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Tu P, Hu D, Wu S, Li J, Jiang X, Pei K, Zhang WH. Characteristics and contraceptive practices among Chinese women seeking abortion: a multicentre, descriptive study from 2019 to 2021. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024:bmjsrh-2023-202181. [PMID: 38702180 DOI: 10.1136/bmjsrh-2023-202181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Despite the widespread provision of free contraceptives and post-abortion care (PAC) services, China grapples with a high rate of unintended pregnancies and subsequent abortions. We aimed to study the evolving characteristics of women seeking abortion and their contraceptive practices before and after abortions, to shed light on the optimisation of Chinese PAC services. METHODS This study utilised data from an abortion cohort between 2019 and 2021. We studied their demographic features, contraception and abortion histories, reasons and choices using chi-square or linear-by-linear tests. We also explored the potential impact of receiving services at PAC facilities on post-abortion contraception use and repeat abortions using logistic regression models. RESULTS Among the 9005 participants, 43.4% experienced repeat abortion, without a discernible trend over the 3 years. Noteworthy increases were observed in the percentages of college students (from 1.7% to 6.6%, p<0.01) and middle-aged women (from 23.2% to 26.8%, p<0.01) seeking abortions. Surgical abortion was chosen by nearly 90% of participants with a continuously increasing trend (p trend <0.01). Nearly half of the participants experienced unintended pregnancies due to non-use of contraception. Of the remainder, the majority preferred less or the least effective methods both before and after abortion. Women residing in moderate-gross domestic product (GDP) regions faced a higher risk of repeat abortions (OR 1.33, 95% CI 1.16 to 1.54). Despite this, high-quality PAC services may encourage the use of reliable contraceptive methods, with 86.8% of women changing from least effective or no methods to (most) effective methods post-abortion, and prevent repeat abortions (OR 0.65, 95% CI 0.56 to 0.75). CONCLUSIONS Increased proportions of college students and middle-aged multiparous women seeking abortions were observed, together with inappropriate preferences for less effective contraception and increasing choice of surgical abortions. Future research should extend the focus to cover the entire abortion period, advocate the rational selection of contraceptive methods, and emphasise the specified PAC services tailored to different socioeconomic groups.
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Affiliation(s)
- Pengcheng Tu
- Social Medicine Center, National Research Institute for Family Planning, Beijing, China
| | - Denghui Hu
- Social Medicine Center, National Research Institute for Family Planning, Beijing, China
- Graduate School, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Shangchun Wu
- Social Medicine Center, National Research Institute for Family Planning, Beijing, China
| | - Jianan Li
- Social Medicine Center, National Research Institute for Family Planning, Beijing, China
| | - Xiaomei Jiang
- Social Medicine Center, National Research Institute for Family Planning, Beijing, China
| | - Kaiyan Pei
- Social Medicine Center, National Research Institute for Family Planning, Beijing, China
- Graduate School, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Wei-Hong Zhang
- International Center for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Footman K. The illusion of treatment choice in abortion care: A qualitative study of comparative care experiences in England and Wales. Soc Sci Med 2024; 348:116873. [PMID: 38615614 DOI: 10.1016/j.socscimed.2024.116873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
Treatment choice is a key component of quality, person-centred care, but policies promoting choice often ignore how capacity to choose is unequally distributed and influenced by social structures. In abortion care, the choice of either medication or a procedure is limited in many countries, but the structuring of treatment choice from the perspective of people accessing abortion care is poorly understood. This qualitative study explored comparative experiences of abortion treatment choice in England and Wales, using in-depth interviews with 32 people who recently accessed abortion care and had one or more prior abortions. A codebook approach was used to analyse the data, informed by a multidisciplinary framework for understanding the relationship between choice and equity. Abortion treatment choice was structured by multiple intersecting mechanisms: limitations on the supply of abortion care, incomplete or unbalanced information from providers, and participants' socio-economic environments. Long waiting times or travel distances could reduce choice of both treatment options. In interactions with providers, participants described not being offered procedural abortions or receiving information that favoured medication abortion. Participants' socio-economic environments impacted the way they navigated decision-making and their ability to manage the experience of either treatment option. Individual preferences for care were shaped in part by the interplay between these structural barriers, creating an illusion of choice, as the health system bias towards medication abortion reinforced some participants' negative perceptions of procedural abortion. The erosion of choice, to the point it is rendered illusory, has unequal impacts on quality of care. People's needs for their abortion care are complex and diverse, and access to varied service models is required to meet these needs. Treatment choice could be expanded by integrating public and private non-profit sector provision, aligning time limits and workforce requirements for abortion care with international standards, addressing financial pressures on service delivery, and revising the language used to depict each treatment option.
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Affiliation(s)
- Katy Footman
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, WC2A 2AE, UK.
