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Aiken ARA, Wells ES, Gomperts R, Scott JG. Provision of Medications for Self-Managed Abortion Before and After the Dobbs v Jackson Women's Health Organization Decision. JAMA 2024:2816817. [PMID: 38526865 DOI: 10.1001/jama.2024.4266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Importance The Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US, with at least 16 states subsequently implementing abortion bans or 6-week gestational limits. Prior research indicates that in the 6 months following Dobbs, approximately 32 360 fewer abortions were provided within the US formal health care setting. However, trends in the provision of medications for self-managed abortion outside the formal health care setting have not been studied. Objective To determine whether the provision of medications for self-managed abortion outside the formal health care setting increased in the 6 months after Dobbs. Design, Setting, and Participants Cross-sectional study using data from sources that provided abortion medications outside the formal health care setting to people in the US between March 1 and December 31, 2022, including online telemedicine organizations, community networks, and online vendors. Using a hierarchical bayesian model, we imputed missing values from sources not providing data. We estimated the change in provision of medications for self-managed abortion after the Dobbs decision. We then estimated actual use of these medications by accounting for the possibility that not all provided medications are used by recipients. Exposure Abortion restrictions following the Dobbs decision. Main Outcomes and Measures Provision and use of medications for a self-managed abortion. Results In the 6-month post-Dobbs period (July 1 to December 31, 2022), the total number of provisions of medications for self-managed abortion increased by 27 838 (95% credible interval [CrI], 26 374-29 175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27 145; 95% CrI, 25 747-28 246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26 055 (95% CrI, 24 739-27 245) vs what would have been expected had the Dobbs decision not occurred. Conclusions and Relevance Provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. Results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions.
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Affiliation(s)
| | - Elisa S Wells
- Plan C, National Women's Health Network, Washington, DC
| | | | - James G Scott
- McCombs School of Business, University of Texas at Austin
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Johnson DM, Aiken ARA, Thompson TA. Telehealth enables safe medication abortion in shifting health and legal contexts. Nat Med 2024:10.1038/s41591-024-02876-0. [PMID: 38491153 DOI: 10.1038/s41591-024-02876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Affiliation(s)
| | - Abigail R A Aiken
- LBJ School of Public Affairs, The University of Texas at Austin, Austin, TX, USA
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Aiken ARA, Starling JE, van Blitterswijk DC, Looijen C, van Vliet T, Essink DR, Gomperts R. Advance Provision of Mifepristone and Misoprostol via Online Telemedicine in the US. JAMA Intern Med 2024; 184:220-223. [PMID: 38165689 PMCID: PMC10762629 DOI: 10.1001/jamainternmed.2023.7291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/03/2023] [Indexed: 01/04/2024]
Abstract
This cross-sectional study examines trends in the demand and characteristics and motivations of individuals who requested advance provision of abortion medications.
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Aiken ARA, Tello-Pérez LA, Madera M, Starling JE, Johnson DM, Broussard K, Padron E, Ze-Noah CA, Baldwin A, Scott JG. Factors Associated With Knowledge and Experience of Self-managed Abortion Among Patients Seeking Care at 49 US Abortion Clinics. JAMA Netw Open 2023; 6:e238701. [PMID: 37071424 PMCID: PMC10114063 DOI: 10.1001/jamanetworkopen.2023.8701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Importance Patients attending US abortion clinics may consider or try self-managing their abortion before coming to the clinic, yet little is known about the factors associated with self-management behavior. Objective To examine the prevalence and factors associated with considering or attempting a self-managed abortion before attending a clinic. Design, Setting, and Participants This survey study included patients obtaining an abortion at 49 independent, Planned Parenthood, and academic-affiliated clinics chosen to maximize diversity in geographic, state policy, and demographic context in 29 states between December 2018 and May 2020. Data were analyzed from December 2020 to July 2021. Exposures Obtaining an abortion at a clinic. Main Outcomes and Measures Knowledge of medications used to self-manage an abortion, having considered medication self-management before attending the clinic, having considered any method of self-management before attending the clinic, and having tried any method of self-management before attending the clinic. Results The study included 19 830 patients, of which 99.6.% (17 823 patients) identified as female; 60.9% (11 834 patients) were aged 20 to 29 years; 29.6% (5824 patients) identified as Black, 19.3% (3799 patients) as Hispanic, and 36.0% (7095 patients) as non-Hispanic White; 44.1% (8252 patients) received social services; and 78.3% (15 197 patients) were 10 weeks pregnant or less. Approximately 1 in 3 (34%) knew about self-managed medication abortion, and among this subsample of 6750 patients, 1 in 6 (1079 patients [16.1%]) had considered using medications to self-manage before attending the clinic. Among the full sample, 1 in 8 (11.7%) considered self-managing using any method before clinic attendance, and among this subsample of 2328 patients, almost 1 in 3 (670 patients [28.8%]) attempted to do so. Preference for at-home abortion care was associated with considering medication self-management (odds ratio [OR], 3.52; 95% CI, 2.94-4.21), considering any method of self-management (OR, 2.80; 95% CI, 2.50-3.13), and attempting any method of self-management (OR, 1.37; 95% CI, 1.10-1.69). Experiencing clinic access barriers was also associated with considering medication self-management (OR, 1.98; 95% CI, 1.69-2.32) and considering any method of self-management (OR, 2.09; 95% CI, 1.89-2.32). Conclusions and Relevance In this survey study, considering self-managed abortion was common before accessing in-clinic care, particularly among those on the margins of access or with a preference for at-home care. These findings suggest a need for expanded access to telemedicine and other decentralized abortion care models.
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Affiliation(s)
- Abigail R A Aiken
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin
| | - Luisa Alejandra Tello-Pérez
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco
| | - Melissa Madera
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin
| | | | - Dana M Johnson
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin
| | | | - Elisa Padron
- Stanford School of Medicine, Stanford University, Palo Alto, California
| | - Carol Armelle Ze-Noah
- Charles and Louise Travers Department of Political Science, University of California Berkeley, Berkeley
| | - Aleta Baldwin
- Department of Public Health, California State University Sacramento, Sacramento
| | - James G Scott
- Department of Statistics and Data Sciences, University of Texas at Austin, Austin
- McCombs School of Business, University of Texas at Austin, Austin
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Johnson DM, Michels-Gualtieri M, Gomperts R, Aiken ARA. Safety and effectiveness of self-managed abortion using misoprostol alone acquired from an online telemedicine service in the United States. Perspect Sex Reprod Health 2023; 55:4-11. [PMID: 36744631 DOI: 10.1363/psrh.12219] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To evaluate self-reported outcomes and serious adverse events following self-managed medication abortion using misoprostol alone provided from an online service. STUDY DESIGN We conducted a retrospective record review of self-managed abortion outcomes using misoprostol obtained from Aid Access, an online telemedicine organization serving United States (US) residents, between June 1, 2020, and June 30, 2020. The main outcomes were the proportion of people who reported ending their pregnancy without instrumentation intervention and the proportion who received treatment for serious adverse events. RESULTS During the study period, 1016 people received prescriptions for misoprostol. We obtained follow-up information for 610 (60%) of whom 568 confirmed use of the medication and 42 confirmed non-use. When taking the medication, 96% were at or less than 10 weeks' gestation and 4% were more than 10 weeks. Overall, 88% (95% CI: 84.6-90.2) reported successfully ending their pregnancy without instrumentation intervention. Of the 568 who took the misoprostol, 12 (2%) reported experiencing one or more serious adverse events and 20 (4%) reported experiencing a symptom of a potential complication. CONCLUSIONS Self-managed medication abortion using misoprostol provided by an online telemedicine service has a high rate of effectiveness and a low rate of serious adverse events. Outcomes compare favorably to other service delivery models using a similar regimen. As mifepristone continues to be over-regulated and the 2022 US Supreme Court ruling allows states to severely restrict access to in-clinic abortion care, this regimen is a promising option for self-managed abortion in the US.
