contraceptive counseling.
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Affiliation(s)
- Cosette A Kathawa
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, USA
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22
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Blackwell S, Louis JM, Norton ME, Lappen JR, Pettker CM, Kaimal A, Landy U, Edelman A, Teal S, Landis R. Reproductive services for women at high risk for maternal mortality: a report of the workshop of the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, the Fellowship in Family Planning, and the Society of Family Planning. Am J Obstet Gynecol 2020; 222:B2-B18. [PMID: 32252942 DOI: 10.1016/j.ajog.2019.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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23
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Hardeman RR, Karbeah J, Kozhimannil KB. Applying a critical race lens to relationship-centered care in pregnancy and childbirth: An antidote to structural racism. Birth 2020; 47:3-7. [PMID: 31630454 DOI: 10.1111/birt.12462] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Rachel R Hardeman
- Division of Health Policy & Management, University of Minnesota, School of Public Health, Minneapolis, Minnesota
| | - J'Mag Karbeah
- Division of Health Policy & Management, University of Minnesota, School of Public Health, Minneapolis, Minnesota
| | - Katy B Kozhimannil
- Division of Health Policy & Management, University of Minnesota, School of Public Health, Minneapolis, Minnesota
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24
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Caldwell MT, Hambrick N, Vallee P, Thomas CSD, Sutton A, Daniels G, Goyal N, Manteuffel J, Joseph CLM, Guetterman TC. "They're Doing Their Job": Women's Acceptance of Emergency Department Contraception Counseling. Ann Emerg Med 2020; 76:515-526. [PMID: 31959536 DOI: 10.1016/j.annemergmed.2019.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE We explore reproductive-aged women's acceptance of contraception counseling in the emergency department (ED). METHODS This study is phase 1 of an exploratory sequential mixed methods study. We purposively interviewed 31 participants with the following criteria: black, white, or Latina race/ethnicity; nonpregnant; aged 15 to 44 years; receiving nonemergency care; not using highly effective contraception; and did not intend to become pregnant. We conducted semistructured interviews with a piloted interview guide until reaching thematic saturation. We coded transcripts with an iteratively developed codebook, maintaining intercoder agreement greater than 80%. Qualitative acceptance of ED contraception counseling was grouped into 3 categories: acceptable, unacceptable, and equivocal. We conducted a thematic text analysis to assess themes expressing support and concern for ED contraception counseling. Qualitative findings were stratified by age, race, and frequency of ED use. Using components of grounded theory, we developed a conceptual model. RESULTS Most participants (81%) accepted ED contraception counseling. Themes expressing support and concern for ED contraception counseling included opportunity to address women's unmet contraception needs, contraception is within the scope of ED practice, the ED is a convenient setting with competent providers, contraception is a sensitive topic, and the ED may be an inappropriate setting for some women. Latina participants had lower acceptance of ED contraception counseling. Dominant subthemes varied slightly by race, age, and frequency of ED use. CONCLUSION Diverse women had high acceptance of contraception counseling in the ED. Perspectives expressing both support and concern in regard to ED contraception counseling were explored in detail.
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Affiliation(s)
| | - Nanci Hambrick
- Center for Behavioral Health and Justice, Wayne State University School of Social Work, Detroit, MI
| | - Phyllis Vallee
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI
| | | | | | | | - Nikhil Goyal
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI; Department of Internal Medicine, Henry Ford Hospital, Detroit, MI
| | - Jacob Manteuffel
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI
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25
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Katon JG, Bossick AS, Doll KM, Fortney J, Gray KE, Hebert P, Lynch KE, Ma EW, Washington DL, Zephyrin L, Callegari LS. Contributors to Racial Disparities in Minimally Invasive Hysterectomy in the US Department of Veterans Affairs. Med Care 2019; 57:930-936. [PMID: 31730567 DOI: 10.1097/mlr.0000000000001200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Minimally invasive hysterectomy for fibroids decreases recovery time and risk of postoperative complications compared with abdominal hysterectomy. Within Veterans Affair (VA), black women with uterine fibroids are less likely to receive a minimally invasive hysterectomy than white women. OBJECTIVE To quantify the contributions of patient, facility, temporal and geographic factors to VA black-white disparity in minimally invasive hysterectomy. RESEARCH DESIGN A cross-sectional study. SUBJECTS Veterans with fibroids and hysterectomy performed in VA between October 1, 2012 and September 30, 2015. MEASURES Hysterectomy mode was defined using ICD-9 codes as minimally invasive (laparoscopic, vaginal, or robotic-assisted) versus abdominal. The authors estimated a logistic regression model with minimally invasive hysterectomy modeled as a function of 4 sets of factors: sociodemographic characteristics other than race, health risk factors, facility, and temporal and geographic factors. Using decomposition techniques, systematically substituting each white woman's characteristics for each black woman's characteristics, then recalculating the predicted probability of minimally invasive hysterectomy for black women for each possible combination of factors, we quantified the contribution of each set of factors to observed disparities in minimally invasive hysterectomy. RESULTS Among 1255 veterans with fibroids who had a hysterectomy at a VA, 61% of black women and 39% of white women had an abdominal hysterectomy. Our models indicated there were 99 excess abdominal hysterectomies among black women. The majority (n=77) of excess abdominal hysterectomies were unexplained by measured sociodemographic factors beyond race, health risk factors, facility, and temporal or geographic trends. CONCLUSION Closer examination of the equity of VA gynecology care and ways in which the VA can work to ensure equitable care for all women veterans is necessary.