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Schueler K, Jacobs M, Averbach S, Marengo A, Mody SK. Understanding medication abortion ineligibility due to gestational age among a cohort of patients in Southern California. Contraception 2024; 133:110386. [PMID: 38307486 DOI: 10.1016/j.contraception.2024.110386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Medication abortion (MAB) is safe and effective up to 77 days gestation. Limited data are available on how often patients are ineligible for MAB due to advanced gestational age and how many of those ineligible go on to receive procedural abortion. STUDY DESIGN Retrospective analysis of electronic health records from Planned Parenthood of the Pacific Southwest (PPPSW) from January - December 2021. PPPSW has four procedural abortion sites and 15 MAB-only clinics that offered appointments only if last menstrual period-based GA was ≤70 days or unknown. Patients >70 days gestation by intake ultrasound at a MAB-only clinic were referred to a procedural center. RESULTS Of 11,684 patients presenting for MAB at MAB-only sites 2224 (19%) did not receive a MAB; 3.8% (N = 444) presented past 70 days gestation and were thus ineligible due to gestational age limits. Of those ineligible (N = 444), 234 (53%) measured between 71-77 days of gestation. Three quarters (75.7%) of those ineligible went on to receive a procedural abortion at PPPSW after a mean wait time of 10 days. In multivariable analysis, no demographic factors were associated with higher odds of receiving a procedural abortion. CONCLUSIONS Presenting for MAB past a gestational age limit was uncommon, supporting safety of no-test MAB protocols. A quarter of people ineligible for MAB due to gestational age did not receive a procedural abortion at PPPSW. If MAB were offered up to 77 days, half of patients who were denied MAB due to gestational age could have received MAB, expanding patient access. IMPLICATIONS Being ineligible for MAB due to advanced gestational age was uncommon. Increasing MAB gestational age limits from 70 days to 77 days could further improve abortion access.
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Affiliation(s)
- Kellie Schueler
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, CA, United States.
| | - Marni Jacobs
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, CA, United States
| | - Sarah Averbach
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, CA, United States; Center on Gender Equity and Health, University of California, San Diego, CA, United States
| | - Antoinette Marengo
- Planned Parenthood of the Pacific Southwest, San Diego, CA, United States
| | - Sheila K Mody
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, CA, United States
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Mackinnon Krems J, Grossman D, Ehrenreich K, Ralph L. Money and place: Quantifying the types of obstacles associated with seeking an abortion after 10 weeks' gestation, 2019-2020. Contraception 2024:110476. [PMID: 38679274 DOI: 10.1016/j.contraception.2024.110476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Identify factors associated with presenting for abortion after 10 weeks' gestation in a large, geographically diverse sample. STUDY DESIGN From October 2019 to March 2020, we surveyed 1089 patients seeking abortion at seven U.S. facilities. We identified four domains of barriers: geographic, financial, logistical/personal, and legislative. Using multivariable logistic regression, we investigated the relationship between each domain and presenting for abortion after 10 weeks' gestation, overall and stratified by state policy landscape. RESULTS One-third of participants reported geographic (33.0%), financial (33.3%), and logistical/personal (31.4%) barriers; fewer (4.8%) reported legislative barriers. One-third (30.8%) traveled over 50 miles to the clinic. One-quarter (25.2%) presented after 10 weeks' gestation. In multivariable analyses, financial barriers (adjusted odds ratio [aOR] = 1.49, 95% confidence interval [CI] = 1.06-2.09), geographic barriers (aOR = 2.05, 95% CI = 1.44-2.90), and difficulty meeting basic expenses (aOR = 1.47, 95% CI = 1.15-1.89) were associated with presenting after 10 weeks' gestation across the seven clinics. Among participants accessing care at clinics in states with supportive abortion policies (n = 178), geographic barriers remained significantly associated with presenting after 10 weeks' gestation. CONCLUSIONS In a large, geographically diverse sample, financial and geographic barriers were associated with presenting after the threshold for medication abortion. In supportive states, the association with geographic barriers persisted. Cost and geographic barriers are increasing as more states restrict abortion post-Dobbs, highlighting the urgent need to expand financial and travel support. IMPLICATIONS People seeking abortion faced barriers before the Dobbs decision. Now, post-Dobbs, restrictions to abortion have only increased, making barriers to care even more threatening. Providing access to financial resources and transportation for people seeking abortion and expanding telehealth medication for abortion is now even more important.
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Affiliation(s)
- Jennifer Mackinnon Krems
- Joint Medical Program, University of California San Francisco and University of California Berkeley, San Francisco and Berkeley, CA, USA.
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, USA
| | - Katherine Ehrenreich
- Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, USA
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, USA
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Lands M, Dyer RL, Seymour JW. Sampling strategies among studies of barriers to abortion in the United States: A scoping review of abortion access research. Contraception 2024; 131:110342. [PMID: 38012964 DOI: 10.1016/j.contraception.2023.110342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Understanding barriers to abortion care is particularly important post-Dobbs. However, many abortion access studies recruit from abortion-providing facilities, which overlook individuals who do not present for clinic-based care. To our knowledge, no studies have reviewed research recruitment strategies in the literature or considered how they might affect our knowledge of abortion barriers. We aimed to identify populations included and sampling methods used in studies of abortion barriers in the United States. STUDY DESIGN We used a scoping review protocol to search five databases for articles examining US-based individuals' experiences accessing abortion. We included English-language articles published between January 2011 and February 2022. For included studies, we identified the sampling strategy and population recruited. RESULTS Our search produced 2763 articles, of which 71 met inclusion criteria. Half of the included papers recruited participants at abortion-providing facilities (n = 35), while the remainder recruited from online sources (n = 14), other health clinics (n = 10), professional organizations (n = 8), abortion funds (n = 2), community organizations (n = 2), key informants (n = 2), and an abortion storytelling project (n = 1). Most articles (n = 61) reported information from people discussing their own abortions; the rest asked nonabortion seekers (e.g., physicians, genetic counselors, attorneys) about barriers to care. CONCLUSIONS Studies of abortion barriers enroll participants from a range of venues, but the majority recruit people who obtained abortions, and half recruit from abortion clinics. IMPLICATIONS As abortion access becomes constrained and criminalized in the post-Roe context, our findings indicate how investigators might recruit study participants from a variety of settings to fully understand the abortion seeking experience.
