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Shahawy S, Onwuzurike C, Premkumar A, Henricks AA, Simon MA. Perspectives of women of refugee background on healthcare needs in a major urban metropolitan community in the US: A qualitative needs assessment. Health Soc Care Community 2022; 30:e5637-e5646. [PMID: 36111793 DOI: 10.1111/hsc.13989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/15/2022] [Accepted: 08/13/2022] [Indexed: 06/02/2023]
Abstract
The objective of this study was to describe the healthcare needs and experiences of women of refugee background in Chicago-home to one of the largest and most diverse refugee populations in the United States. We used a phenomenological study design with a desire-centered rather than damage-centered approach to conduct a series of focus group discussions with 24 women of refugee background in their native languages in Chicago, Illinois between December 2018 and February 2019. Convenience sampling was used to recruit women of refugee background at least 18 years of age living in the Chicago metropolitan area who attended educational women's health workshops at local refugee community centers. An inductive approach to the analysis was used to code transcripts and generate themes. Our study identified four major healthcare priorities for women of refugee background in a major metropolitan area: (1) central and centralised healthcare, (2) continuity of care, (3) trauma-informed care and (4) community engagement and partnerships. The healthcare priorities identified by the participants in this study should inform existing and future healthcare models and clinics providing care for women of refugee background in urban and sub-urban contexts across the United States.
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Affiliation(s)
- Sarrah Shahawy
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachusetts, USA
| | - Chiamaka Onwuzurike
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashish Premkumar
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
- Department of Anthropology, The Graduate School, Northwestern University, Evanston, Illinois, USA
| | - Andrea A Henricks
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics & Gynecology, University of North Carolina, Raleigh, North Carolina, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine (IPHAM) - Center for Health Equity Transformation, Chicago, Illinois, USA
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Fay KE, Onwuzurike C, Finley A, Miller E. Integrating anti-violence efforts into sexual and reproductive health: reproductive coercion as a case example. Contraception 2022; 115:75-79. [PMID: 35716807 DOI: 10.1016/j.contraception.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/31/2022] [Accepted: 06/05/2022] [Indexed: 11/03/2022]
Abstract
Integration of anti-oppression approaches into clinical practice, including sexual and reproductive health, is needed. Reproductive coercion is a common form of violence that directly impacts sexual and reproductive health. Person-centered harm reduction strategies for reproductive coercion can be integrated readily into routine care utilizing clinicians' existing skill set. Interventions for reproductive coercion may serve as a proof of concept for the incorporation of anti-violence and healing justice efforts within medical care.
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Affiliation(s)
- Kathryn E Fay
- Harvard Medical School, Department of Obstetrics, Gynecology and Reproductive Biology, Boston, MA, USA.
| | - Chiamaka Onwuzurike
- Harvard Medical School, Department of Obstetrics, Gynecology and Reproductive Biology, Boston, MA, USA
| | | | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
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Fulcher IR, Onwuzurike C, Goldberg AB, Cottrill AA, Fortin J, Janiak E. The impact of the COVID-19 pandemic on abortion care utilization and disparities by age. Am J Obstet Gynecol 2022; 226:819.e1-819.e15. [PMID: 35114184 PMCID: PMC8802456 DOI: 10.1016/j.ajog.2022.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/08/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
Background A variety of state-level restrictions were placed on abortion care in response to the COVID-19 pandemic, leading to drops in utilization and delays in time to abortion. Other pandemic-related factors also may have impacted receipt of abortion care, potentially exacerbating existing barriers to care. Massachusetts is an ideal setting to study the impact of these other pandemic-related factors on abortion care utilization because there was no wide-scale abortion policy change in response to the pandemic. Objective This study aimed to evaluate the impact of the COVID-19 pandemic on abortion care utilization and disparities in utilization by patient age in Massachusetts. Study Design Using the electronic medical records from all abortions that occurred at the Planned Parenthood League of Massachusetts from May 1, 2017 through December 31, 2020 (N=35,411), we performed time series modeling to estimate monthly changes in the number of abortions from the expected counts during the COVID-19 pandemic. We also assessed if legal minors (<18 years) experienced delays in time to abortion, based on gestational age at procedure, and whether minors were differentially impacted by the pandemic. Results There were 1725 less abortions than expected, corresponding to a 20% drop, from March 2020 to December 2020 (95% prediction interval, −2025 to −1394) with 888 less (20% reduction) abortions among adults, 792 (20% reduction) less among young adults, and 45 (27% reduction) among minors. Adults and young adults experienced significant reductions in the number of abortions beginning in March 2020, whereas decreases among minors did not begin until July 2020. The rate of abortions occurring ≥12 weeks gestational age was unchanged during the COVID-19 pandemic among minors (adjusted rate ratio, 0.92; 95% confidence interval, 0.55–1.51) and among adults (adjusted rate ratio, 0.92; 95% confidence interval, 0.78–1.09). Young adults had a lower rate of second trimester abortion during the pandemic (adjusted rate ratio, 0.79; 95% confidence interval, 0.66–0.95). Conclusion Despite uninterrupted abortion service provision, abortion care utilization decreased markedly in Massachusetts during the pandemic. There was no evidence of an increase in second trimester abortions in any age group. Further research is needed to determine if a decline in the pregnancy rate or other factors, such as financial and travel barriers, fear of infection, or privacy concerns, may have contributed to this decline.