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Affiliation(s)
- Jodie G Katon
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Department of Health Services, University of Washington
| | | | - Kemi M Doll
- Department of Health Services, University of Washington
- Departments of Obstetrics and Gynecology
| | - John Fortney
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA
| | - Kristen E Gray
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Department of Health Services, University of Washington
| | - Paul Hebert
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Department of Health Services, University of Washington
| | - Kristine E Lynch
- Department of Veterans Affairs Salt Lake City Health Care System
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Erica W Ma
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
| | - Donna L Washington
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System
- Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Laurie Zephyrin
- Women's Health Services, Office of Patient Services, VA Central Office, Washington, DC
- Department of Obstetrics and Gynecology, New York University Langone School of Medicine, New York, NY
| | - Lisa S Callegari
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Department of Health Services, University of Washington
- Departments of Obstetrics and Gynecology
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26
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Karbeah J, Hardeman R, Almanza J, Kozhimannil KB. Identifying the Key Elements of Racially Concordant Care in a Freestanding Birth Center. J Midwifery Womens Health 2019; 64:592-597. [PMID: 31373434 DOI: 10.1111/jmwh.13018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/11/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is empirical evidence that the quality of interpersonal care patients receive varies dramatically along racial and ethnic lines, with African American people often reporting much lower quality of care than their white counterparts. Improving the interpersonal relationship between clinicians and patients has been identified as one way to improve quality of care. Specifically, research has identified that patients feel more satisfied with the care that they receive from clinicians with whom they share a racial identity. However, little is known about how clinicians provide racially concordant care. The goal of this analysis was to identify the key components of high-quality care that were most salient for African American birthworkers providing perinatal care to African American patients. METHODS We conducted semistructured interviews (30 to 90 minutes) with clinicians (N = 10; midwives, student midwives, and doulas) who either worked at or worked closely with an African American-owned birth center in North Minneapolis, Minnesota. We used inductive coding methods to analyze data and to identify key themes. RESULTS Providing racially concordant perinatal care to African American birthing individuals required clinicians to acknowledge and center the sociocultural realities and experiences of their patients. Four key themes emerged in our analysis. The first overarching theme identified was the need to acknowledge how cultural identity of patients is fundamental to the clinical encounter. The second theme that emerged was a commitment to racial justice. The third and fourth themes were agency and cultural humility, which highlight the reciprocal nature of the clinician-patient relationship. DISCUSSION The most salient aspect of the care that birthworkers of color provide is their culturally centered approach. This approach and all subsequent themes suggest that achieving birth equity for pregnant African American people starts by acknowledging and honoring their sociocultural experiences.
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Affiliation(s)
- J'Mag Karbeah
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Rachel Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Jennifer Almanza
- University of Minnesota Physicians Group, Minneapolis, Minnesota.,Department of Obstetrics and Gynecology, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Katy B Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Assessing Patient Satisfaction Among Transgender Individuals Seeking Medical Services. Ann Plast Surg 2018; 81:725-729. [DOI: 10.1097/sap.0000000000001582] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Greene MZ, Meghani SH, Sommers MS, Hughes TL. Health Care-Related Correlates of Cervical Cancer Screening among Sexual Minority Women: An Integrative Review. J Midwifery Womens Health 2018; 63:10.1111/jmwh.12872. [PMID: 30251464 PMCID: PMC6433555 DOI: 10.1111/jmwh.12872] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/20/2018] [Accepted: 04/28/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Sexual minority women (SMW; lesbian, bisexual, nonheterosexual women) may have lower rates of cervical cancer screening than heterosexual women. Health care-related factors may explain some of the variation in cervical cancer screening rates among SMW. We aimed to synthesize published evidence of health care-related correlates of cervical cancer screening among SMW. METHODS We searched PubMed, CINAHL, and PsycINFO databases for English-language studies published between January 2000 and March 2017 that 1) assessed sexual identity or the sexual partners of female participants, 2) included cervical cancer screening as a main outcome of interest, and 3) measured at least one health care-related variable in addition to cervical cancer screening. We excluded articles that 1) reported on non-US samples or 2) did not report original research. We reviewed the sample, methods, and findings of 17 studies. We then summarized current knowledge about health care-related factors across 3 categories and generated recommendations for clinical practice and future research. RESULTS Several health care-related factors such as previous contraception use, having a primary care provider, knowledge of screening recommendations, and disclosing sexual orientation to providers were consistently positively associated with cervical cancer screening. Three groups of factors-previous health care use, health care provider-related factors, and belief-related factors-account for a substantial part of the variation in cervical cancer screening among SMW. DISCUSSION Several gaps in knowledge remain that could be addressed by recruiting more diverse samples of SMW with improved generalizability. Clinicians and clinical institutions can address factors associated with low rates of screening among SMW by preventing sexual orientation-based discrimination, inviting sexual orientation disclosure, and offering cervical cancer screening to SMW at a variety of health care encounters. Future research should examine how the location of care and health care provider type affect SMW's cervical cancer screening behaviors and should test the effectiveness of health care interventions designed to address sexual orientation-related disparities.