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Affiliation(s)
- Madison Lands
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States.
| | - Rachel L Dyer
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States; University of Wisconsin Department of Counseling Psychology, Madison, WI, United States
| | - Jane W Seymour
- University of Wisconsin Collaborative for Reproductive Equity, Madison, WI, United States
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Chandrasekaran S, Ruggiero S, Goodrick G. Outpatient medical management of later second trimester abortion (18-23.6 weeks) with procedural evacuation backup: A large case series. Contracept X 2024; 6:100104. [PMID: 38515629 PMCID: PMC10950721 DOI: 10.1016/j.conx.2024.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
Objective Document the clinical outcomes of an outpatient medical management with procedural evacuation backup procedure for abortions between 18 weeks zero days to 23 weeks six days gestation. Study design We conducted a retrospective medical records review of adult patients who received mifepristone and repeated misoprostol for second trimester abortion with procedural evacuation backup at an Arizona clinic between October 2017 and November 2021. We extracted patient demographics; pregnancy and medical history; and preoperative, intraoperative, and postoperative data. We assessed abortion outcomes, including procedure timing, mode of completion (medication alone or medications and procedural evacuation), and safety. Results All 359 patients had a complete abortion with 63.5% of patients completing with medication alone and 36.5% with procedural evacuation backup. The median time from first dose of misoprostol to fetal expulsion was six hours, among those who completed the abortion with medications alone. Of those who received procedural evacuation as backup, the median time for procedural evacuation was 10 minutes. The vast majority of patients (99.4%) did not have any adverse events. Two safety incidents (0.6%) occurred, a broad right ligament tear and a uterine rupture. Conclusion Patients in one outpatient setting safely and effectively received medical management of second trimester abortion with procedural evacuation backup, and two thirds completed with medications alone. Implications Outpatient settings may consider medical management of abortion between 18 and 24 weeks with procedural evacuation back-up as a safe, effective, and manageable second trimester abortion option. Additional research is needed on patient experience and satisfaction.
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Cartwright AF, Bell SO, Upadhyay UD. Separating Procedure-related Fears From Future Fertility Concerns Among a Cohort Seeking Abortion Information Online. Womens Health Issues 2024; 34:45-50. [PMID: 37479629 PMCID: PMC10796831 DOI: 10.1016/j.whi.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION The general public and abortion patients in the United States have misinformation about the risks of infertility associated with abortion, which may influence abortion care-seeking. METHODS The Google Ads Abortion Access Study was a national study of people considering abortion and searching online for information. Participants completed baseline and follow-up surveys, providing free text responses to questions about barriers and facilitators to abortion. We conducted an exploratory analysis of the free text responses related to fertility and used thematic analysis to identify concerns raised about links between abortion and future fertility. RESULTS Of 864 participants who provided free text responses in the follow-up survey, 32 specifically mentioned fertility. Few expressed fear that complications from the abortion procedure would somehow lead to infertility; rather, most discussed complex and overlapping thoughts about how abortion factored into their reproductive life plans. These included age-related concerns, missing out on their "chance" to have a child, fear of being punished by God with infertility for having an abortion, and conflicting emotions if they had previously been told they were subfecund or infertile. CONCLUSION Although previous research has focused on misinformation about the link between abortion and infertility, participants in this study rarely mentioned it as a concern. Researchers and practitioners should be attuned to the distinctions people make between infertility occurring as a result of abortion and other fears they might have about not achieving their future reproductive aspirations, ask questions, and provide counseling accordingly.
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Affiliation(s)
- Alice F Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Suzanne O Bell
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California
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Jones RK, Chiu DW, Kohn JE. Characteristics of people obtaining medication vs procedural abortions in clinical settings in the United States: Findings from the 2021-2022 Abortion Patient Survey. Contraception 2023; 128:110137. [PMID: 37544573 DOI: 10.1016/j.contraception.2023.110137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES This study aimed to compare the characteristics of people obtaining medication and procedural abortions in clinical settings in the United States. STUDY DESIGN We conducted a cross-sectional survey of people obtaining abortions at a sample of 56 US facilities between June 2021 and July 2022. We restricted analyses to patients with pregnancies less than 11 weeks' gestation presenting at 43 clinics offering both medication and procedural abortion. We conducted bivariate analyses and multivariable logistic regression to identify factors associated with obtaining a medication vs procedural abortion. RESULTS Our analytic sample includes 4717 respondents, 57% of whom obtained a medication abortion. In bivariate analyses, individuals who identified as Asian or White, had no prior births or abortions, or were paying out of pocket were all more likely to have a medication abortion. Non-Hispanic Black individuals, those with incomes at or below the poverty level, and those paying with insurance were more likely to have a procedural abortion. Some 24% of respondents chose the facility because it offered medication abortion, but even after controlling for this proxy for method preference in a logistic regression model, Black respondents and those with poverty-level incomes were less likely to have a medication abortion. CONCLUSIONS The findings of the study suggest that Black individuals and those with low incomes-who often face systemic barriers to care-are less likely to have medication abortions. When medication abortion is the only option available, for example, at a medication-only clinic or from an online source, these groups may be most impacted by the lack of options. IMPLICATIONS To the extent possible, offering both medication and procedural abortion and increasing access to both types are important to meet patients' individual needs and preferences.
