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Upadhyay MT, Fusire T, Loi UR, Sorhaindo A, Salahuddin M, Hossain MA, Tshomo T, Mulati E, Daisy L, Anggraweni DP, Gultom T, Indrawati F, Jenyfa M, Than MM, Bhattarai B, Moonasinghe L, Mathota C, Jitruknatee A, Cham C, Ganatra B, Raina N. Strengthening regional commitment to ensuring access to medical abortion medicines in WHO's South-East Asia region: report of a participatory assessment and workshop. Reprod Health 2024; 20:191. [PMID: 38760864 PMCID: PMC11102148 DOI: 10.1186/s12978-024-01791-4] [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: 05/20/2023] [Accepted: 04/10/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In 2019, the World Health Organization identified improving access to safe abortion as an important priority toward improving sexual and reproductive health and rights and achieving Sustainable Development Goals. One strategy for addressing this priority is strengthening access to medicines for medical abortion. All 11 countries in the South-East Asia Region have some indications for legal abortion and permit post-abortion care. Therefore, strengthening access to medical abortion medicines is a reasonable strategy for improving access to safe abortion for the Region. METHODOLOGY We applied an adapted version of an existing World Health Organization landscape assessment protocol for the availability of medical abortion medicines at the country-level in the South-East Asia Region. We collected publicly available data on the existence of national health laws, policies, and standard treatment guidelines; inclusion of medical abortion medicines in the national essential medicines list; and marketing authorization status for medical abortion medicines for each country and verified by Ministries of health. The findings were once more presented, discussed and recommendations were formulated during regional technical consultation workshop. Each country teams participated in the process, and subsequently, the suggestions were validated by representatives from Ministries of Health.. RESULTS Few countries in the Region currently have national policies and guidelines for comprehensive safe abortion. However, either mifepristone-misoprostol in combination or misoprostol alone (for other indications) is included in national essential medicines lists in all countries except Indonesia and Sri Lanka. Few countries earmark specific public funds for procuring and distributing medical abortion commodities. In countries where abortion is legal, the private sector and NGOs support access to medical abortion information and medicines. Several countries only allow registered medical practitioners or specialists to administer medical abortion. CONCLUSION Following this rapid participatory assessment and technical consultation workshop, the World Health Organization South-East Asia Regional Technical Advisory and Sexual and Reproductive Health and Rights technical committee recommended priority actions for policy and advocacy, service delivery, and monitoring and evaluation, and indicated areas for support.
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Affiliation(s)
- Meera Thapa Upadhyay
- World Health Organization, South-East Asia Region - WHO SEARO, New Delhi, India.
| | - Terence Fusire
- World Health Organization, South-East Asia Region - WHO SEARO, New Delhi, India
| | - Ulrika Rehnström Loi
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Annik Sorhaindo
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | | | | | | | - Erna Mulati
- Nutrition, Maternal, Newborn and Child Health, Ministry of Health, Jakarta, Indonesia
| | - Lovely Daisy
- Nutrition, Maternal, Newborn and Child Health, Ministry of Health, Jakarta, Indonesia
| | | | - Tumiur Gultom
- Directorate of Drug, Narcotic, Psychotropic, Precursor Distribution and Service Control, Jakarta, Indonesia
| | - Fitri Indrawati
- Directorate of Safety, Quality and Export-Import of Drug, Narcotic, Psychotropic, Precursor, Addictive Substance Control, Jakarta, Indonesia
| | - Mariyam Jenyfa
- Health Protection Agency Ministry of Health, Male, Maldives
| | - Myint Myint Than
- Department of Public Health, Ministry of Health, Naypyidaw, Myanmar
| | - Bharat Bhattarai
- Department of Drug Administration Ministry of Health & Population, Kathmandu, Nepal
| | | | | | - Anchalee Jitruknatee
- National Drug Policy Unit, Medicines Regulation Division, FDA, Nonthaburi, Thailand
| | - Celeste Cham
- National Directorate of Pharmacy Ministry of Health, Dili, Timor-Leste
| | - Bela Ganatra
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Neena Raina
