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Smith MH, McGowan ML, Kerestes C, Bessett D, Norris AH. Longitudinal Impact of Dobbs v Jackson Women's Health Organization on Abortion Service Delivery in Ohio, 2022‒2023. Am J Public Health 2024; 114:1034-1042. [PMID: 39231404 PMCID: PMC11375362 DOI: 10.2105/ajph.2024.307775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Objectives. To assess the impact of Ohio's abortion policy changes on abortion provision following Dobbs v Jackson Women's Health Organization. Methods. We analyzed quantitative and write-in responses from an ongoing survey of 6 abortion facilities in Ohio for 3 time periods: January‒June 2022 (pre-Dobbs), July‒September 2022 (6-week ban in effect), and October 2022‒June 2023 (post-Dobbs, ban blocked). We disaggregated counts by method, gestation, and state of residence. Results. Following Dobbs, Ohio banned abortions after detection of embryonic cardiac activity, and monthly abortion provision decreased 56%. Several months after the ban was lifted, monthly abortion means exceeded pre-Dobbs means. The percentage of patients from out of state increased over time. Conclusions. The post-Dobbs enactment of a restrictive abortion ban drastically reduced availability of reproductive health care in Ohio. Nevertheless, Ohio remained an important destination for patients from surrounding states with abortion restrictions. Public Health Implications. Gestational bans decrease access to necessary health care; instead, states like Ohio should work to eliminate barriers to abortion care to support the health and well-being of people in their own and surrounding states. (Am J Public Health. 2024;114(10):1034-1042. https://doi.org/10.2105/AJPH.2024.307775).
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Affiliation(s)
- Mikaela H Smith
- Mikaela H. Smith and Alison H. Norris are with the College of Public Health, The Ohio State University, Columbus. Michelle L. McGowan is with the Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, and the Department of Women's, Gender, and Sexuality Studies, University of Cincinnati, OH. Courtney Kerestes is with the Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University. Danielle Bessett is with the Department of Sociology, University of Cincinnati
| | - Michelle L McGowan
- Mikaela H. Smith and Alison H. Norris are with the College of Public Health, The Ohio State University, Columbus. Michelle L. McGowan is with the Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, and the Department of Women's, Gender, and Sexuality Studies, University of Cincinnati, OH. Courtney Kerestes is with the Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University. Danielle Bessett is with the Department of Sociology, University of Cincinnati
| | - Courtney Kerestes
- Mikaela H. Smith and Alison H. Norris are with the College of Public Health, The Ohio State University, Columbus. Michelle L. McGowan is with the Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, and the Department of Women's, Gender, and Sexuality Studies, University of Cincinnati, OH. Courtney Kerestes is with the Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University. Danielle Bessett is with the Department of Sociology, University of Cincinnati
| | - Danielle Bessett
- Mikaela H. Smith and Alison H. Norris are with the College of Public Health, The Ohio State University, Columbus. Michelle L. McGowan is with the Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, and the Department of Women's, Gender, and Sexuality Studies, University of Cincinnati, OH. Courtney Kerestes is with the Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University. Danielle Bessett is with the Department of Sociology, University of Cincinnati
| | - Alison H Norris
- Mikaela H. Smith and Alison H. Norris are with the College of Public Health, The Ohio State University, Columbus. Michelle L. McGowan is with the Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, and the Department of Women's, Gender, and Sexuality Studies, University of Cincinnati, OH. Courtney Kerestes is with the Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University. Danielle Bessett is with the Department of Sociology, University of Cincinnati
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Dozier JL, Burke AE, McMahon HV, Berger BO, Quasebarth M, Sufrin C, Bell SO. "Maybe if we weren't in the pandemic, I would have reconsidered": Experiences of abortion care-seeking during the COVID-19 pandemic in Maryland. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:124-135. [PMID: 38655782 DOI: 10.1111/psrh.12265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To understand the COVID-19 pandemic's impact on abortion care-seeking in Maryland, a state with Medicaid coverage for abortion, high service availability, and laws supporting abortion rights. METHODS We conducted semi-structured telephone interviews with 15 women who had an abortion between January 2021 and March 2022 at a hospital-based clinic in a mid-sized Maryland city. We purposively recruited participants with varied pandemic financial impacts. Interview questions prompted participants to reflect on how the pandemic affected their lives, pregnancy decisions, and experiences seeking abortion care. We analyzed our data for themes. RESULTS All participants had some insurance coverage for their abortion; over half paid using Medicaid. Many participants experienced pandemic financial hardship, with several reporting job, food, and housing insecurity as circumstances influencing their decision to have an abortion. Most women who self-reported minimal financial hardship caused by the pandemic indicated they sought an abortion for reasons unrelated to COVID-19. In contrast, women with economic hardship viewed their pregnancies as unsupportable due to COVID-19 exacerbating financial instability, even when they desired to continue the pregnancy. All participants expressed that having an abortion was the best decision for their lives. Yet, when making decisions about their pregnancy, the most financially disadvantaged women weighed their desires against the pandemic's constraints on their reproductive self-determination. CONCLUSIONS The pandemic changed abortion care-seeking circumstances even in a setting with minimal access barriers. Financial hardship influenced some women to have an abortion for a pregnancy that-while unplanned-they may have preferred to continue.
