The end of Roe v. Wade: implications for Women's mental health and care

Integrating public preferences to overcome racial disparities in research: findings from a US survey on enhancing trust in research data-sharing practices

Objectives

Data-sharing policies are rapidly evolving toward increased data sharing. However, participants' perspectives are not well understood and could have an adverse impact on participation in research. We evaluated participants' preferences for sharing specific types of data with specific groups, and strategies to enhance trust in data-sharing practices.

Materials and Methods

In March 2023, we conducted a nationally representative online survey with 610 US adults and used logistic regression models to assess sociodemographic differences in their willingness to share different types of data.

Results

Our findings highlight notable racial disparities in willingness to share research data with external entities, especially health policy and public health organizations. Black participants were significantly less likely to share most health data with public health organizations, including mental health (odds ratio [OR]: 0.543, 95% CI, 0.323-0.895) and sexual health/fertility information (OR: 0.404, 95% CI, 0.228-0.691), compared to White participants. Moreover, 63% of participants expressed that their trust in researchers would improve if given control over the data recipients.

Discussion

Participants exhibit reluctance to share specific types of personal research data, emphasizing strong preferences regarding external data access. This highlights the need for a critical reassessment of current data-sharing policies to align with participant concerns.

Conclusion

It is imperative for data-sharing policies to integrate diverse patient viewpoints to mitigate risk of distrust and a potential unintended consequence of lower participation among racial and ethnic minority participants in research.

Maternal Health Implications of Overturning Roe v. Wade in the United States

The 2022 overturning of Roe v. Wade by the U.S. Supreme Court has profound implications for maternal health in the United States, exacerbating existing disparities in maternal mortality, particularly among Black American women and all women of color. With the rollback of federal abortion protections, numerous states have implemented restrictive abortion laws, leading to reduced access to safe and timely care. Women who are marginalized and historically excluded, especially women of color who already face disproportionately higher rates of maternal mortality compared to their White counterparts, are particularly vulnerable to the consequences of these restrictions. The decision to limit access to abortion exacerbates these challenges, and women are more likely to be forced into carrying high-risk pregnancies to term, further increasing their risk of maternal mortality.

Decrease in reproductive desires among non-parent heterosexual women during the COVID-19 pandemic in Poland: the role of epidemiological stress, socioeconomic status, and reproductive rights

Introduction

Deterioration of economic conditions, societal uncertainty, and negative expectations about the future have all been linked to delayed childbearing plans. All these negative circumstances can be related to epidemiological stress, which in turn becomes one of the culprits for changes in fertility plans. This study aims to analyze the individual factors that decrease the probability of wanting to have children after exposure to epidemiological stress from the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Recruitment was conducted between April and July 2021. Participants who were heterosexual, non-parent, and non-pregnant without a diagnosis of infertility completed an online, anonymous survey providing information on sociodemographic variables, COVID-19 exposure, COVID-19-related stress, and changes in their reproductive desires. Multiple logistic regression models were used to analyze the data. Participants were also given the opportunity to provide a descriptive explanation for changes in fertility desires due to the pandemic or the political situation (abortion restrictions coinciding with the pandemic in Poland), which was then used for qualitative analysis.

Results

A total of 706 participants completed the survey (mean age = 28.11, SD = 4.87, min = 19, max = 47). We found that (1) the desire to have children decreased in 43.3% of respondents, and (2) women with higher levels of epidemiological stress were more likely to report a decrease in their desired number of children than the less-stressed ones, after adjusting for potential covariates (aOR = 1.064, 95%CI = 1.03-1.10, p < 0.001). Disease exposure yielded no significant results (aOR = 0.862, 95% CI = 0.73-1.02, p = 0.072). Additionally, 70% of participants declared a decrease in their willingness to have children due to the political situation. All models were adjusted for age, education, place of residence, socioeconomic and relationship status.

Conclusion

The situation in Poland during the COVID-19 restrictions provided a unique combination of political and epidemiological stressors, showing that women's reproductive desires were related to pandemic stress (less so with the exposure to disease) and limitation of reproductive rights.

The impact of the SB 8 Texas abortion ban on pregnancy duration at time of abortion in a large volume Colorado clinic

OBJECTIVES

To assess changes in type of abortion, gestational duration, and changes in the proportion of out-of-state residents at a university-affiliated clinic in Denver, Colorado after Texas passed Senate Bill 8 (SB 8) that banned abortion after embryonic cardiac activity can be detected.

STUDY DESIGN

We reviewed records of all visits of patients obtaining an abortion ≤22 weeks and 6 days gestation between January 2019 and June 2022. We created two time periods: before SB 8 (January 2019-August 2021) and after SB 8 (September 2021-June 2022). We assessed changes in type of abortion, gestational duration, and the proportion of out-of-state residents. We determined the odds of a second-trimester abortion (≥13 weeks and 0 day) after SB 8 using logistic regression models adjusted for gravida, parity, age, and the proportion of out-of-state residents.

RESULTS

There were 3844 abortions: 2875 before and 969 after SB 8. Second trimester abortions increased from 16.8% to 24.4% for Colorado residents and from 19.5% to 33.5% for out-of-state residents (p < 0.001). The proportion of patients that were Texas residents increased from 1.2% to 17.7% after SB 8 (p < 0.001). The adjusted odds of a second trimester abortion nearly doubled overall (adjusted odds ratio [aOR] 1.86 95% CI 1.55-2.23) and for Colorado residents (aOR,1.76, 95% CI, 1.44-2.16, respectively), and more than doubled for out-of-state residents (aOR, 2.34, 95% CI,1.53-3.59).

CONCLUSIONS

Laws that ban abortion early in pregnancy delay care and increase abortions occurring later in pregnancy, not only for people forced to seek care out of state, but for residents of states with abortion access.

