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Kottke MJ, Aiyedipe SF, Goedken P, Lyles RH, McCool-Myers M. A 3-year Retrospective Review of Contraceptive Initiation, Continuation, Switching, and Pregnancy Among Adolescents and Young Adults. J Adolesc Health 2024; 74:794-800. [PMID: 38099900 PMCID: PMC10960688 DOI: 10.1016/j.jadohealth.2023.11.010] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/17/2023] [Accepted: 11/10/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE To understand contraceptive use patterns (initiation, switching, discontinuation) as well as associations with pregnancy in adolescents and young adults attending a teen family planning clinic. METHODS We performed a chart review of adolescent and young adult patients (ages 12-20) attending a teen family planning clinic in Atlanta, GA between January 1, 2017, and December 31, 2019. Using a standardized abstraction form with quality controls, we collected available data on contraceptive methods used and pregnancy test results during the 3-year period. We analyzed contraceptive use patterns descriptively. We calculated and compared pregnancy incidence according to different contraceptive switch patterns. RESULTS Our sample included 2,798 individuals who initiated 2,358 prescribed methods. The most commonly prescribed methods of contraception were the contraceptive injection (28.3%), etonogestrel implant (23.5%) and combined hormonal pill (23.2%). There were 599 discontinuations of prescribed methods; side effects like bleeding and headache were the most cited reasons for discontinuation. Most (75.8%) initiated a moderately or highly effective method after discontinuing a moderately or highly effective method. The incidence rate of pregnancy was highest for those who had discontinued an intrauterine device or implant and started a shorter-acting contraceptive method. DISCUSSION Employing patient-centered contraceptive counseling that incorporates contraceptive experiences in addition to facts and allows for exploration and change may be valuable for young people. Successful navigation of contraceptive switches may require additional attention, education, and strategy, which could include hypothetical problem solving, close follow-up, and telehealth or virtual care.
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Affiliation(s)
- Melissa J Kottke
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University School of Medicine, Atlanta, Georgia.
| | - Samuel F Aiyedipe
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Peggy Goedken
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University School of Medicine, Atlanta, Georgia
| | - Robert H Lyles
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Megan McCool-Myers
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University School of Medicine, Atlanta, Georgia
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Reeves JA, Goedken P, Hall KS, Lee SC, Cwiak CA. Southeastern US anesthesia providers' perspectives on abortion provision: inductive findings from a qualitative study. Contraception 2023:110058. [PMID: 37164148 DOI: 10.1016/j.contraception.2023.110058] [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] [Received: 05/14/2022] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Healthcare providers, including anesthesia providers, hold varied personal views on abortion, which influence their involvement in multidisciplinary abortion care. We aimed to explore Southeastern US anesthesia providers' perspectives on abortion provision and factors impacting their decision to provide anesthesia for hospital-based induced abortion. STUDY DESIGN We conducted in-depth, individual interviews with currently practicing anesthesia providers in the southeastern United States. We recruited participants from regional anesthesiology conferences and via snowball sampling. A semi-structured interview guide explored domains of obstetric experiences, standardized abortion cases, and personal abortion attitudes. We coded data iteratively and analyzed data thematically using inductive approaches with qualitative software. RESULTS Fifteen participants completed interviews, at which point thematic saturation occurred. Participants represented a range of provider type and prior abortion experience. Participants weighed 'personal and professional viewpoints' in considering their willingness to provide anesthesia care for hospital-based abortion. Many participants who personally disagreed with some abortion indications were still willing to provide anesthesia in those cases, some implicitly naming principles of medical ethics to justify differing professional and personal opinions. Participants also considered their 'role in abortion decision-making:' all participants reporting that the abortion decision belongs to the patient or their obstetrician and not the anesthesia provider. CONCLUSIONS Southeastern US anesthesia providers are influenced by multiple factors when considering their participation in hospital-based abortion care. Acknowledging differences in professional and personal viewpoints and identifying roles in abortion decision-making might be important to engaging anesthesia providers in abortion care, especially for high-risk medical or fetal indications. IMPLICATIONS This original, qualitative study identified several inductive themes that characterize how Southeastern US anesthesia providers formulate their level of participation in hospital-based abortion care. Acknowledging differences in professional and personal viewpoints and identifying roles in abortion decision-making might facilitate interdisciplinary abortion care, especially for high-risk medical or fetal indications.
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Affiliation(s)
- Jennifer A Reeves
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 550 Peachtree St NE, 8th floor, Atlanta, GA 30308 USA.
| | - Peggy Goedken
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 550 Peachtree St NE, 8th floor, Atlanta, GA 30308 USA.
| | - Kelli S Hall
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd. NE, Atlanta, GA 30322 USA
| | - Simon C Lee
- Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Rd. NE, Atlanta, GA, USA 30322.
| | - Carrie A Cwiak
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 550 Peachtree St NE, 8th floor, Atlanta, GA 30308 USA.