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Affiliation(s)
- Jessica L Dozier
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne E Burke
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hayley V McMahon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Blair O Berger
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Madeline Quasebarth
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carolyn Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Jones HE, Manze M, Brakman A, Kwan A, Davies M, Romero D. Physician engagement in reproductive health advocacy: findings from a mixed methods evaluation of a leadership and advocacy program. BMC MEDICAL EDUCATION 2024; 24:476. [PMID: 38689263 PMCID: PMC11061897 DOI: 10.1186/s12909-024-05410-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Medical curricula include advocacy competencies, but how much physicians engage in advocacy and what enables this engagement is not well characterized. The authors assessed facilitators and barriers to advocacy identified by physician alumni of a reproductive health advocacy training program. METHODS The authors present secondary results from a mixed methods program evaluation from 2018 to 2020, using alumni data from a cross-sectional survey (n = 231) and in-depth interviews (IDIs, n = 36). The survey measured engagement in policy, media, professional organization, and medical education advocacy and the value placed on the community fostered by the program (eight questions, Cronbach's alpha = 0.81). The authors estimated the association of community value score with advocacy engagement using multivariable Poisson regression to estimate prevalence ratios and analyzed IDI data inductively. RESULTS Over one third of alumni were highly engaged in legislative policy (n = 90, 39%), professional organizations (n = 98, 42%), or medical education (n = 89, 39%), with fewer highly active in media-based advocacy (n = 54, 23%) in the year prior to the survey. Survey and IDI data demonstrated that passion, sense of urgency, confidence in skills, and the program's emphasis on different forms of advocacy facilitated engagement in advocacy, while insufficient time, safety concerns, and sense of effort redundancies were barriers. The program community was also an important facilitator, especially for "out loud" efforts and for those working in environments perceived as hostile to abortion care (e.g., alumni in hostile environments with high community value scores were 1.8 times [95% CI 1.3, 2.6] as likely to report medium/high levels of media advocacy compared to those with low scores after adjusting for age, gender, and clinical specialty). CONCLUSION Physician advocacy training curricula should include both skills- and community-building and identify a full range of forms of advocacy. Community-building is especially important for physician advocacy for reproductive health services such as abortion care.
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Affiliation(s)
- Heidi E Jones
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), 55 W. 125th St #7th Floor, 10027, New York, NY, USA.
- City University of New York Institute of Implementation Science in Population Health (CUNY ISPH), New York, USA.
| | - Meredith Manze
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), 55 W. 125th St #7th Floor, 10027, New York, NY, USA
| | - Anita Brakman
- Physicians for Reproductive Health, Hartsdale, NY, USA
| | - Amy Kwan
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), 55 W. 125th St #7th Floor, 10027, New York, NY, USA
| | - MiQuel Davies
- Physicians for Reproductive Health, Hartsdale, NY, USA
| | - Diana Romero
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), 55 W. 125th St #7th Floor, 10027, New York, NY, USA
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Dunlop H, Sinay AM, Kerestes C. Telemedicine Abortion. Clin Obstet Gynecol 2023; 66:725-738. [PMID: 37910115 DOI: 10.1097/grf.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Telemedicine has become a substantial part of abortion care in recent years. In this review, we discuss the history and regulatory landscape of telemedicine for medication abortion in the United States, different models of care for telemedicine, and the safety and effectiveness of medication abortion via telemedicine, including using history-based screening protocols for medication abortion without ultrasound. We also explore the acceptability of telemedicine for patients and their perspectives on its benefits, as well as the use of telemedicine for other parts of abortion care. Telemedicine has expanded access to abortion for many, although there remain limitations to its implementation.