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Affiliation(s)
- Isabel R Fulcher
- Harvard Data Science Initiative, Cambridge, MA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA.
| | - Chiamaka Onwuzurike
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Alisa B Goldberg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA; Planned Parenthood League of Massachusetts, Boston, MA
| | - Alischer A Cottrill
- Planned Parenthood League of Massachusetts, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Elizabeth Janiak
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA; Planned Parenthood League of Massachusetts, Boston, MA
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Wilkinson B, Onwuzurike C, Bartz D. Restrictive State Abortion Bans - A Reproductive Injustice. N Engl J Med 2022; 386:1197-1199. [PMID: 35333482 DOI: 10.1056/nejmp2119364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Barbara Wilkinson
- From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School - both in Boston
| | - Chiamaka Onwuzurike
- From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School - both in Boston
| | - Deborah Bartz
- From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School - both in Boston
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Onwuzurike C, Ungaretti J, Cejtin HE. A County Hospital Experience with Reproductive Travelers to the United States for Obstetric Care: Maternal and Neonatal Outcomes. J Womens Health (Larchmt) 2021; 31:864-869. [PMID: 34491116 DOI: 10.1089/jwh.2021.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To describe the maternal and neonatal outcomes, health care utilization, and cost to reproductive travelers for obstetric care (RTOC) at a single institution. Methods: A retrospective chart review was conducted of women identified as reproductive travelers who delivered at Stroger Hospital in Chicago, IL when a self-pay package of obstetrical services was offered. Data included maternal characteristics and obstetric and neonatal outcomes. Results: A total of 413 reproductive travelers delivered during the study period. The majority (88%) was of Nigerian citizenship. The median gestational age at first prenatal visit was 35 weeks with a median of three prenatal visits. The patients were in good health with a high prevalence of infectious disease and a low prevalence of chronic disease. Women had complex obstetric histories, and 28.6% had cesarean delivery, with the most common indication being prior uterine surgery. Severe maternal morbidity occurred in 4.1% of the women and admission to the neonatal intensive care unit (NICU) in 16.3% of the babies. Extra charges beyond those covered by the financial package were incurred by 230 (55.7%) of the women. Conclusion: Reproductive travelers have better obstetric outcomes and fewer NICU admissions than non-travelers who delivered at the same institution. However, the care of RTOC in this manner is fraught with challenges, including late presentation for care, lack of medical records, providers at times managing unfamiliar conditions, and unforeseen financial obligations assumed by patients.
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Affiliation(s)
- Chiamaka Onwuzurike
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joy Ungaretti
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Obstetrics and Gynecology, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Helen E Cejtin
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Obstetrics and Gynecology, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
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Onwuzurike C, Diouf K, Meadows AR, Nour NM. Racial and ethnic disparities in severity of COVID-19 disease in pregnancy in the United States. Int J Gynaecol Obstet 2020; 151:293-295. [PMID: 32735741 PMCID: PMC9087767 DOI: 10.1002/ijgo.13333] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
Racial and ethnic disparities in the severity of COVID‐19 in pregnant women in the United States reflect the health consequences of the structural effects of racism.
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Affiliation(s)
- Chiamaka Onwuzurike
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Khady Diouf
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Audra R Meadows
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Nawal M Nour
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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