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Krems JM, Grossman D, Ehrenreich K, Ralph L. Money and Place: Quantifying the types of obstacles associated with seeking an abortion after 10 weeks' gestation, 2019-2020. Contraception 2024:110476. [PMID: 38679274 DOI: 10.1016/j.contraception.2024.110476] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Identify factors associated with presenting for abortion after 10 weeks' gestation in a large, geographically diverse sample. STUDY DESIGN From October 2019 to March 2020, we surveyed 1,089 patients seeking abortion at 7 U.S. facilities. We identified four domains of barriers: geographic, financial, logistical/personal, and legislative. Using multivariable logistic regression, we investigated the relationship between each domain and presenting for abortion after 10 weeks' gestation, overall and stratified by state policy landscape. RESULTS One-third of participants reported geographic (33.0%), financial (33.3%), and logistical/personal (31.4%) barriers; fewer (4.8%) reported legislative barriers. One-third (30.8%) traveled over 50 miles to the clinic. One-quarter (25.2%) presented after 10 weeks' gestation. In multivariable analyses, financial barriers (adjusted Odds Ratio (aOR)=1.49, 95% Confidence Interval (CI)=1.06-2.09), geographic barriers (aOR=2.05, 95% CI=1.44-2.90) and difficulty meeting basic expenses (aOR=1.47, 95% CI=1.15-1.89) were associated with presenting after 10 weeks' gestation across the 7 clinics. Among participants accessing care at clinics in states with supportive abortion policies (n=178), geographic barriers remained significantly associated with presenting after 10 weeks' gestation. CONCLUSION In a large, geographically diverse sample, financial and geographic barriers were associated with presenting after the threshold for medication abortion. In supportive states, the association with geographic barriers persisted. Cost and geographic barriers are increasing as more states restrict abortion post-Dobbs, highlighting the urgent need to expand financial and travel support. IMPLICATIONS People seeking abortion faced barriers before the Dobbs decision. Now post-Dobbs, restrictions to abortion have only increased, making barriers to care even more threatening. Providing access to financial resources and transportation for people seeking abortion and expanding telehealth medication abortion is now even more important.
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Affiliation(s)
- Jennifer Mackinnon Krems
- Joint Medical Program, University of California San Francisco and University of California Berkeley.
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco
| | - Katherine Ehrenreich
- Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco
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Biggs MA, Becker A, Schroeder R, Kaller S, Scott K, Grossman D, Raifman S, Ralph L. Support for criminalization of self-managed abortion (SMA): A national representative survey. Soc Sci Med 2024; 340:116433. [PMID: 38039765 DOI: 10.1016/j.socscimed.2023.116433] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/24/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Since the U.S. Supreme Court eliminated the federal right to abortion, there is a heightened need to understand public opinion about the criminalization of people who attempt to end their pregnancies outside the formal healthcare setting, referred to as self-managed abortion (SMA). We assessed U.S. attitudes about whether three forms of SMA should be legal, reported or punished: 1) using abortion pills obtained outside the healthcare system, 2) using other medications, drugs, herbs, or by drinking alcohol, and 3) using traumatic methods (inserting an object in their body or hitting their stomach). METHODS From December 2021 to January 2022, we administered a national probability-based online survey to English- and Spanish-speaking people assigned female (AFAB, ages 15-49) or male at birth (AMAB, ages 18-49) regarding their attitudes about criminalizing SMA, using Ipsos' KnowledgePanel. We estimated weighted proportions and conducted multivariable regression analyses to identify characteristics associated with support for SMA legality and punishment (reporting to authorities, paying a fine or going to jail). RESULTS A total of 7,016 AFAB and 360 AMAB completed the survey. People were less likely (p < .05) to agree that SMA using abortion pills should be illegal (34% of AFAB and 43% of AMAB) than other forms of SMA (36-48%), although over one-fifth were unsure (AFAB, 20-23% and AMAB, 24-27%). People were less likely to agree SMA using abortion pills should be criminalized than SMA using other drugs, medications, herbs, alcohol or by using traumatic methods. In multivariable analyses, AMAB and Christian religion were associated with agreeing that SMA using abortion pills should be illegal; people who identified as Hispanic/Latinx ethnicity and experienced medical mistreatment were less likely to agree SMA with medication abortion pills should be illegal. CONCLUSIONS Public support for criminalizing SMA is complex and varied by SMA method and form of punishment.
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Affiliation(s)
- M Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA.