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Prather C, Fuller TR, Jeffries WL, Marshall KJ, Howell AV, Belyue-Umole A, King W. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Health Equity 2018; 2:249-259. [PMID: 30283874 PMCID: PMC6167003 DOI: 10.1089/heq.2017.0045] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: The sexual and reproductive health of African American women has been compromised due to multiple experiences of racism, including discriminatory healthcare practices from slavery through the post-Civil Rights era. However, studies rarely consider how the historical underpinnings of racism negatively influence the present-day health outcomes of African American women. Although some improvements to ensure equitable healthcare have been made, these historical influences provide an unexplored context for illuminating present-day epidemiology of sexual and reproductive health disparities among African American women. Methods: To account for the unique healthcare experiences influenced by racism, including healthcare provision, we searched online databases for peer-reviewed sources and books published in English only. We explored the link between historical and current experiences of racism and sexual and reproductive health outcomes. Results: The legacy of medical experimentation and inadequate healthcare coupled with social determinants has exacerbated African American women's complex relationship with healthcare systems. The social determinants of health associated with institutionalized and interpersonal racism, including poverty, unemployment, and residential segregation, may make African American women more vulnerable to disparate sexual and reproductive health outcomes. Conclusions: The development of innovative models and strategies to improve the health of African American women may be informed by an understanding of the historical and enduring legacy of racism in the United States. Addressing sexual and reproductive health through a historical lens and ensuring the implementation of culturally appropriate programs, research, and treatment efforts will likely move public health toward achieving health equity. Furthermore, it is necessary to develop interventions that address the intersection of the social determinants of health that contribute to sexual and reproductive health inequities.
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Affiliation(s)
- Cynthia Prather
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Taleria R. Fuller
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William L. Jeffries
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Khiya J. Marshall
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - A. Vyann Howell
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela Belyue-Umole
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Winifred King
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Greene MZ, Hughes TL, Sommers MS, Hanlon A, Meghani SH. Association of Pregnancy History and Cervical Cancer Screening in a Community Sample of Sexual Minority Women. J Womens Health (Larchmt) 2018; 28:526-534. [PMID: 30118364 DOI: 10.1089/jwh.2018.6960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sexual minority women (SMW) face barriers to healthcare that may result in lower utilization of cervical cancer screening. Previous experiences with the healthcare system-specifically reproductive health-related encounters-have the potential to affect future use of screening services. This study aimed to examine the association between pregnancy history and cervical cancer screening in a diverse sample of SMW. Anderson's Behavioral Model of Health Services Use guided the selection of variables included in the study. METHODS We performed a secondary analysis of cross-sectional data from the third wave of the Chicago Health and Life Experiences of Women (CHLEW) Study, a longitudinal study of SMW in the Midwestern United States. We performed multivariable logistic regression to address the study aims, restricting the sample to women ages 21-45 (n = 430). RESULTS Reporting a previous pregnancy was consistently positively associated with past-year Pap testing. In the multivariable model, bisexual identity and disclosing one's sexual orientation to healthcare providers were also positively associated with past-year Pap test. CONCLUSIONS This analysis provides preliminary evidence that SMW who have been pregnant are more likely to receive Pap testing and that multiple sociodemographic factors are likely to impact screening in this population. Clinicians should screen all patients with a cervix for cervical cancer and should encourage screening for all SMW. Future studies should prioritize longitudinal analyses to examine the temporality of reproductive history and healthcare seeking, focus on where SMW seek care, and understand how intersecting components of identity may shape the healthcare utilization of this population.
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Affiliation(s)
- Madelyne Z Greene
- 1 Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Tonda L Hughes
- 2 School of Nursing, Columbia University, New York, New York
| | - Marilyn S Sommers
- 3 School of Nursing, University of Pennsylvania, Philadephia, Pennsylvania
| | - Alexandra Hanlon
- 3 School of Nursing, University of Pennsylvania, Philadephia, Pennsylvania
| | - Salimah H Meghani
- 3 School of Nursing, University of Pennsylvania, Philadephia, Pennsylvania
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Hall KS, Manu A, Morhe E, Dalton VK, Challa S, Loll D, Dozier JL, Zochowski MK, Boakye A, Harris LH. Bad girl and unmet family planning need among Sub-Saharan African adolescents: the role of sexual and reproductive health stigma. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2018; 2:55-64. [PMID: 30556052 PMCID: PMC6292434 DOI: 10.4081/qrmh.2018.7062] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Adolescent pregnancy contributes to high maternal mortality rates in Sub-Saharan Africa. We explored stigma surrounding adolescent sexual and reproductive health (SRH) and its impact on young Ghanaian women's family planning (FP) outcomes. We conducted in-depth, semi-structured interviews with 63 women ages 15-24 recruited from health facilities and schools in Accra and Kumasi, Ghana. Purposive sampling provided diversity in reproductive/relationship/socioeconomic/religious characteristics. Using both deductive and inductive approaches, our thematic analysis applied principles of grounded theory. Participants described adolescent SRH experiences as cutting across five stigma domains. First, community norms identified non-marital sex and its consequences (pregnancy, childbearing, abortion, sexually transmitted infections) as immoral, disrespectful, and disobedient, resulting in bad girl labeling. Second, enacted stigma entailed gossip, marginalization, and mistreatment from all community members, especially healthcare workers. Third, young sexually active, pregnant, and childbearing women experienced internalized stigma as disgrace, shame and shyness. Fourth, non-disclosure and secret-keeping were used to avoid/reduce stigma. Fifth, stigma resilience was achieved through social support. Collectively, SRH stigma precluded adolescents' use of FP methods and services. Our resulting conceptual model of adolescent SRH stigma can guide health service, public health, and policy efforts to address unmet FP need and de-stigmatize SRH for young women worldwide.