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Affiliation(s)
- Rachel K Jones
- Guttmacher Institute, Research Division, New York, NY, United States.
| | - Doris W Chiu
- Guttmacher Institute, Research Division, New York, NY, United States
| | - Julia E Kohn
- Guttmacher Institute, Research Division, New York, NY, United States; Columbia University Irving Medical Center, Division of Family Planning and Preventive Services, Department of Obstetrics and Gynecology, New York, NY, USA
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Rafferty K, Longbons T. Understanding Women's Communication with Their Providers During Medication Abortion and Abortion Pill Reversal: An Exploratory Analysis. LINACRE QUARTERLY 2023; 90:172-181. [PMID: 37325429 PMCID: PMC10265391 DOI: 10.1177/00243639231153724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Introduction/Objective: Medication abortion is a common experience for women in the United States, now totaling over 50% of all abortions. The purpose of this exploratory analysis is to understand women's medication abortion and abortion pill reversal decision-making experiences, with a particular focus on their communication with their medical providers. Methods: We surveyed women who contacted Heartbeat International to inquire about abortion pill reversal. Eligible women had to complete a minimum of the 2-week progesterone protocol in order to answer the questions on the electronic survey about their medication abortion and abortion pill reversal decisions. We assessed decision difficulty using a Likert scale and provider communication using the Questionnaire on the Quality of Physician-Patient (QQPPI) and analyzed women's narratives about their experiences using thematic analysis. Results: Thirty-three respondents met the eligibility criteria and filled out the QQPPI and decision-difficulty scales. Using the QQPPI scale, women scored their communication with their APR providers as significantly better than their communication with their abortion providers (p < 0.0001). Women reported that choosing medication abortion was significantly more difficult than choosing abortion pill reversal (p < 0.0001). White women, women with college degrees, and women who were not in a relationship with the father of the child reported more difficulty in choosing APR. Conclusion: As the number of women who contact the national hotline to inquire about abortion pill reversal increases, the need to understand the experiences of this growing population of women becomes more salient. This need is particularly important for health care providers who prescribe medication abortion and abortion pill reversal. The quality of the physician-patient interaction is essential to providing effective medical care to pregnant women.
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Baum SE, Sierra G, Grossman D, Vizcarra E, Potter JE, White K. Comparing preference for and use of medication abortion in Texas after policy changes in 2014 and 2018. Contraception 2023; 119:109912. [PMID: 36473511 PMCID: PMC9985975 DOI: 10.1016/j.contraception.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Assess preferences for and use of medication abortion in Texas after implementation of two policy changes: a 2013 state law restricting medication abortion and the FDA label change for mifepristone in 2016 nullifying some of this restriction. STUDY DESIGN We analyzed surveys conducted in 2014 and 2018 with abortion patients at 10 Texas abortion facilities. We calculated the percentage of all respondents with an initial preference for medication abortion by survey year, and the type of abortion obtained or planned to obtain among those who were at <10 weeks of gestation. We used multivariable-adjusted mixed-effects Poisson regression models to assess factors associated with medication abortion preference and actual/planned use. RESULTS Overall, 156 (41%) of 376 respondents in 2014 and 247 (55%) of 448 respondents in 2018 reported initial preference for medication abortion (Prevalence ratio [PR]: 1.28; 95% CI 1.03-1.59). Among those who were <10 weeks of gestation and initially preferred medication abortion, 39 of 124 (31%) obtained or were planning to obtain the method in 2014, compared with 188 of 223 (84%) in 2018 (PR: 2.65; 95% CI: 1.69-4.15). After multivariable adjustment, respondents who initially preferred medication abortion and were 7 to 9 weeks of gestation at the time of their ultrasonography (vs <7 weeks) were less likely to obtain or plan to obtain the method (PR: 0.69; 95% CI: 0.57-0.84). CONCLUSIONS Abortion patients were more likely to prefer and obtain or plan to obtain their preferred medication abortion after legal restrictions in Texas were nullified. IMPLICATIONS State policies can affect people's ability to obtain their preferred abortion method. Efforts to provide both abortion options whenever possible, and inform people where each can be obtained, remains an important component of person-centered care despite increasing state abortion restrictions and bans following the reversal of Roe v Wade.