| | - Andréa Becker
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA; Department of Sociology, Hunter College, City University of New York, 695 Park Ave NY, NY, 10065, USA
| | - Rosalyn Schroeder
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
| | - Karen Scott
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA; Birthing Cultural Rigor, LLC, Nashville, TN, 37209, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
| | - Sarah Raifman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, 94612, USA
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Heise M, Dillard J, Taft-Benz S, Knight A, Anderson E, Pressey K, Parotti B, Martinez S, Diaz J, Sarkar S, Madden E, De la Cruz G, Adams L, Dinnon K, Leist S, Martinez D, Schaefer A, Powers J, Yount B, Castillo I, Morales N, Burdick J, Evangelista MK, Ralph L, Pankow N, Linnertz C, Lakshmanane P, Montgomery S, Ferris M, Baric R, Baxter V. Adjuvant-dependent effects on the safety and efficacy of inactivated SARS-CoV-2 vaccines during heterologous infection by a SARS-related coronavirus. Res Sq 2023:rs.3.rs-3401539. [PMID: 37961507 PMCID: PMC10635311 DOI: 10.21203/rs.3.rs-3401539/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Inactivated whole virus SARS-CoV-2 vaccines adjuvanted with aluminum hydroxide (Alum) are among the most widely used COVID-19 vaccines globally and have been critical to the COVID-19 pandemic response. Although these vaccines are protective against homologous virus infection in healthy recipients, the emergence of novel SARS-CoV-2 variants and the presence of large zoonotic reservoirs provide significant opportunities for vaccine breakthrough, which raises the risk of adverse outcomes including vaccine-associated enhanced respiratory disease (VAERD). To evaluate this possibility, we tested the performance of an inactivated SARS-CoV-2 vaccine (iCoV2) in combination with Alum against either homologous or heterologous coronavirus challenge in a mouse model of coronavirus-induced pulmonary disease. Consistent with human results, iCoV2 + Alum protected against homologous challenge. However, challenge with a heterologous SARS-related coronavirus, Rs-SHC014-CoV (SHC014), up to at least 10 months post-vaccination, resulted in VAERD in iCoV2 + Alum-vaccinated animals, characterized by pulmonary eosinophilic infiltrates, enhanced pulmonary pathology, delayed viral clearance, and decreased pulmonary function. In contrast, vaccination with iCoV2 in combination with an alternative adjuvant (RIBI) did not induce VAERD and promoted enhanced SHC014 clearance. Further characterization of iCoV2 + Alum-induced immunity suggested that CD4+ T cells were a major driver of VAERD, and these responses were partially reversed by re-boosting with recombinant Spike protein + RIBI adjuvant. These results highlight potential risks associated with vaccine breakthrough in recipients of Alum-adjuvanted inactivated vaccines and provide important insights into factors affecting both the safety and efficacy of coronavirus vaccines in the face of heterologous virus infections.
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Affiliation(s)
- Mark Heise
- University of North Carolina at Chapel Hill
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- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill
| | | | | | | | | | | | | | | | - Prem Lakshmanane
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | | | - Victoria Baxter
- Texas Biomedical Research Institute, San Antonio, Texas, USA
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Ralph L, Hasselbacher L. Adolescents and Abortion Restrictions: Disproportionate Burdens and Critical Warnings. J Adolesc Health 2023; 73:221-223. [PMID: 37455044 DOI: 10.1016/j.jadohealth.2023.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Lauren Ralph
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Lee Hasselbacher
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
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Ralph L, Biggs MA, Ehrenreich K, Grossman D. Accuracy of Self-assessment of Gestational Duration Among Adolescents Seeking Abortion Using Information in Addition to Date of Last Menstrual Period. JAMA Pediatr 2023; 177:642-644. [PMID: 37067809 PMCID: PMC10111228 DOI: 10.1001/jamapediatrics.2023.0483] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/01/2023] [Indexed: 04/18/2023]
Abstract
This diagnostic study evaluates whether using additional information beyond the date of last menstrual period is associated with improved accuracy of self-assessed gestational duration among adolescents seeking abortion.
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Affiliation(s)
- Lauren Ralph
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco
| | - M. Antonia Biggs
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco
| | - Katherine Ehrenreich
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco
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Adler A, Biggs MA, Kaller S, Schroeder R, Ralph L. Changes in the Frequency and Type of Barriers to Reproductive Health Care Between 2017 and 2021. JAMA Netw Open 2023; 6:e237461. [PMID: 37036704 PMCID: PMC10087056 DOI: 10.1001/jamanetworkopen.2023.7461] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
Importance Previous research has documented individual-level barriers to reproductive health services, but few studies have examined national trends. Objective To determine whether the number and type of barriers to reproductive health care experienced by US women of reproductive age changed from 2017 to 2021. Design, Setting, and Participants This cross-sectional study used serial survey data, weighted to be nationally representative, collected in August 2017 and December 2021 from members of Ipsos's KnowledgePanel who were aged 18 to 49 years and assigned female at birth. Exposures Having experienced barriers to reproductive health care over the past 3 years. Main Outcomes and Measures The primary outcome was number and type of barriers to reproductive health care services, including Papanicolaou tests or birth control, experienced in the past 3 years. Increases in barriers to reproductive health care were measured using multivariable linear regressions adjusted for age, race and ethnicity, education level, employment status, metropolitan area, geographic region, household income, and language (English vs Spanish). Results Of 29 496 KnowledgePanel members invited, 7022 (mean [SD] age, 33.9 [9.0] years) and 6841 (mean [SD] age, 34.2 [8.6] years) completed the 2017 and 2021 surveys (50% and 45% response rates, respectively). Among 12 351 participants who indicated that they had ever tried accessing reproductive health services, 35.9% (95% CI, 34.8%-37.0%) were aged 30 to 39 years; 5.5% (95% CI, 4.9%-6.2%) were Asian or Pacific Islander, 13.7% (95% CI, 12.8%-14.6%) were Black, 19.1% (95% CI, 18.1%-20.1%) were Hispanic, 58.2% (95% CI, 57.0%-59.5%) were White, and 3.5% (95% CI, 3.1%-4.0%) were multiracial or of other race or ethnicity; and 11.7% (95% CI, 11.0%-12.5%) were living below 100% of the federal poverty level. Covariate distribution was similar across years. In bivariable analyses, participants were more likely to report experiencing a given barrier in the past 3 years in 2021 than in 2017 for all but 2 barriers. More people experienced 3 or more barriers in 2021 (18.6%; 95% CI, 17.3%-20.0%) than in 2017 (16.1%; 95% CI, 14.9%-17.4%) (P = .008). In multivariable analyses, the mean number of barriers increased significantly from 1.09 (95% CI, 1.02-1.14) in 2017 to 1.29 (95% CI, 1.22-1.37) (P < .001) in 2021. Participants who were aged 25 to 29 years (0.42; 95% CI, 0.37-0.47), identified as Hispanic (0.41; 95% CI, 0.38-0.45), had no high school diploma or General Educational Development test (0.62; 95% CI, 0.53-0.72), lived below 100% of the federal poverty level (0.65; 95% CI, 0.55-0.73), and took the survey in Spanish (0.87; 95% CI, 0.73-1.01) saw the greatest increases in mean number of barriers between 2017 and 2021. Conclusions and Relevance The study findings suggest that barriers to reproductive health care increased between 2017 and 2021, with the largest increases observed among individuals from historically disadvantaged populations. Efforts are needed to ensure that reproductive health care access remains a priority.