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Affiliation(s)
| | - Anne-Marie Sinay
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Courtney Kerestes
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
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Brown C, Neerland CE, Weinfurter EV, Saftner MA. The Provision of Abortion Care via Telehealth in the United States: A Rapid Review. J Midwifery Womens Health 2023; 68:744-758. [PMID: 38069588 DOI: 10.1111/jmwh.13586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/11/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The recent Supreme Court decision Dobbs v. Jackson Women's Health that has overruled Roe v. Wade has resulted in severe limitations of abortion access throughout the United States. Telehealth has been put forth as one solution for improving access for reproductive health care, including abortion services. Telehealth has demonstrated safety and efficacy in several health care disciplines; however, its use for abortion care and services has not been explored and synthesized. METHODS As part of a larger review on telehealth and general reproductive health, our team identified a moderate amount of literature on telehealth and abortion care. We conducted a rapid review searching for eligible studies in MEDLINE, Embase, and CINAHL. Information was extracted from each included study to explore 4 key areas of inquiry: (1) clinical effectiveness, (2) patient and provider experiences, (3) barriers and facilitators, and (4) the impact of the coronavirus disease 2019 (COVID-19) pandemic. RESULTS Twenty-five studies on the use of telehealth for providing abortion services published between 2011 and 2022 were included. Telehealth for medical abortion increased during the COVID-19 pandemic and was found to be safe and clinically effective, with high patient satisfaction. Overall, telehealth improved access and removed barriers for patients including lack of transportation. Legal restrictions in certain states were cited as the primary barriers. Studies contained limited information on the perspectives and experiences of health care providers and diverse patient populations. DISCUSSION Abortion care via telehealth is safe and effective with high satisfaction and may also remove barriers to care including transportation and fear. Removing restrictions on telehealth for the provision of abortion services may further improve access to care and promote greater health equity.
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Affiliation(s)
- Camille Brown
- University of Minnesota School of Nursing, Minneapolis, Minnesota
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Hwang CS, Kesselheim AS, Sarpatwari A, Huybrechts KF, Brill G, Rome BN. Changes in Induced Medical and Procedural Abortion Rates in a Commercially Insured Population, 2018 to 2022 : An Interrupted Time-Series Analysis. Ann Intern Med 2023; 176:1508-1515. [PMID: 37871317 DOI: 10.7326/m23-1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, access to in-person care was limited, and regulations requiring in-person dispensing of mifepristone for medical abortions were relaxed. The effect of the pandemic and accompanying regulatory changes on abortion use is unknown. OBJECTIVE To estimate changes in the incidence rate of induced medical and procedural abortions. DESIGN Serial cross-sectional study with interrupted time-series analyses. SETTING Commercially insured persons in the United States. PARTICIPANTS Reproductive-aged women. INTERVENTION Onset of the COVID-19 pandemic in March 2020 and subsequent regulatory changes affecting the in-person dispensing requirement for mifepristone. MEASUREMENTS Monthly age-adjusted incidence rates of medical and procedural abortions were measured among women aged 15 to 44 years from January 2018 to June 2022. Medical abortions were classified as in-person or telehealth. Linear segmented time-series regression was used to calculate changes in abortion rates after March 2020. RESULTS In January 2018, the estimated age-adjusted monthly incidence rate of abortions was 151 per million women (95% CI, 142 to 161 per million women), with equal rates of medical and procedural abortions. After March 2020, there was an immediate 14% decrease in the monthly incidence rate of abortions (21 per million women [CI, 7 to 35 per million women]; P = 0.004), driven by a 31% decline in procedural abortions (22 per million women [CI, 16 to 28 per million women]; P < 0.001). Fewer than 4% of medical abortions each month were administered via telehealth. LIMITATION Only abortions reimbursed by commercial insurance were measured. CONCLUSION The incidence rate of procedural abortions declined during the COVID-19 pandemic, and this lower rate persisted after other elective procedures rebounded to prepandemic rates. Despite removal of the in-person dispensing requirement for mifepristone, the use of telehealth for insurance-covered medical abortions remained rare. Amid increasing state restrictions, commercial insurers have the opportunity to increase access to abortion care, particularly via telehealth. PRIMARY FUNDING SOURCE Health Resources and Services Administration.