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Affiliation(s)
- Sarah E Baum
- Texas Policy Evaluation Project, Population Resource Center, The University of Texas at Austin, Austin, TX, United States; Ibis Reproductive Health, Oakland, CA, United States.
| | - Gracia Sierra
- Texas Policy Evaluation Project, Population Resource Center, The University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States
| | - Daniel Grossman
- Texas Policy Evaluation Project, Population Resource Center, The University of Texas at Austin, Austin, TX, United States; Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, CA, United States
| | - Elsa Vizcarra
- Texas Policy Evaluation Project, Population Resource Center, The University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States
| | - Joseph E Potter
- Texas Policy Evaluation Project, Population Resource Center, The University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States
| | - Kari White
- Texas Policy Evaluation Project, Population Resource Center, The University of Texas at Austin, Austin, TX, United States; Population Research Center, The University of Texas at Austin, Austin, TX, United States; Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
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Footman K. Structural barriers or patient preference? A mixed methods appraisal of medical abortion use in England and Wales. Health Policy 2023; 132:104799. [PMID: 37001286 DOI: 10.1016/j.healthpol.2023.104799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/13/2023] [Accepted: 03/19/2023] [Indexed: 03/28/2023]
Abstract
Although patient choice of abortion method is a key component of quality care, medical abortion (MA) has become the most common method (87%) in England and Wales, as in many countries worldwide. This research aimed to critically examine factors influencing the growth in MA use in England and Wales. Mixed methods were used, combining multi-level regression analysis of national abortion statistics (2011-2020) and key informant interviews with abortion service managers, commissioners, and providers (n=27). Overall trends have been driven by growth in MA use for abortions under 10 weeks in the private non-profit sector. Variation in MA use between patient sub-groups and regions has narrowed over time. Qualitative findings highlight health system constraints that have influenced the shift towards MA, including workforce constraints, infrastructure requirements, provider policies, cost, and commissioning practices involving under-funding and competition, which have caused the private non-profit sector to limit method choice across their services to remain financially viable. While removal of legal restrictions on MA has expanded choice, similar policy progress has not been seen for surgical methods. The study concludes that abortion method choice has been constrained by structural health system factors, with potential negative consequences for service acceptability, inequalities, and patient-centredness.
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Carpenter E, Gyuras H, Burke KL, Czarnecki D, Bessett D, McGowan M, White K. Seeking abortion care in Ohio and Texas during the COVID-19 pandemic. Contraception 2023; 118:109896. [PMID: 36240904 PMCID: PMC9554324 DOI: 10.1016/j.contraception.2022.09.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Political and public health responses to the COVID-19 pandemic changed provision of abortion care and exacerbated existing barriers. We aimed to explore experiences of individuals seeking abortion care in 2 abortion-restrictive states in the United States where state policies and practice changes disrupted abortion provision during the pandemic. STUDY DESIGN We conducted 22 semistructured interviews in Texas (n = 10) and Ohio (n = 12) to assess how state executive orders limiting abortion, along with other public health guidance and pandemic-related service delivery changes, affected individuals seeking abortion care. We included individuals 18 years and older who contacted a facility for abortion care between March and November 2020. We coded and analyzed interview transcripts using both inductive and deductive approaches. RESULTS Participants reported obstacles to obtaining their preferred timing and method of abortion. These obstacles placed greater demands on those seeking abortion and resulted in delays in obtaining care for as long as 11 weeks, as well as some being unable to obtain an abortion at all. CONCLUSIONS Political and public health responses to the COVID-19 pandemic - exacerbated pre-pandemic barriers and existing restrictions and constrained options for people seeking abortion in Ohio and Texas. Delays were consequential for all participants, regardless of their ultimate ability to obtain an abortion. IMPLICATIONS During the COVID-19 pandemic, state executive orders and clinic practices exacerbated already constrained access to care. Findings highlight the importance of protecting timely care and the full range of abortion methods. Findings also preview barriers individuals seeking abortion may encounter in states that restrict or ban abortion.
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Affiliation(s)
- Emma Carpenter
- Texas Policy Evaluation Project, University of Texas-Austin, Austin, TX, United States; Population Research Center, University of Texas at Austin, Austin, TX, United States; Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, OH, United States.
