1
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Cook EL. Possible Individual-, System-, and Policy-Level Contributors to Teen Pregnancy and Risk of Premature Mortality. JAMA Netw Open 2024; 7:e241815. [PMID: 38483394 DOI: 10.1001/jamanetworkopen.2024.1815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Affiliation(s)
- Elizabeth L Cook
- Sexual and Reproductive Health Research Area, Child Trends, Rockville, Maryland
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2
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Hollenberger JC, Madden EE. The practice of pregnancy options counseling in social service and healthcare settings in the United States: a systematic literature review. SOCIAL WORK IN HEALTH CARE 2024; 63:285-310. [PMID: 38288975 DOI: 10.1080/00981389.2024.2304016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/05/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION The purpose of this systematic literature was to summarize the literature on pregnancy options counseling for women and patients who experience an unintended pregnancy across healthcare and social service settings. METHODS We conducted a systematic literature review using the PRISMA Checklist. Following the literature search of 8 electronic databases, we used a three-stage search process to screen articles for inclusion. RESULTS A total of 20 peer-reviewed articles met the inclusion criteria for this study. Half (n = 10) of the articles reviewed were empirical studies utilizing quantitative or qualitative methodology while the other half (n = 10) were conceptual or non-empirical. The articles affirmed a shared definition of pregnancy options counseling, but terminology differences were noted over time. Lastly, variations of intervention practices appeared across practice settings, with referral practice variations being the most notable. CONCLUSION Pregnancy options counseling practices varied across settings, suggesting patients who received this intervention may not have accessed equitable or ethical care.
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Affiliation(s)
| | - Elissa E Madden
- Diana R. Garland School of Social Work, Baylor University, Waco, TX, USA
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3
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Kirkpatrick L, Goldman P, Bell LA, Tyler CP, Harrison E, Russell M, Syed T, Szoko N, Kazmerski TM. Structured Engagement of Community Partners to Revise a Pregnancy Options Counseling Curriculum for Pediatric Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231190476. [PMID: 37528948 PMCID: PMC10388627 DOI: 10.1177/23821205231190476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/05/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE The engagement of community partners, including patients, is increasingly recognized as important in developing medical education curricula. Structured methodology for partner engagement in curriculum development is lacking in the existing literature. This article describes a structured approach to engaging community partners to provide input on revising a curriculum for pediatric residents about pregnancy options counseling with adolescents. METHODS We used the five-step Method for Program Adaptation through Community Engagement: (1) development of a panel of community partners including patients and professionals, (2) and (3) partner evaluation of the existing curriculum and recommendations for revisions, (4) summarization of partner feedback, and (5) development of the revised curriculum. We surveyed partners about their perceived impact on the revision and satisfaction with the process. RESULTS Seventeen partners participated. Five experienced adolescent pregnancy, while the remaining 12 included healthcare and social service professionals. All partners provided multiple recommendations, generating 124 discrete recommendations. Twenty recommendations were suggested by multiple individuals. The authors reviewed all recommendations by category during consensus meetings and determined which recommendations would be incorporated into the revised curriculum to meet stated learning objectives. We implemented 14 of these 20 recommendations, including adding a values clarification exercise, information about mental health crisis resources, and more detail about adoption. We also incorporated 15 individual recommendations pertaining to curriculum clarity. Recommendations from professionals and patients were similar. Fourteen out of 17 participants completed the survey at the close of the project. All respondents understood their roles, were satisfied with their degree of engagement, and felt that their expectations for participation were met or exceeded. CONCLUSIONS This study describes a methodology for a formal process to engage community partners in curriculum development and revision processes. Such methodology can ensure that medical education curricula are optimally attuned to the needs of key community members and integrate the patient's voice.