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Affiliation(s)
- Catherine S Hwang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (C.S.H., A.S.K., A.S., K.F.H., G.B., B.N.R.)
| | - Aaron S Kesselheim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (C.S.H., A.S.K., A.S., K.F.H., G.B., B.N.R.)
| | - Ameet Sarpatwari
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (C.S.H., A.S.K., A.S., K.F.H., G.B., B.N.R.)
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (C.S.H., A.S.K., A.S., K.F.H., G.B., B.N.R.)
| | - Gregory Brill
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (C.S.H., A.S.K., A.S., K.F.H., G.B., B.N.R.)
| | - Benjamin N Rome
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (C.S.H., A.S.K., A.S., K.F.H., G.B., B.N.R.)
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Smith MH, Broscoe M, Chakraborty P, Hill J, Hood R, McGowan M, Bessett D, Norris AH. COVID-19 and abortion in the Ohio River Valley: A case study of Kentucky, Ohio, and West Virginia. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:178-191. [PMID: 37571959 DOI: 10.1363/psrh.12244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
INTRODUCTION During early stages of COVID-19 in the United States, government representatives in Kentucky, Ohio, and West Virginia restricted or threatened to restrict abortion care under elective surgery bans. We examined how abortion utilization changed in these states. METHODOLOGY We examined COVID-19 abortion-related state policies implemented in March and April 2020 using publicly available sources. We analyzed data on abortions by method and gestation and experiences of facility staff, using a survey of 14 facilities. We assessed abortions that took place in February-June 2020 and February-June 2021. RESULTS In February-June 2020 the monthly average abortion count was 1916; 863 (45%) were medication abortions and 229 (12%) were ≥14 weeks gestation. Of 1959 abortions performed across all three states in April 2020, 1319 (67%) were medication abortions and 231 (12%) were ≥14 weeks gestation. The shift toward medication abortion that took place in April 2020 was not observed in April 2021. Although the total abortion count in the three-state region remained steady, West Virginia had the greatest decline in total abortions, Ohio experienced a shift from instrumentation to medication abortions, and Kentucky saw little change. Staff reported increased stress from concerns over health and safety and increased scrutiny by the state and anti-abortion protesters. DISCUSSION Although abortion provision continued in this region, policy changes restricting abortion in Ohio and West Virginia resulted in a decrease in first trimester instrumentation abortions, an overall shift toward medication abortion care, and an increase in stress among facility staff during the early phase of COVID-19.
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Affiliation(s)
- Mikaela H Smith
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, USA
| | - Molly Broscoe
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jessie Hill
- Case Western Reserve University School of Law, Cleveland, Ohio, USA
| | - Robert Hood
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michelle McGowan
- Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, Ohio, USA
| | - Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alison H Norris
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, USA
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JACQUES L, VALLEY T, ZHAO S, LANDS M, RIVERA N, HIGGINS JA. "I'm going to be forced to have a baby": A study of COVID-19 abortion experiences on Reddit. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:86-93. [PMID: 37167095 PMCID: PMC10864016 DOI: 10.1363/psrh.12225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION The initial stages of the COVID-19 pandemic affected abortion care in the United States (US) in myriad ways. While research has documented systems-level pandemic-related impacts on abortion access and care delivery little information exists about the experiences of abortion seekers during this period. We sought to document the effects of COVID-19 pandemic restrictions US abortion seekers by analyzing posts on Reddit, a popular social media website. METHODS We compiled and coded 528 anonymous posts on the abortion subreddit from 3/20/2020 to 4/12/2020 and applied inductive qualitative analytic techniques to identify themes. RESULTS We identified four primary themes. First, posters reported several COVID-19-related barriers to abortion services: reduced in-person access due to clinic closures, mail delivery delays of abortion medications, and pandemic-related financial barriers to both self-managed and in-clinic abortion. The second theme encompassed quarantine-driven privacy challenges, primarily challenges with concealing an abortion from household members. Third, posters detailed how the pandemic constrained their pregnancy decision making, including time pressure from impending clinic closures. Finally, posters reported COVID-19-related changes to service delivery that negatively affected their abortion experiences, for example being unable to bring a support person into the clinic due to pandemic visitor restrictions. DISCUSSION This analysis of real-time social media posts reveals multiple ways that the COVID-19 pandemic limited abortion access in the US and affected abortion seekers' decisions and experiences. Findings shed light on the consequences of sudden changes, whether pandemic or policy related, on abortion service delivery.