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Affiliation(s)
- Dana M Johnson
- LBJ School of Public Affairs, University of Texas at Austin, Austin, Texas, USA
| | | | | | - Abigail R A Aiken
- LBJ School of Public Affairs, University of Texas at Austin, Austin, Texas, USA
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Johnson DM, Ramaswamy SM, Gomperts R, Aiken ARA. P012Acceptability of self-managed medication abortion using misoprostol-alone provided via a hybrid telemedicine and pharmacy pick-up model in the US. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Aiken ARA, Starling JE, Scott JG, Gomperts R. Requests for Self-managed Medication Abortion Provided Using Online Telemedicine in 30 US States Before and After the Dobbs v Jackson Women's Health Organization Decision. JAMA 2022; 328:1768-1770. [PMID: 36318139 PMCID: PMC9627414 DOI: 10.1001/jama.2022.18865] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study assesses changes in online telemedicine requests to self-manage abortions with medications before vs after the Dobbs v Jackson Women’s Health Organization Supreme Court decision overturning Roe v Wade.
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Affiliation(s)
| | | | - James G. Scott
- Department of Statistics and Data Sciences, University of Texas at Austin
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Baldwin A, Johnson DM, Broussard K, Tello-Pérez LA, Madera M, Ze-Noah C, Padron E, Aiken ARA. U.S. Abortion Care Providers' Perspectives on Self-Managed Abortion. Qual Health Res 2022; 32:788-799. [PMID: 35322703 PMCID: PMC9152602 DOI: 10.1177/10497323221077296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
State-level restrictions on abortion access may prompt greater numbers of people to self-manage their abortion. The few studies exploring perspectives of providers towards self-managed abortion are focused on physicians and advanced practice clinicians. Little is known about the wider spectrum of abortion care providers who encounter self-managed abortion in their clinic-based work. To gain a deeper understanding of this issue and inform future care delivery, we conducted in-depth interviews with 46 individuals working in a range of positions in 46 abortion clinics across 29 states. Our interpretative analysis resulted in themes shaped by beliefs about safety and autonomy, and a tension between the two: that self-managed abortion is too great a risk, that people are capable of self-managing an abortion, and that people have a right to a self-managed abortion. Our findings highlight the importance of increasing knowledge and clarifying values among all abortion care providers, including clinic staff.
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Affiliation(s)
- Aleta Baldwin
- Department of Public Health, California State University
Sacramento, USA
| | - Dana M. Johnson
- Lyndon B Johnson School of Public Affairs, The University of Texas at Austin, USA
| | | | | | - Melissa Madera
- Lyndon B Johnson School of Public Affairs, The University of Texas at Austin, USA
| | - Carol Ze-Noah
- Department of Political Science, University of California Berkeley, USA
| | | | - Abigail R. A. Aiken
- Lyndon B Johnson School of Public Affairs, The University of Texas at Austin, USA
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Abstract
This cross-sectional study examines whether the passage of Texas Senate Bill 8 was associated with an increase in requests for self-managed medication abortion.
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Affiliation(s)
| | | | - James G. Scott
- Department of Statistics and Data Sciences, University of Texas at Austin
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Johnson DM, Michels-Gualtieri MG, Gomperts R, Aiken ARA. POSTER ABSTRACTS. Contraception 2021. [DOI: 10.1016/j.contraception.2021.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Aiken ARA, Starling JE, Gomperts R, Scott JG, Aiken CE. Demand for self-managed online telemedicine abortion in eight European countries during the COVID-19 pandemic: a regression discontinuity analysis. BMJ Sex Reprod Health 2021; 47:238-245. [PMID: 33431614 PMCID: PMC7802389 DOI: 10.1136/bmjsrh-2020-200880] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 05/23/2023]
Abstract
OBJECTIVES In most European countries, patients seeking medication abortion during the COVID-19 pandemic are still required to attend healthcare settings in person. We assessed whether demand for self-managed medication abortion provided by online telemedicine increased following the emergence of COVID-19. METHODS We examined 3915 requests for self-managed abortion to online telemedicine service Women on Web (WoW) between 1 January 2019 and 1 June 2020. We used regression discontinuity to compare request rates in eight European countries before and after they implemented lockdown measures to slow COVID-19 transmission. We examined the prevalence of COVID-19 infection, the degree of government-provided economic support, the severity of lockdown travel restrictions and the medication abortion service provision model in countries with and without significant changes in requests. RESULTS Five countries showed significant increases in requests to WoW, ranging from 28% in Northern Ireland (97 requests vs 75.8 expected requests, p=0.001) to 139% in Portugal (34 requests vs 14.2 expected requests, p<0.001). Two countries showed no significant change in requests, and one country, Great Britain, showed an 88% decrease in requests (1 request vs 8.1 expected requests, p<0.001). Among countries with significant increases in requests, abortion services are provided mainly in person in hospitals or abortion is unavailable and international travel was prohibited during lockdown. By contrast, Great Britain implemented a fully remote no-test telemedicine service. CONCLUSION These marked changes in requests for self-managed medication abortion during the COVID-19 pandemic demonstrate demand for remote models of care, which could be fulfilled by expanding access to medication abortion by telemedicine.
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Affiliation(s)
- Abigail R A Aiken
- LBJ School of Public Affairs, The University of Texas at Austin, Austin, Texas, USA
| | | | | | - James G Scott
- Red McCombs School of Business, The University of Texas at Austin, Austin, Texas, USA
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Starling JE, Murray JS, Lohr PA, Aiken ARA, Carvalho CM, Scott JG. Targeted Smooth Bayesian Causal Forests: An analysis of heterogeneous treatment effects for simultaneous vs. interval medical abortion regimens over gestation. Ann Appl Stat 2021. [DOI: 10.1214/20-aoas1438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Jared S. Murray
- Department of Statistics and Data Sciences and McCombs School of Business, University of Texas at Austin
| | | | | | - Carlos M. Carvalho
- Department of Statistics and Data Sciences and McCombs School of Business, University of Texas at Austin
| | - James G. Scott
- Department of Statistics and Data Sciences and McCombs School of Business, University of Texas at Austin
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Bras S, Gomperts R, Kelly M, Aiken ARA, Conlon C. Accessing abortion outside jurisdiction following legalisation of abortion in the Republic of Ireland. BMJ Sex Reprod Health 2021; 47:200-204. [PMID: 33361119 PMCID: PMC10905971 DOI: 10.1136/bmjsrh-2020-200849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND After having one of the most restrictive abortion laws worldwide, Ireland legalised abortion in January 2019. We examine how legalisation impacted on demand for online telemedicine outside the jurisdiction. METHODS We analysed anonymised data from 534 people from Ireland seeking online telemedicine abortion prior to legalisation (January-March and October-December 2018) and in the first 3 months following legalisation (January-March 2019). Numbers, characteristics and reasons for seeking the service before and after legalisation were compared. Content analysis of emails from people seeking the service following legalisation explored reasons for seeking care. RESULTS Half as many people contacted Women on Web in the 3 months immediately after legalisation as compared with contacts 12 months prior (103 vs 221). Of these, the proportion receiving the service reduced, from 72% prior to legalisation to 26% after legalisation (p≤0.001). After legalisation, access related reasons for seeking online telemedicine featured less while reasons relating to privacy, stigma and avoiding protestors featured more. CONCLUSIONS People continued to seek abortion through online telemedicine after legalisation, though the number of contacts reduced by half and the proportion receiving the service decreased considerably. To address access issues, policy measures should promote normalisation of abortion, legislate for safe zones around providers, and consider access in situations of coercive control or abuse including the role of telemedicine in the local model of care. Abortion provided through online telemedicine continues to be an important part of providing safe, accessible abortion even after legalisation.