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Affiliation(s)
- Kelli Stidham Hall
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Abubakar Manu
- School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Sneha Challa
- University of Michigan, Women’s Hospital, Ann Arbor, USA
| | - Dana Loll
- University of Michigan, Women’s Hospital, Ann Arbor, USA
| | | | | | - Andrew Boakye
- Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lisa H. Harris
- University of Michigan, Women’s Hospital, Ann Arbor, USA
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Kramer RD, Higgins JA, Godecker AL, Ehrenthal DB. Racial and ethnic differences in patterns of long-acting reversible contraceptive use in the United States, 2011-2015. Contraception 2018; 97:399-404. [PMID: 29355492 PMCID: PMC5965256 DOI: 10.1016/j.contraception.2018.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate whether demographic, socioeconomic, and reproductive health characteristics affect long-acting reversible contraceptive (LARC) use differently by race-ethnicity. Results may inform the dialogue on racial pressure and bias in LARC promotion. STUDY DESIGN Data derived from the 2011-2013 and 2013-2015 National Surveys of Family Growth (NSFG). Our study sample included 9321 women aged 15-44. Logistic regression analyses predicted current LARC use (yes vs. no). We tested interaction terms between race-ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic) and covariates (for example, education, parity, poverty level) to explore whether their effects on LARC use vary by race-ethnicity. RESULTS In the race-interactions model, data did not show that low income and education predict LARC use more strongly among Black and Hispanic women than among White women. There was just one statistically significant race-interaction: experience of unintended pregnancy (p=.014). Among Whites and Hispanics, women who reported ever experiencing an unintended pregnancy had a higher predicted probability of LARC use than those who did not. On the other hand, among Black women, the experience of unintended pregnancy was not associated with a higher predicted probability of LARC use. CONCLUSIONS With the exception of the experience of unintended pregnancy, findings from this large, nationally representative sample of women suggest similar patterns in LARC use by race-ethnicity. IMPLICATIONS Results from this analysis of NSFG data do not provide evidence that observed differences in LARC use by race-ethnicity represent socioeconomic disparities, and may assuage some concerns about reproductive coercion among women of color. Nevertheless, it is absolutely critical that providers use patient-centered approaches for contraceptive counseling that promote women's autonomy in their reproductive health care decision-making.
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Affiliation(s)
- Renee D Kramer
- Department of Population Health, School of Medicine and Public Health, University of Wisconsin-Madison, WARF Office Building Room 675, 610 Walnut Street, Madison, WI 53726, USA.
| | - Jenny A Higgins
- Department of Gender and Women's Studies, University of Wisconsin-Madison, Sterling Hall Room 3309, 475 North Charter Street, Madison, WI 53706, USA.
| | - Amy L Godecker
- Population Health Institute, School of Medicine and Public Health, University of Wisconsin-Madison, WARF Office Building Room 656, 610 Walnut Street, Madison, WI 53726, USA.
| | - Deborah B Ehrenthal
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, WARF Office Building Room 658, 610 Walnut St., Madison, WI 53726, USA.
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Seidman D, Weber S, Carlson K, Witt J. Family planning providers' role in offering PrEP to women. Contraception 2018; 97:467-470. [PMID: 29408284 DOI: 10.1016/j.contraception.2018.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 10/17/2022]
Abstract
Pre-exposure prophylaxis (PrEP) provides a radically different HIV prevention option for women. Not only is PrEP the first discrete, woman-controlled method that is taken in advance of exposure, but it is both safe and highly effective, offering over 90% protection if taken daily. While multiple modalities of PrEP are in development ranging from vaginal rings to injectables and implants, only PrEP with oral tenofovir/emtricitabine is currently FDA-approved. Family planning clinics provide key access points for many women to learn about and obtain PrEP. By incorporating PrEP services into family planning care, family planning providers have the opportunity to meet women's expectations, ensure women are aware of and offered comprehensive HIV prevention options, and reverse emerging disparities in PrEP access. Despite real and perceived barriers to integrating PrEP into family planning care, providing PrEP services, ranging from education to onsite provision, is not only possible but an important component of providing high-quality sexual and reproductive healthcare to women. Lessons learned from early adopters will help guide those in family planning settings initiating or enhancing PrEP services.
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Affiliation(s)
- Dominika Seidman
- University of California, 1001 Potrero Ave Ward 6D, San Francisco, CA 94110
| | - Shannon Weber
- University of California, 1001 Potrero Ave Ward 6D, San Francisco, CA 94110; HIVE, 1001 Potrero Ave Ward 6D, San Francisco, CA 94110
| | - Kimberly Carlson
- University of Missouri, 2464 Charlotte Street, Kansas City, MO 64108
| | - Jacki Witt
- University of Missouri, 2464 Charlotte Street, Kansas City, MO 64108.