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Affiliation(s)
- Laura Kirkpatrick
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Paula Goldman
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Arnold Bell
- Department of Pediatrics, Riley Children's Hospital, 705 Riley Hospital Drive, Indianapolis, IN, USA
| | | | - Elizabeth Harrison
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Margaret Russell
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Tahniat Syed
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Nicholas Szoko
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Traci M Kazmerski
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Center for Innovative Research on Gender Health Equity, Pittsburgh, PA, USA
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4
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Abstract
Although teenage pregnancy rates have decreased over the past 30 years, many adolescents become pregnant every year. It is important for pediatricians to have the ability and the resources to make a timely pregnancy diagnosis in their adolescent patients and provide them with nonjudgmental counseling that includes the full range of pregnancy options. Counseling includes an unbiased discussion of the adolescent's options to continue or terminate the pregnancy, supporting the adolescent in the decision-making process, and referring the adolescent to appropriate resources and services. It is important for pediatricians to be familiar with laws and policies impacting access to abortion care, especially for minor adolescents, as well as laws that seek to limit health care professionals' provision of unbiased pregnancy options counseling and referrals, either for abortion care or continuation of pregnancy in accordance with the adolescent's choice. Pediatricians who choose not to provide such discussions should promptly refer pregnant adolescent patients to a health care professional who will offer developmentally appropriate pregnancy options counseling that includes the full range of pregnancy options. Pediatricians should be aware of and oppose policies that restrict their ability to provide pregnant adolescents with unbiased counseling that includes the full range of pregnancy options. This approach to pregnancy options counseling has not changed since the original 1989 American Academy of Pediatrics statement on this issue.
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Krass P, Tam V, Min J, Joslin I, Khabie L, Wilkinson TA, Wood SM. Adolescent Access to Federally Funded Clinics Providing Confidential Family Planning Following Changes to Title X Funding Regulations. JAMA Netw Open 2022; 5:e2217488. [PMID: 35713904 PMCID: PMC9206194 DOI: 10.1001/jamanetworkopen.2022.17488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE In May 2019, new federal regulations regarding Title X funding were introduced. There has been no formal evaluation of the impact of this regulatory shift as it pertains to minors' access to services. OBJECTIVE To explore the geography of federally funded clinics providing confidential reproductive care to adolescents following changes to Title X funding regulations. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study used a population-based sample of US Census tracts. All clinics participating in the Title X program in August 2018 and August 2020 were included in the analysis. Data were analyzed from January to December 2021. EXPOSURES Period, defined as before and after the 2019 Title X rule change (August 2018 and August 2020, respectively). MAIN OUTCOMES AND MEASURES US Census tracts were evaluated for the availability of confidential family planning care within a 30-minute drive, according to the presence of a Title X clinic or a permissive state law. Census tracts in which minors lost access to confidential care after the rule change were characterized in terms of demographic characteristics. Univariate logistic regression evaluated associations between Census tract characteristics and the odds of losing vs maintaining access to legally protected confidential minor services. RESULTS The study included 72 620 Census tracts, accounting for approximately 324 697 728 US residents (99.96% of the population). After the Title X rule change, 1743 clinics in the Title X program left (39.0%) and minors living in 6299 Census tracts (8.7%) lost access to confidential family planning care, corresponding to an estimated 933 649 youth aged 15 to 17 years. Minors living in rural Census tracts (odds ratio [OR], 1.27; 95% CI, 1.18-1.36) and those in the Midwest (OR, 2.41; 95% CI, 2.24-2.60) had higher odds of losing access to care. Minors living in Census tracts with a higher Social Vulnerability Index (OR, 0.51; 95% CI, 0.47-0.55), a larger proportion of Black individuals (OR, 0.34; 95% CI, 0.31-0.37), and/or a larger proportion of Hispanic individuals (OR, 0.45; 95% CI, 0.42-0.49) were less likely to lose access to care. CONCLUSIONS AND RELEVANCE These findings suggest that there were losses in access to legally protected confidential reproductive health services for youth after the 2019 Title X rule change. Although evidence-based Title X guidelines have since been reinstated, state laws that ensure adolescent confidentiality in obtaining family planning services may protect youth from future alterations to the Title X program.