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Affiliation(s)
| | | | - Michaela Kelly
- London School of Hygiene & Tropical Medicine, London, UK
| | - Abigail R A Aiken
- Lyndon B Johnson (LBJ) School of Public Affairs, University of Texas at Austin, Austin, Texas, USA
| | - Catherine Conlon
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
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Abstract
IMPORTANCE People in the US have been seeking self-managed abortions outside the formal health care system using medications obtained through online telemedicine. However, little is known about this practice, including potential motivating factors. OBJECTIVE To examine individual reasons for accessing medication abortion through an online telemedicine service as well as associations between state- and county-level factors and the rate of requests. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study examined all requests for self-managed medication abortion through an online consultation form available from Aid Access, a telemedicine service in the US, between March 20, 2018, and March 20, 2020. MAIN OUTCOMES AND MEASURES Individual-level reasons for accessing the telemedicine service were examined as well as the rate of requests per 100 000 women of reproductive age by state. Zip code data provided by individuals making requests were used to examine county-level factors hypothesized to be associated with increased demand for self-managed abortion: distance to a clinic (calculated using location data for US abortion clinics) and the population proportion identifying as a member of a racial/ethnic minority group, living below the federal poverty level, and having broadband internet access (calculated using census data). RESULTS During the 2-year study period, 57 506 individuals in 2458 counties in 50 states requested self-managed medication abortion; 52.1% were aged 20 to 29 years (mean [SD] age, 25.9 [6.7] years), 50.0% had children, and 99.9% were 10 weeks' pregnant or less. The most common reasons cited by individuals making requests were the inability to afford in-clinic care (73.5%), privacy (49.3%), and clinic distance (40.4%). States with the highest rate of requests were Louisiana (202.7 per 100 000 women) and Mississippi (199.9 per 100 000 women). At the county level, an increase of 1 SD (47 miles) in distance to the nearest clinic was significantly associated with a 41% increase in requests (incidence rate ratio, 1.41; 95% CI, 1.31-1.51; P < .001), and a 10% increase in the population living below the federal poverty level was significantly associated with a 20% increase in requests (incidence rate ratio, 1.20; 95% CI, 1.13-1.28; P < .001). CONCLUSIONS AND RELEVANCE In this cross-sectional study, clinic access barriers were the most commonly cited reason for requesting self-managed medication abortion using an online telemedicine service. At the county level, distance to an abortion clinic and living below the federal poverty level were associated with a higher rate of requests. State and federal legislation could address these access barriers.
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Affiliation(s)
- Abigail R. A. Aiken
- LBJ School of Public Affairs, The University of Texas at Austin
- Population Research Center, The University of Texas at Austin
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15
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Bateson DJ, Lohr PA, Norman WV, Moreau C, Gemzell-Danielsson K, Blumenthal PD, Hoggart L, Li HWR, Aiken ARA, Black KI. The impact of COVID-19 on contraception and abortion care policy and practice: experiences from selected countries. BMJ Sex Reprod Health 2020; 46:241-243. [PMID: 32788180 DOI: 10.1136/bmjsrh-2020-200709] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 05/23/2023]
Affiliation(s)
- Deborah J Bateson
- Family Planning New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patricia A Lohr
- British Pregnancy Advisory Service (BPAS), Stratford upon Avon, UK
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline Moreau
- Population Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- CESP Centre for Research in Epidemiology and Population Health, INSERM (Institut National de la Santé et de la Recherche Medicale), Villejuif, France
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | | | - Lesley Hoggart
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Hang-Wun Raymond Li
- Department of Obstetrics and Gynaecology, University of Hong Kong, Hong Kong, Hong Kong
| | - Abigail R A Aiken
- LBJ School of Public Affairs, The University of Texas at Austin, Austin, Texas, USA
| | - Kirsten I Black
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Women's Health, Neonatology and Paediatrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Goyal V, Wallace R, Dermish AI, Kumar B, Schutt-Ainé A, Beasley A, Aiken ARA. Factors associated with abortion at 12 or more weeks gestation after implementation of a restrictive Texas law. Contraception 2020; 102:314-317. [PMID: 32592799 DOI: 10.1016/j.contraception.2020.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine factors associated with obtaining abortion at 12 or more weeks gestation in Texas after implementation of a restrictive law. STUDY DESIGN In this retrospective cohort study, we collected data from eight Texas abortion clinics that provided services at 12 or more weeks gestation from April 1, 2015 to March 30, 2016, after a restrictive abortion law enacted in November 2013 shuttered many of the state's clinics. We examined factors associated with obtaining in-clinic abortion services between 3-11 versus 12-24 weeks gestation including patient race-ethnicity, income level, and driving distance to the clinic using chi-square tests and calculating odds ratios. We further subcategorized abortion between 15-24 weeks to determine who may be most affected by a Texas law banning dilation and evacuation (D&E). RESULTS Among 24,555 in-clinic abortions, 19.2% (n = 4,714) occurred at 12 or more weeks gestation. Compared to patients who obtained care between 3-11 weeks, those who obtained care at 12 or more weeks were more likely to be Black than White (OR 1.18; 95% CI 1.05-1.31), live ≤110% of the federal poverty level than have higher income (OR 2.09; 95% CI 1.94-2.26), and drive 50+ miles than 1-24 miles to obtain care (OR 1.25; 95% CI 1.15-1.38). These associations remained for those obtaining care between 15-24 weeks. Even after adjusting for race-ethnicity and driving distance, low-income patients had greater odds of obtaining care in between 15-24 weeks (aOR 1.52; 95% CI 1.21-1.91). CONCLUSIONS Patients obtaining abortion at 12 or more weeks gestation in Texas are more likely to be Black, low-income, and travel far distances to obtain in-clinic care. IMPLICATIONS In Texas, patients who are Black, low-income, and travel the farthest are more likely to obtain in-clinic abortion between 15-24 weeks gestation, commonly performed via D&E. If Texas Senate Bill 8 (SB8) banning D&E goes into effect, these patients may be prevented from obtaining care.
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Affiliation(s)
- Vinita Goyal
- Population Research Center, University of Texas at Austin, Austin, TX, United States.
| | - Robin Wallace
- Southwestern Women's Surgery Center, Dallas, TX, United States
| | - Amna I Dermish
- Planned Parenthood of Greater Texas, Austin, TX, United States
| | - Bhavik Kumar
- Planned Parenthood Gulf Coast/Planned Parenthood Center for Choice, Houston, TX, United States
| | - Ann Schutt-Ainé
- Planned Parenthood Gulf Coast/Planned Parenthood Center for Choice, Houston, TX, United States
| | - Anitra Beasley
- Planned Parenthood Gulf Coast/Planned Parenthood Center for Choice, Houston, TX, United States
| | - Abigail R A Aiken
- Population Research Center, University of Texas at Austin, Austin, TX, United States; LBJ School of Public Affairs, University of Texas at Austin, Austin, TX, United States
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Singer R, Xu TH, Herrera LNS, Villar MJ, Faust KM, Hotez PJ, Aiken ARA, Mejia R. Prevalence of Intestinal Parasites in a Low-Income Texas Community. Am J Trop Med Hyg 2020; 102:1386-1395. [PMID: 32207401 PMCID: PMC7253135 DOI: 10.4269/ajtmh.19-0915] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/09/2020] [Indexed: 01/14/2023] Open
Abstract
Strongyloidiasis affects an estimated hundreds of millions of people worldwide, with infection possibly persisting for life without appropriate therapy because of the helminth's unique autoinfection cycle. Like other soil-transmitted helminths, because of the environmental conditions required for the life cycle of Strongyloides stercoralis, this parasite is endemic to tropical, subtropical, and temperate countries and areas with inadequate sanitation infrastructure. Given continued poverty and that nearly one in five American homes are lacking proper sanitation systems, many U.S. regions are at risk for intestinal parasites. A central Texas community was chosen as the study site, given previous reports of widespread sanitation failure, degree of poverty, and community willingness to participate. A total of 92 households were surveyed and residents tested for nine intestinal parasites using a multi-parallel quantitative real-time polymerase chain reaction and ELISA serology. From 43 stool samples, 27 (62.8%) tested positive for Blastocystis spp. and one (2.3%) for Giardia lamblia. From 97 serum samples, Strongyloides serology detected 16 (16.5%) positive individuals. These high rates of heterokont and helminthic laboratory findings in a peri-urban central Texas community suggest several key policy implications, including that strongyloidiasis should be added to the Texas notifiable conditions list, that clinical suspicion for this infection should be heightened in the region, and that residents without access to functioning and sustainable sanitation infrastructure should be provided that access as a basic human right and to promote public health.