IMPLICATIONS

Our data suggests that abortion bans may increase wait times, gestational duration, and force people to travel great distances for care. As more states ban abortion or restrict abortion, surrounding states where abortion is protected may need to meet the needs of those traveling in addition to their in-state residents.

Post-traumatic Stress Disorder and the Mental Burden Resulting from the Dobbs Decision

The obstetrics and mental health care fields have significant crossover. Women with unintended, undesired, or medically complex pregnancies are at greater risk of adverse mental health outcomes, which have the capacity to create long-lasting and intergenerational ripple effects within their larger family unit. Given the frequency with which women seek pregnancy terminations, the numerous factors that influence care accessibility, and the serious repercussions that stem from insufficient use of evidence-based care surrounding pregnancy termination, women are at risk of experiencing a range of mental health outcomes based on their experiences around pregnancy termination.

Perceptions of Women in Opioid Recovery Regarding Policies and Laws on Sexual and Reproductive Health

OBJECTIVE

To explore perceptions of policies and laws on sexual and reproductive health among women in recovery from opioid use disorder (OUD).

DESIGN

Qualitative descriptive.

SETTING

Telephone interviews conducted in a midsized urban area in the midwestern region of the United States.

PARTICIPANTS

Twenty-two women ages 18 to 49 years who self-identified as being in recovery from OUD.

METHODS

We conducted individual, semistructured telephone interviews and analyzed the data using reflexive thematic analysis.

RESULTS

We identified three themes: Barriers to OUD Treatment and Recovery, Pregnancy as a Gateway to Treatment and Recovery, and The Dobbs Effect. Participants described OUD treatment barriers such as inadequate recovery resources for women and the criminalization of drug use. Many participants described pregnancy as a gateway to recovery because of improved access to treatment services and enhanced motivation for engaging in recovery. Participants described unintended pregnancy as a threat to recovery that made them seek woman-controlled contraceptive methods they could use without negotiating with a partner (e.g., intrauterine devices) after the Supreme Court overturned constitutionally protected access to abortion.

CONCLUSION

Opioid use disorder is a public and mental health crisis in the United States that affects reproductive-age women. Participants in our study closely connected recovery from OUD with sexual and reproductive health policy and laws. There is a need for regulation to support the unique needs of women in OUD treatment. The recent Supreme Court decision that overturned constitutionally protected abortion creates challenges for women in recovery from OUD. Nurses are ideally positioned to advocate for recovery and sexual and reproductive health policies and laws that improve the physical and mental health of women in recovery.

Abortion and Mental Health and Wellbeing: A Contemporary Review of the Literature

PURPOSEOF REVIEW

This review discusses the importance of abortion care and access for mental wellbeing for people seeking abortion, abortion providers, and trainees. The recent Dobbs v. Jackson case has jeopardized the physical and mental health of millions.

RECENT FINDINGS

Much of the data regarding mental health impacts of abortion access comes from the Turnaway Study. This study supports that abortion does not cause negative mental health effects and being denied abortion is detrimental to mental health, physical health, and has negative socioeconomic impacts. Other recent studies support that the Dobbs decision continues to disproportionately harm historically marginalized groups. Additionally, there is more anxiety and depression reported in states with abortion restrictions. Many obstetrician gynecologists are moving away from restricted states and report moral distress due to restrictions. Many medical students are choosing not to apply to obstetrics and gynecology residency programs in states with abortion restrictions. Access to abortion care is important for mental and physical health, and socioeconomic well-being for people seeking abortion. Restrictive bans negatively affect people seeking abortion, as well as healthcare providers and trainees.

Intersectionality in Black Maternal Health Experiences: Implications for Intersectional Maternal Mental Health Research, Policy, and Practice

INTRODUCTION

Black women experience significant maternal mortality and morbidity disparities in the United States. Although emerging research has focused on reducing maternal mortality rates among Black birthing individuals, we must explore structural and social factors contributing to mental health outcomes during the perinatal period. Gaps exist where intersectional identities and experiences in maternal and child health are examined. This study explores the intersectional stress experiences of Black perinatal women in the South.

METHODS

We collected qualitative data through virtual semistructured interviews with 9 pregnant and 7 postpartum participants (N = 16).These interviews assessed feelings, attitudes, and perceptions about psychological stress due to their intersectional experiences of being Black, pregnant, and a woman in the United States. Findings were analyzed through the lens of critical race theory and intersectionality.

RESULTS

We identified 5 overarching themes: (1) perinatal mental health experiences, (2) birthing and parenting while Black, (3) socioeconomic factors, (4) how we cope, and (5) community and social support.

DISCUSSION

Overall, this study revealed how the layers of race, gender, pregnancy, and socioeconomic status influence mental health during the perinatal period. These findings show the need for antiracist and intersectional maternal mental health policies and practices.

Orchestrating moral bearability in the clinical management of second-trimester selective abortion

In present-day Denmark, second-trimester selective abortion has become a regular medical event, which has turned selective abortion care into a routinized task for health staff. In this article, we explore what forms of care practices abortion providers in Danish public hospitals engage in. Using in-depth interviews, medical documents and social media data, we show that at the center of selective abortion care provision is not only securing safe medical outcomes, but moral labor orientated towards achieving a morally manageable medical event, permeating institutionally developed clinical guidelines, relational face-to-face care, and ideologically driven encouragement of parental-fetal attachment through the use of material objects and visibility practices. We propose to view these entangled realms of practices as aiming towards generating what we term "moral bearability", meaning that selective abortion care is orchestrated in particular ways to make the abortion, and the implied making and handling of death, simultaneously bearable for couples and health staff.