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Hartwig SA, Youm A, Contreras A, Mosley EA, McCloud C, Goedken P, Carroll E, Lathrop E, Cwiak C, Hall KS. "The right thing to do would be to provide care… and we can't": Provider experiences with Georgia's 22-week abortion ban. Contraception 2023:110059. [PMID: 37160176 DOI: 10.1016/j.contraception.2023.110059] [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] [Received: 06/28/2022] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE In 2015, the Georgia (US) legislature implemented a gestational limit, or "ban" on abortion at or beyond 22 weeks from last menstrual period. In this study, we qualitatively examined abortion provider perspectives of the ban's impact on abortion care access and provision. STUDY DESIGN Between May 2018 and September 2019, we conducted in-depth individual interviews with 20 abortion providers (clinicians, staff, administrators) from four clinics in Georgia. Interviews explored perceptions of and experiences with the ban and its effects on abortion care. Team members coded all transcripts to 100% agreement using an iterative, group consensus process, and conducted thematic analysis using inductive and deductive techniques. RESULTS Participants reported strict adherence to the ban, but also its negative consequences: additional labor plus service-delivery restrictions, legally constructed risks for providers, intrusion into the provider-patient relationship, and impact of limited services felt by patients and thus providers. Participants commonly mentioned disparities in the ban's impact and viewed the ban as disproportionately affecting people of color, those experiencing financial insecurity, and those with underlying medical conditions. Nonetheless, participants described clear, unrelenting commitment to providing quality patient-centered care, and dedication to and satisfaction in their work. CONCLUSIONS Georgia's ban operates as legislative interference, adversely affecting provision of quality, patient-centered abortion care, despite providers' resilience and commitment. These experiences in Georgia have timely and clear implications for the entire country following the Supreme Court's decision to overturn Roe v. Wade, thus reducing care access and increasing negative health and social consequences and inequities for patients and communities on a national scale. IMPLICATIONS STATEMENT Our findings from Georgia (US) indicate an urgent need for coordinated efforts to challenge the Dobbs v. Jackson Women's Health Organization decision and for proactive policies that protect access to later abortion care. Research that identifies strategies for supporting providers and patients faced with continuing restrictive legal environments is warranted.
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Affiliation(s)
- Sophie A Hartwig
- Center for Reproductive Health Research in the Southeast (RISE), 1518 Clifton Rd, Atlanta, GA 30322 USA; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA.
| | - Awa Youm
- Center for Reproductive Health Research in the Southeast (RISE), 1518 Clifton Rd, Atlanta, GA 30322 USA; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Alyssa Contreras
- Center for Reproductive Health Research in the Southeast (RISE), 1518 Clifton Rd, Atlanta, GA 30322 USA; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Elizabeth A Mosley
- Center for Reproductive Health Research in the Southeast (RISE), 1518 Clifton Rd, Atlanta, GA 30322 USA; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Candace McCloud
- Center for Reproductive Health Research in the Southeast (RISE), 1518 Clifton Rd, Atlanta, GA 30322 USA; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Peggy Goedken
- Emory University, School of Medicine, Department of Obstetrics and Gynecology, 201 Dowman Dr, Atlanta, GA 30307 USA
| | - Erin Carroll
- Center for Reproductive Health Research in the Southeast (RISE), 1518 Clifton Rd, Atlanta, GA 30322 USA; University of Alabama at Birmingham, Department of Health Care Organization and Policy, 1665 University Boulevard Birmingham, AL 35233 USA
| | - Eva Lathrop
- Center for Reproductive Health Research in the Southeast (RISE), 1518 Clifton Rd, Atlanta, GA 30322 USA; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA; Emory University, School of Medicine, Department of Obstetrics and Gynecology, 201 Dowman Dr, Atlanta, GA 30307 USA
| | - Carrie Cwiak
- Center for Reproductive Health Research in the Southeast (RISE), 1518 Clifton Rd, Atlanta, GA 30322 USA; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA; Emory University, School of Medicine, Department of Obstetrics and Gynecology, 201 Dowman Dr, Atlanta, GA 30307 USA
| | - Kelli Stidham Hall
- Center for Reproductive Health Research in the Southeast (RISE), 1518 Clifton Rd, Atlanta, GA 30322 USA; Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322 USA; Emory University, School of Medicine, Department of Obstetrics and Gynecology, 201 Dowman Dr, Atlanta, GA 30307 USA
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Verma N, Goedken P, Cwiak C, Kottke M. Perspectives on an Early Abortion Ban in a Restrictive US State: A Qualitative Exploration. Contraception 2023:110025. [PMID: 36948436 DOI: 10.1016/j.contraception.2023.110025] [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] [Received: 08/01/2022] [Revised: 02/07/2023] [Accepted: 03/15/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To gain a deeper understanding of perspectives on abortion and early abortion bans in a restrictive US state. STUDY DESIGN We conducted a qualitative study using semi-structured Zoom interviews with residents of the US state Georgia's 6th Congressional District. Potential participants first completed a screening tool to recruit people who held "middle-of-the-spectrum" views on abortion based on two abortion questions on a 5-point Likert scale. The interviews focused on participants' thoughts and feelings on abortion and Georgia's early abortion ban. We transcribed, coded, and analyzed the interviews, and present a subset of themes. RESULTS We interviewed 28 people from March to May 2020. Participants often described holding complex views on abortion shaped by a range of lived experiences, values, and identities. They lamented the "black-and-white" nature of the national abortion discussion, which they felt oversimplified the issue and did not represent their views. Participants discussed the importance of experiences that allowed them to empathize with people who choose abortion, even when they personally felt they would make a different decision in a similar situation. Based on these experiences, many participants emphasized the importance of separating their own views on abortion from what needed to be regulated for others. However, participants often demonstrated a lack of understanding about the extent to which HB481 makes abortion inaccessible in Georgia. CONCLUSION Our results indicate that, even in states traditionally labelled as restrictive or hostile towards abortion, many people express an openness to understand others' experiences and hold complex and multifaceted views.