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Affiliation(s)
- Laura JACQUES
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, 1010 Mound St, Madison, WI 53715, USA
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, Medical Sciences Center 4245, 1300 University Avenue, Madison WI 53706
| | - Taryn VALLEY
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, 1010 Mound St, Madison, WI 53715, USA
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, Medical Sciences Center 4245, 1300 University Avenue, Madison WI 53706
- Department of Anthropology, University of Wisconsin-Madison, 1180 Observatory Dr, Madison, WI 53706
| | - Shimin ZHAO
- Department of Philosophy, University of Wisconsin-Madison, Helen C. White Hall, 600 N Park St #5185, Madison, WI 53706
| | - Madison LANDS
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, 1010 Mound St, Madison, WI 53715, USA
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, Medical Sciences Center 4245, 1300 University Avenue, Madison WI 53706
| | - Natalie RIVERA
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, Medical Sciences Center 4245, 1300 University Avenue, Madison WI 53706
- Department of Counseling Psychology, University of Wisconsin-Madison, School of Education, 1000 Bascom Mall, Madison, WI 53706
| | - Jenny A. HIGGINS
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, 1010 Mound St, Madison, WI 53715, USA
- Collaborative for Reproductive Equity (CORE), University of Wisconsin-Madison, Medical Sciences Center 4245, 1300 University Avenue, Madison WI 53706
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Rivlin K, Brenner-Levoy J, Odum T, Muzyczka Z, Norris A, Norris Turner A, Bessett D. Provider Mistrust and Telemedicine Abortion Care Preferences Among Patients in Ohio, West Virginia, and Kentucky. Telemed J E Health 2023; 29:414-424. [PMID: 35856859 PMCID: PMC10081726 DOI: 10.1089/tmj.2022.0101] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: The convenience and privacy provided by telemedicine medication abortion may make this service preferable to patients who mistrust their abortion provider. We assessed associations between mistrust in the abortion provider and preferences for telemedicine abortion. Study Design: From April 2020 to April 2021, we surveyed patients seeking abortion in Ohio, West Virginia, and Kentucky. Using unconditional logistic regression models, we examined unadjusted and adjusted associations between mistrust in the abortion provider and preferences for telemedicine abortion among all participants, and among only participants undergoing medication abortion. Results: Of 1,218 patients who met inclusion criteria, 546 used medication abortion services. Just more than half (56%) of all participants and many (64%) of medication abortion participants preferred telemedicine services. Only 6% of medication abortion participants received telemedicine medication dispensing services. Only 1.4% of all participants and 1% of medication abortion participants mistrusted the abortion provider. Participants who mistrusted the abortion provider were somewhat more likely to prefer telemedicine abortion (unadjusted odds ratio [OR]: 2.5, 95% CI: 0.8-7.9; adjusted OR: 2.9, 95% CI: 0.9-9), and medication abortion participants who mistrusted the abortion provider were also somewhat more likely to prefer telemedicine abortion (unadjusted OR: 3.5, 95% CI: 0.4-28.9; adjusted OR: 5.0, 95% CI: 0.6-43), although these associations were not statistically significant. Conclusions: In three abortion-restrictive states, most patients expressed preferences for telemedicine abortion, but few accessed them. Provider mistrust was rare, but those experiencing mistrust trended toward preferring telemedicine services. Telemedicine may improve access to abortion services for patients experiencing medical mistrust.