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Affiliation(s)
- Rachael Singer
- Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, Austin, Texas
| | - Teena Huan Xu
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Lauren Nicholas S. Herrera
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Maria Jose Villar
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Kasey M. Faust
- Department of Civil, Architectural and Environmental Engineering, The University of Texas at Austin, Austin, Texas
| | - Peter J. Hotez
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Abigail R. A. Aiken
- Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, Austin, Texas
| | - Rojelio Mejia
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
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Aiken ARA, Starling JE, van der Wal A, van der Vliet S, Broussard K, Johnson DM, Padron E, Gomperts R, Scott JG. Demand for Self-Managed Medication Abortion Through an Online Telemedicine Service in the United States. Am J Public Health 2019; 110:90-97. [PMID: 31622157 DOI: 10.2105/ajph.2019.305369] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine demand for abortion medications through an online telemedicine service in the United States.Methods. We examined requests from US residents to the online telemedicine abortion service Women on Web (WoW) between October 15, 2017, and August 15, 2018. We calculated the population-adjusted rate of requests by state and examined the demographics, clinical characteristics, and motivations of those seeking services, comparing those in states with hostile versus supportive abortion policy climates.Results. Over 10 months, WoW received 6022 requests from US residents; 76% from hostile states. Mississippi had the highest rate of requests (24.9 per 100 000 women of reproductive age). In both hostile and supportive states, a majority (60%) reported a combination of barriers to clinic access and preferences for self-management. Cost was the most common barrier (71% in hostile states; 63% in supportive states; P < .001). Privacy was the most common preference (49% in both hostile and supportive states; P = .66).Conclusions. Demand for self-managed medication abortion through online telemedicine is prevalent in the United States. There is a public health justification to make these abortions as safe, effective, and supported as possible.
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Affiliation(s)
- Abigail R A Aiken
- Abigail R. A. Aiken and Dana M. Johnson are with the LBJ School of Public Affairs, University of Texas, Austin. Jennifer E. Starling and James G. Scott are with the Department of Statistics and Data Sciences, University of Texas, Austin. Alexandra van der Wal and Sascha van der Vliet are with the Faculty of Science, VU University, Amsterdam. Kathleen Broussard is with the Department of Sociology, University of Texas, Austin. Elisa Padron is with the College of Natural Sciences, University of Texas, Austin. Rebecca Gomperts is with the Women on Web International Foundation, Amsterdam
| | - Jennifer E Starling
- Abigail R. A. Aiken and Dana M. Johnson are with the LBJ School of Public Affairs, University of Texas, Austin. Jennifer E. Starling and James G. Scott are with the Department of Statistics and Data Sciences, University of Texas, Austin. Alexandra van der Wal and Sascha van der Vliet are with the Faculty of Science, VU University, Amsterdam. Kathleen Broussard is with the Department of Sociology, University of Texas, Austin. Elisa Padron is with the College of Natural Sciences, University of Texas, Austin. Rebecca Gomperts is with the Women on Web International Foundation, Amsterdam
| | - Alexandra van der Wal
- Abigail R. A. Aiken and Dana M. Johnson are with the LBJ School of Public Affairs, University of Texas, Austin. Jennifer E. Starling and James G. Scott are with the Department of Statistics and Data Sciences, University of Texas, Austin. Alexandra van der Wal and Sascha van der Vliet are with the Faculty of Science, VU University, Amsterdam. Kathleen Broussard is with the Department of Sociology, University of Texas, Austin. Elisa Padron is with the College of Natural Sciences, University of Texas, Austin. Rebecca Gomperts is with the Women on Web International Foundation, Amsterdam
| | - Sascha van der Vliet
- Abigail R. A. Aiken and Dana M. Johnson are with the LBJ School of Public Affairs, University of Texas, Austin. Jennifer E. Starling and James G. Scott are with the Department of Statistics and Data Sciences, University of Texas, Austin. Alexandra van der Wal and Sascha van der Vliet are with the Faculty of Science, VU University, Amsterdam. Kathleen Broussard is with the Department of Sociology, University of Texas, Austin. Elisa Padron is with the College of Natural Sciences, University of Texas, Austin. Rebecca Gomperts is with the Women on Web International Foundation, Amsterdam
| | - Kathleen Broussard
- Abigail R. A. Aiken and Dana M. Johnson are with the LBJ School of Public Affairs, University of Texas, Austin. Jennifer E. Starling and James G. Scott are with the Department of Statistics and Data Sciences, University of Texas, Austin. Alexandra van der Wal and Sascha van der Vliet are with the Faculty of Science, VU University, Amsterdam. Kathleen Broussard is with the Department of Sociology, University of Texas, Austin. Elisa Padron is with the College of Natural Sciences, University of Texas, Austin. Rebecca Gomperts is with the Women on Web International Foundation, Amsterdam
| | - Dana M Johnson
- Abigail R. A. Aiken and Dana M. Johnson are with the LBJ School of Public Affairs, University of Texas, Austin. Jennifer E. Starling and James G. Scott are with the Department of Statistics and Data Sciences, University of Texas, Austin. Alexandra van der Wal and Sascha van der Vliet are with the Faculty of Science, VU University, Amsterdam. Kathleen Broussard is with the Department of Sociology, University of Texas, Austin. Elisa Padron is with the College of Natural Sciences, University of Texas, Austin. Rebecca Gomperts is with the Women on Web International Foundation, Amsterdam
| | - Elisa Padron
- Abigail R. A. Aiken and Dana M. Johnson are with the LBJ School of Public Affairs, University of Texas, Austin. Jennifer E. Starling and James G. Scott are with the Department of Statistics and Data Sciences, University of Texas, Austin. Alexandra van der Wal and Sascha van der Vliet are with the Faculty of Science, VU University, Amsterdam. Kathleen Broussard is with the Department of Sociology, University of Texas, Austin. Elisa Padron is with the College of Natural Sciences, University of Texas, Austin. Rebecca Gomperts is with the Women on Web International Foundation, Amsterdam
| | - Rebecca Gomperts
- Abigail R. A. Aiken and Dana M. Johnson are with the LBJ School of Public Affairs, University of Texas, Austin. Jennifer E. Starling and James G. Scott are with the Department of Statistics and Data Sciences, University of Texas, Austin. Alexandra van der Wal and Sascha van der Vliet are with the Faculty of Science, VU University, Amsterdam. Kathleen Broussard is with the Department of Sociology, University of Texas, Austin. Elisa Padron is with the College of Natural Sciences, University of Texas, Austin. Rebecca Gomperts is with the Women on Web International Foundation, Amsterdam
| | - James G Scott
- Abigail R. A. Aiken and Dana M. Johnson are with the LBJ School of Public Affairs, University of Texas, Austin. Jennifer E. Starling and James G. Scott are with the Department of Statistics and Data Sciences, University of Texas, Austin. Alexandra van der Wal and Sascha van der Vliet are with the Faculty of Science, VU University, Amsterdam. Kathleen Broussard is with the Department of Sociology, University of Texas, Austin. Elisa Padron is with the College of Natural Sciences, University of Texas, Austin. Rebecca Gomperts is with the Women on Web International Foundation, Amsterdam
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Affiliation(s)
- Abigail R A Aiken
- LBJ School of Public Affairs, University of Texas at Austin, Austin, TX, USA
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Callegari LS, Aiken ARA, Dehlendorf C, Borrero S. Reproductive Life Planning and Patient-Centered Care: Can the Inconsistencies be Reconciled? Matern Child Health J 2019; 23:869-870. [PMID: 31152282 DOI: 10.1007/s10995-019-02734-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lisa S Callegari
- Departments of Obstetrics & Gynecology and Health Services, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA.