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Affiliation(s)
- Nisha Verma
- Division of Family Planning, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
| | - Peggy Goedken
- Division of Family Planning, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
| | - Carrie Cwiak
- Division of Family Planning, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
| | - Melissa Kottke
- Division of Family Planning, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
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Kottke MJ, Sales JM, Goedken P, Brown JL, Hatfield-Timajchy K, Koumans EH, Hardin JW, Kraft JM, Kourtis AP. 2gether: A Clinic-Based Intervention to Increase Dual Protection from Sexually Transmitted Infections and Pregnancy in Young African American Females. J Womens Health (Larchmt) 2023; 32:29-38. [PMID: 36413049 DOI: 10.1089/jwh.2022.0209] [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: 11/24/2022] Open
Abstract
Background: To determine whether the 2gether intervention increases use of a dual protection (DP; concurrent prevention of pregnancy and sexually transmitted infections [STIs]) strategy and decreases pregnancy and STIs among young African American females, who disproportionately experience these outcomes. Materials and Methods: We conducted a randomized clinical trial comparing the 2gether intervention to standard of care (SOC). Participants were self-identified African American females aged 14-19 years who were sexually active with a male partner in the past 6 months. Participants were followed for 12 months; 685 were included in the analytic sample. The primary biologic outcome was time to any incident biologic event (chlamydia, gonorrhea, trichomonas infections, or pregnancy). The primary behavioral outcomes were use of and adherence to a DP strategy. Results: 2gether intervention participants had a decreased hazard of chlamydia, gonorrhea, trichomonas infections, or pregnancy during follow-up, hazard ratio = 0.73 (95% confidence interval [CI] 0.58-0.92), and were more likely to report use of condoms plus contraception, generally, adjusted risk ratio (aRR) = 1.61 (95% CI 1.15-2.26) and condoms plus an implant or intrauterine device (IUD), specifically, aRR = 2.11 (95% CI 1.35-3.29) in the prior 3 months compared with those receiving SOC. 2gether participants were also more likely to report use of condoms plus an implant or IUD at last sex and consistently over the prior 3 months. Conclusions: 2gether was efficacious in increasing use of condoms with contraception and decreasing pregnancy or selected STIs in our participants. Implementation of this intervention in clinical settings serving young people with high rates of pregnancy and STIs may be beneficial. ClinicalTrials.gov, No. NCT02291224 (https://clinicaltrials.gov/ct2/show/NCT02291224?term=2gether&draw=2&rank=5).
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Affiliation(s)
- Melissa J Kottke
- Department of Gynecology and Obstetrics, Jane Fonda Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jessica M Sales
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Peggy Goedken
- Department of Gynecology and Obstetrics, Jane Fonda Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer L Brown
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kendra Hatfield-Timajchy
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emilia H Koumans
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James W Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Joan Marie Kraft
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Athena P Kourtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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McCool-Myers M, Grasso D, Kozlowski D, Cordes S, Jean V, Gold H, Goedken P. The COVID-19 pandemic’s intersectional impact on work life, home life and wellbeing: an exploratory mixed-methods analysis of Georgia women’s experiences during the pandemic. BMC Public Health 2022; 22:1988. [PMCID: PMC9619013 DOI: 10.1186/s12889-022-14285-4] [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] [Received: 12/14/2021] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Women have been especially impacted by the COVID-19 pandemic. This exploratory study aimed to characterize women’s adverse experiences related to their work, home lives, and wellbeing during the height of the COVID-19 pandemic and to describe demographic differences of those lived experiences. Methods Using the validated Epidemic-Pandemic Impacts Inventory, we collected data from reproductive-aged women in the state of Georgia about their exposure to adverse events during the pandemic. A latent class analysis (LCA) was performed to identify subgroups of women reporting similar adverse experiences and describe their sociodemographic characteristics. An optional open-ended question yielded qualitative data that were analyzed thematically and merged with subgroup findings. Data were collected from September 2020 to January 2021. Results 423 individuals aged 18–49 completed the survey with 314 (74.2%) providing qualitative responses. The LCA yielded 4 subgroups: (1) a “low exposure” subgroup (n = 123, 29.1%) with relatively low probability of adverse experiences across domains (e.g. financial insecurity, health challenges, barriers to access to healthcare, intimate partner violence (IPV)); (2) a “high exposure” subgroup (n = 46, 10.9%) with high probability of experiencing multiple adversities across domains including the loss of loved ones to COVID-19; (3) a “caregiving stress” subgroup (n = 104, 24.6%) with high probability of experiencing challenges with home and work life including increased partner conflict; and (4) a “mental health changes” subgroup (n = 150, 35.5%) characterized by relatively low probability of adverse experiences but high probability of negative changes in mental health and lifestyle. Individuals in subgroups 1 and 4, which had low probabilities of adverse experiences, were significantly more likely to be non-Hispanic white. Individuals in subgroup 2 were more likely to identify with a sexual or racial/ethnic minority population. Inductive coding of qualitative data yielded themes such as stress, mental health, financial impact, and adaptation/resilience, providing context for pandemic-related adversity. Conclusion Though many individuals in our sample experienced hardship, minority populations were unequally impacted by pandemic-related adversity in work life, home life, and wellbeing. Recovery and future emergency preparedness efforts in Georgia must incorporate support mechanisms for mental health and IPV, focusing especially on the intersectional needs of racial, ethnic, and sexual minorities. Supplementary information The online version contains supplementary material available at 10.1186/s12889-022-14285-4.