| | - Hillary Gyuras
- Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, OH, United States; Ohio Policy Evaluation Network, University of Cincinnati, The Ohio State University, Columbus, Cincinnati OH, United States; College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Kristen L Burke
- Texas Policy Evaluation Project, University of Texas-Austin, Austin, TX, United States; Population Research Center, University of Texas at Austin, Austin, TX, United States; Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, OH, United States
| | - Danielle Czarnecki
- Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, OH, United States; Ohio Policy Evaluation Network, University of Cincinnati, The Ohio State University, Columbus, Cincinnati OH, United States; Department of Sociology, University of Cincinnati, Cincinnati, OH, United States
| | - Danielle Bessett
- Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, OH, United States; Ohio Policy Evaluation Network, University of Cincinnati, The Ohio State University, Columbus, Cincinnati OH, United States; Department of Sociology, University of Cincinnati, Cincinnati, OH, United States
| | - Michelle McGowan
- Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, OH, United States; Ohio Policy Evaluation Network, University of Cincinnati, The Ohio State University, Columbus, Cincinnati OH, United States; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States; Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kari White
- Texas Policy Evaluation Project, University of Texas-Austin, Austin, TX, United States; Population Research Center, University of Texas at Austin, Austin, TX, United States; Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, OH, United States; Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
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13
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Mosley EA, Ayala S, Jah Z, Hailstorks T, Hairston I, Rice WS, Hernandez N, Jackson K, Scales M, Gutierrez M, Goode B, Filippa S, Strader S, Umbria M, Watson A, Faruque J, Raji A, Dunkley J, Rogers P, Ellison C, Suarez K, Diallo DD, Hall KS. " I don't regret it at all. It's just I wish the process had a bit more humanity to it … a bit more holistic": a qualitative, community-led medication abortion study with Black and Latinx Women in Georgia, USA. Sex Reprod Health Matters 2022; 30:2129686. [PMID: 36368036 PMCID: PMC9664998 DOI: 10.1080/26410397.2022.2129686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traditional family planning research has excluded Black and Latinx leaders, and little is known about medication abortion (MA) among racial/ethnic minorities, although it is an increasingly vital reproductive health service, particularly after the fall of Roe v. Wade. Reproductive justice (RJ) community-based organisation (CBO) SisterLove led a study on Black and Latinx women's MA perceptions and experiences in Georgia. From April 2019 to December 2020, we conducted key informant interviews with 20 abortion providers and CBO leaders and 32 in-depth interviews and 6 focus groups (n = 30) with Black and Latinx women. We analysed data thematically using a team-based, iterative approach of coding, memo-ing, and discussion. Participants described multilevel barriers to and strategies for MA access, wishing that "the process had a bit more humanity … [it] should be more holistic." Barriers included (1) sociocultural factors (intersectional oppression, intersectional stigma, and medical experimentation); (2) national and state policies; (3) clinic- and provider-related factors (lack of diverse clinic staff, long waiting times); and (4) individual-level factors (lack of knowledge and social support). Suggested solutions included (1) social media campaigns and story-sharing; (2) RJ-based policy advocacy; (3) diversifying clinic staff, offering flexible scheduling and fees, community integration of abortion, and RJ abortion funds; and (4) social support (including abortion doulas) and comprehensive sex education. Findings suggest that equitable MA access for Black and Latinx communities in the post-Roe era will require multi-level intervention, informed by community-led evidence production; holistic, de-medicalised, and human rights-based care models; and intersectional RJ policy advocacy.
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Affiliation(s)
- Elizabeth A. Mosley
- Affiliated Faculty Member, Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health Atlanta, GA, USA,Assistant Professor, Center for Innovative Research on Gender Health Equity, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Correspondence:
| | - Sequoia Ayala
- Director of Policy and Advocacy, SisterLove, Inc., Atlanta, GA, USA
| | - Zainab Jah
- Research Director, SisterLove, Inc., Atlanta, GA, USA
| | - Tiffany Hailstorks
- Assistant Professor, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Indya Hairston
- Community-Based Research Program Manager, SisterLove, Inc., Atlanta, GA, USA
| | - Whitney S. Rice
- Assistant Professor, Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Kwajelyn Jackson
- Executive Director, Feminist Women’s Health Center, Atlanta, GA, USA
| | - Marieh Scales
- MPH Student, Emory University Rollins School of Public Health, Atlanta, GA, USA,Research Intern, SisterLove, Inc., Atlanta, GA, USA
| | - Mariana Gutierrez
- MPH Student, Emory University Rollins School of Public Health, Atlanta, GA, USA,Research Intern, SisterLove, Inc., Atlanta, GA, USA
| | - Bria Goode
- MPH Student, Emory University Rollins School of Public Health, Atlanta, GA, USA,Research Intern, SisterLove, Inc., Atlanta, GA, USA
| | - Sofia Filippa
- MPH Student, Emory University Rollins School of Public Health, Atlanta, GA, USA,Research Intern, SisterLove, Inc., Atlanta, GA, USA
| | - Shani Strader
- MPH Student, Emory University Rollins School of Public Health, Atlanta, GA, USA,Research Intern, SisterLove, Inc., Atlanta, GA, USA
| | - Mariana Umbria
- Research Intern, SisterLove, Inc., Atlanta, GA, USA,MPH Student, Georgia State University School of Public Health, Atlanta, GA, USA
| | - Autumn Watson
- MPH Student, Emory University Rollins School of Public Health, Atlanta, GA, USA,Research Intern, SisterLove, Inc., Atlanta, GA, USA
| | - Joya Faruque
- MPH Student, Emory University Rollins School of Public Health, Atlanta, GA, USA,Research Intern, SisterLove, Inc., Atlanta, GA, USA
| | - Adeola Raji
- Research Intern, SisterLove, Inc., Atlanta, GA, USA,MPH Student, Georgia State University School of Public Health, Atlanta, GA, USA
| | - Janae Dunkley
- MPH Student, Emory University Rollins School of Public Health, Atlanta, GA, USA,Research Intern, SisterLove, Inc., Atlanta, GA, USA
| | - Peyton Rogers
- MPH Student, Emory University Rollins School of Public Health, Atlanta, GA, USA,Research Intern, SisterLove, Inc., Atlanta, GA, USA
| | - Celeste Ellison
- MPH Student, Emory University Rollins School of Public Health, Atlanta, GA, USA,Research Intern, SisterLove, Inc., Atlanta, GA, USA
| | - Kheyanna Suarez
- MPH Student, Emory University Rollins School of Public Health, Atlanta, GA, USA,Research Intern, SisterLove, Inc., Atlanta, GA, USA
| | | | - Kelli S. Hall
- Founding Director, Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, GA, USA,Associate Professor, Columbia University Mailman School of Public Health, New York, NY, USA
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14