- World Health Organization, South-East Asia Region - WHO SEARO, New Delhi, India
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Henry TL, Olakunle OE. The Physician's Role in Countering Medical Misinformation Through Advocacy. Popul Health Manag 2024. [PMID: 38577915 DOI: 10.1089/pop.2024.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
- Tracey L Henry
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Oreoluwa E Olakunle
- Doctor of Medicine Program, Emory University School of Medicine, Atlanta, Georgia, USA
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Jenkins D, Wolfe I, Dillard-Wright J. Nurses as Disciplinary Agents of the State: Ethical Practice and Mandatory Reporting in the United States. ANS Adv Nurs Sci 2023; Publish Ahead of Print:00012272-990000000-00073. [PMID: 37192597 DOI: 10.1097/ans.0000000000000503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
This article reviews legislative initiatives that mandate nurses to report patients, families, and clinicians to law enforcement. Most recently, these laws target transgender and gender diverse (TGD) youth and people seeking abortion. In this article, we examine the ethics of such laws through professional ethical codes. Furthermore, through a biopolitical lens, we critically analyze examples of nurses' participation in complying with laws that harm patients. Finally, we discuss the damage these laws have on the nursing profession and assert the necessity of a resituating of professional ethics that considers the complexity of nursing care amidst increasingly blatant state-sanctioned violence.
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Affiliation(s)
- Danisha Jenkins
- San Diego State University School of Nursing, San Diego, California (Dr Jenkins); Department of Clinical Ethics, Children's Minnesota, Minneapolis (Dr Wolfe); Center for Bioethics, University of Minnesota, Minneapolis (Dr Wolfe); and Elaine Marieb College of Nursing, UMass Amherst, Amherst, Massachusetts (Dr Dillard-Wright)
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Alvarez BA. Sexual and Reproductive Health Information and Services in Public Libraries: A National Survey of Public Library Professionals. PUBLIC LIBRARY QUARTERLY 2023. [DOI: 10.1080/01616846.2023.2187182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Barbara A. Alvarez
- The Information School, University of Wisconsin-Madison, Madison, WI, USA
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Coverdale J, Gordon MR, Beresin EV, Guerrero APS, Louie AK, Balon R, Morreale MK, Aggarwal R, Brenner AM. Access to Abortion After Dobbs v. Jackson Women's Health Organization: Advocacy and a Call to Action for the Profession of Psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:1-6. [PMID: 36369427 PMCID: PMC9652041 DOI: 10.1007/s40596-022-01729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Redd SK, AbiSamra R, Blake SC, Komro KA, Neal R, Rice WS, Hall KS. Medication Abortion "Reversal" Laws: How Unsound Science Paved the Way for Dangerous Abortion Policy. Am J Public Health 2023; 113:202-212. [PMID: 36652652 PMCID: PMC9850634 DOI: 10.2105/ajph.2022.307140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 01/19/2023]
Abstract
Objectives. To longitudinally examine the legal landscape of laws requiring abortion patients be informed about the possibility of medication abortion (MAB) "reversal" (in quotes as it does not refer to an evidence-based medical procedure). Methods. We collected legal data on enacted state MAB-reversal laws across all 50 US states and Washington, DC, (collectively, states) from 2012 through 2021. We descriptively analyzed these laws to identify legal variation over time and geography, and conducted a content analysis to identify qualitative themes and patterns in MAB-reversal laws. Results. As of 2021, 14 states (27%)-mostly in the midwestern and southern United States-have enacted MAB-reversal laws. States largely use explicit language to describe reversal, require patients receive information during preabortion counseling, require physicians or physicians' agents to inform patients, instruct patients to contact a health care provider or visit "abortion pill reversal" resources for more information, and require reversal information be posted on state-managed Web sites. Conclusions. Reversal laws continue a dangerous precedent of using unsound science to justify laws regulating abortion access, intrude upon the patient‒provider relationship, and may negatively affect the emotional and physical health of patients seeking an MAB. (Am J Public Health. 2023;113(2):202-212. https://doi.org/10.2105/AJPH.2022.307140).