- VA Health Services Research & Development, Puget Sound Health Care System, Department of Veterans Affairs, 1660 South Columbian Way S-152, Seattle, WA, 98108, USA.
| | - Abigail R A Aiken
- LBJ School of Public Affairs and Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Christine Dehlendorf
- Departments of Family & Community Medicine, Obstetrics, Gynecology & Reproductive Sciences, and Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Sonya Borrero
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
- VA Center for Health Equity, Research, and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
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Aiken ARA, Broussard K, Johnson DM, Padron E. Motivations and Experiences of People Seeking Medication Abortion Online in the United States. Perspect Sex Reprod Health 2018; 50:157-163. [PMID: 29992793 PMCID: PMC8256438 DOI: 10.1363/psrh.12073] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 05/16/2023]
Abstract
CONTEXT State legislation restricting access to abortion in the clinic setting raises the possibility that an increasing number of individuals in the United States will self-manage their abortion at home. Medications sourced online represent a potential pathway to abortion self-management. Yet, very little is known about the reasons U.S. residents may seek abortion online or their experiences finding medications and information. METHODS In January-June 2017, anonymous in-depth interviews were conducted with 32 people from 20 states who sought abortion medications online (30 women and two men seeking medications for their partners). Participants were asked about their (or their partners') motivations for considering self-managed abortion, the sources of medications they identified and any other methods they considered. Transcripts were coded and analyzed according to the principles of grounded theory. RESULTS The analysis revealed four key themes: Seeking abortion medications online can be a response to clinic access barriers both in states with and in ones without restrictive abortion laws; self-managed abortion can be a preference over clinical care; online options offer either information or medications, but not both; and the lack of trusted online options can delay care and lead to consideration of ineffective or unsafe alternatives. CONCLUSION Current online options for abortion medications leave many important needs unmet, particularly for women who encounter barriers to obtaining clinic-based abortion services. There is a public health justification to reduce clinic access barriers and to make medication abortion that is sourced online and managed at home as safe and supported as possible.
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Affiliation(s)
- Abigail R A Aiken
- Assistant professor, LBJ School of Public Affairs, and faculty research associate, Population Research Center, University of Texas at Austin
| | - Kathleen Broussard
- Graduate student, Department of Sociology, and graduate research trainee, Population Research Center, University of Texas at Austin
| | - Dana M Johnson
- Graduate student, LBJ School of Public Affairs, University of Texas at Austin
| | - Elisa Padron
- Undergraduate student, College of Natural Sciences, University of Texas at Austin
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Aiken ARA, Padron E, Broussard K, Johnson D. The impact of Northern Ireland's abortion laws on women's abortion decision-making and experiences. BMJ Sex Reprod Health 2018; 45:bmjsrh-2018-200198. [PMID: 30341065 PMCID: PMC9202511 DOI: 10.1136/bmjsrh-2018-200198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/05/2018] [Accepted: 10/05/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND In Northern Ireland, abortion is illegal except in very limited circumstances to preserve a woman's life or to prevent permanent or long-term injury to her physical or mental health. Abortions conducted outside the law are a criminal offence punishable by imprisonment. We assessed the impacts of Northern Ireland's abortion laws on women's decision-making and experiences in accessing abortion. METHODS Between April 2017 and February 2018 we interviewed 30 women living in Northern Ireland who had sought abortion by travelling to a clinic in Great Britain or by using online telemedicine to self-manage a medication abortion at home. We interviewed women both before and after a policy change that allowed women from Northern Ireland access to free abortion services in Great Britain. We used a semi-structured in-depth approach and analysed the interviews using grounded theory methodology to identify key themes. RESULTS Four key findings emerged from our analysis: (1) women experience multiple barriers to travelling for abortion services, even when abortion is provided without charge; (2) self-management is often preferred over travel, but its criminalisation engenders fear and isolation; (3) obstruction of import of abortion medications by Northern Ireland Customs contributes to stress, anxiety, a higher risk of complications, and trial of ineffective or unsafe methods; and (4) lack of clarity surrounding the obligations of healthcare professionals in Northern Ireland causes mistrust of the healthcare system. CONCLUSIONS Northern Ireland's abortion laws negatively affect the quality and safety of women's healthcare and can have serious implications for women's physical and emotional health. Our findings offer new perspectives for the current policy debate over Northern Ireland's abortion laws and suggest a public health rationale for decriminalising abortion.
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Affiliation(s)
- Abigail R A Aiken
- LBJ School of Public Affairs, University of Texas at Austin, Austin, Texas, USA
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - Elisa Padron
- College of Natural Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Kathleen Broussard
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
- Department of Sociology, University of Texas at Austin, Austin, Texas, USA
| | - Dana Johnson
- LBJ School of Public Affairs, University of Texas at Austin, Austin, Texas, USA
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Lohr PA, Starling JE, Scott JG, Aiken ARA. Simultaneous administration of mifepristone and misoprostol increases access to early medical abortion where home-use of misoprostol is not permitted. Contraception 2018. [DOI: 10.1016/j.contraception.2018.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aiken ARA. Self-sourced online and self-directed at home: a new frontier for abortion in the United States. Contraception 2018; 97:285-286. [PMID: 29030226 PMCID: PMC10684252 DOI: 10.1016/j.contraception.2017.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/25/2017] [Accepted: 09/29/2017] [Indexed: 11/21/2022]
Affiliation(s)
- Abigail R A Aiken
- LBJ School of Public Affairs, P.O. Box Y, University of Texas at Austin, Austin, TX 78713, USA.
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Edelman A, Trussell J, Aiken ARA, Portman DJ, Chiodo JA, Garner EIO. The emerging role of obesity in short-acting hormonal contraceptive effectiveness. Contraception 2017; 97:371-377. [PMID: 29269251 DOI: 10.1016/j.contraception.2017.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Alison Edelman
- Oregon Health & Science University, Department of Ob-Gyn UHN 50, 3181 Sam Jackson Park Rd, Portland, OR 97239.
| | - James Trussell
- Princeton University, Office of Population Research, Wallace Hall, Princeton, NJ 08544.
| | - Abigail R A Aiken
- University of Texas at Austin, LBJ School of Public Affairs, P.O. Box Y, Austin, TX, 78713.
| | - David J Portman
- Sermonix Pharmaceuticals, 3000 East Main St, Suite 218, Columbus, OH, 43209.
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Coleman-Minahan K, Aiken ARA, Potter JE. Prevalence and Predictors of Prenatal and Postpartum Contraceptive Counseling in Two Texas Cities. Womens Health Issues 2017; 27:707-714. [PMID: 28662935 PMCID: PMC5694359 DOI: 10.1016/j.whi.2017.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/07/2017] [Accepted: 05/15/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We investigated the prevalence of and sociodemographic associations with receiving prenatal and postpartum contraceptive counseling, including counseling on intrauterine devices (IUDs) and implants. METHODS We used data from a prospective cohort study of 803 postpartum women in El Paso and Austin, Texas. We examined the prevalence of prenatal and postpartum counseling, provider discouragement of IUDs and implants, and associated sociodemographic characteristics using χ2 tests and logistic regression. RESULTS One-half of participants had received any prenatal contraceptive counseling, and 13% and 37% received counseling on both IUDs and implants prenatally and postpartum, respectively. Women with more children were more likely to receive any contraceptive counseling prenatally (odds ratio [OR], 1.99; p < .01). Privately insured women (OR, 0.53; p < .05) had a lower odds of receiving prenatal counseling on IUDs and implants than publicly insured women. Higher education (OR, 2.16; p < .05) and attending a private practice (OR, 2.16; p < .05) were associated with receiving any postpartum counseling. Older age (OR, 0.61; p < .05) was negatively associated with receiving postpartum counseling about IUDs and implants and a family income of $10,000 to $19,000 (OR, 2.21; p < .01) was positively associated. Approximately 20% of women receiving prenatal counseling and 10% receiving postpartum counseling on IUDs and implants were discouraged from using them. The most common reason providers restricted use of these methods was inaccurate medical advice. CONCLUSIONS Prenatal and postpartum counseling, particularly about IUDs and implants, was infrequent and varied by sociodemographics. Providers should implement evidence-based prenatal and postpartum contraceptive counseling to ensure women can make informed choices and access their preferred method of postpartum contraception.