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Affiliation(s)
- Megan McCool-Myers
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University School of Medicine, 46 Armstrong St SE, 30303 Atlanta, GA USA
| | - Damion Grasso
- grid.63054.340000 0001 0860 4915Department of Psychiatry, University of Connecticut Health, Connecticut, USA
| | - Debra Kozlowski
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University School of Medicine, 46 Armstrong St SE, 30303 Atlanta, GA USA
| | - Sarah Cordes
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University School of Medicine, 46 Armstrong St SE, 30303 Atlanta, GA USA
| | - Valerie Jean
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University School of Medicine, 46 Armstrong St SE, 30303 Atlanta, GA USA
| | - Heather Gold
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University School of Medicine, 46 Armstrong St SE, 30303 Atlanta, GA USA
| | - Peggy Goedken
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University School of Medicine, 46 Armstrong St SE, 30303 Atlanta, GA USA
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McCool-Myers M, Kozlowski D, Jean V, Cordes S, Gold H, Goedken P. The COVID-19 pandemic's impact on sexual and reproductive health in Georgia, USA: An exploration of behaviors, contraceptive care, and partner abuse. Contraception 2022; 113:30-36. [PMID: 35489392 PMCID: PMC9042735 DOI: 10.1016/j.contraception.2022.04.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Assessing access to sexual and reproductive health care during the COVID-19 pandemic, experiences with intimate partner violence (IPV), and exploring sociodemographic disparities STUDY DESIGN: From September 2020 to January 2021, we recruited 436 individuals assigned female at birth (18-49 years.) in Georgia, USA for an online survey. The final convenience sample was n = 423; a response rate could not be calculated. Survey themes included: sociodemographic and financial information, access to contraceptive services/care, IPV, and pregnancy. Respondents who reported a loss of health insurance, difficulty accessing contraception, barriers to medical care, or IPV were characterized as having a negative sexual and reproductive health experience during the pandemic. We explored associations between sociodemographic variables and negative sexual and reproductive health experiences. RESULTS Since March 2020, 66/436 (16%) of respondents lost their health insurance, and 45% (89/436) reported income loss. Of our sample, 144/436 people (33%) attempted to access contraception. The pandemic made contraceptive access more difficult for 38/144 (26%) of respondents; however, 106/144 (74%) said it had no effect or positive effect on access. Twenty-one respondents reported IPV (5%). COVID-19 amplified negative views of unplanned pregnancy. Seventy-six people (18%) reported at least 1 negative sexual and reproductive health experience during the pandemic; people in an urban setting and those identifying as homo/bisexual were more likely to report negative experiences (24%, 28% respectively). CONCLUSION Urban and sexual minority populations had negative sexual and reproductive health experiences during COVID-19 more than their counterparts. The pandemic has shifted perspectives on family planning, likely due to the diverse impacts of COVID-19, including loss of health insurance and income. IMPLICATION Females across Georgia reported varying impacts of the COVID-19's pandemic on their sexual and reproductive health care. These findings could be utilized to propose recommendations for care and intimate partner violence support mechanisms, tailored to urban and sexual minority populations.
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Affiliation(s)
- Megan McCool-Myers
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University School of Medicine, Atlanta GA, United States
| | - Debra Kozlowski
- Department of Gynecology and Obstetrics, Family Planning Division, Emory University School of Medicine, Atlanta GA, United States
| | - Valerie Jean
- Department of Gynecology and Obstetrics, Family Planning Division, Emory University School of Medicine, Atlanta GA, United States
| | - Sarah Cordes
- Department of Gynecology and Obstetrics, Family Planning Division, Emory University School of Medicine, Atlanta GA, United States
| | - Heather Gold
- Department of Gynecology and Obstetrics, Family Planning Division, Emory University School of Medicine, Atlanta GA, United States,Corresponding author at: Emory University School of Medicine, University Faculty Office Building, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, United States. Phone: not available, Fax: not available
| | - Peggy Goedken
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University School of Medicine, Atlanta GA, United States,Department of Gynecology and Obstetrics, Family Planning Division, Emory University School of Medicine, Atlanta GA, United States
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Reeves JA, Goedken P, Hall KS, Lee SC, Cwiak CA. Anesthesia providers' perspectives on abortion provision: deductive findings from a qualitative study. Int J Obstet Anesth 2021; 49:103239. [PMID: 34872830 DOI: 10.1016/j.ijoa.2021.103239] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/16/2021] [Accepted: 10/31/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION A clinician's willingness to provide abortion care is complex. Anesthesia providers' experiences in providing anesthesia for abortion are not well studied. We aimed to explore anesthesia providers' perspectives on abortion provision. METHODS We conducted semi-structured, qualitative interviews with currently practising anesthesia providers in the southeastern United States. Participants were recruited from scientific meetings of two regional anesthesiology organizations and via snowball sampling. A semi-structured interview guide included domains of standardized second trimester abortion cases and personal abortion attitudes. Data were coded and analyzed iteratively using both inductive and deductive approaches with MAXQDA software. Deductive results are presented. RESULTS Fifteen participants completed interviews from February 2018 to February 2019, at which point thematic saturation occurred. Participants represented a range of provider type, years of experience, workplace setting, and prior abortion experience. Participants demonstrated varied personal abortion attitudes, with greater acceptability of maternal or fetal health indications than social or financial indications for abortion. Most participants were willing to provide anesthesia for abortion in specific clinical scenarios. CONCLUSIONS Southeastern United States anesthesia providers hold a spectrum of personal views on abortion and are willing to provide anesthesia for second trimester abortion in specific clinical scenarios. Findings may inform future research or professional development activities, which are important efforts toward improving multidisciplinary abortion care.