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Affiliation(s)
- Katherine Rivlin
- Department of Obstetrics and Gynecology, The College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Tamika Odum
- Behavioral Science Department, Blue Ash College, University of Cincinnati, Cincinnati, Ohio, USA
| | - Zoe Muzyczka
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alison Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Abigail Norris Turner
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
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Bell SO, Berger BO, Sufrin C, Dozier JL, Burke AE. An exploratory study of COVID-19-related changes in abortion service availability and use in Washington, DC, Maryland, and Virginia. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:12-22. [PMID: 36751866 DOI: 10.1363/psrh.12220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES This exploratory study aimed to assess COVID-19-related changes in abortion service availability and use in Washington, DC, Maryland, and Virginia. DESIGN Data came from a convenience sample of eight abortion clinics in this region. We implemented a cross-sectional survey and collected retrospective aggregate monthly abortion data overall and by facility type, abortion type, and patient characteristics for March 2019-August 2020. We evaluated changes in the distribution of the total number of patients for March-August in 2019 compared to March-August 2020. We also conducted segmented regression analyses and produced scatter plots of monthly abortion patients overall and by facility type, abortion type, and patient characteristics, with separate fitted regression lines from the segmented regression models for the pre- and during-COVID-19 periods. RESULTS Five clinics reported a reduced number of appointments early in the pandemic while four reported increased call volume. There were declines in the monthly abortion trend at hospital-based clinics at the outset of the pandemic. Monthly number of medication abortions increased from March 2020 through August 2020 compared to pre-COVID-19 trends while instrumentation abortions 11 up to 19 weeks decreased. The share of abortions to Black individuals increased during the early phase of the pandemic, as did the monthly trend in abortions among this group. We also saw changes in payment type, with declines in patients paying out-of-pocket. CONCLUSIONS Results revealed differences in abortion services, numbers, and types during the early stages of the COVID-19 pandemic in Washington, DC, Maryland, and Virginia.
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Affiliation(s)
- Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Blair O Berger
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carolyn Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jessica L Dozier
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne E Burke
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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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: 2] [Impact Index Per Article: 2.0] [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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VanBenschoten H, Kuganantham H, Larsson EC, Endler M, Thorson A, Gemzell-Danielsson K, Hanson C, Ganatra B, Ali M, Cleeve A. Impact of the COVID-19 pandemic on access to and utilisation of services for sexual and reproductive health: a scoping review. BMJ Glob Health 2022; 7:e009594. [PMID: 36202429 PMCID: PMC9539651 DOI: 10.1136/bmjgh-2022-009594] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/13/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has negatively impacted health systems globally and widened preexisting disparities. We conducted a scoping review on the impact of the COVID-19 pandemic on women and girls' access to and utilisation of sexual and reproductive health (SRH) services for contraception, abortion, gender-based and intimate partner violence (GBV/IPV) and sexually transmitted infections (STIs). METHODS We systematically searched peer reviewed literature and quantitative reports, published between December 2019 and July 2021, focused on women and girls' (15-49 years old) access to and utilisation of selected SRH services during the COVID-19 pandemic. Included studies were grouped based on setting, SRH service area, study design, population and reported impact. Qualitative data were coded, organised thematically and grouped by major findings. RESULTS We included 83 of 3067 identified studies and found that access to contraception, in-person safe abortion services, in-person services for GBV/IPV and STI/HIV testing, prevention and treatment decreased. The geographical distribution of this body of research was uneven and significantly less representative of countries where COVID-19 restrictions were very strict. Access was limited by demand and supply side barriers including transportation disruptions, financial hardships, limited resources and legal restrictions. Few studies focused on marginalised groups with distinct SRH needs. CONCLUSION Reports indicated negative impacts on access to and utilisation of SRH services globally, especially for marginalised populations during the pandemic. Our findings call for strengthening of health systems preparedness and resilience to safeguard global access to essential SRH services in ongoing and future emergencies.