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Affiliation(s)
- Polina Krass
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia
- PolicyLab and the Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Vicky Tam
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jungwon Min
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Isabella Joslin
- Pediatric Residency Program, Yale University School of Medicine, New Haven, Connecticut
| | - Lily Khabie
- School of Arts and Sciences, University of Pennsylvania, Philadelphia
| | - Tracey A. Wilkinson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Sarah M. Wood
- PolicyLab and the Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Bull MJ, Trotter T, Santoro SL, Christensen C, Grout RW, Burke LW, Berry SA, Geleske TA, Holm I, Hopkin RJ, Introne WJ, Lyons MJ, Monteil DC, Scheuerle A, Stoler JM, Vergano SA, Chen E, Hamid R, Downs SM, Grout RW, Cunniff C, Parisi MA, Ralston SJ, Scott JA, Shapira SK, Spire P. Health Supervision for Children and Adolescents With Down Syndrome. Pediatrics 2022; 149:e2022057010. [PMID: 35490285 DOI: 10.1542/peds.2022-057010] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Marilyn J Bull
- Department of Pediatrics, Division of Developmental Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Tracy Trotter
- Department of Pediatrics, Division of Developmental Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | | | - Celanie Christensen
- Department of Pediatrics, Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Randall W Grout
- Division of Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Abstract
Teen pregnancy and parenting remain important public health issues in the United States and around the world. A significant proportion of teen parents reside with their families of origin, which may positively or negatively affect the family structure. Teen parents, defined as those 15 to 19 years of age, are at high risk for repeat births. Pediatricians can play an important role in the care of adolescent parents and their children. This clinical report updates a previous report on the care of adolescent parents and their children and addresses clinical management specific to this population, including updates on breastfeeding, prenatal management, and adjustments to parenthood. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.
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Affiliation(s)
- Makia E Powers
- Children's Healthcare of Atlanta and Morehouse School of Medicine, Atlanta, Georgia; and
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Cappiello JD, Boardman MB. Did I learn enough to practice? Reflections of new nurse practitioner graduates in providing sexual and reproductive health care. J Am Assoc Nurse Pract 2021; 34:109-118. [PMID: 34978543 DOI: 10.1097/jxx.0000000000000552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/06/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Centers for Disease Control and Prevention and the US Office of Population Health have published guidelines for providing family planning services. PURPOSE The study explores how nurse practitioners (NPs) perceived their preparation and competency in providing a range of sexual and reproductive health care in their first two years of community-based practice. METHODOLOGICAL ORIENTATION Qualitative. Thematic analysis used to analyze data from structured and open-ended interview questions. SAMPLE Through snowballing recruitment, 35 NPs participated in interviews. CONCLUSIONS Participants were most confident and likely to provide contraceptive and sexually transmitted infection services. Participants felt less prepared to provide male sexual health and care to the lesbian, gay, bisexual, transgender, queer, and intersex+ population. Nurse practitioners expressed interest in building skills with discussing healthy sexuality across the life span, specifically postmenopausal sexual concerns, teen sexuality, trauma-informed care related to sexual violence, and early pregnancy decision making. Some participants had little preparation in early pregnancy decision making/options counseling. Faculty need to examine barriers to teaching these skills because the curriculum should address all legal pregnancy options, including discussing the NP's professional obligations. More preparation was needed in the clinical management of erectile dysfunction, polycystic ovary syndrome, herpes, syphilis, abnormal uterine bleeding, dyspareunia, pelvic pain, miscarriage management, and how to discuss prostate cancer screening. IMPLICATIONS FOR PRACTICE The recommendations of the quality family planning, with additions, form a sound basis for sexual and reproductive health care standards, education, and clinical practice, should be part of NP education.