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Affiliation(s)
- J A Reeves
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - P Goedken
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - K S Hall
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - S C Lee
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - C A Cwiak
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
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McCool-Myers M, Goedken P, Henn MC, Sheth AN, Kottke MJ. Who Is Practicing Expedited Partner Therapy and Why? Insights From Providers Working in Specialties With High Volumes of Sexually Transmitted Infections. Sex Transm Dis 2021; 48:474-480. [PMID: 33264262 DOI: 10.1097/olq.0000000000001337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Expedited partner therapy (EPT), the practice of prescribing antibiotics for sexual partners of patients, is underutilized in Georgia. This qualitative study in a large urban institution aimed to (1) characterize the clinical specialties that predominantly treat sexually transmitted infections (STIs), (2) identify perceived barriers to EPT, and (3) describe strategies to advance routine EPT use. METHODS Providers in obstetrics/gynecology (OB/GYN), infectious disease (ID), and emergency medicine (EM) were interviewed using a structured discussion guide. Transcripts were double-coded and iteratively analyzed using qualitative content analysis. Barriers and strategies were summarized and supported with quotes from providers (n = 23). RESULTS Perceived EPT barriers overlapped across OB/GYN, ID, and EM, yet the settings were diverse in their patient populations, resources, and concerns. Providers in OB/GYN were the only ones practicing EPT, yet there was a lack of standardization. Providers in ID noted that an EPT prescription from an ID provider could inadvertently disclose the HIV status of a patient to a sexual partner, posing an ethical dilemma. Providers in EM exhibited readiness for EPT, although routine empiric treatment for index patients in EM (estimated at 90%) gave some providers pause in prescribing for partners: "I do not know what I'm treating." Point-of-care testing could increase providers' confidence in prescribing EPT, yet some worried it could contribute to overutilization of the emergency department as a sexually transmitted infection clinic. All settings prioritized setting-specific training and protocols. CONCLUSIONS Providers in OB/GYN, ID, and EM report unique hurdles, specific to their settings and patient populations; tailored EPT implementation strategies, particularly provider training, are urgently needed to improve patient/partner outcomes.
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Affiliation(s)
| | - Peggy Goedken
- From the Jane Fonda Center, Departments of Gynecology and Obstetrics
| | | | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Melissa J Kottke
- From the Jane Fonda Center, Departments of Gynecology and Obstetrics
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Reeves J, Goedken P, Hall K, Lee S, Cwiak C. P26 Anesthesia providers perspectives on abortion provision: A qualitative study. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kraft JM, Snead MC, Brown JL, Sales JM, Kottke MJ, Hatfield-Timajchy K, Goedken P. Reproductive Coercion Among African American Female Adolescents: Associations with Contraception and Sexually Transmitted Diseases. J Womens Health (Larchmt) 2020; 30:429-437. [PMID: 32667837 DOI: 10.1089/jwh.2019.8236] [Citation(s) in RCA: 2] [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] [Indexed: 10/23/2022] Open
Abstract
Background: Among adolescents, racial disparities in reproductive health outcomes persist. The question of whether reproductive coercion (RC) influences these outcomes has received increased attention. Little is known about whether RC is independently associated with contraceptive use and having a sexually transmitted disease (STD) among African American female adolescents. Materials and Methods: Survey data for self-identified African American young women 14-19 years of age (n = 735) who accessed services at a publicly funded clinic were used to assess the extent of RC, the association between RC and other forms of intimate partner violence (IPV), and whether RC was independently associated with contraceptive use and an STD diagnosis. Results: Approximately 20% of participants had experienced RC; there was a statistically significant bivariate association between RC and other forms of IPV. In multivariate analyses, experiencing two or more forms of RC (vs. not experiencing any RC) was associated with reduced odds of contraceptive use in the past 3 months (adjusted odds ratio [aOR] = 0.46; 95% confidence interval [CI] = 0.24-0.76) and with increased odds of having an STD (aOR = 2.43; 95% CI = 2.35-4.37). Experiencing only one type of RC and experiencing other forms of IPV were not associated with the outcomes. Although ease of partner communication (aOR = 0.94; 95% CI = 0.80-0.98) was associated with having an STD, few other psychosocial variables were associated with the outcomes. Conclusions: RC is associated with reduced contraceptive use and increased STDs among African American adolescent women. Interventions to prevent and respond to RC that engage adolescent women and men are needed.