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Affiliation(s)
- Aliza Adler
- Maternal, Adolescent and Child Health Division, School of Public Health, University of California, Berkeley
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Rosalyn Schroeder
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
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Kaller S, Ralph L, Wingo E, Biggs MA. Abortion terminology preferences: a cross-sectional survey of people accessing abortion care. BMC Womens Health 2023; 23:26. [PMID: 36658525 PMCID: PMC9850636 DOI: 10.1186/s12905-022-02152-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Abortion stigma likely affects the terminology abortion patients, providers and the public use or avoid using to refer to abortion care. Knowing the terminology people seeking abortion prefer could help inform the language used in clinical interactions and improve patients' experiences with abortion care. However, research in the U.S. has not examined patients' preferences in this area or whether terminology preferences vary by participant characteristics, in the way that experiences of stigma vary across different contexts and communities. This study aims to describe preferred terminology among people presenting for abortion care and to explore the pregnancy-related characteristics associated with these preferences. METHODS We surveyed abortion patients about their experiences accessing abortion care, including preferred terms for the procedure. Respondents could mark more than one term, suggest their own term, or indicate no preference. We recruited people ages 15-45 seeking abortion from four U.S. abortion facilities located in three states (California, Illinois, and New Mexico) from January to June 2019. We used descriptive statistics and multivariable multinomial logistic regression to explore associations between respondents' pregnancy-related characteristics and their preferred terminology. RESULTS Among the 1092 people approached, 784 (77%) initiated the survey and 697 responded to the terminology preference question. Most participants (57%, n = 400) preferred only one term. Among those participants, "abortion" (43%) was most preferred, followed by "ending a pregnancy" (29%), and "pregnancy termination" (24%). In adjusted multivariable models, participants who worried "very much" that other people might find out about the abortion (29%) were significantly more likely than those who were "not at all" worried (13%) to prefer "ending a pregnancy" over having no preference for a term (adjusted relative risk ratio: 2.68, 95% Confidence Interval: 1.46-4.92). CONCLUSIONS People seeking abortion have varied preferences for how they want to refer to their abortions, in particular if they anticipate abortion stigma. Findings can be useful for clinicians and researchers so that they can be responsive to people's preferences during clinical interactions and in the design and conduct of abortion research.
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Affiliation(s)
- Shelly Kaller
- grid.266102.10000 0001 2297 6811Advancing New Standards in Reproductive Health, University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
| | - Lauren Ralph
- grid.266102.10000 0001 2297 6811Advancing New Standards in Reproductive Health, University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
| | - Erin Wingo
- grid.266102.10000 0001 2297 6811Advancing New Standards in Reproductive Health, University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612 USA ,grid.266102.10000 0001 2297 6811Present Address: Department of Family and Community Medicine, University of California San Francisco, 995 Potrero Ave, San Francisco, CA 94110 USA
| | - M. Antonia Biggs
- grid.266102.10000 0001 2297 6811Advancing New Standards in Reproductive Health, University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
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Biggs A, Foster DG, Gould H, Kimport K, Ralph L, Roberts S, Rocca C, Sisson G, Upadhyay U, Woodruff K. Commentary: The Turnaway Study: A case of self-correction in science upended by political motivation and unvetted findings. Front Psychol 2022; 13:1003116. [DOI: 10.3389/fpsyg.2022.1003116] [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] [Received: 07/29/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
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Biggs MA, Ralph L, Schroeder R, Kaller S, Grossman D. P021National levels of support for legalizing and not criminalizing people involved in self-managed abortion (SMA): A national representative survey. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.046] [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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Biggs MA, Grossman D, Kaller S, Schroeder R, Ralph L. P022Growing national interest and support for advance provision and over-the-counter access to medication abortion. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.047] [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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Ralph L, Biggs MA, Ehrenreich K, Grossman D. P007Accuracy of self-assessment of pregnancy duration eligibility for medication abortion among young people: The advantages of expanding screening questions beyond date of last menstrual period. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.032] [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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Krems JAM, Ralph L, Grossman D, Ehrenreich K. P029Barriers to abortion and timing of presentation for care. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.054] [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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Rocca CH, Muñoz I, Gonzalez E, Gould H, Foster DG, Bonilla IO, Ralph L. O14Pregnancy and abortion: A longitudinal study of the predictive ability of people's desire to avoid pregnancy. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.019] [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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Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour MM. Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States. Am J Public Health 2022; 112:1290-1296. [PMID: 35969820 PMCID: PMC9382171 DOI: 10.2105/ajph.2017.304247r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ralph L, Ehrenreich K, Kaller S, Biggs MA. A cross-sectional study examining consideration of self-managed abortion among people seeking facility-based care in the United States. Reprod Health 2022; 19:176. [PMID: 35962384 PMCID: PMC9375262 DOI: 10.1186/s12978-022-01486-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/22/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction With increasing restrictions on abortion across the United States, we sought to understand whether people seeking abortion would consider ending their pregnancy on their own if unable to access a facility-based abortion. Methods From January to June 2019, we surveyed patients seeking abortion at 4 facilities in 3 US states. We explored consideration of self-managed abortion (SMA) using responses to the question: “Would you consider ending this pregnancy on your own if you are unable to obtain care at a health care facility?” We used multivariable Poisson regression to assess associations between individual sociodemographic, pregnancy and care-seeking characteristics and prevalence of considering SMA. In bivariate Poisson models, we also explored whether consideration of SMA differed by specific obstacles to abortion care. Results One-third (34%) of 741 participants indicated they would definitely or probably consider ending the pregnancy on their own if unable to obtain care at a facility. Consideration of SMA was higher among those who reported no health insurance (adjusted prevalence ratio [aPR] = 1.66; 95% Confidence Interval [CI] 1.12–2.44), described the pregnancy as unintended (aPR = 1.53; 95% CI 1.08–2.16), were seeking abortion due to concerns about their own physical or mental health (aPR = 1.50, 95% CI 1.02, 2.20), or experienced obstacles that delayed their abortion care seeking (aPR = 2.26, 95% CI 1.49, 3.40). Compared to those who would not consider SMA, participants who would consider SMA expressed higher difficulty finding an abortion facility (35 vs. 27%, p = 0.019), figuring out how to get to the clinic (29 vs 21%, p = 0.021) and needing multiple clinic visits (23 vs 17%, p = 0.044). Conclusions. One in three people seeking facility-based abortion would consider SMA if unable to obtain abortion care at a facility. As abortion access becomes increasingly restricted in the US, SMA may become more common. Future research should continue to monitor people’s consideration and use of SMA and ensure that they have access to safe and effective methods.