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Baraitser P, Free C, Norman WV, Lewandowska M, Meiksin R, Palmer MJ, Scott R, French R, Wellings K, Ivory A, Wong G. Improving experience of medical abortion at home in a changing therapeutic, technological and regulatory landscape: a realist review. BMJ Open 2022; 12:e066650. [PMID: 36385017 PMCID: PMC9670095 DOI: 10.1136/bmjopen-2022-066650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To inform UK service development to support medical abortion at home, appropriate for person and context. DESIGN Realist review SETTING/PARTICIPANTS: Peer-reviewed literature from 1 January 2000 to 9 December 2021, describing interventions or models of home abortion care. Participants included people seeking or having had an abortion. INTERVENTIONS Interventions and new models of abortion care relevant to the UK. OUTCOME MEASURES Causal explanations, in the form of context-mechanism-outcome configurations, to test and develop our realist programme theory. RESULTS We identified 12 401 abstracts, selecting 944 for full text assessment. Our final review included 50 papers. Medical abortion at home is safe, effective and acceptable to most, but clinical pathways and user experience are variable and a minority would not choose this method again. Having a choice of abortion location remains essential, as some people are unable to have a medical abortion at home. Choice of place of abortion (home or clinical setting) was influenced by service factors (appointment number, timing and wait-times), personal responsibilities (caring/work commitments), geography (travel time/distance), relationships (need for secrecy) and desire for awareness/involvement in the process. We found experiences could be improved by offering: an option for self-referral through a telemedicine consultation, realistic information on a range of experiences, opportunities to personalise the process, improved pain relief, and choice of when and how to discuss contraception. CONCLUSIONS Acknowledging the work done by patients when moving medical abortion care from clinic to home is important. Patients may benefit from support to: prepare a space, manage privacy and work/caring obligations, decide when/how to take medications, understand what is normal, assess experience and decide when and how to ask for help. The transition of this complex intervention when delivered outside healthcare environments could be supported by strategies that reduce surprise or anxiety, enabling preparation and a sense of control.
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Affiliation(s)
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Wendy V Norman
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Lewandowska
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca Meiksin
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa J Palmer
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Scott
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca French
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaye Wellings
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Alice Ivory
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
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15
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Ehrenreich K, Biggs MA, Grossman D. Making the case for advance provision of mifepristone and misoprostol for abortion in the United States. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:238-242. [PMID: 34862207 DOI: 10.1136/bmjsrh-2021-201321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Katherine Ehrenreich
- Advancing New Standards In Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, California, USA
| | - M Antonia Biggs
- Advancing New Standards In Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, California, USA
| | - Daniel Grossman
- Advancing New Standards In Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, Oakland, California, USA
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16
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Ruggiero SP, Seymour JW, Thompson TA, Kohn JE, Snow JL, Grossman D, Fix L. Patient and provider experiences using a site-to-site telehealth model for medication abortion. Mhealth 2022; 8:32. [PMID: 36338311 PMCID: PMC9634192 DOI: 10.21037/mhealth-22-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/07/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In the site-to-site telehealth for medication abortion model, patients visit a health center to meet with a remote clinician using telehealth technology. This model is safe, effective, and acceptable to patients and providers. The objective of this study was to document the experiences of patients and providers using telehealth for medication abortion in Planned Parenthood health centers across different geographical contexts in the United States. METHODS We conducted in-depth interviews with Planned Parenthood medication abortion patients who either met with a clinician at the clinic via telehealth or in-person about their experiences receiving care. We also interviewed Planned Parenthood staff members about their experiences implementing telehealth for medication abortion at their health center. RESULTS We interviewed 29 patients who received care at Planned Parenthood health centers in five states. Both telehealth and in-person patients described positive interactions with health center staff and clinicians. The vast majority of telehealth patients said that they felt comfortable speaking with the clinician over telehealth and had no trouble using the telehealth technology. We interviewed 12 providers, including clinicians and administrative staff, who worked in seven states. Providers largely thought that telehealth for medication abortion expanded access to medication abortion. CONCLUSIONS Across different locations, our findings indicate that patients found telehealth for medication abortion services to be highly acceptable and providers found that telehealth services may help improve medication abortion access. As the use of telehealth for medication abortion expands, future research should include additional measures of quality to ensure that services are acceptable across different identities and experiences, including age, race, gender, and income level.
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Affiliation(s)
| | | | | | - Julia E. Kohn
- Planned Parenthood Federation of America, New York, NY, USA
| | | | - Daniel Grossman
- Advancing New Standards in Reproductive Health, University of California, San Francisco, CA, USA
| | - Laura Fix
- Ibis Reproductive Health, Cambridge, MA, USA
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17
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Abstract
PURPOSE OF REVIEW People seeking reproductive care experience trauma on many levels including personal, structural, in medical care, and in barriers to care. This article reviews key aspects of a Trauma-Informed Care approach in abortion and reproductive healthcare. RECENT FINDINGS Experiences of trauma are common and compounding, including systemic trauma, such as racism, sexism, and transphobia. Reproductive healthcare itself traumatizes and re-traumatizes. Trauma Informed Care (TIC) approach to individual abortion care includes maximize patient safety, choice, and privacy. TIC approach to systemic abortion care includes dismantling barriers to care and stigma. SUMMARY The experience of trauma is prevalent, often unrecognized and can be multifactorial, especially for those seeking abortion and contraception care. Reproductive care can create situations or power dynamics that reactivate a trauma experience. History of trauma influences a person's health, relationships, experience, and use of reproductive healthcare, as well as trust in reproductive health recommendations. Laws restricting access to abortion and reproductive health add another layer of trauma and disproportionately affect marginalized groups. Guidelines for Trauma Informed Abortion Care recognize the complexity of trauma in reproductive health experiences and seek to promote safety, empowerment, and healing on individual and systemic levels.