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Affiliation(s)
- Kate Coleman-Minahan
- College of Nursing, University of Colorado Denver, Aurora, Colorado; Population Research Center, University of Texas at Austin, Austin, Texas.
| | - Abigail R A Aiken
- Population Research Center, University of Texas at Austin, Austin, Texas; LBJ School of Public Affairs, University of Texas at Austin, Austin, Texas
| | - Joseph E Potter
- Population Research Center, University of Texas at Austin, Austin, Texas
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Aiken ARA, Guthrie KA, Schellekens M, Trussell J, Gomperts R. Barriers to accessing abortion services and perspectives on using mifepristone and misoprostol at home in Great Britain. Contraception 2017; 97:177-183. [PMID: 28941978 DOI: 10.1016/j.contraception.2017.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/04/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine reasons for seeking abortion services outside the formal healthcare system in Great Britain, where abortion is legally available. STUDY DESIGN We conducted a mixed-methods study among women resident in England, Scotland, and Wales who requested at-home medication abortion through online telemedicine initiative Women on Web (WoW) between November 22, 2016, and March 22, 2017. We examined the demographics and circumstances of all women requesting early medication abortion and conducted a content analysis of a sample of their anonymized emails to the service to explore their reasons for seeking help. RESULTS Over a 4-month period, 519 women contacted WoW seeking medication abortion. These women were diverse with respect to age, parity, and circumstance. One hundred eighty women reported 209 reasons for seeking abortion outside the formal healthcare setting. Among all reasons, 49% were access barriers, including long waiting times, distance to clinic, work or childcare commitments, lack of eligibility for free NHS services, and prior negative experiences of abortion care; 30% were privacy concerns, including lack of confidentiality of services, perceived or experienced stigma, and preferring the privacy and comfort of using pills at home; and 18% were controlling circumstances, including partner violence and partner/family control. CONCLUSION Despite the presence of abortion services in Great Britain, a diverse group of women still experiences logistical and personal barriers to accessing care through the formal healthcare system, or prefer the privacy of conducting their abortions in their own homes. Health services commissioning bodies could address existing barriers if supported by policy frameworks. IMPLICATIONS The presence of multiple barriers to accessing abortion care in Great Britain highlights the need for future guidelines to recommend a more woman-centered approach to service provision. Reducing the number of clinic visits and designing services to meet the needs of those living in controlling circumstances are particularly important goals.
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Affiliation(s)
- Abigail R A Aiken
- LBJ School of Public Affairs, University of Texas at Austin, Austin, TX, 78712, USA; Population Research Center, University of Texas at Austin, Austin, TX, 78712, USA.
| | | | | | - James Trussell
- Office of Population Research, Princeton University, Princeton, NJ, 08544, USA; Chalmers Centre, University of Edinburgh, Edinburgh, EH3 9ES, UK
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Abstract
Women in areas of the Americas with endemic Aedes mosquito populations are at risk for exposure to Zika virus, which can cause fetal brain abnormalities and associated congenital microcephaly. Individual health care providers may encounter health system barriers to providing evidence-based care. We focus on Mexico and the state of Texas to highlight the role of health system factors in contraceptive access in the context of Zika and highlight efforts in Puerto Rico as an example of initiatives to improve access to contraception. In Mexico, states with the highest unmet need for contraception are low-lying coastal states. The government recently announced an investment to combat Zika but made no mention of family planning initiatives to assist women in preventing pregnancy. In Texas, the Department of State Health Services has issued recommendations to help women and men avoid mosquito bites; the issue of whether women should plan or avoid pregnancy is not addressed. Puerto Rico has the largest number of confirmed cases of Zika virus in the U.S. states and territories. Recently, the Centers for Disease Control and Prevention Foundation launched the Zika Contraception Access Network, which provides contraceptives at no cost to participating clinics in Puerto Rico. The Zika virus highlights weaknesses in health systems that make it difficult for women to use contraception if they want to delay births. Women across the globe, with or without Zika virus, need access to contraception to prevent unintended pregnancy, and health care providers require functioning health systems that offer support to ensure access is a reality.
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Affiliation(s)
- Blair G Darney
- Instituto Nacional de Salud Pública, Centro de Investigación en Sistemas de Salud, Cuernavaca, Mexico; Oregon Health & Science University, Portland, Oregon; LBJ School of Public Affairs and the Population Research Center, University of Texas at Austin, Austin, Texas; and Columbia University Mailman School of Public Health, New York, New York
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Affiliation(s)
- ARA Aiken
- University of Texas at Austin; Austin TX USA
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Aiken ARA, Digol I, Trussell J, Gomperts R. Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland. BMJ 2017; 357:j2011. [PMID: 28512085 PMCID: PMC5431774 DOI: 10.1136/bmj.j2011] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To assess self reported outcomes and adverse events after self sourced medical abortion through online telemedicine.Design Population based study.Setting Republic of Ireland and Northern Ireland, where abortion is unavailable through the formal healthcare system except in a few restricted circumstances.Population 1000 women who underwent self sourced medical abortion through Women on Web (WoW), an online telemedicine service, between 1 January 2010 and 31 December 2012.Main outcome measures Successful medical abortion: the proportion of women who reported ending their pregnancy without surgical intervention. Rates of adverse events: the proportion who reported treatment for adverse events, including receipt of antibiotics and blood transfusion, and deaths reported by family members, friends, or the authorities. Care seeking for symptoms of potential complications: the frequency with which women reported experiencing symptoms of a potentially serious complication and the proportion who reported seeking medical attention as advised.Results In 2010-12, abortion medications (mifepristone and misoprostol) were sent to 1636 women and follow-up information was obtained for 1158 (71%). Among these, 1023 women confirmed use of the medications, and follow-up information was available for 1000. At the time women requested help from WoW, 781 (78%) were <7 weeks pregnant and 219 (22%) were 7-9 weeks pregnant. Overall, 94.7% (95% confidence interval 93.1% to 96.0%) reported successfully ending their pregnancy without surgical intervention. Seven women (0.7%, 0.3% to 1.5%) reported receiving a blood transfusion, and 26 (2.6%, 1.7% to 3.8%) reported receiving antibiotics (route of administration (IV or oral) could not be determined). No deaths resulting from the intervention were reported by family, friends, the authorities, or the media. Ninety three women (9.3%, 7.6% to 11.3%) reported experiencing any symptom for which they were advised to seek medical advice, and, of these, 87 (95%, 87.8% to 98.2%) sought attention. None of the five women who did not seek medical attention reported experiencing an adverse outcome.Conclusions Self sourced medical abortion using online telemedicine can be highly effective, and outcomes compare favourably with in clinic protocols. Reported rates of adverse events are low. Women are able to self identify the symptoms of potentially serious complications, and most report seeking medical attention when advised. Results have important implications for women worldwide living in areas where access to abortion is restricted.
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Affiliation(s)
- Abigail R A Aiken
- LBJ School of Public Affairs, University of Texas at Austin, TX 78713, USA
- Population Research Center, University of Texas at Austin, TX 78712, USA
| | - Irena Digol
- Women on Web International Foundation, Amsterdam, Netherlands
- Centre for Reproductive Health and Medical Genetics, Chisinau, Moldova
| | - James Trussell
- Office of Population Research, Princeton University, NJ 08544, USA
- Chalmers Centre, University of Edinburgh, Edinburgh EH3 9ES, UK
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Callegari LS, Aiken ARA, Dehlendorf C, Cason P, Borrero S. Addressing potential pitfalls of reproductive life planning with patient-centered counseling. Am J Obstet Gynecol 2017; 216:129-134. [PMID: 27776920 DOI: 10.1016/j.ajog.2016.10.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/25/2016] [Accepted: 10/03/2016] [Indexed: 11/16/2022]
Abstract
Engaging women in discussions about reproductive goals in health care settings is increasingly recognized as an important public health strategy to reduce unintended pregnancy and improve pregnancy outcomes. "Reproductive life planning" has gained visibility as a framework for these discussions, endorsed by public health and professional organizations and integrated into practice guidelines. However, women's health advocates and researchers have voiced the concern that aspects of the reproductive life planning framework may have the unintended consequence of alienating rather than empowering some women. This concern is based on evidence indicating that women may not hold clear intentions regarding pregnancy timing and may have complex feelings about achieving or avoiding pregnancy, which in turn may make defining a reproductive life plan challenging or less meaningful. We examine potential pitfalls of reproductive life planning counseling and, based on available evidence, offer suggestions for a patient-centered approach to counseling, including building open and trusting relationships with patients, asking open-ended questions, and prioritizing information delivery based on patient preferences. Research is needed to ensure that efforts to engage women in conversations about their reproductive goals are effective in both achieving public health objectives and empowering individual women to achieve the reproductive lives they desire.