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Affiliation(s)
- Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA.
| | - Katherine Ehrenreich
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
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McKay FH, Spiteri S, Zinga J, Sulemani K, Jacobs SE, Ranjan N, Ralph L, Raeburn E, Threlfall S, Bergmeier ML, van der Pligt P. Systematic Review of Interventions Addressing Food Insecurity in Pregnant Women and New Mothers. Curr Nutr Rep 2022; 11:486-499. [PMID: 35501553 PMCID: PMC9381473 DOI: 10.1007/s13668-022-00418-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 10/27/2022]
Abstract
Abstract
Purpose of the Review
Food insecurity can have a negative health impact for women during pregnancy and the postpartum period; however, there are a range of barriers to meeting nutritional guidelines during pregnancy. Food insecurity is associated with an increased risk of pregnancy complications and mental and physical health outcomes. This review aims to provide insight into programmes and interventions which have targeted food insecurity in pregnant and early postpartum women. The central research question for this review is as follows: What programmes and interventions have sought to address food insecurity among pregnant and postpartum women? A systematic search of five electronic databases including Medline, CINAHL, Global Health, Embase, and Cochrane was undertaken on August 2021. Key thematic areas searched were food insecurity, pregnancy, nutritional outcomes, and interventions or programmes. Only studies that were published since 2000 in English were considered.
Recent Findings
Eleven studies were included in this review. Studies employed a range of methods and outcomes measures. They were conducted in mostly low- and middle-income countries, and in general, focused on nutritional supplementation, with some studies also incorporating nutrition education or counselling.
Summary
The findings of this review suggest that while there are a range of possible interventions that seek to address food insecurity and hunger among pregnant and postpartum women, the limited number of robust evaluations or long-term interventions mean that evidence for any one intervention type is limited. Furthermore, the programmes and interventions that do exist are generally embedded within a single context or structure, and as such, may not be able to be widely implemented. (Prospero Registration CRD42022245787)
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Biggs M, Ehrenreich K, Morris N, Blanchard K, Bustamante C, Choimorrow S, Hauser D, Hernandez Y, Kapp N, Kromenaker T, Moayedi G, Perritt J, Ralph L, Raymond E, Valladares E, White K, Grossman D. Comprehension of an Over-the-counter Drug Facts Label Prototype for a Mifepristone and Misoprostol Medication Abortion Product. Contraception 2022. [DOI: 10.1016/j.contraception.2022.03.010] [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: 11/29/2022]
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Anastasiou E, McCarthy KJ, Gollub EL, Ralph L, van de Wijgert JH, Jones HE. The relationship between hormonal contraception and cervical dysplasia/cancer controlling for human papillomavirus infection: A systematic review. Contraception 2022; 107:1-9. [PMID: 34752778 PMCID: PMC8837691 DOI: 10.1016/j.contraception.2021.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/29/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Studies on the effect of long-term use of combined oral contraceptives (COCs) on cervical dysplasia and/or cancer risk have been inconsistent. Less is known about the effects of other forms of hormonal contraception (HC). We examine whether HC use increases the risk of incident cervical intraepithelial neoplasia (CIN) 2, 3 and/or cancer after accounting for preexisting human papillomavirus (HPV) infection. STUDY DESIGN Systematic review of prospective studies on HC use as risk factor for cervical dysplasia with HPV infection documented prior to outcome assessment including PubMed and EMBASE records between January 2000 and February 2020 (Prospero #CRD42019130725). RESULTS Among nine eligible studies, seven described recency and type of HC use and therefore comprise the primary analysis; two studies limit comparisons to ever versus never use and are summarized separately. All seven studies explored the relationship between oral contraceptive (OC) use and cervical dysplasia/cancer incidence: two found increased risk (adjusted odds ratio, aOR = 1.5-2.7), one found no association but decreased risk when restricted to women with persistent HPV (adjusted hazard ratio = 0.5), and four found no association. None of the seven studies differentiated between COC and progestin-only pills (POPs) by use recency or duration. The only study that included injectable progestin-only contraception (DMPA) found increased CIN3 incidence among current versus never users (aOR = 1.6). The one study that included Norplant found no association. Two studies included intrauterine device (IUD) use, but did not differentiate between hormonal and copper IUDs, and found no association. CONCLUSION We found no consistent evidence that OC use is associated with increased risk for cervical dysplasia/cancer after controlling for HPV infection. There were too few studies of progestin-only injectables, implants or IUDs to assess their effect on cervical dysplasia/cancer risk. IMPLICATIONS Use of single self-reported HC measures and insufficient distinction by hormonal constituent cloud our understanding of whether some HCs increase risk for cervical cancer. Methodologically rigorous studies with distinct HCs measured as time-varying exposures are needed to inform cervical cancer prevention efforts and improve our understanding of cervical cancer etiology.