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Affiliation(s)
- Joan Marie Kraft
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Margaret Christine Snead
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer L Brown
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jessica M Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Melissa J Kottke
- Department of Gynecology and Obstetrics, Jane Fonda Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kendra Hatfield-Timajchy
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Peggy Goedken
- Department of Gynecology and Obstetrics, Jane Fonda Center, Emory University School of Medicine, Atlanta, Georgia, USA
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Reeves JA, Goedken P, Cwiak C, Hall K. “I’m Not Going to Jail for This,” an Analysis of Anesthesia Providers’ Responses to Georgia’s 22-Week Abortion Ban [01I]. Obstet Gynecol 2020. [DOI: 10.1097/01.aog.0000664100.63536.ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ewing AC, Kottke MJ, Kraft JM, Sales JM, Brown JL, Goedken P, Wiener J, Kourtis AP. 2GETHER - The Dual Protection Project: Design and rationale of a randomized controlled trial to increase dual protection strategy selection and adherence among African American adolescent females. Contemp Clin Trials 2017; 54:1-7. [PMID: 28007634 PMCID: PMC5890330 DOI: 10.1016/j.cct.2016.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/13/2016] [Accepted: 12/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND African American adolescent females are at elevated risk for unintended pregnancy and sexually transmitted infections (STIs). Dual protection (DP) is defined as concurrent prevention of pregnancy and STIs. This can be achieved by abstinence, consistent condom use, or the dual methods of condoms plus an effective non-barrier contraceptive. Previous clinic-based interventions showed short-term effects on increasing dual method use, but evidence of sustained effects on dual method use and decreased incident pregnancies and STIs are lacking. METHODS/DESIGN This manuscript describes the 2GETHER Project. 2GETHER is a randomized controlled trial of a multi-component intervention to increase dual protection use among sexually active African American females aged 14-19years not desiring pregnancy at a Title X clinic in Atlanta, GA. The intervention is clinic-based and includes a culturally tailored interactive multimedia component and counseling sessions, both to assist in selection of a DP method and to reinforce use of the DP method. The participants are randomized to the study intervention or the standard of care, and followed for 12months to evaluate how the intervention influences DP method selection and adherence, pregnancy and STI incidence, and participants' DP knowledge, intentions, and self-efficacy. DISCUSSION The 2GETHER Project is a novel trial to reduce unintended pregnancies and STIs among African American adolescents. The intervention is unique in the comprehensive and complementary nature of its components and its individual tailoring of provider-patient interaction. If the trial interventions are shown to be effective, then it will be reasonable to assess their scalability and applicability in other populations.
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Affiliation(s)
- Alexander C Ewing
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Melissa J Kottke
- Jane Fonda Center, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Joan Marie Kraft
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica M Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L Brown
- Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Peggy Goedken
- Jane Fonda Center, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey Wiener
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Athena P Kourtis
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Clarke KEN, Kraft JM, Wiener JB, Hatfield-Timajchy K, Kottke M, Sales JM, Goedken P, Kourtis AP. Factors Associated with Contraceptive Use Differ between Younger and Older African-American Female Adolescents. J Pediatr Adolesc Gynecol 2016; 29:448-453. [PMID: 26877099 PMCID: PMC6391058 DOI: 10.1016/j.jpag.2016.01.129] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 01/31/2016] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE To examine differences in factors associated with contraceptive use between younger and older adolescent age groups, which has not previously been well described. DESIGN Age group-specific analyses were performed on cross-sectional survey data to identify factors associated with any contraceptive use at last sex among younger (14- to 16-year-old) and older (17- to 19-year-old) sexually active African American female adolescents; interaction analyses were used to assess whether these associations differed by age. SETTING Adolescent reproductive health clinic in Atlanta, Georgia. PARTICIPANTS Sexually active African American female adolescents 14-19 years of age. INTERVENTIONS No intervention tested; cross-sectional design. MAIN OUTCOME MEASURE Self-reported contraceptive use during most recent vaginal sex with a male partner. RESULTS The prevalence of contraceptive use at last sex was identical in both groups; however, factors associated with contraceptive use differed according to age. The only factor associated with contraceptive use in both age groups was involvement in decisions about sexual health in the most recent relationship. Associations between factors and contraceptive use significantly differed according to age. History of sexually transmitted infection, age difference with partner, discussion of condoms with partner, and concurrent partners were important factors among younger adolescents; worry about pregnancy and discussion of birth control with partner were important among older adolescents. CONCLUSION Factors associated with contraceptive use at last sex differ according to adolescent age; this should be considered when designing counseling and interventions for teens, as well as research.