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Affiliation(s)
- Lisa S Callegari
- Departments of Obstetrics and Gynecology and Health Services, University of Washington Schools of Medicine and Public Health, Seattle, WA; Health Services Research and Development, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA.
| | - Abigail R A Aiken
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX
| | - Christine Dehlendorf
- Departments of Family and Community Medicine, Obstetrics, Gynecology, and Reproductive Sciences, and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Patty Cason
- School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Sonya Borrero
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA; Center for Health Equity, Research, and Promotion, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
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Aiken ARA, Westhoff CL, Trussell J, Castaño PM. Comparison of a Timing-Based Measure of Unintended Pregnancy and the London Measure of Unplanned Pregnancy. Perspect Sex Reprod Health 2016; 48:139-146. [PMID: 27574959 PMCID: PMC5028288 DOI: 10.1363/48e11316] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/07/2016] [Accepted: 07/07/2016] [Indexed: 06/01/2023]
Abstract
CONTEXT Unintended pregnancy is a universal benchmark for reproductive health, but whether variations reflect differences in measurement and how well measures predict pregnancy outcomes warrant further examination. U.S. and British measures of unintended and unplanned pregnancy offer a useful comparison. METHODS Some 220 women seeking pregnancy testing at the Columbia University Medical Center in 2005 responded to three pregnancy measures: a binary timing-based measure of unintended pregnancy (TMUP); a multi-item measure of timing-based intentions and planning behaviors, the London Measure of Unplanned Pregnancy (LMUP); and a measure combining intentions (from the TMUP) and how women would feel about a positive pregnancy test. Six-month pregnancy status was assessed among 159 respondents. Estimates of unintended and unplanned pregnancy were calculated using the TMUP and the LMUP, and receiver operating characteristic (ROC) curves were generated to assess congruence. RESULTS According to the TMUP, 76% of pregnancies were unintended; by contrast, LMUP scores categorized 39% as unplanned. The ROC curve indicated that expanding the range of scores for classifying pregnancies as unplanned on the LMUP would achieve greater congruence between these measures. At six months, the proportion of pregnancies that had ended in abortion was 42% of those classified as unintended using the TMUP, 60% of those classified as unplanned using the LMUP and 71% of those that women said they had not intended and were very upset about. CONCLUSIONS U.S. and British measures of unintended pregnancy are not directly comparable, and a measure combining intentions and feelings may better predict pregnancy outcomes.
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Affiliation(s)
- Abigail R A Aiken
- LBJ School of Public Affairs, University of Texas at Austin.
- Population Research Center, University of Texas at Austin.
| | - Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York
| | - James Trussell
- Office of Population Research, Princeton University, Princeton, NJ
| | - Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York
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Aiken ARA, Borrero S, Callegari LS, Dehlendorf C. Rethinking the Pregnancy Planning Paradigm: Unintended Conceptions or Unrepresentative Concepts? Perspect Sex Reprod Health 2016; 48:147-51. [PMID: 27513444 PMCID: PMC5028285 DOI: 10.1363/48e10316] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/07/2016] [Accepted: 06/15/2016] [Indexed: 05/26/2023]
Affiliation(s)
- Abigail R A Aiken
- assistant professor, LBJ School of Public Affairs; and faculty associate, Population Research Center, University of Texas at Austin.
| | - Sonya Borrero
- associate professor, Center for Research on Health Care, Department of Medicine, University of Pittsburgh; and codirector, VA Advanced Fellowship Program in Women's Health, VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
| | - Lisa S Callegari
- assistant professor, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle; and advanced research fellow, Health Services Research and Development, Puget Sound Health Care System, Department of Veterans Affairs, Seattle
| | - Christine Dehlendorf
- associate professor, Departments of Family and Community Medicine; Obstetrics, Gynecology and Reproductive Sciences; and Epidemiology and Biostatistics, University of California, San Francisco
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Aiken ARA, Scott JG. Family planning policy in the United States: the converging politics of abortion and contraception. Contraception 2016; 93:412-20. [PMID: 26794846 DOI: 10.1016/j.contraception.2016.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 01/07/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Following decades of mainstream bipartisan support, contraception has reemerged as a controversial political issue in the United States. At the same time, opposition to abortion has intensified. State legislatures across the country have enacted highly visible policies limiting access to family planning. Perhaps the most striking example occurred in 2011 in Texas, when legislators instituted unprecedented requirements on abortion providers and cut public funding for contraception by two thirds. Yet, despite popular interpretations of this phenomenon as a simple byproduct of increasing partisan divisions, little is understood about the factors underlying such policy shifts. STUDY DESIGN We fit Bayesian ideal-point models to analyze correlation patterns in record-vote data in the Texas House of Representatives in the 2003 and 2011 Legislatures. Both sessions had large Republican majorities and saw the passage of restrictive abortion bills, but they differed markedly with respect to public funding for contraception. RESULTS We demonstrate that variation in voting on family-planning issues cannot be fully attributed to partisanship in either session. However, the politics of abortion and contraception have converged over time, and - at least for Democrats - the correlation between constituency characteristics and voting behavior on family-planning legislation is markedly higher in 2011 than in 2003. These shifts have been partly driven by legislators from high-poverty, majority Latino districts near the US-Mexico border. CONCLUSIONS Recent dramatic shifts in family-planning policy go beyond simple partisan divisions. As the politics of abortion and contraception have converged, policies that are increasingly hostile to reproductive health and that disproportionately affect low-income minority women have emerged. IMPLICATIONS Recent shifts in family-planning policy restrict women's access to contraception and abortion, yet little research has examined why such shifts are occurring. This paper analyzes factors underlying voting behavior on restrictive policies in Texas. Identification of these factors helps us to better understand the current political climate surrounding our field.
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Affiliation(s)
| | - James G Scott
- Red McCombs School of Business, University of Texas at Austin, Austin, TX
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White K, Hopkins K, Aiken ARA, Stevenson A, Hubert C, Grossman D, Potter JE. The impact of reproductive health legislation on family planning clinic services in Texas. Am J Public Health 2015; 105:851-8. [PMID: 25790404 DOI: 10.2105/ajph.2014.302515] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We examined the impact of legislation in Texas that dramatically cut and restricted participation in the state's family planning program in 2011 using surveys and interviews with leaders at organizations that received family planning funding. Overall, 25% of family planning clinics in Texas closed. In 2011, 71% of organizations widely offered long-acting reversible contraception; in 2012-2013, only 46% did so. Organizations served 54% fewer clients than they had in the previous period. Specialized family planning providers, which were the targets of the legislation, experienced the largest reductions in services, but other agencies were also adversely affected. The Texas experience provides valuable insight into the potential effects that legislation proposed in other states may have on low-income women's access to family planning services.
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Affiliation(s)
- Kari White
- Kari White is with the Department of Health Care Organization & Policy, University of Alabama, Birmingham. At the time of the study, Kristine Hopkins, Abigail R. A. Aiken, Amanda Stevenson, Celia Hubert, and Joseph E. Potter were with the Population Research Center, University of Texas, Austin. Daniel Grossman is with Ibis Reproductive Health, Oakland, CA
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Abstract
An unresolved paradox in the measurement and interpretation of unintended pregnancy is that women frequently report feeling happy about pregnancies they also classify as unintended (i.e. they have incongruent intentions and feelings). This study explores the underlying reasons why women profess such happiness and how these relate to their motivations to avoid pregnancy. Between September 2013 and February 2014, semi-structured in-depth interviews were conducted with 27 women (8 white, 19 Latina) selected from a longitudinal study measuring prospective pregnancy intentions and feelings among 403 women in Austin, Texas. Women were selected for interview on the basis of wanting no more children and consistently professing either happiness (n = 17) or unhappiness (n = 10) at the prospect of pregnancy. Interviews were coded and analyzed following the principles of grounded theory. We found that it is possible for women to express happiness at the idea of pregnancy while simultaneously earnestly trying to prevent conception. Happiness at the idea of an unintended pregnancy was explained as the result of deep and heartfelt feelings about children taking precedence over practical considerations, the perception that the psychosocial stress resulting from another child would be low, and the ability to rationalize an unintended pregnancy as the result of fate or God's plan. The major exception to the sincerity of professed happiness was that conveyed as a result of social pressure despite truly negative feelings, predominantly expressed by foreign-born Latina women. Overall, equating incongruence with ambivalence about avoiding conception may undermine the sincerity of women's intentions and their desires for highly-effective contraception. At the same time, unintended pregnancies that are greeted with happiness may have different implications for maternal and child health outcomes compared to pregnancies that are greeted with unhappiness. Identifying which unintended pregnancies are most likely to result in adverse outcomes is a target for future research.