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Affiliation(s)
- Elle Anastasiou
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 W. 125th St., New York, NY 10027, USA
| | - Katharine J. McCarthy
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 W. 125th St., New York, NY 10027, USA
| | - Erica L. Gollub
- College of Health Professions, Health Science Program, Pace University, 861 Bedford Rd, Pleasantville, NY 10570, USA
| | - Lauren Ralph
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1330 Broadway Suite 1100 Oakland CA 94612 USA
| | - Janneke H.H.M. van de Wijgert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Stratenum room 7.127, 3584 Utrecht, Netherlands
| | - Heidi E. Jones
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, 55 W. 125th St., New York, NY 10027, USA,CUNY Institute for Implementation Science in Public Health, 55 W. 125th St., New York, NY 10027, USA
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Biggs MA, Ralph L, Morris N, Ehrenreich K, Perritt J, Kapp N, Blanchard K, White K, Barar R, Grossman D. A cross-sectional survey of U.S. abortion patients’ interest in obtaining medication abortion over the counter. Contraception 2022; 109:25-31. [DOI: 10.1016/j.contraception.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/08/2022] [Accepted: 01/12/2022] [Indexed: 11/15/2022]
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Raifman S, Ralph L, Biggs MA, Grossman D. "I'll just deal with this on my own": a qualitative exploration of experiences with self-managed abortion in the United States. Reprod Health 2021; 18:91. [PMID: 33947413 PMCID: PMC8093912 DOI: 10.1186/s12978-021-01142-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background A growing body of evidence indicates that some people seek options to terminate a pregnancy without medical assistance, but experiences doing so have largely been documented only among people accessing a clinic-based abortion. We aim to describe self-managed abortion (SMA) experiences of people recruited outside of clinics, including their motivations for SMA, pregnancy confirmation and decision-making processes, method choices, and clinical outcomes. Methods In 2017, we conducted 14 in-depth interviews with self-identified females of reproductive age who recently reported in an online survey administered to Ipsos’ KnowledgePanel that, since 2000, they had attempted SMA while living in the United States. We asked participants about their reproductive histories, experiences seeking reproductive health care, and SMA experiences. We used an iterative process to develop codes and analyzed transcripts using thematic content analysis methods. Results Motivations and perceptions of effectiveness varied by whether participants had confirmed the pregnancy prior to SMA. Participants who confirmed their pregnancies chose SMA because it was convenient, accessible, and private. Those who did not test for pregnancy were motivated by a preference for autonomy and felt empowered by the ability to try something on their own before seeking facility-based care. Participants prioritized methods that were safe and available, though not always effective. Most used herbs or over-the-counter medications; none used self-sourced abortion medications, mifepristone and/or misoprostol. Five participants obtained facility-based abortions and one participant decided to continue the pregnancy after attempting SMA. The remaining eight reported being no longer pregnant after SMA. None of the participants sought care for SMA complications; one participant saw a provider to confirm abortion completion. Conclusions There are many types of SMA experiences. In addition to those who pursue SMA as a last resort (after facing barriers to facility-based care) or as a first resort (because they prefer homeopathic remedies), our findings show that some individuals view SMA as a potential interim step worth trying after suspecting pregnancy and before accessing facility-based care. These people in particular would benefit from a medication abortion product available over the counter, online, or in the form of a missed-period pill. Some people in the United States (US) attempt to end a pregnancy on their own without medical supervision. What we know about this experience comes from studies focused on people who go to clinics. In this study, we conducted 14 interviews with self-identified women ages 18–49 who recently reported attempting to end a pregnancy on their own and who were recruited outside of the clinic setting. We asked participants about their fertility histories, experiences seeking reproductive health care, and experiences ending a pregnancy without medical assistance. Those who took a pregnancy test and then chose to end the pregnancy on their own did so because it was convenient, accessible, and private. Those who did not test for pregnancy felt empowered by the ability to try something on their own before seeking facility-based care. All participants prioritized methods that were safe and available, though not always effective. After they attempted to end the pregnancy on their own, five participants accessed abortion care in facilities, one decided to continue the pregnancy, and eight were no longer pregnant. Our findings show that, in addition to people who end a pregnancy on their own as a last resort (after facing barriers to facility-based care) or as a first resort (because of preferences for homeopathic methods), a third group values having an interim step to try after suspecting pregnancy and before accessing facility-based care. These people would particularly benefit from a medication abortion product available over the counter, online, or in the form of a missed-period pill.
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Affiliation(s)
- Sarah Raifman
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA.