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Affiliation(s)
- Joyce D Cappiello
- Department of Nursing, University of New Hampshire, Durham, New Hampshire
| | - Maureen B Boardman
- Community and Family Medicine, Dartmouth, Geisel School of Medicine, Hanover, New Hampshire
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Oswalt SB, Eastman-Mueller HP, Baldwin A. Counseling college students after a positive pregnancy test: Trends in practice. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:227-231. [PMID: 31498756 DOI: 10.1080/07448481.2019.1657120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/22/2019] [Accepted: 08/11/2019] [Indexed: 06/10/2023]
Abstract
Objective: To provide an overview of college health centers' practices surrounding education, counseling and referral after a patient receives a positive pregnancy test. Participants: College health centers that participated in the annual ACHA Pap Test and STI Survey years 2008 to 2014. Methods: Descriptive analyses for items regarding all-options and limited counseling/education and types of referrals (adoption, abortion and prenatal care) provided to students. Chi-square statistics were calculated to examine trends over time and differences between demographic characteristics. Results: There were no significant differences across time but there were significant differences between regions of the US and if the institution was faith-based, though few had strong association values. Conclusions: The results indicate most college health centers are following best practices regarding counseling and education for a positive pregnancy test result. Understanding limitations for those institutions not in compliance require further exploration.
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Affiliation(s)
- Sara B Oswalt
- Department of Kinesiology, Health and Nutrition, One UTSA Circle, University of Texas at San Antonio, San Antonio, TX, USA
| | - Heather P Eastman-Mueller
- Department of Applied Health Science, Indiana University Bloomington, Bloomington, IN, USA
- University Health Center, Indiana University Bloomington, Bloomington, IN, USA
| | - Aleta Baldwin
- Department of Kinesiology, Health and Nutrition, One UTSA Circle, University of Texas at San Antonio, San Antonio, TX, USA
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10
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Ayerbe L, Pérez-Piñar M, Del Burgo CL, Burgueño E. Continuation of Unintended Pregnancy. LINACRE QUARTERLY 2019; 86:161-167. [PMID: 32431404 DOI: 10.1177/0024363919838368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Forty-four percent of all pregnancies worldwide are unintended. Induced abortion has drawn a lot of attention from clinicians and policy makers, and the care for women requesting it has been covered in many publications. However, abortion challenges the values of many women, is associated with negative emotions, and has its own medical complications. Women have the right to discuss their unintended pregnancy with a clinician and receive elaborate information about other options to deal with it. Continuing an unintended pregnancy, and receiving the necessary care and support for it, is also a reproductive right of women. However, the provision of medical information and support required for the continuation of an unintended pregnancy has hardly been approached in the medical literature. Objective This review presents a clinical approach to unintentionally pregnant patients and describes the information and support that can be offered for the continuation of the unintended pregnancy. Discussion Clinicians should approach patients with an unintended pregnancy with a sympathetic tone in order to provide the most support and present the most complete options. A complete clinical history can help frame the problem and identify concerns related to the pregnancy. Any underlying medical or obstetric problems can be discussed. A social history, that includes the personal support from the patient's partner, parents, and siblings, can be taken. Doctors should also be alert of possible cases of violence from the partner or child abuse in adolescent patients. Finally, the clinician can provide the first information regarding the social care available and refer the patients for further support. For women who continue an unintended pregnancy, clinicians should start antenatal care immediately. Conclusion Unintentionally pregnant women deserve a supportive and complete response from their clinicians, who should inform about, and sometimes activate, all the resources available for the continuation of unintended pregnancy. Summary Forty-four percent of all pregnancies worldwide are unintended. Induced abortion has drawn a lot of attention and the care for women requesting it has been covered in many publications. However, abortion challenges the values of many women, is associated with negative emotions, and has its own medical complications. Women have the right to discuss their unintended pregnancy with a clinician and receive elaborate information about other options to deal with it. Continuing an unintended pregnancy, and receiving the necessary care and support for it, is also a reproductive right of women. However, the provision of medical information and support required for the continuation of an unintended pregnancy has hardly been approached in the medical literature. This review presents a clinical approach to unintentionally pregnant patients and describes the information and support that can be offered for the continuation of the unintended pregnancy. Clinicians should approach patients with an unintended pregnancy with a sympathetic tone. A complete clinical history can help frame the problem and identify concerns related to the pregnancy. Any underlying medical or obstetric problems can be discussed. A social history, that includes the personal support from the patient's partner, parents, and siblings, can be taken. Doctors should also be alert of possible cases of violence from the partner or child abuse in adolescent patients. Finally, the clinician can provide the first information regarding the social care available and refer the patients for further support. For women who continue an unintended pregnancy, clinicians should start antenatal care immediately.