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Affiliation(s)
- Sara K Redd
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
| | - Roula AbiSamra
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
| | - Sarah C Blake
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
| | - Kelli A Komro
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
| | - Rachel Neal
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
| | - Whitney S Rice
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
| | - Kelli S Hall
- Sara K. Redd and Sarah C. Blake are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA. Roula AbiSamra is with the Amplify Georgia Collaborative, Atlanta. Kelli A. Komro and Whitney S. Rice are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health. Rachel Neal is with the Department of Gynecology and Obstetrics, School of Medicine, Emory University. Kelli S. Hall is with the Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY
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Nobel K, Luke AA, Rice WS. Racial disparities in pregnancy options counseling and referral in the US South. Health Serv Res 2023; 58:9-18. [PMID: 36068681 PMCID: PMC9836946 DOI: 10.1111/1475-6773.14049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The objective of this study is to examine racial variation in receipt of counseling and referral for pregnancy options (abortion, adoption, and parenting) following pregnancy confirmation. Equitable offering of such information is a professional and ethical obligation and an opportunity to prevent racial disparities in maternal and child health. DATA SOURCE Primary data from patients at southern United States publicly funded family planning clinics, October 2018-June 2019. STUDY DESIGN Patients at 14 clinics completed a survey about their experiences with pregnancy options counseling and referral following a positive pregnancy test. The primary predictor variable was patients' self-reported racial identity. Outcomes included discussion of pregnancy options, referral for those options, and for support services. DATA COLLECTION Data from eligible patients with non-missing information for key variables (n = 313) were analyzed using descriptive statistics, χ2 tests, and multivariable logistic regression. PRINCIPAL FINDINGS Patients were largely Black (58%), uninsured (64%), and 18-29 years of age (80%). Intention to continue pregnancy and receipt of prenatal care referral did not differ significantly among Black as compared to non-Black patients. However, Black patients had a higher likelihood of wanting an abortion or adoption referral and not receiving one (abortion: marginal effect [ME] = 7.68%, p = 0.037; adjusted ME [aME] = 9.02%, p = 0.015; adoption: ME = 7.06%, p = 0.031; aME = 8.42%, p = 0.011). Black patients intending to end their pregnancies had a lower probability of receiving an abortion referral than non-Black patients (ME = -22.37%, p = 0.004; aME = -19.69%, p = 0.023). In the fully adjusted model, Black patients also had a higher probability of wanting access to care resources (including transportation, childcare, and financial support) and not receiving them (aME = 5.38%, p = 0.019). CONCLUSIONS Clinical interactions surrounding pregnancy confirmation provide critical opportunities to discuss options, coordinate care, and mitigate risk, yet are susceptible to systemic bias. These findings add to limited evidence around pregnancy counseling and referral disparities. Ongoing assessment of pregnancy counseling and referral disparities can provide insight into organizational strengths or the potential to increase structural equity.
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Affiliation(s)
- Kristin Nobel
- Evaluation DepartmentProvide, Inc.Round RockTexasUSA
| | - Alina A. Luke
- Department of Behavioral, Social and Health Education SciencesRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA,Center for Reproductive Health Research in the Southeast (RISE)Rollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
| | - Whitney S. Rice
- Department of Behavioral, Social and Health Education SciencesRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA,Center for Reproductive Health Research in the Southeast (RISE)Rollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
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Sorhaindo AM, Lavelanet AF. Why does abortion stigma matter? A scoping review and hybrid analysis of qualitative evidence illustrating the role of stigma in the quality of abortion care. Soc Sci Med 2022; 311:115271. [PMID: 36152401 PMCID: PMC9577010 DOI: 10.1016/j.socscimed.2022.115271] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/24/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022]
Abstract
Abortion stigma shapes the environment in which abortion is delivered and received and can have important implications for quality in abortion care. However, this has not previously been clearly articulated and evidenced. We conducted a scoping review of existing qualitative evidence to characterize the relationship between abortion stigma and quality in abortion care. Using a systematic process, we located 50 qualitative studies to include in our analysis. We applied the interface of the WHO quality of care and abortion stigma frameworks to the qualitative evidence to capture manifestations of the interaction between abortion stigma and quality in abortion care in the existing literature. Four overarching themes linked to abortion stigma emerged: A) abortion as a sin and other religious views; B) regulation of abortion; C) judgement, labelling and marking; and D) shame, denial, and secrecy. We further characterized the emerging ways in which abortion stigma operates to inhibit quality in abortion care into seven manifestations of the relationship between abortion stigma and quality in abortion care: 1) poor treatment and the repercussions, 2) gatekeeping and obstruction of access, 3) avoiding disclosure, 4) arduous and unnecessary requirements, 5) poor infrastructure and lack of resources, 6) punishment and threats and 7) lack of a designated place for abortion services. This evidence complements the abortion stigma-adapted WHO quality of care framework suggested by the International Network for the Reduction of Abortion Discrimination and Stigma (inroads) by illustrating specifically how the postulated stigma-related barriers to quality abortion care occur in practice. Further research should assess these manifestations in the quantitative literature and contribute to the development of quality in abortion care indicators that include measures of abortion stigma, and the development of abortion stigma reduction interventions to improve quality in abortion care.