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA
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Ralph L, Foster DG, Raifman S, Biggs MA, Samari G, Upadhyay U, Gerdts C, Grossman D. Prevalence of Self-Managed Abortion Among Women of Reproductive Age in the United States. JAMA Netw Open 2020; 3:e2029245. [PMID: 33337493 PMCID: PMC7749440 DOI: 10.1001/jamanetworkopen.2020.29245] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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: 11/14/2022] Open
Abstract
IMPORTANCE Increasing evidence indicates that people are attempting their own abortions outside the formal health care system. However, population-based estimates of experience with self-managed abortion (SMA) are lacking. OBJECTIVE To estimate the prevalence of SMA attempts among the general US population. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study was fielded August 2 to 17, 2017 among English- and Spanish- speaking, self-identified female panel members from the GfK web-based KnowledgePanel. Women ages 18 to 49 years were approached to complete a 1-time survey. Data were analyzed from September 22, 2017, to March 26, 2020. MAIN OUTCOMES AND MEASURES SMA was defined as "some women may do something on their own to try to end a pregnancy without medical assistance. For example, they may get information from the internet, a friend, or family member about pills, medicine, or herbs they can take on their own, or they may do something else to try to end the pregnancy." SMA was assessed using the question, "Have you ever taken or used something on your own, without medical assistance, to try to end an unwanted pregnancy?" Participants reporting SMA were asked about methods used, reasons, and outcomes. Factors associated with SMA experience, including age, race/ethnicity, socioeconomic status, nativity, reproductive health history, and geography, were assessed. Projected lifetime SMA prevalence was estimated using discrete-time event history models, adjusting for abortion underreporting. RESULTS Among 14 151 participants invited to participate, 7022 women (49.6%) (mean [SE] age, 33.9 [9.0] years) agreed to participate. Among these, 57.4% (95% CI, 55.8%-59.0%) were non-Hispanic White, 20.2% (95% CI, 18.9%-21.5%) were Hispanic, and 13.3% (95% CI, 12.1%-14.5%) were non-Hispanic Black; and 15.1% (95% CI, 14.1%-16.3%) reported living at less than 100% federal poverty level (FPL). A total of 1.4% (95% CI, 1.0%-1.8%) of participants reported a history of attempting SMA while in the US. Projected lifetime prevalence of SMA adjusting for underreporting of abortion was 7.0% (95% CI, 5.5%-8.4%). In bivariable analyses, non-Hispanic Black (prevalence ratio [PR], 3.16; 95% CI, 1.48-6.75) and Hispanic women surveyed in English (PR, 3.74; 95% CI, 1.78-7.87) were more likely than non-Hispanic White women to have attempted SMA. Women living below 100% of the FPL were also more likely to have attempted SMA compared with those at 200% FPL or greater (PR, 3.43; 95% CI, 1.83-6.42). At most recent SMA attempt, 20.0% (95% CI, 10.9%-33.8%) of respondents used misoprostol, 29.2% (95% CI, 17.5%-44.5%) used another medication or drug, 38.4% (95% CI, 25.3%-53.4%) used herbs, and 19.8% (95% CI, 10.0%-35.5%) used physical methods. The most common reasons for SMA included that it seemed faster or easier (47.2% [95% CI, 33.0%-61.8%]) and the clinic was too expensive (25.2% [95% CI, 15.7%-37.7%]). Of all attempts, 27.8% (95% CI, 16.6%-42.7%) of respondents reported they were successful; the remainder reported they had subsequent facility-based abortions (33.6% [95% CI, 21.0%-49.0%]), continued the pregnancy (13.4% [95% CI, 7.4%-23.1%]), had a miscarriage (11.4% [95% CI, 4.2%-27.5%]), or were unsure (13.3% [95% CI, 6.8%-24.7%]). A total of 11.0% (95% CI, 5.5%-21.0%) of respondents reported a complication. CONCLUSIONS AND RELEVANCE This cross-sectional study found that approximately 7% of US women reported having attempted SMA in their lifetime, commonly with ineffective methods. These findings suggest that surveys of SMA experience among patients at abortion clinics may capture only one-third of SMA attempts. People's reasons for attempting SMA indicate that as abortion becomes more restricted, SMA may become more common.
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Affiliation(s)
- Lauren Ralph
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Diana G. Foster
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Sarah Raifman
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - M. Antonia Biggs
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Goleen Samari
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York
| | - Ushma Upadhyay
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Caitlin Gerdts
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York
- Ibis Reproductive Health, Oakland, California
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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Biggs M, Ralph L, Morris N, Ehrenreich K, Perritt J, Kapp N, Raymond E, Grossman D. P8 ‘Abortion patients’ interest in obtaining medication abortion over-the-counter (OTC). Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.030] [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: 10/23/2022]
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McCarthy MA, Upadhyay U, Ralph L, Biggs MA, Foster DG. The effect of receiving versus being denied an abortion on making and achieving aspirational 5-year life plans. BMJ Sex Reprod Health 2020; 46:177-183. [PMID: 32098771 DOI: 10.1136/bmjsrh-2019-200456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/19/2019] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Popular support for access to abortion and contraceptive services is often based on the idea that they will help women determine the trajectory of their life course. This study examined whether receiving versus being denied an abortion affects aspirational life goal setting and attainment 5 years later. METHODS We compared women who sought and were denied an abortion because they were 3 weeks beyond the gestational limit ('Parenting-Turnaways') to those who received an abortion in the first trimester ('First-Trimesters'); received an abortion within 2 weeks of the facility's gestational limit ('Near-Limits'); and sought an abortion, were turned away and received an abortion elsewhere or placed their baby for adoption ('Non-Parenting-Turnaways'). We used mixed effects logistic regression analyses to estimate the odds of setting an aspirational plan and to estimate the odds of both setting and achieving an aspirational 5-year plan. RESULTS At 1 week post abortion-seeking, 791 women reported 1864 5-year plans, most of which were aspirational (n=1692, 91%). Parenting-Turnaways had lower odds of setting an aspirational 5-year plan than Near-Limits (OR 0.36, 95% CI 0.18 to 0.73). There were no differences by group in achieving aspirational 5-year plans among those who had them. CONCLUSIONS Soon after abortion-seeking, women denied a wanted abortion were less optimistic about their long-term futures than women who received a wanted abortion. Abortion access can help women set positive long-term goals.