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Kimport K. Talking about male body-based contraceptives: The counseling visit and the feminization of contraception. Soc Sci Med 2018; 201:44-50. [PMID: 29433012 DOI: 10.1016/j.socscimed.2018.01.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
In developed countries, women bear the primary, and sometimes exclusive, responsibility for preventing pregnancy in heterosexual sexual relations. This unequal burden is not an intrinsic fact; it is the consequence of broad social narratives and interpersonal negotiations. The contraceptive counseling visit is increasingly recognized as a site of the discursive production of normative ideas about reproduction, suggesting that clinicians themselves may contribute to the assignment of responsibility for contraceptive labor to women (i.e. the feminization of contraception). Scholars have not yet considered how providers talk to patients about methods that are male body-based (i.e. condoms, withdrawal, and vasectomy) and, as such, may disrupt the feminization of responsibility for contraception. Using transcripts of 101 contraceptive counseling visits recorded between 2009 and 2012 in the San Francisco Bay Area, I investigate how clinicians discuss male body-based methods with female patients. Drawing on a constructivist approach, I find that clinicians generally devalued male body-based methods in their counseling. They did so by, first, failing to discuss them as options for long-term contraception. Second, when they did discuss them, clinicians tended to emphasize aspects of the methods that were presumed "negative" (e.g. the lower efficacy of withdrawal and condoms) but not features that patients might view positively (e.g. the high efficacy of vasectomy or the lack of side effects with condoms and withdrawal). In aggregate, these discursive practices marginalize male body-based methods as contraceptive choices. As a practical effect, this may encourage women to choose a method that does not best meet their preferences. At a structural level, by devaluing methods that could undercut the unequal division of fertility work, these discursive patterns contribute to the feminization of responsibility for contraception and the retrenchment of the unequal gendered division of fertility work.
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Affiliation(s)
- Katrina Kimport
- Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
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Ben J, Cormack D, Harris R, Paradies Y. Racism and health service utilisation: A systematic review and meta-analysis. PLoS One 2017; 12:e0189900. [PMID: 29253855 PMCID: PMC5734775 DOI: 10.1371/journal.pone.0189900] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/04/2017] [Indexed: 11/18/2022] Open
Abstract
Although racism has been posited as driver of racial/ethnic inequities in healthcare, the relationship between racism and health service use and experience has yet to be systematically reviewed or meta-analysed. This paper presents a systematic review and meta-analysis of quantitative empirical studies that report associations between self-reported racism and various measures of healthcare service utilisation. Data were reviewed and extracted from 83 papers reporting 70 studies. Studies included 250,850 participants and were conducted predominately in the U.S. The meta-analysis included 59 papers reporting 52 studies, which were analysed using random effects models and mean weighted effect sizes. Racism was associated with more negative patient experiences of health services (HSU-E) (OR = 0.351 (95% CI [0.236,0.521], k = 19), including lower levels of healthcare-related trust, satisfaction, and communication. Racism was not associated with health service use (HSU-U) as an outcome group, and was not associated with most individual HSU-U outcomes, including having had examinations, health service visits and admissions to health professionals and services. Racism was associated with health service use outcomes such as delaying/not getting healthcare, and lack of adherence to treatment uptake, although these effects may be influenced by a small sample of studies, and publication bias, respectively. Limitations to the literature reviewed in terms of study designs, sampling methods and measurements are discussed along with suggested future directions in the field.
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Affiliation(s)
- Jehonathan Ben
- Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
| | - Donna Cormack
- Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago, Wellington South, New Zealand
| | - Ricci Harris
- Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago, Wellington South, New Zealand
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
- * E-mail:
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Sawyer AN, Kwitowski MA, Benotsch EG. Are You Covered? Associations Between Patient Protection and Affordable Care Act Knowledge and Preventive Reproductive Service Use. Am J Health Promot 2017; 32:906-915. [PMID: 29121792 DOI: 10.1177/0890117117736091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Sexual and reproductive health conditions (eg, infections, cancers) represent public health concerns for American women. The present study examined how knowledge of the Patient Protection and Affordable Care Act (PPACA) relates to receipt of preventive reproductive health services among women. DESIGN Cross-sectional online survey. SETTING Online questionnaires were completed via Amazon Mechanical Turk, a crowdsourcing website where individuals complete web-based tasks for compensation. PARTICIPANTS Cisgendered women aged 18 to 44 years (N = 1083) from across the United States. MEASURES Participants completed online questionnaires assessing demographics, insurance status, preventive service use, and knowledge of PPACA provisions. ANALYSIS Chi-squares showed that receipt of well-woman, pelvic, and breast examinations, as well as pap smears, was related to insurance coverage, with those not having coverage at all during the previous year having significantly lower rates of use. Hierarchical logistic regressions determined the independent relationship between PPACA knowledge and use of health services after controlling for demographic factors and insurance status. RESULTS Knowledge of PPACA provisions was associated with receiving well-woman, pelvic, and breast examinations, human papillomavirus vaccination, and sexually transmitted infections testing, after controlling for these factors. Results indicate that expanding knowledge about health-care legislation may be beneficial in increasing preventive reproductive health service use among women. CONCLUSION Current findings provide support for increasing resources for outreach and education of the general population about the provisions and benefits of health-care legislation, as well as personal health coverage plans.
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Affiliation(s)
- Ashlee N Sawyer
- 1 Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Melissa A Kwitowski
- 1 Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Eric G Benotsch
- 1 Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Performance Measures for Contraceptive Care: A New Tool to Enhance Access to Contraception. Obstet Gynecol 2017; 130:1121-1125. [PMID: 29016515 DOI: 10.1097/aog.0000000000002314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Contraception is an essential health service for reducing unintended pregnancy rates, improving health outcomes, and reducing health care costs. However, contraceptive services may not consistently provide access to the full method mix and to patient-centered care. Improving the quality of contraceptive care is a critical strategy to improve contraceptive use, health outcomes, and the patient experience of care. We here describe the three National Quality Forum-endorsed performance measures for contraceptive care, which are intended to monitor 1) provision of most and moderately effective methods, 2) access to long-acting reversible contraception, and 3) provision of most and moderately effective methods and access to long-acting reversible contraception after childbirth. These contraceptive care measures are designed to ensure that contraceptive care is accessible and offers the full spectrum of methods. Payers, health care systems, public agencies, and researchers could all monitor these performance measures for different populations. We describe the crucial role of clinicians in disseminating and using the contraceptive care performance measures for quality improvement. We describe ongoing efforts to improve contraceptive care quality, including the development of measures to monitor other dimensions of quality such as the safety and patient-centeredness of care. Thirty-eight million women at risk of unintended pregnancy are counting on us to improve the quality of family planning care in the United States and ensure that all women have the resources and tools to make free, informed choices about whether and when to become pregnant.