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Affiliation(s)
- Luis Ayerbe
- Strangeways Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,Carnarvon Medical Centre, Southend-on-Sea, United Kingdom
| | | | - Cristina López Del Burgo
- Department of Preventive Medicine and Public Health, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Eduardo Burgueño
- Department of Medicine, University of Mwene-Ditu, Mwene-Ditu, Democratic Republic of Congo
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11
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White K, Adams K, Hopkins K. Counseling and referrals for women with unplanned pregnancies at publicly funded family planning organizations in Texas. Contraception 2019; 99:48-51. [PMID: 30287246 PMCID: PMC6289663 DOI: 10.1016/j.contraception.2018.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/15/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To compare pregnancy options counseling and referral practices at state- and Title X-funded family planning organizations in Texas after enforcement of a policy restricting abortion referrals for providers participating in state-funded programs, which differed from Title X guidelines to provide referrals for services upon request. STUDY DESIGN Between November 2014 and February 2015, we conducted in-depth interviews with administrators at publicly funded family planning organizations in Texas about how they integrated primary care and family planning services, including pregnancy options counseling and referrals for unplanned pregnancies. We conducted a thematic analysis of transcripts related to organizations' pregnancy options counseling and referral practices, and compared themes across organizations that did and did not receive Title X funding. RESULTS Of the 37 organizations with transcript segments on options counseling and referrals, 15 received Title X and 22 relied on state funding only. All Title X-funded organizations but only nine state-funded organizations reported offering pregnancy options counseling. Respondents at state-only-funded organizations often described directing pregnant women exclusively to prenatal care. Regardless of funding source, most organizations provided women a list of agencies offering abortion, adoption and prenatal care. However, some respondents expressed concern that providing other information about abortion would threaten their state funding. In contrast, respondents indicated staff would make appointments for prenatal care, assist with Medicaid applications and, in some instances, directly connect women with adoption-related services. CONCLUSIONS Pregnancy options counseling varied by organizations' funding guidelines. Additionally, abortion referrals were less common than referrals for other pregnancy-related care. IMPLICATIONS Programmatic guidelines restricting information on abortion counseling and referrals may adversely affect care for pregnant women at publicly funded family planning organizations.
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Affiliation(s)
- Kari White
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1720 2(nd) Ave South RPHB 320, Birmingham, AL, 35294.
| | - Katelin Adams
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1720 2(nd) Ave South RPHB 320, Birmingham, AL, 35294
| | - Kristine Hopkins
- Population Research Center and the Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712
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12
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Janiak E, O’Donnell J, Holt K. Proposed Title X Regulatory Changes: Silencing Health Care Providers and Undermining Quality of Care. Womens Health Issues 2018; 28:477-479. [DOI: 10.1016/j.whi.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
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Berglas NF, Williams V, Mark K, Roberts SCM. Should prenatal care providers offer pregnancy options counseling? BMC Pregnancy Childbirth 2018; 18:384. [PMID: 30261849 PMCID: PMC6161325 DOI: 10.1186/s12884-018-2012-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Professional guidelines indicate that pregnancy options counseling should be offered to pregnant women, in particular those experiencing an unintended pregnancy. However, research on whether pregnancy options counseling would benefit women as they enter prenatal care is limited. This study examines which women might benefit from options counseling during early prenatal care and whether women are interested in receiving counseling from their prenatal care provider. METHODS At four prenatal care facilities in Louisiana and Maryland, women entering prenatal care completed a self-administered survey and brief structured interview (N = 586). Data were analyzed through descriptive statistics, bivariate analyses, multivariate multinomial logistic regression, and coding of open-ended responses. RESULTS At entry into prenatal care, most women reported that they planned to continue their pregnancy and raise the child. A subset (3%) scored as having low certainty about their decision on the validated Decision Conflict Scale, indicating need for counseling. In addition, 9% of women stated that they would be interested in discussing their pregnancy options with their prenatal care provider. Regression analyses indicated some sociodemographic differences among women who are in need of or interested in options counseling. Notably, women who reported food insecurity in the prior year were found to be significantly more likely to be in need of options counseling (RRR = 3.20, p < 0.001) and interested in options counseling (RRR = 5.48, p < 0.001) than those who were food secure. Most women were open to discussing with their provider if their pregnancy was planned (88%) or if they had considered abortion (81%). More than 95% stated they would be honest with their provider if asked about these topics. CONCLUSIONS Most women are certain of their decision to continue their pregnancy at the initiation of prenatal care. However, there is a subset of women who, despite entering prenatal care, are uncertain of their decision and wish to discuss their options with their health care provider. Screening tools and/or probing questions are needed to support prenatal care providers in identifying these women and ensuring unbiased, non-directive counseling on all pregnancy options.