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Affiliation(s)
- Abigail R A Aiken
- Office of Population Research, Princeton University, Princeton, NJ, USA.
| | - Chloe Dillaway
- Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Natasha Mevs-Korff
- Population Research Center, University of Texas at Austin, Austin, TX, USA
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Abstract
Focusing on intrauterine contraceptives (IUC), contraceptive implants, and emergency contraceptives, we review recent advances in contraceptive development and discuss progress in policies to improve access to the most effective methods. We report on the shift in practice towards routinely providing IUCs and implants to young and nulliparous women, prompted in part by the reduced diameter of the insertion tube for the Mirena IUC and the development of a smaller IUC called Skyla. Additionally, we describe the new SCu300A intrauterine ball and the development of an implant called Nexplanon, which comes with a preloaded inserter. We also discuss the efficacy of ulipristal acetate versus levonorgestrel for emergency contraception, especially for women who weigh more than 75 kg. Finally, in light of the increasing interest in providing IUCs and implants to women in the immediate postpartum and post-abortion periods, we consider the rationale for this change in practice and review the progress that has been made so far in the United States.
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Aiken ARA, Creinin MD, Kaunitz AM, Nelson AL, Trussell J. Global fee prohibits postpartum provision of the most effective reversible contraceptives. Contraception 2014; 90:466-7. [PMID: 25212061 DOI: 10.1016/j.contraception.2014.08.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Abigail R A Aiken
- Office of Population Research, Princeton University, Princeton, NJ, USA.
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Anita L Nelson
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - James Trussell
- Office of Population Research, Princeton University, Princeton, NJ, USA
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Potter JE, Hopkins K, Aiken ARA, Hubert C, Stevenson AJ, White K, Grossman D. Unmet demand for highly effective postpartum contraception in Texas. Contraception 2014; 90:488-95. [PMID: 25129329 DOI: 10.1016/j.contraception.2014.06.039] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We aimed to assess women's contraceptive preferences and use in the first 6 months after delivery. The postpartum period represents a key opportunity for women to learn about and obtain effective contraception, especially since 50% of unintended pregnancies to parous women occur within 2 years of a previous birth. METHODS We conducted a prospective cohort study of 800 postpartum women recruited from three hospitals in Austin and El Paso, TX. Women aged 18-44 who wanted to delay childbearing for at least 24 months were eligible for the study and completed interviews following delivery and at 3 and 6 months postpartum. Participants were asked about the contraceptive method they were currently using and the method they would prefer to use at 6 months after delivery. RESULTS At 6 months postpartum, 13% of women were using an intrauterine device or implant, and 17% were sterilized or had a partner who had had a vasectomy. Twenty-four percent were using hormonal methods, and 45% relied on less effective methods, mainly condoms and withdrawal. Yet 44% reported that they would prefer to be using sterilization, and 34% would prefer to be using long-acting reversible contraception (LARC). CONCLUSIONS This study shows a considerable preference for LARC and permanent methods at 6 months postpartum. However, there is a marked discordance between women's method preference and actual use, indicating substantial unmet demand for highly effective methods of contraception. IMPLICATIONS In two Texas cities, many more women preferred long-acting and permanent contraceptive methods (LAPM) than were able to access these methods at 6 months postpartum. Women's contraceptive needs could be better met by counseling about all methods, by reducing cost barriers and by making LAPM available at more sites.
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Affiliation(s)
- Joseph E Potter
- Population Research Center, University of Texas at Austin, TX, USA.
| | - Kristine Hopkins
- Population Research Center, University of Texas at Austin, TX, USA
| | - Abigail R A Aiken
- Population Research Center, University of Texas at Austin, TX, USA; LBJ School of Public Affairs, University of Texas at Austin, TX, USA
| | - Celia Hubert
- Population Research Center, University of Texas at Austin, TX, USA
| | | | - Kari White
- Health Care Organization and Policy, University of Alabama at Birmingham, AL, USA
| | - Daniel Grossman
- Ibis Reproductive Health, Oakland, CA, USA; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
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Aiken ARA, Potter JE. Are Latina women ambivalent about pregnancies they are trying to prevent? Evidence from the Border Contraceptive Access Study. Perspect Sex Reprod Health 2013; 45:196-203. [PMID: 24192284 PMCID: PMC3891865 DOI: 10.1363/4519613] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
CONTEXT Women's retrospective reports of their feelings about a pregnancy and of its intendedness are often inconsistent, particularly among Latinas. Interpretation of this incongruence as ambivalence overlooks the possibility that happiness about the prospect of pregnancy and desire to prevent pregnancy need not be mutually exclusive. METHODS Data from the 2006-2008 Border Contraceptive Access Study--a prospective study of 956 Latina oral contraceptive users aged 18-44 in El Paso, Texas--were used to compare women's planned pill use and childbearing intentions with their feelings about a possible pregnancy. Associations between women's feelings and their perceptions of their partner's feelings were examined using logistic regression. Prospective and retrospective intentions and feelings were compared among women who became pregnant during the study. RESULTS Forty-one percent of women who planned to use the pill for at least another year and 34% of those who wanted no more children said they would feel very or somewhat happy about becoming pregnant in the next three months. Perceiving that a male partner would feel very upset about a pregnancy was negatively associated with happiness about the pregnancy among both women who planned to continue pill use and those who wanted no more children (coefficients, -4.4 and -3.9, respectively). Of the 36 women who became pregnant during the study, 24 reported feeling very happy about the pregnancy in retrospect, while only 14 had prospectively reported feeling happy about a possible pregnancy. CONCLUSION Intentions and happiness appear to be distinct concepts for this sample of Latina women.
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Abstract
OBJECTIVES We investigated the relationship between the number of times a woman has been pregnant and walking difficulty in later life. METHODS With data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly, a representative population-based cohort of Mexican Americans aged 65 years and older residing in 5 Southwestern states, we measured walking difficulty using 2 items from the performance-oriented mobility assessments: the timed walk and seated chair rise. RESULTS We observed significantly higher rates of ambulatory limitation among women with 6 or more pregnancies than among women with 4 or fewer pregnancies: 44.9% and 27.0%, respectively, were unable to perform or performed poorly in the seated chair rise and timed walk. Ordinal logistic regression models show that gravidity predicts level of performance in both mobility tasks and that higher gravidity is associated with worse performance, even after adjustment for both age and chronic disease. CONCLUSIONS Gravidity is a risk factor for ambulatory limitation in old age. A life course approach to reproduction in public health research and practice is warranted.
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Affiliation(s)
- Abigail R A Aiken
- Lyndon B. Johnson School of Public Affairs and the Population Research Center, University of Texas, Austin, TX 78713-8925, USA
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Aiken ARA, Lever AML. Ethnic diversity and patterns of infection of a UK HIV-positive patient population outwith major conurbations. Int J STD AIDS 2011; 21:823-5. [PMID: 21297091 DOI: 10.1258/ijsa.2010.010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We surveyed the HIV-positive population attending a major teaching hospital sited outwith a major conurbation. Eighty-five percent of homosexually acquired infections were contracted within the UK and 91% of heterosexually acquired infections were contracted outside of the UK. A strikingly wide range of nationalities (45) and countries of origin of infection were represented within a relatively small patient population. Most patients were non-UK-born immigrants. A high proportion of illegal immigrants were identified within which there was a high proportion lost to follow-up. This degree of ethnic diversity and domiciliary instability is rarely a feature of non-HIV populations in this setting and imposes additional demands on delivery of care and health-care planning.
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Affiliation(s)
- A R A Aiken
- Department of Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
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