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Affiliation(s)
- Hannah VanBenschoten
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | | | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- WHO Collaborating Center for Human Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Margit Endler
- Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Obsetrics and Gynecology, Stockholm South General Hospital, Stockholm, Sweden
| | - Anna Thorson
- Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- WHO Collaborating Center for Human Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene & Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Bela Ganatra
- Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
| | - Moazzam Ali
- Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland
| | - Amanda Cleeve
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- Department of Obsetrics and Gynecology, Stockholm South General Hospital, Stockholm, Sweden
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Dozier JL, Sufrin C, Berger BO, Burke AE, Bell SO. COVID-19 impacts on abortion care-seeking experiences in the Washington, DC, Maryland, and Virginia regions of the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:68-79. [PMID: 35790127 PMCID: PMC9349554 DOI: 10.1363/psrh.12202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Many people wanted to avoid or delay childbearing during the COVID-19 pandemic. This study sought to examine the extent COVID-19 influenced abortion care-seeking in a region that did not enact policy restricting abortion due to the pandemic, has high service availability, and few abortion-restrictive policies. METHODOLOGY We conducted telephone surveys with adults (n=72) requesting abortion appointments between September 2020 and March 2021 at five clinics in Washington, DC, Maryland, and Virginia. We used χ2 tests to compare sociodemographic, reproductive history, service delivery characteristics, and pandemic-related life changes by whether COVID-19 influenced abortion care-seeking. RESULTS Most respondents (93%) had an abortion at the time of the survey, 4% were awaiting their scheduled appointment, and 3% did not have an appointment scheduled. Nearly 40% of people reported COVID-19 influenced their decision to have an abortion. These individuals were significantly more likely to report "not financially prepared" (44% vs. 16%) as a reason for termination compared to people reporting no influence of COVID-19. They were also more likely to have lost or changed their health insurance due to pandemic-related employment changes (15% vs. 2%), report substantial money difficulties due to COVID-19 (59% vs. 33%), and report that paying for their abortion was "very difficult" (25% vs. 2%). CONCLUSION COVID-19 influenced many people to have an abortion, particularly those financially disadvantaged by the pandemic. Expansion of Medicaid abortion coverage in Washington, DC and Virginia could reduce financial barriers to care and help people to better meet their reproductive needs amid future crises.
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Affiliation(s)
- Jessica L. Dozier
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Carolyn Sufrin
- Department of Gynecology and ObstetricsJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of Health, Behavior, and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Blair O. Berger
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Anne E. Burke
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Gynecology and ObstetricsJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Suzanne O. Bell
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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14
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Chakraborty P, Murawsky S, Smith MH, McGowan ML, Norris AH, Bessett D. How Ohio's proposed abortion bans would impact travel distance to access abortion care. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:54-63. [PMID: 35442569 PMCID: PMC9324164 DOI: 10.1363/psrh.12191] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 05/30/2023]
Abstract
CONTEXT Since March 2021, the Ohio legislature has been actively considering laws that would ban abortion if the United States Supreme Court overturns the Roe v. Wade decision that legalized abortion nationally in 1973. METHODS We used a national database of publicly advertised abortion facilities to calculate driving distances for Ohioans before and after the activation of proposed abortion bans. Using a legal analysis of abortion laws following the overturn of Roe, we determined which states surrounding Ohio would continue providing abortion care. We calculated distances from each Ohio county centroid to the nearest open abortion facility in three scenarios: (1) as of February 2022, (2) the best-case post-Roe scenario (two of the five surrounding states continue to offer abortion care), and (3) worst-case post-Roe scenario (no surrounding states continue to offer abortion care). We calculated population-weighted distances using county-level data about women aged 15-44 years from the 2019 American Community Survey. RESULTS In February 2022, all Ohio county centroids were at most 99 miles from an abortion facility (median = 50 miles). The best-case post-Roe scenario shows 62 of Ohio's 88 counties to be 115-279 miles away from the nearest facility (median = 146). The worst-case shows 85 counties to be 191-339 miles away from the nearest facility (median = 264). The current average population-weighted driving distance from county centroid to the nearest facility is 26 miles; the post-Roe scenarios would increase this to 157 miles (best-case) or 269 miles (worst-case). CONCLUSIONS Ohio's proposed abortion bans would substantially increase travel distances to abortion care, impacting over 2.2 million reproductive-aged Ohioans.