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Affiliation(s)
| | - Joan Marie Kraft
- Division of Reproductive Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey B Wiener
- Division of Reproductive Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kendra Hatfield-Timajchy
- Division of Reproductive Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Melissa Kottke
- Division of Family Planning, Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Jessica M Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Peggy Goedken
- Division of Family Planning, Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Athena P Kourtis
- Division of Reproductive Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
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Jatlaoui TC, Cordes S, Goedken P, Jamieson DJ, Cwiak C. Family planning knowledge, attitudes and practices among bariatric healthcare providers. Contraception 2016; 93:455-62. [DOI: 10.1016/j.contraception.2015.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 12/23/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
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Kottke M, Whiteman MK, Kraft JM, Goedken P, Wiener J, Kourtis AP, DiClemente R. Use of Dual Methods for Protection from Unintended Pregnancy and Sexually Transmitted Diseases in Adolescent African American Women. J Pediatr Adolesc Gynecol 2015; 28:543-8. [PMID: 26152648 PMCID: PMC4618263 DOI: 10.1016/j.jpag.2015.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/19/2015] [Accepted: 04/14/2015] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To characterize factors associated with dual method contraceptive use in a sample of adolescent women. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cross-sectional survey of sexually active African American women aged 14-19 years who attended an urban Title X clinic in Georgia in 2012 (N = 350). Participants completed a computerized survey to assess contraceptive and condom use during the past 2 sexual encounters with their most recent partner. Dual method use was defined as use of a hormonal contraceptive or intrauterine device and a condom. We applied multinomial logistic regression, using generalized estimating equations, to examine the adjusted association between dual method use (vs use of no methods or less effective methods alone; eg, withdrawal) and select characteristics. RESULTS Dual methods were used by 20.6% of participants at last sexual intercourse and 23.6% at next to last sexual intercourse. Having a previous sexually transmitted disease (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.26-4.18), negative attitude toward pregnancy (aOR, 2.25; 95% CI, 1.19-4.28), and a mother who gave birth as a teen (aOR, 2.34; 95% CI, 1.21-4.52) were associated with higher odds of dual method use. Having no health insurance (aOR, 0.39; 95% CI, 0.18-0.82), 4 or more lifetime sexual partners (aOR, 0.42; 95% CI, 0.22-0.78), sex at least weekly (aOR, 0.54; 95% CI, 0.29-0.99), and agreeing to monogamy with the most recent partner (aOR, 0.40; 95% CI, 0.16-0.96) were associated with decreased odds of dual method use. CONCLUSION Dual method use was uncommon in our sample. Efforts to increase use of dual methods should address individual and relationship factors.
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Affiliation(s)
- Melissa Kottke
- Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia.
| | - Maura K Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joan Marie Kraft
- Department of Behavioral Science and Health Education, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Peggy Goedken
- Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia
| | - Jeffrey Wiener
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Athena P Kourtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ralph DiClemente
- Department of Behavioral Science and Health Education, Emory University, Rollins School of Public Health, Atlanta, Georgia
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Jatlaoui TC, Cordes S, Cwiak C, Goedken P, Jamieson DJ. Family Planning Knowledge, Attitudes, and Practices Among Bariatric Health Care Providers [205]. Obstet Gynecol 2015. [DOI: 10.1097/01.aog.0000463109.32807.7b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lathrop E, Haddad L, McWhorter CP, Goedken P. Self-administration of misoprostol prior to intrauterine device insertion among nulliparous women: a randomized controlled trial. Contraception 2013; 88:725-9. [DOI: 10.1016/j.contraception.2013.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 11/28/2022]
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Jatlaoui TC, Marcus M, Jamieson DJ, Goedken P, Cwiak C. Postplacental intrauterine device insertion at a teaching hospital. Contraception 2013; 89:528-33. [PMID: 24565735 DOI: 10.1016/j.contraception.2013.10.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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: 04/30/2013] [Revised: 10/11/2013] [Accepted: 10/16/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether postplacental intrauterine device (IUD) insertion can be safely and effectively performed within a teaching program. STUDY DESIGN This was a prospective cohort of 177 subjects planning vaginal delivery enrolled antenatally who desired postplacental IUD insertion of either the copper T380A IUD or levonorgestrel IUS. Insertions were performed primarily by resident physicians following a training session. Follow-up included a 4- to 8-week visit and telephone calls at 3 and 6 months. RESULTS Ninety-nine subjects underwent successful postplacental IUD insertion of 100 attempts. Seventeen expulsions (17%) were noted: 10 complete and 7 partial. The study identified no differences in outcome by training level; however, the study lacked statistical power to evaluate anything other than large differences. CONCLUSION Postplacental IUD insertions can be safely and effectively performed within a training program. IMPLICATIONS A training protocol may safely and feasibly be initiated among physicians, advanced practice clinicians or trainees with no prior experience with postplacental IUD insertion. By initiating this practice, access to highly effective contraception may increase for patients who have difficulty returning for a visit or otherwise receiving effective methods.
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Affiliation(s)
- Tara C Jatlaoui
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Michele Marcus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Peggy Goedken
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Carrie Cwiak
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
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Kottke M, Whiteman M, Kraft J, Goedken P, DiClemente R. Dual method use in young African American women. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Whiteman M, Tepper N, Kottke M, Goedken P, Marchbanks P, Curtis K. Use of a checklist to rule out pregnancy in teens. Contraception 2013. [DOI: 10.1016/j.contraception.2013.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lathrop E, Telemaque Y, Haddad L, Stephenson R, Goedken P, Cwiak C, Jamieson DJ. Knowledge and use of and opportunities for emergency contraception in Northern Haiti. Int J Gynaecol Obstet 2013; 121:60-3. [PMID: 23332133 DOI: 10.1016/j.ijgo.2012.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 11/02/2012] [Accepted: 12/21/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the knowledge and experience of, and desire for, emergency contraception (EC) in postpartum women in Haiti, and to determine the knowledge and practices of EC providers. METHODS As part of a larger postpartum family planning study, 6 focus groups were conducted with postpartum women (n=33), 3 were conducted with providers (n=22), and a questionnaire was given to postpartum women (n=250). RESULTS Of the 249 women who completed the survey, 145 (58.2%) were aware of the concept of EC as an emergency measure in the postcoital period. Of these, 130 (89.7%) had knowledge of traditional methods only. Twenty-eight (11.2%) women had used some form of EC in the past, but only 2 (0.8%) reported ever using a modern form of EC. Providers reported that EC was offered to women only in cases of sexual assault. Their impression was that there was no demand for EC. CONCLUSION Awareness and use of EC is low in the context of high unmet need. The results demonstrate a need for improved education and provision of modern effective EC as part of the constellation of family planning choices.