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Kavanaugh ML, Jerman J. Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014. Contraception 2017; 97:14-21. [PMID: 29038071 PMCID: PMC5959010 DOI: 10.1016/j.contraception.2017.10.003] [Citation(s) in RCA: 313] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 12/02/2022]
Abstract
Objective The objective was to examine levels of, correlates of and changes in the use of individual and grouped methods of contraception among US females aged 15–44 from 2008 to 2014. Study design Using three rounds of the National Survey of Family Growth, we analyzed samples of 12,279 (2008), 5601 (2012) and 5699 (2014) females. We conducted simple and multivariable logistic regression analyses to identify associations between demographic characteristics and contraceptive use, as well as between characteristics and changes in use patterns. Results In terms of overall trends in contraceptive use between 2008 and 2014, there was no significant change in the proportion of women who used a method among either all women (60%) or those at risk of unintended pregnancy (90%). Significant changes in use occurred among six methods. The largest increase in use was among users of long-acting reversible contraceptive (LARC) methods, including the intrauterine device and implant — from 6% to 14% — across almost all population groups of female contraceptive users, while the largest decrease occurred among users of sterilization — from 37% to 28% — with lower-income women driving the decline in female sterilization and higher-income women driving the decline in a partner’s sterilization as a primary method. Moderate increases were seen in the use of withdrawal and natural family planning. Conclusion Most shifts in recent contraceptive use have occurred among the most effective methods — sterilization and LARCs. Differences in method-specific user characteristics underscore the importance of ensuring full access to the broad range of methods available. Implications The lack of change in the overall use of contraceptives among women at risk for unintended pregnancy may have implications for the extent to which further declines in national rates of unintended pregnancy can be expected.
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Affiliation(s)
- Megan L Kavanaugh
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038.
| | - Jenna Jerman
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038
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Gomez AM, Wapman M. Under (implicit) pressure: young Black and Latina women's perceptions of contraceptive care. Contraception 2017; 96:221-226. [DOI: 10.1016/j.contraception.2017.07.007] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 11/25/2022]
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Associations Between Perceived Race-based Discrimination and Contraceptive Use Among Women Veterans in the ECUUN Study. Med Care 2017; 55 Suppl 9 Suppl 2:S43-S49. [PMID: 28806365 DOI: 10.1097/mlr.0000000000000746] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe perceived race-based discrimination in Veterans Affairs (VA) health care settings and assess its associations with contraceptive use among a sample of women Veterans. METHODOLOGY This study used data from a national telephone survey of women Veterans aged 18-44 receiving health care in VA who were at risk of unintended pregnancy. Participants were asked about their perceptions of race-based discrimination while seeking VA health care and about their contraceptive use at last heterosexual intercourse. Logistic and multinomial regression analyses were used to examine associations between perceived race-based discrimination with use of prescription contraception. RESULTS In our sample of 1341 women Veterans, 7.9% report perceived race-based discrimination when receiving VA care, with blacks and Hispanics reporting higher levels of perceived discrimination than white women (11.3% and 11.2% vs. 4.4%; P<0.001). In logistic and multinomial regression analyses adjusting for race/ethnicity, age, income, marital status, parity, and insurance, women who perceived race-based discrimination were less likely to use any prescription birth control than women who did not (odds ratio, 0.65; 95% confidence interval, 0.42-1.00), with the largest difference seen in rates of intrauterine device or implant use (odds ratio, 0.40; 95% confidence interval, 0.20-0.79). CONCLUSIONS In this national sample of women Veterans, over 10% of racial/ethnic minority women perceived race-based discrimination when receiving care in VA settings, and perceived racial/ethnic discrimination was associated with lower likelihood of prescription contraception use, especially intrauterine devices and implants. VA efforts to enhance respectful interactions may not only improve patient health care experiences, but also represent an opportunity to improve reproductive health outcomes for women Veterans.
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Gomez AM, Mann ES, Torres V. ‘It would have control over me instead of me having control’: intrauterine devices and the meaning of reproductive freedom. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1343935] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Emily S. Mann
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Vanessa Torres
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
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Morse JE, Ramesh S, Jackson A. Reassessing Unintended Pregnancy: Toward a Patient-centered Approach to Family Planning. Obstet Gynecol Clin North Am 2017; 44:27-40. [PMID: 28160891 DOI: 10.1016/j.ogc.2016.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Underserved women, especially those with low incomes and from racial and ethnic minorities, experience a disproportionate share of unintended pregnancies in the United States. Although unintended pregnancy rates are general markers of women's health and status, they may not accurately capture women's experiences of these pregnancies or their social circumstances. A patient-centered approach to family planning optimizes women's reproductive preferences, is cognizant of historical harms and current disparities, and may more comprehensively address the issue of unintended pregnancy. Clinicians, researchers, and policy makers can all adopt a patient-centered approach to help underserved women regain their reproductive autonomy.