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Affiliation(s)
- Molly A McCarthy
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ushma Upadhyay
- University of California San Francisco (UCSF), San Francisco, California, USA
| | - Lauren Ralph
- University of California San Francisco (UCSF), San Francisco, California, USA
| | - M Antonia Biggs
- University of California San Francisco (UCSF), San Francisco, California, USA
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), UCSF, Oakland, California, USA
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Rowland B, Rocca C, Ralph L. Certainty and Intention in Pregnancy Decision-making: an exploratory study. Contraception 2020. [DOI: 10.1016/j.contraception.2020.03.017] [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: 10/24/2022]
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Affiliation(s)
- Erica L Gollub
- College of Health Professions, Pace University, Pleasantville, New York, NY 10570, USA.
| | - Zena Stein
- Department of Epidemiology, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Janneke H H M van de Wijgert
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Clinical Infection, Microbiology, and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Heidi Jones
- Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, USA
| | - Lauren Ralph
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Advancing New Standards in Reproductive Health, University of California San Francisco, California, CA, USA
| | - Nancy Padian
- Department of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA
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Nance N, Ralph L, Padian N, Cowan F, Buzdugan R, Mushavi A, Mahomva A, McCoy SI. Unintended pregnancy and subsequent postpartum long-acting reversible contraceptive use in Zimbabwe. BMC Womens Health 2018; 18:193. [PMID: 30477497 PMCID: PMC6258256 DOI: 10.1186/s12905-018-0668-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/16/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The postpartum period is an opportune time for contraception adoption, as women have extended interaction with the reproductive healthcare system and therefore more opportunity to learn about and adopt contraceptive methods. This may be especially true for women who experience unintended pregnancy, a key target population for contraceptive programs and programs to eliminate mother-to-child HIV transmission. Among women in Zimbabwe surveyed in 2014, we examined the relationship between pregnancy intention associated with a woman's most recent pregnancy, and her subsequent postpartum contraceptive use. METHODS In our analysis we utilized a dataset from a random selection of catchment areas in Zimbabwe to examine the association between pregnancy intention of most recent pregnancy and subsequent postpartum contraceptive use using multinomial logistic regression models. We also explored whether this association differed by women's HIV status. Finally, we examined the association between pregnancy intention and changes in contraception from the pre- to postpartum periods. RESULTS Findings suggest that women who reported that their pregnancy was unintended adopted less modern (all non-traditional) contraceptive methods overall, but adopted long-acting reversible contraception (LARC) more frequently than women reporting an intended pregnancy (OR 1.41; CI 1.18, 1.68). Among HIV-positive women, this relationship was particularly strong (OR 3.12; CI 1.96, 4.97). However, when examining changes in contraceptive use from the pre-pregnancy to the postpartum period, women who had an unintended pregnancy had lower odds of changing to a more effective method postpartum overall (OR 0.71; CI 0.64, 0.79). CONCLUSIONS We did not find evidence of higher modern method adoption in the postpartum period among women with an unintended pregnancy. However, women who were already on a method in the pre-pregnancy period were catalyzed to move to more effective methods (such as LARC) postpartum. This study provides evidence of low modern (non-traditional) method adoption in general in the postpartum period among a vulnerable sub-population in Zimbabwe (women who experience unintended pregnancy). Simultaneously, however, it shows a relatively greater portion specifically of LARC use among women with an unintended pregnancy. Further research is needed to more closely examine the motivations behind these contraceptive decisions in order to better inform distribution and counseling programs.
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Affiliation(s)
- Nerissa Nance
- University of California, Berkeley School of Public Health, Berkeley, USA.
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, USA
| | - Nancy Padian
- University of California, Berkeley School of Public Health, Berkeley, USA
| | - Frances Cowan
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK.,Centre for Sexual Health and HIV AIDS Research Zimbabwe (CeSHHAR), Harare, Zimbabwe
| | - Raluca Buzdugan
- University of California, Berkeley School of Public Health, Berkeley, USA
| | | | - Agnes Mahomva
- Elizabeth Glazier Pediatric AIDS Foundation, Washington, D.C., USA
| | - Sandra I McCoy
- University of California, Berkeley School of Public Health, Berkeley, USA
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Biggs MA, Ralph L, Raifman S, Foster DG, Grossman D. Support for and interest in alternative models of medication abortion provision among a national probability sample of U.S. women. Contraception 2018; 99:118-124. [PMID: 30448203 DOI: 10.1016/j.contraception.2018.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 08/16/2018] [Revised: 10/10/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective was to assess women's personal interest in and support for three alternative models of medication abortion (MA) provision. STUDY DESIGN Using an online survey of a U.S. national, probability-based representative sample of women ages 18-49, we gauged personal interest in and general support for three alternative models for accessing abortion pills: (1) in advance from a doctor for future use, (2) over-the-counter (OTC) from a drugstore and (3) online without a prescription. We conducted multivariable analyses to identify characteristics associated with support for these provision models. RESULTS Fifty percent (n=7022) of eligible women invited completed the survey. Nearly half (49%) supported and 30% were personally interested in one or more of the three access models; 44% supported advance provision, 37% supported OTC access, and 29% supported online access. Common advantages reported for advance provision, OTC and online access included privacy (49%, 29% and 46%, respectively), convenience (38%, 44% and 38%) and being able to end the pregnancy earlier (48%, 40% and 29%). Common disadvantages included concern that women might take the pills incorrectly (55%, 53% and 57%), not seeing a clinician before the abortion (52%, 54% and 53%) and safety (42%, 43% and 60%). History of abortion and experiencing barriers accessing reproductive health services were associated with greater support for the alternative models. CONCLUSION Women are interested in and support alternative models of MA provision, in particular, advance provision. However, they also reported concerns about incorrect pill use and not seeing a clinician beforehand. IMPLICATIONS Offering women more choices in how they access medication abortion, including options where they can safely self-manage their own care, has the potential to expand access to care.
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Affiliation(s)
- M Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA 94612, USA.