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Affiliation(s)
- Annik Mahalia Sorhaindo
- World Health Organization, Department of Reproductive Health and Research and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), 20 Avenue Appia, 1211, Geneva, Switzerland.
| | - Antonella Francheska Lavelanet
- World Health Organization, Department of Reproductive Health and Research and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), 20 Avenue Appia, 1211, Geneva, Switzerland
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Keefe-Oates B, Tejada CG, Zurbriggen R, Grosso B, Gerdts C. Abortion beyond 13 weeks in Argentina: healthcare seeking experiences during self-managed abortion accompanied by the Socorristas en Red. Reprod Health 2022; 19:185. [PMID: 36028868 PMCID: PMC9419329 DOI: 10.1186/s12978-022-01488-6] [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: 07/22/2021] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Argentina, a group of feminist activists, the Socorristas en Red, provide information and accompaniment to people seeking abortions, including beyond 13 weeks gestation. Recently-released WHO guidelines for abortion care acknowledge that abortion trajectories vary and people may seek services and support from a range of settings in the process of an abortion. It follows, therefore, that people who self manage abortions beyond 13 weeks with the support of accompaniment groups may interact with health professionals in the public and/or private sector. Understanding the reasons for and experiences with these interactions can help to inform best practice. METHODS In 2016, we conducted 23 exploratory interviews among women who self managed abortions beyond 13 weeks gestation accompanied by Socorristas, to understand healthcare-seeking decisions and experiences. We used narrative inquiry as an interview technique and coded interviews using first a holistic coding and, second, a content analysis technique to identify emergent themes in the text and subsequently identify themes relevant to study aims. RESULTS We found that many participants had disclosed their abortion intentions to health professionals prior to their abortions. Some were provided with emotional support and referrals to the Socorristas, while others were admonished and warned of serious health consequences. Most participants sought post-abortion care in public or private-sector health facilities; for fear of legal repercussions, many participants did not share that they had used abortion medications with post-abortion care providers. During care seeking, some participants reported poor treatment, in several cases because they were suspected of inducing abortion, while others reported supportive care from health professionals who had previously-established relationships with the Socorristas. CONCLUSIONS This study illuminates the important role that supportive health professionals can play to ensure that, regardless of the trajectory of an abortion, people feel comfortable accessing clinical services during their abortion process, even in restrictive settings. Feminist activists can help build bridges with the medical system to ensure that providers who interact with people seeking abortion-related services are empathic, understand their legal rights, and provide supportive care.
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Affiliation(s)
- Brianna Keefe-Oates
- Ibis Reproductive Health, 2067 Massachusetts Ave, Suite 320, Cambridge, MA, 02140, USA. .,Department of Social and Behavioral Sciences, Harvard University TH Chan School of Public Health, Boston, USA.
| | - Chelsea G Tejada
- Ibis Reproductive Health, 2067 Massachusetts Ave, Suite 320, Cambridge, MA, 02140, USA
| | | | - Belén Grosso
- La Colectiva Feminista La Revuelta, Neuquen, Argentina
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Affiliation(s)
- M Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Corinne Rocca
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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