Who attends a crisis pregnancy center in Ohio?

OBJECTIVES

We sought to quantify the prevalence of ever attendance at a crisis pregnancy center (CPC) among adult, reproductive-age women in Ohio and identify demographic factors associated with ever attendance.

STUDY DESIGN

We analyzed data from the Ohio Survey of Women, a survey of adult, reproductive-age women (N = 2529) conducted in 2018 to 2019. We calculated unadjusted and adjusted prevalence ratios (PRs) to evaluate the possible associations between demographic factors and ever CPC attendance. Analyses used statistical weights to be population-representative.

RESULTS

Analyses are based on women reporting ever (n = 291) or never CPC attendance (n = 2151). Prevalence of ever CPC attendance was 13.5%. Ever CPC attendance was higher among women of Black, non-Hispanic race/ethnicity (adjusted PR, 2.1; 95% confidence interval [CI], 1.4-3.2) and currently in the lowest socioeconomic status (SES) stratum (defined as less than a college degree and annual household income less than $75,000) (aPR, 1.6; 95% CI, 1.1-2.3) compared to those of other race/ethnicity and in the highest SES stratum.

CONCLUSIONS

Disparities exist among adult women in Ohio regarding their ever use of CPCs. Because CPCs typically are not medical facilities and may provide inaccurate information, future studies should evaluate a wider range of correlates of recent CPC attendance.

IMPLICATIONS

Findings from a population-based survey of adult, reproductive-age women in Ohio indicate that ever attendance to a CPC for pregnancy-related care is not rare, and this attendance is higher among Black/non-Hispanic women and those of low SES compared to other women.

Abortion Access in Ohio's Changing Legislative Context, 2010-2018

Objectives. To examine abortion utilization in Ohio from 2010 to 2018, a period when more than 15 abortion-related laws became effective.Methods. We evaluated changes in abortion rates and ratios examining gestation, geographic distribution, and abortion method in Ohio from 2010 to 2018. We used data from Ohio's Office of Vital Statistics, the Centers for Disease Control and Prevention's Abortion Surveillance Reports, the American Community Survey, and Ohio's Public Health Data Warehouse.Results. During 2010 through 2018, abortion rates declined similarly in Ohio, the Midwest, and the United States. In Ohio, the proportion of early first trimester abortions decreased; the proportion of abortions increased in nearly every later gestation category. Abortion ratios decreased sharply in most rural counties. When clinics closed, abortion ratios dropped in nearby counties.Conclusions. More Ohioans had abortions later in the first trimester, compared with national patterns, suggesting delays to care. Steeper decreases in abortion ratios in rural versus urban counties suggest geographic inequity in abortion access.Public Health Implications. Policies restricting abortion access in Ohio co-occur with delays to care and increasing geographic inequities. Restrictive policies do not improve reproductive health.

Multicenter trial of the clinical activities tool to document the comparability of clinical experiences in obstetrics-gynecology clerkships

PURPOSE

To assess the implementation of the Clinical Activities Tool (CAT) for facilitating Liaison Committee on Medical Education-required documentation of the comparability of obstetrics-gynecology (ob/gyn) clinical experiences and midclerkship feedback at multiple sites during one academic year.

METHOD

Ob/gyn clerkship students at six U.S. medical schools were given CATs to guide and document clinical experiences from June 2006 to June 2007. Students used a paper CAT at five institutions and an electronic version at one. CATs listed procedures, skills, and topics recommended by the Association of Professors of Gynecology and Obstetrics and included a midclerkship feedback section. Resident/faculty signatures documented completion of items for paper CATs. Electronic CAT item completion was self-documented by students. Students completed a questionnaire on CAT use.

RESULTS

At the six schools, 876 medical students rotated on ob/gyn clerkships; 808 (92%) submitted CATs. Mean item completion rate was 72%. Five of six schools achieved >/=70% completion rates. Midclerkship feedback signature rates ranged from 0% to 97.8% with four of six schools reporting >/=65% feedback. Comparability of clinical experiences and midclerkship feedback was successfully documented across sites for each institution (number of sites: range = 1-9; median = 5). Questionnaires on CAT use were submitted by 231 students (26%). Students using paper CATs reported that doing so clarified course objectives (93%), provided clerkship guidance/structure (93%), and facilitated interaction with faculty/residents (76%/74%). Students rated the electronic CAT significantly less favorably.

CONCLUSIONS

CAT implementation at multiple institutions for documentation of student clinical experience comparability and midclerkship feedback was successful. Students evaluated the paper CAT positively.

Methotrexate and misoprostol for early abortion: a multicenter trial. I. Safety and efficacy

A prospective trial was conducted including 300 pregnant women seeking elective abortion to evaluate the safety and efficacy of methotrexate and misoprostol for abortion at < or = 56 days gestation. Subjects received methotrexate 50 mg/ m2 intramuscularly followed 7 days later by misoprostol 800 micrograms vaginally. The misoprostol dose was repeated the next day if the abortion did not occur. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure), duration of vaginal bleeding, and side effects. Complete abortion occurred in 263/ 300 (87.7%, 95% CI 83.4, 91.2%) patients. The complete abortion rate was higher for early gestations: 183/202 (90.6%, 95% CI 85.7, 94.2%) at < or = 49 days gestation, and 80/98 (81.6%, 95% CI 72.5, 88.7%) from 50-56 days gestation (p = 0.038). Abortion occurred in the 24 hours following the initial or repeat misoprostol dose (immediate success) in 65.0%; the remaining 22.7% of women who aborted did so after a delay of 23.6 +/- 9.1 (mean +/- standard deviation) days. Vaginal bleeding lasted 14 +/- 7 days and 11 +/- 9 days in immediate success and delayed success patients, respectively. Overall, 69.7%, 87.7%, and 91.7% of patients had passed the pregnancy by 14, 28, and 35 days, respectively, after receiving methotrexate. Methotrexate and misoprostol side effects were minimal. This treatment regimen offers an alternative to surgical abortion or the use of antiprogestins and prostaglandin for medical abortion.