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Affiliation(s)
- Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30303, USA.
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Badell ML, Lathrop E, Haddad LB, Goedken P, Nguyen ML, Cwiak CA. Reproductive healthcare needs and desires in a cohort of HIV-positive women. Infect Dis Obstet Gynecol 2012; 2012:107878. [PMID: 22761541 PMCID: PMC3384906 DOI: 10.1155/2012/107878] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/20/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to determine current contraceptive use, contraceptive desires and knowledge, future fertility desires, and sterilization regret in a cohort of HIV-positive women. STUDY DESIGN 127 HIV-positive women receiving care at an urban infectious disease clinic completed a survey addressing their contraceptive and reproductive histories as well as their future contraceptive and fertility desires. RESULTS The most common forms of contraception used were sterilization (44.4%) and condoms (41.3%). Less than 1% used a long-term reversible method of contraception (LARC) despite these being the methods that best fit their desired attributes of a contraceptive method. Overall, 29.4% desired future fertility. Only 50.6% of those sexually active had spoken with a provider within the last year regarding their contraceptive plans. There was a high degree of sterilization regret (36.4%), and 18.2% of sterilized women desired future fertility. Multivariate analysis found women in a monogamous relationship had a statistically increased rate of regret compared to women who were not sexually active (OR 13.8, 95% CI 1.6-119, P = 0.17). CONCLUSION Given the diversity in contraceptive and fertility desires, coupled with a higher rate of sterilization regret than is seen in the general population, integration of comprehensive family planning services into HIV care via increased contraceptive education and access is imperative.
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Affiliation(s)
- Martina L Badell
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA 30306, USA.
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Collins E, Goedken P, Cwiak C. The availability of behind-the-counter emergency contraception in Atlanta, GA: a comparison of national pharmacy chain policies and their implementation at local stores. Contraception 2012. [DOI: 10.1016/j.contraception.2011.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Haddad L, Phiri S, Cwiak C, Feldacker C, Hosseinipour M, Hoffman I, Bryant A, Stuart G, Goedken P, Jamieson D. Fertility preferences, unintended pregnancy and contraceptive use among HIV-positive women desiring family planning in Lilongwe, Malawi. Contraception 2011. [DOI: 10.1016/j.contraception.2011.05.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kottke M, Goedken P, Gidvani M, Cwiak C. Factors associated with choosing a long acting reversible contraceptive method amongst postpartum women in an urban teaching hospital. Contraception 2010. [DOI: 10.1016/j.contraception.2010.04.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Badell M, Lathrop E, Goedken P, Nash S, Nguyen M, Cwiak C. Reproductive healthcare needs of HIV-positive women. Contraception 2010. [DOI: 10.1016/j.contraception.2010.04.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lathrop E, Telemaque Y, Goedken P, Cwiak C. O508 Postpartum family planning needs assessment in Cap Haitien, Haiti. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hayes JL, Cwiak C, Goedken P, Zieman M. A pilot clinical trial of ultrasound-guided postplacental insertion of a levonorgestrel intrauterine device. Contraception 2007; 76:292-6. [PMID: 17900440 DOI: 10.1016/j.contraception.2007.06.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 06/11/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Postplacental intrauterine device (IUD) insertion is a safe, convenient and effective option for postpartum contraception. Few studies involve ultrasound-guided insertion, and none involve the levonorgestrel IUD or take place in the United States. STUDY DESIGN The study was conducted to assess the safety and feasibility of ultrasound-guided postplacental insertion of the levonorgestrel IUD following vaginal delivery in a U.S. residency program. Levonorgestrel IUDs were inserted under ultrasound guidance within 10 min of placental delivery by hand or using ring forceps. Subjects were examined at 4 and 10 weeks postpartum for evidence of expulsion or infection. RESULTS Thirty-four subjects were enrolled and 20 received an IUD. Follow-up data are available for 19 subjects over the 10-week follow-up period; 16 subjects returned for the 4-week follow-up, and 14 returned at 10 weeks. Two additional subjects could be contacted by telephone only. At 4 and 10 weeks postpartum, no subjects had evidence of infection. There were two expulsions (2/19, 10.5%) by 10 weeks postpartum. None of the subjects examined had a partial expulsion (intracervical location of the IUD). CONCLUSIONS In this pilot study, ultrasound-guided postplacental insertion of the levonorgestrel IUD was feasible and not associated with infection. The risk of expulsion was acceptable. Ultrasound-guided postplacental insertion of the levonorgestrel IUD may be an alternative to delayed insertion but warrants further study.
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Affiliation(s)
- Jennifer L Hayes
- Department of Gynecology and Obstetrics, Grady Memorial Hospital, Emory University, Atlanta, GA 30303, USA.
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Kottke M, Cwiak C, Goedken P, Pham-Fellman K, Hatcher R. Development of a contraceptive survey to be used in a computerized tool providing personalized output. Contraception 2007. [DOI: 10.1016/j.contraception.2007.05.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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