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Affiliation(s)
- Jessica E Morse
- Family Planning Division, Department of Obstetrics & Gynecology, University of North Carolina, 101 Manning Drive, Campus Box #7570, Chapel Hill, NC 27514, USA.
| | - Shanthi Ramesh
- Family Planning Division, Department of Obstetrics & Gynecology, University of North Carolina, 101 Manning Drive, Campus Box #7570, Chapel Hill, NC 27514, USA
| | - Andrea Jackson
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 2356 Sutter Street, 5th Floor, San Francisco, CA 94143, USA
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Fazeli Dehkordy S, Hall KS, Dalton VK, Carlos RC. The Link Between Everyday Discrimination, Healthcare Utilization, and Health Status Among a National Sample of Women. J Womens Health (Larchmt) 2016; 25:1044-1051. [PMID: 27429363 DOI: 10.1089/jwh.2015.5522] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research has not adequately examined the potential negative effects of perceiving routine discrimination on general healthcare utilization or health status, especially among reproductive-aged women. We sought to evaluate the association between everyday discrimination, health service use, and perceived health among a national sample of women in the United States. MATERIALS AND METHODS Data were drawn from the Women's Healthcare Experiences and Preferences survey, a randomly selected, national probability sample of 1078 U.S. women aged 18-55 years. We examined associations between everyday discrimination (via a standardized scale) on frequency of health service utilization and perceived general health status using chi-square and multivariable logistic regression modeling. RESULTS Compared with women who reported healthcare visits every 3 years or less (reference group), each one-point increase in discrimination score was associated with higher odds of having healthcare visits annually or more often (odds ratio [OR] = 1.36, confidence interval [95% CI] = 1.01-1.83). Additionally, each one-point increase in discrimination score was significantly associated with lower odds of having excellent/very good perceived health (OR = 0.65; 95% CI = 0.54-0.80). CONCLUSION Perceived discrimination was associated with increased exposure to the healthcare setting among this national sample of women. Perceived discrimination was also inversely associated with excellent/very good perceived health status.
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Affiliation(s)
- Soudabeh Fazeli Dehkordy
- 1 Department of Radiology, University of Michigan School of Medicine , Ann Arbor, Michigan.,2 Department of Graduate Medical Education, St. John Providence Hospital , Southfield, Michigan
| | - Kelli S Hall
- 3 Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - Vanessa K Dalton
- 4 Department of Obstetrics and Gynecology, University of Michigan School of Medicine , Ann Arbor, Michigan.,5 University of Michigan Institute for Healthcare Policy and Innovation , Ann Arbor, Michigan
| | - Ruth C Carlos
- 1 Department of Radiology, University of Michigan School of Medicine , Ann Arbor, Michigan.,5 University of Michigan Institute for Healthcare Policy and Innovation , Ann Arbor, Michigan.,6 University of Michigan Program for Imaging Comparative Effectiveness and Health Services Research , Ann Arbor, Michigan
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Manze MG, McCloskey L, Bokhour BG, Paasche-Orlow MK, Parker VA. The perceived role of clinicians in pregnancy prevention among young Black women. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 8:19-24. [PMID: 27179373 DOI: 10.1016/j.srhc.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/14/2015] [Accepted: 01/31/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study is to identify young Black women's attitudes toward clinicians and understand how they affect contraceptive behavior. STUDY DESIGN AND MAIN OUTCOME MEASURES We conducted semi-structured qualitative interviews with women aged 18-23 who self-identified as Black or African-American and analyzed data using techniques informed by grounded theory. Initial codes were grouped thematically, and these themes into larger concepts. RESULTS Participants discussed two salient concepts related to pregnancy prevention: (1) sexual responsibility and self-efficacy and (2) the perceived limited role of health care clinicians. Women portrayed themselves as in control of their contraceptive decision-making and practices. Many viewed their life plan, to finish school and gain financial stability, as crucial to their resolve to use contraception. Participants gathered information from various sources to make their own independent decision about which method, if any, was most appropriate for their needs. Most had limited expectations of clinicians and considered in-depth conversations about details of contraceptive use to be irrelevant and unnecessary. CONCLUSION These findings help understand factors contributing to contraceptive decision-making. The patient-clinician interaction is a necessary focus of future research to improve sexual health discussions and understand if and what aspects of this interaction can influence behavior.
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Affiliation(s)
- Meredith G Manze
- CUNY Graduate School of Public Health & Health Policy, New York, NY, USA.