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Affiliation(s)
- Payal Chakraborty
- Division of Epidemiology, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | - Stef Murawsky
- Department of Sociology, College of Arts and SciencesUniversity of CincinnatiCincinnatiOhioUSA
| | - Mikaela H. Smith
- Division of Epidemiology, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | - Michelle L. McGowan
- Ethics CenterCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of Pediatrics, College of MedicineUniversity of CincinnatiCincinnatiOhioUSA
- Department of Women's, Gender & Sexuality Studies, College of Arts and SciencesUniversity of CincinnatiCincinnatiOhioUSA
| | - Alison H. Norris
- Division of Epidemiology, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
- Division of Infectious Diseases, College of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Danielle Bessett
- Department of Sociology, College of Arts and SciencesUniversity of CincinnatiCincinnatiOhioUSA
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15
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Vilain A, Rey S, Le Ray C, Quantin C, Zeitlin J, Fresson J. Impact of the COVID-19 pandemic on induced abortions in France in 2020. Am J Obstet Gynecol 2022; 226:739-741.e1. [PMID: 34999085 PMCID: PMC8824736 DOI: 10.1016/j.ajog.2021.12.265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Annick Vilain
- Population Health Office, Directorate of Research, Studies, Evaluation and Statistics (DREES), French Ministry of Health and Solidarity, Paris, France
| | - Sylvie Rey
- Population Health Office, Directorate of Research, Studies, Evaluation and Statistics (DREES), French Ministry of Health and Solidarity, Paris, France
| | - Camille Le Ray
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Université de Paris, Paris, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France; Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center 1432, Dijon, France
| | - Jennifer Zeitlin
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and Statistics, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Université de Paris, Paris, France
| | - Jeanne Fresson
- Population Health Office, Directorate of Research, Studies, Evaluation and Statistics (DREES), French Ministry of Health and Solidarity, 14, Ave. Duquesne, 75007 Paris Cedex, Paris; Department of Medical Information (DIM), University Hospital, Nancy, France.
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16
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Mukherjee TI, Khan AG, Dasgupta A, Samari G. Reproductive justice in the time of COVID-19: a systematic review of the indirect impacts of COVID-19 on sexual and reproductive health. Reprod Health 2021; 18:252. [PMID: 34930318 PMCID: PMC8686348 DOI: 10.1186/s12978-021-01286-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 11/06/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Despite gendered dimensions of COVID-19 becoming increasingly apparent, the impact of COVID-19 and other respiratory epidemics on women and girls' sexual and reproductive health (SRH) have yet to be synthesized. This review uses a reproductive justice framework to systematically review empirical evidence of the indirect impacts of respiratory epidemics on SRH. METHODS We searched MEDLINE and CINAHL for original, peer-reviewed articles related to respiratory epidemics and women and girls' SRH through May 31, 2021. Studies focusing on various SRH outcomes were included, however those exclusively examining pregnancy, perinatal-related outcomes, and gender-based violence were excluded due to previously published systematic reviews on these topics. The review consisted of title and abstract screening, full-text screening, and data abstraction. RESULTS Twenty-four studies met all eligibility criteria. These studies emphasized that COVID-19 resulted in service disruptions that effected access to abortion, contraceptives, HIV/STI testing, and changes in sexual behaviors, menstruation, and pregnancy intentions. CONCLUSIONS These findings highlight the need to enact policies that ensure equitable, timely access to quality SRH services for women and girls, despite quarantine and distancing policies. Research gaps include understanding how COVID-19 disruptions in SRH service provision, access and/or utilization have impacted underserved populations and those with intersectional identities, who faced SRH inequities notwithstanding an epidemic. More robust research is also needed to understand the indirect impact of COVID-19 and epidemic control measures on a wider range of SRH outcomes (e.g., menstrual disorders, fertility services, gynecologic oncology) in the long-term.
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Affiliation(s)
- Trena I Mukherjee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Angubeen G Khan
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Anindita Dasgupta
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | - Goleen Samari
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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Contraception Special Issue on the mifepristone Risk Evaluation and Mitigation Strategy (REMS). Contraception 2021; 104:1-3. [PMID: 34130794 DOI: 10.1016/j.contraception.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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