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Affiliation(s)
- Erica P Cahill
- Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
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18
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Whitehouse KC, Blaylock R, Makleff S, Lohr PA. It's a small bit of advice, but actually on the day, made such a difference…: perceptions of quality in abortion care in England and Wales. Reprod Health 2021; 18:221. [PMID: 34743705 PMCID: PMC8574046 DOI: 10.1186/s12978-021-01270-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Quality of care (QOC) is increasingly identified as an important contributor to healthcare outcomes, however little agreement exists on what constitutes quality in abortion care or the recommended indicators from the service-user perspective. Our study aimed to explore perceptions and experiences of abortion QOC in England and Wales. METHODS We performed in-depth interviews (via phone or in-person) with participants who had an abortion at a nationwide independent sector provider in the previous 6 months. We explored their experiences of the abortion service at each point in the care pathway, their perspectives on what contributed to and detracted from the experience meeting their definitions of quality, and their reflections on different aspects of QOC. We used content analysis to generate themes. RESULTS From December 2018 to July 2019, we conducted 24 interviews. Ten participants had a surgical and 14 had a medical abortion. Seventeen (71%) were treated in the first 12 weeks of pregnancy and 7 (29%) beyond that, with an average gestational age of 10 weeks + 5 days (range 5-23 + 6). We identified 4 major themes that contributed to participant's perception of high quality care: (1) interpersonal interactions with staff or other patients, (2) being informed and prepared, (3) participation and choices in care and (4) accessibility. Nearly all participants identified interpersonal interactions with staff as an important contributor to quality with positive interactions often cited as the best part of their abortion experience and negative interactions as the worst. For information and preparation, participant described not only the importance of being well prepared, but how incongruencies between information and the actual experience detracted from quality. Participants said that making choices about their care, for example, method of abortion, was a positive contributor. Finally, participants identified access to care, specifically in relation to waiting times and travel, as an important aspect of QOC. CONCLUSIONS Participants situated quality in abortion care in 4 domains: interpersonal aspects of care, information and preparation, choices, and accessibility. Indicators identified can be used to develop standard metrics to ensure care meets service-user needs.
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Affiliation(s)
- Katherine C Whitehouse
- Centre for Reproductive Research & Communication, BPAS, 30-31 Furnival Street, London, EC4A 1JQ, UK.
| | - Rebecca Blaylock
- Centre for Reproductive Research & Communication, BPAS, 30-31 Furnival Street, London, EC4A 1JQ, UK
| | - Shelly Makleff
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Patricia A Lohr
- Centre for Reproductive Research & Communication, BPAS, 30-31 Furnival Street, London, EC4A 1JQ, UK
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19
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Foster DG, Gould H, Biggs MA. Timing of pregnancy discovery among women seeking abortion . Contraception 2021; 104:642-647. [PMID: 34363842 DOI: 10.1016/j.contraception.2021.07.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Little is known about the incidence and causes of delay in recognition of pregnancy. Delay in pregnancy recognition is associated with later presentation for abortion and exacerbates the burdens in accessing care. Using Turnaway study data, this study assessed the prevalence of later pregnancy recognition among a sample of people who obtained or were denied a wanted abortion. STUDY DESIGN The Turnaway Study included telephone interviews of 956 women who sought an abortion in the first trimester or just over or under the gestational limit of one of 30 abortion facilities across the United States and in-depth interviews with 31 who completed 5 years of surveys. We describe women's experiences discovering pregnancy and conducted multivariate analyses assessing factors associated with later pregnancy discovery (after 13 weeks since last menstrual period [LMP]). RESULTS Most women seeking second trimester abortions recognized their pregnancy more than 8 weeks after their LMP; more than 1 in 5 recognized pregnancy after 20 weeks. In interviews, women explained that recognition was delayed because of a lack of pregnancy symptoms or concurrence of other conditions with symptoms similar to pregnancy. According to multivariate analyses, women who had never given birth (adjusted odds ratio [aOR] = 1.71; 95% confidence interval [CI]: 1.24, 2.35) and those who used hormonal contraceptives in the month of conception (aOR = 1.83; 95% CI: 1.35, 2.47) were more likely to discover pregnancy after 13 weeks. CONCLUSION Laws imposing gestational limits will make abortion unavailable to people who discover pregnancy after the limit. Such bans are likely to disproportionately affect people using contraceptive methods to prevent pregnancy and those who have never given birth. IMPLICATIONS Some pregnant people have few pregnancy symptoms and/or have conditions with symptoms similar to pregnancy, such as irregular periods or chronic pain. Gestational limits to abortion are likely to disproportionately affect people who recognize pregnancy later in pregnancy, particularly those without prior pregnancy experiences and who are using contraception.
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