| | - Lois McCloskey
- Boston University School of Public Health, Boston, MA, USA
| | - Barbara G Bokhour
- Boston University School of Public Health, Boston, MA, USA; Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, Bedford, MA, USA
| | - Michael K Paasche-Orlow
- Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Racial and ethnic differences in women's preferences for features of contraceptive methods. Contraception 2016; 93:406-11. [DOI: 10.1016/j.contraception.2015.12.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022]
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Reid AE, Rosenthal L, Earnshaw VA, Lewis TT, Lewis JB, Stasko EC, Tobin JN, Ickovics JR. Discrimination and excessive weight gain during pregnancy among Black and Latina young women. Soc Sci Med 2016; 156:134-41. [PMID: 27038321 DOI: 10.1016/j.socscimed.2016.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 02/26/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
RATIONALE Excessive weight gain during pregnancy is a major determinant of later life obesity among both Black and Latina women and their offspring. However, psychosocial determinants of this risk, including everyday discrimination, and potential moderators of such effects remain unexplored. OBJECTIVE We examined the influence of discrimination, a culturally relevant stressor, on odds of gaining weight beyond Institute of Medicine recommendations during pregnancy. Whether the effect was moderated by race/ethnicity, age, or depressive symptoms was also examined. METHOD Participants were 413 Black and Latina pregnant young women, ages 14-21 years. Experience with discrimination and all moderators were assessed in the second trimester. Last weight recorded in the third trimester was abstracted from medical records and used to determine excessive weight gain. RESULTS Ever experiencing discrimination was associated with a 71% increase in the odds of excessive weight gain. The effect of discrimination was primarily present among women who attributed this treatment to membership in a historically oppressed group (e.g., ethnic minority, female) or to membership in other stigmatized groups (e.g., overweight). The effect of ever experiencing discrimination was not moderated by race/ethnicity or age but was moderated by depressive symptoms. Supporting the perspective of the environmental affordances model, discrimination strongly predicted excessive weight gain when women were low in depressive symptoms but had no effect when women were high in depressive symptoms. The moderating role of depressive symptoms was equivalent for Black and Latina women. CONCLUSION Results highlight the role of discrimination in perpetuating weight-related health disparities and suggest opportunities for improving health outcomes among young pregnant women.
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Affiliation(s)
- Allecia E Reid
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States; Colby College, Psychology Department, United States.
| | - Lisa Rosenthal
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States; Pace University, Psychology Department, United States
| | - Valerie A Earnshaw
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States; Harvard Medical School, Department of Pediatrics, United States; Boston Children's Hospital, Department of Medicine, United States
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, United States
| | - Jessica B Lewis
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States
| | - Emily C Stasko
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States
| | | | - Jeannette R Ickovics
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States
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Sufrin C, Oxnard T, Goldenson J, Simonson K, Jackson A. Long-Acting Reversible Contraceptives for Incarcerated Women: Feasibility and Safety of On-Site Provision. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2015; 47:203-211. [PMID: 26484795 DOI: 10.1363/47e5915] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 06/05/2023]
Abstract
CONTEXT Many incarcerated women have an unmet need for contraception. Providing access to long-acting reversible contraceptive (LARC) methods--IUDs and implants--before release is one strategy to meet this need and potentially prepare them for reentry to the community, but the safety and feasibility of providing these methods in this setting have not been described. METHODS A retrospective descriptive study of all LARC insertions at the San Francisco County Jail in 2009-2014 was conducted. Data from community clinic and jail clinic databases were assessed to examine baseline characteristics of LARC initiators, complications from insertion, method continuation, and pregnancy and reincarceration rates. Correlates of method discontinuation were assessed in multivariate logistic regression analyses. RESULTS Eighty-seven LARC devices were inserted during the study period--53 IUDs and 34 implants. There were no cases of pelvic inflammatory disease or other insertion complications in IUD users and no serious complications in implant users. Median duration of known use was 11.4 months for IUDs and 12.9 months for implants. Women who discontinued a LARC method most commonly cited a desire to get pregnant (32%). Black women were more likely than whites to discontinue use (odds ratio, 4.4). CONCLUSIONS It is safe and feasible to provide LARC methods to incarcerated women. Correctional facilities should consider increasing access to all available contraceptives, including LARC methods, in a noncoercive manner as a strategy to reduce reproductive health disparities among marginalized women at high risk of unplanned pregnancies.
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Affiliation(s)
- Carolyn Sufrin
- Assistant professor, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore.
| | - Tianyi Oxnard
- Student at the School of Medicine, University of California, San Francisco
| | - Joe Goldenson
- Director, Jail Health Services, San Francisco Department of Public Health
| | - Kristin Simonson
- Assistant director of program management, Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Andrea Jackson
- Assistant professor, Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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Stacey RE, Dempsey A. The influence of trust in health care systems on postabortion contraceptive choice. Contraception 2015. [DOI: 10.1016/j.contraception.2015.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stevens LM. Planning parenthood: Health care providers' perspectives on pregnancy intention, readiness, and family planning. Soc Sci Med 2015; 139:44-52. [DOI: 10.1016/j.socscimed.2015.06.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 06/17/2015] [Accepted: 06/24/2015] [Indexed: 11/28/2022]
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Addressing reproductive health disparities as a healthcare management priority: pursuing equity in the era of the Affordable Care Act. Curr Opin Obstet Gynecol 2015; 26:531-8. [PMID: 25379769 DOI: 10.1097/gco.0000000000000119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize the newest available evidence on maternal and reproductive health disparities, and to describe elements of the Affordable Care Act most likely to impact these disparities. RECENT FINDINGS Significant racial and ethnic disparities in maternal and reproductive health outcomes have persisted in recent years, contributing to poor outcomes and increasing costs. Pregnancy-related mortality ratios are up to three times higher in Black women compared with non-Hispanic White women, with the risk of severe maternal morbidity also significantly higher in Black and Hispanic women. Unintended pregnancy is twice as likely in minority women. Insurance status, socioeconomic status, and broader social determinants of health are implicated in these disparities. Coverage changes associated with the Affordable Care Act may provide some opportunities to reach communities most at risk. Delivery innovation, payment reform, and further public financing of key services are examples of further management approaches that can be used to address reproductive health disparities. SUMMARY The Affordable Care Act offers important opportunities to address persistent reproductive health disparities, but significant gaps remain. Efforts must be made to reduce the negative outcomes and high financial and human costs associated with disparities in reproductive health.
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