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Affiliation(s)
- Nancy F. Berglas
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
| | - Valerie Williams
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center New Orleans, 1542 Tulane Avenue, Box T5-2, New Orleans, LA 70112 USA
| | - Katrina Mark
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201 USA
| | - Sarah C. M. Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
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14
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Marcell AV, Burstein GR, Braverman P, Adelman W, Alderman E, Breuner C, Hornberger L, Levine D. Sexual and Reproductive Health Care Services in the Pediatric Setting. Pediatrics 2017; 140:peds.2017-2858. [PMID: 29061870 DOI: 10.1542/peds.2017-2858] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians are an important source of health care for adolescents and young adults and can play a significant role in addressing their patients' sexual and reproductive health needs, including preventing unintended pregnancies and sexually transmitted infections (STIs), including HIV, and promoting healthy relationships. STIs, HIV, and unintended pregnancy are all preventable health outcomes with potentially serious permanent sequelae; the highest rates of STIs, HIV, and unintended pregnancy are reported among adolescents and young adults. Office visits present opportunities to provide comprehensive education and health care services to adolescents and young adults to prevent STIs, HIV, and unintended pregnancies. The American Academy of Pediatrics, other professional medical organizations, and the government have guidelines and recommendations regarding the provision of sexual and reproductive health information and services. However, despite these recommendations, recent studies have revealed that there is substantial room for improvement in actually delivering the recommended services. The purpose of this clinical report is to assist pediatricians to operationalize the provision of various aspects of sexual and reproductive health care into their practices and to provide guidance on overcoming barriers to providing this care routinely while maximizing opportunities for confidential health services delivery in their offices.
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Affiliation(s)
- Arik V. Marcell
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine and
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and
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15
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Hornberger LL, Breuner CC, Alderman EM, Garofalo R, Grubb LK, Powers ME, Upadhya KK, Wallace SB. Diagnosis of Pregnancy and Providing Options Counseling for the Adolescent Patient. Pediatrics 2017; 140:peds.2017-2273. [PMID: 28827383 DOI: 10.1542/peds.2017-2273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics policy statement "Options Counseling for the Pregnant Adolescent Patient" recommends the basic content of the pediatrician's counseling for an adolescent facing a new diagnosis of pregnancy. However, options counseling is just one aspect of what may be one of the more challenging scenarios in the pediatric office. Pediatricians must remain alert to the possibility of pregnancy among their adolescent female patients. When discovering symptoms suggestive of pregnancy, pediatricians must obtain a relevant history, perform diagnostic testing and properly interpret the results, and understand the significance of the results from the patient perspective and reveal them to the patient in a sensitive manner. If the patient is indeed pregnant, the pediatrician, in addition to providing comprehensive options counseling, may need to help recruit adult support for the patient and should offer continued assistance to the adolescent and her family after the office visit. All pediatricians should be aware of the legal aspects of adolescent reproductive care and the resources for pregnant adolescents in their communities. This clinical report presents a more comprehensive view of the evaluation and management of pregnancy in the adolescent patient and a context for options counseling.
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Affiliation(s)
| | - Cora C. Breuner
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Elizabeth M. Alderman
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Robert Garofalo
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Laura K. Grubb
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Makia E. Powers
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Krishna Kumari Upadhya
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Stephenie B. Wallace
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
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