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McMahon HV, Serrano L, Vyavahare T, Hairston I, Ayala S, Jah Z, Hailstorks T, Diallo DD, Mosley EA. My Health in My Hands: Improving Medication Abortion Knowledge and Closing Disparities with a Community-Led Media Intervention. Health Equity 2024; 8:138-142. [PMID: 38435024 PMCID: PMC10908321 DOI: 10.1089/heq.2023.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 03/05/2024] Open
Abstract
Purpose Inaccurate beliefs about medication abortion (MA) are common. This study evaluated pilot data from a community-led media intervention designed to increase MA knowledge among Black and Latinx women in Georgia. Methods Participants (N=855) viewed the intervention video and completed pre-post surveys. Data were analyzed using linear and logistic regression. Results Knowledge scores significantly increased from 3.88/5.00 to 4.47/5.00. Participants who were Native American, Asian and Pacific Islander, multiracial, Black, <20 years old, and living in Georgia scored below the sample mean at baseline; however, nearly all disparities disappeared after intervention exposure. Conclusions This intervention effectively increased MA knowledge and narrowed racial/ethnic, age-based, and geographic disparities.
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Affiliation(s)
- Hayley V. McMahon
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- The Center for Reproductive Health Research in the Southeast (RISE), Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Leslie Serrano
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- The Center for Reproductive Health Research in the Southeast (RISE), Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | | | - Sequoia Ayala
- The Raben Group, Washington, District of Columbia, USA
| | - Zainab Jah
- National Birth Equity Collaborative, New Orleans, Louisiana, USA
| | - Tiffany Hailstorks
- The Center for Reproductive Health Research in the Southeast (RISE), Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Elizabeth A. Mosley
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- The Center for Reproductive Health Research in the Southeast (RISE), Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Redd SK, Mosley EA, Narasimhan S, Newton-Levinson A, AbiSamra R, Cwiak C, Hall KS, Hartwig SA, Pringle J, Rice WS. Estimation of Multiyear Consequences for Abortion Access in Georgia Under a Law Limiting Abortion to Early Pregnancy. JAMA Netw Open 2023; 6:e231598. [PMID: 36877521 PMCID: PMC9989903 DOI: 10.1001/jamanetworkopen.2023.1598] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/18/2023] [Indexed: 03/07/2023] Open
Abstract
Importance Following the US Supreme Court ruling in Dobbs v Jackson Women's Health Organization, Georgia's law limiting abortion to early pregnancy, House Bill 481 (HB481), was allowed to go into effect in July 2022. Objectives To estimate anticipated multiyear effects of HB481, which prohibits abortions after detection of embryonic cardiac activity, on abortion incidence in Georgia, and to examine inequities by race, age, and socioeconomic status. Design, Setting, and Participants This repeated cross-sectional analysis used abortion surveillance data from January 1, 2007, to December 31, 2017, to estimate future effects of HB481 on abortion care in Georgia, with a focus on the 2 most recent years of data (2016 and 2017). Abortion surveillance data were obtained from the 2007-2017 Georgia Department of Public Health's Induced Termination of Pregnancy files. Linear regression was used to estimate trends in abortions provided at less than 6 weeks' gestation and at 6 weeks' gestation or later in Georgia, and χ2 analyses were used to compare group differences by race, age, and educational attainment. Data were analyzed from July 26 to September 22, 2022. Exposures HB481, Georgia's law limiting abortion to early pregnancy. Main Outcome and Measures Weeks' gestation at abortion (<6 vs ≥6 weeks). Results From January 1, 2007, to December 31, 2017, there were 360 972 reported abortions in Georgia, with an annual mean (SD) of 32 816 (1812) abortions. Estimates from 2016 to 2017 suggest that 3854 abortions in Georgia (11.6%) would likely meet eligibility requirements for abortion care under HB481. Fewer abortions obtained by Black patients (1943 [9.6%] vs 1280 [16.2%] for White patients), patients younger than 20 years (261 [9.1%] vs 168 [15.0%] for those 40 years and older), and patients with fewer years of education (392 [9.2%] with less than a high school diploma and 1065 [9.6%] with a high school diploma vs 2395 [13.5%] for those with some college) would likely meet eligibility requirements under HB481. Conclusions and Relevance These findings suggest that Georgia's law limiting abortion to early pregnancy (HB481) would eliminate access to abortion for nearly 90% of patients in Georgia, and disproportionately harm patients who are Black, younger, and in lower socioeconomic status groups.
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Affiliation(s)
- Sara K. Redd
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Elizabeth A. Mosley
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Suba Narasimhan
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anna Newton-Levinson
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | | | - Carrie Cwiak
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kelli Stidham Hall
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Sophie A. Hartwig
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Johanna Pringle
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Whitney S. Rice
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
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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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