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA 94612, USA
| | - Sarah Raifman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA 94612, USA
| | - Diana G Foster
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA 94612, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA 94612, USA
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Samari G, Foster D, Ralph L, Rocca C. Pregnancy preferences and contraceptive use among U.S. women: new insights using a validated prospective instrument. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.080] [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: 10/28/2022]
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Biggs MA, Ralph L, Raifman S, Foster D, Grossman D. Interest in and support for alternative models of medication abortion provision according to a U.S. national probability sample. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.048] [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: 10/28/2022]
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Grossman D, Ralph L, Raifman S, Upadhyay U, Gerdts C, Biggs A, Foster DG. Lifetime prevalence of self-induced abortion among a nationally representative sample of U.S. women. Contraception 2018. [DOI: 10.1016/j.contraception.2018.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour MM. Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States. Am J Public Health 2018; 108:407-413. [PMID: 29345993 DOI: 10.2105/ajph.2017.304247] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [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 determine the socioeconomic consequences of receipt versus denial of abortion. METHODS Women who presented for abortion just before or after the gestational age limit of 30 abortion facilities across the United States between 2008 and 2010 were recruited and followed for 5 years via semiannual telephone interviews. Using mixed effects models, we evaluated socioeconomic outcomes for 813 women by receipt or denial of abortion care. RESULTS In analyses that adjusted for the few baseline differences, women denied abortions who gave birth had higher odds of poverty 6 months after denial (adjusted odds ratio [AOR] = 3.77; P < .001) than did women who received abortions; women denied abortions were also more likely to be in poverty for 4 years after denial of abortion. Six months after denial of abortion, women were less likely to be employed full time (AOR = 0.37; P = .001) and were more likely to receive public assistance (AOR = 6.26; P < .001) than were women who obtained abortions, differences that remained significant for 4 years. CONCLUSIONS Women denied an abortion were more likely than were women who received an abortion to experience economic hardship and insecurity lasting years. Laws that restrict access to abortion may result in worsened economic outcomes for women.
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Affiliation(s)
- Diana Greene Foster
- Diana Greene Foster, M. Antonia Biggs, Lauren Ralph, Sarah Roberts, and M. Maria Glymour are with University of California, San Francisco. Caitlin Gerdts is with Ibis Reproductive Health, Oakland, CA
| | - M Antonia Biggs
- Diana Greene Foster, M. Antonia Biggs, Lauren Ralph, Sarah Roberts, and M. Maria Glymour are with University of California, San Francisco. Caitlin Gerdts is with Ibis Reproductive Health, Oakland, CA
| | - Lauren Ralph
- Diana Greene Foster, M. Antonia Biggs, Lauren Ralph, Sarah Roberts, and M. Maria Glymour are with University of California, San Francisco. Caitlin Gerdts is with Ibis Reproductive Health, Oakland, CA
| | - Caitlin Gerdts
- Diana Greene Foster, M. Antonia Biggs, Lauren Ralph, Sarah Roberts, and M. Maria Glymour are with University of California, San Francisco. Caitlin Gerdts is with Ibis Reproductive Health, Oakland, CA
| | - Sarah Roberts
- Diana Greene Foster, M. Antonia Biggs, Lauren Ralph, Sarah Roberts, and M. Maria Glymour are with University of California, San Francisco. Caitlin Gerdts is with Ibis Reproductive Health, Oakland, CA
| | - M Maria Glymour
- Diana Greene Foster, M. Antonia Biggs, Lauren Ralph, Sarah Roberts, and M. Maria Glymour are with University of California, San Francisco. Caitlin Gerdts is with Ibis Reproductive Health, Oakland, CA
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Sisson G, Ralph L, Gould H, Foster DG. Adoption Decision Making among Women Seeking Abortion. Womens Health Issues 2017; 27:136-144. [PMID: 28153742 DOI: 10.1016/j.whi.2016.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/25/2016] [Accepted: 11/29/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about how adoption factors into pregnancy decision making, particularly when abortion is unavailable. METHODS We used data from the Turnaway Study, a longitudinal study of 956 women seeking abortion, including 231 women denied abortions owing to gestational limits. Through semiannual quantitative interviews, we assessed the frequency with which women denied abortion consider and choose adoption, and, among adoption participants, decision satisfaction. We compared differences in the demographic profiles of parenting and adoption participants using mixed effects regression models. We conducted in-depth interviews with 31 women who received or were denied wanted abortions, including 2 adoption participants, focused on understanding pregnancy decision making and feelings about their choice. Interviews were coded using inductive and deductive methods. RESULTS Most women who received abortions were aware of but uninterested in adoption. A minority of women denied abortions (n = 231; 14%) were considering adoption at 1 week after denial. Of participants who gave birth (n = 161), most (91%) chose parenting. Parenting participants (n = 146) did not differ from adoption participants (n = 15) on measures of age, race, or poverty status, although adoption participants were somewhat less likely to be employed (20% vs. 43%; p = .1), and somewhat more likely to have completed high school (87% vs. 74%; p = .08). Although satisfaction with their decision was high among adoption participants, in-depth interviews revealed mixed emotions. CONCLUSIONS Among women motivated to avoid parenthood, as evidenced by abortion seeking, adoption is considered or chosen infrequently. Political promotion of adoption as an alternative to abortion is likely not grounded in the reality of women's decision making.
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Affiliation(s)
- Gretchen Sisson
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, San Francisco, California.
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, San Francisco, California
| | - Heather Gould
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, San Francisco, California
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, San Francisco, California
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Sisson G, Gould H, Ralph L, Foster D. Adoption decision making after being denied a wanted abortion. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.066] [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: 10/21/2022]
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Ralph L, Greene Foster D, Turok D, Roberts S. Evaluating the psychometric properties of two decisional conflict scales among women seeking abortion in Utah. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.066] [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: 11/24/2022]
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Ralph L, Gould H, Baker A, Foster DG. The role of parents and partners in minors' decisions to have an abortion and anticipated coping after abortion. J Adolesc Health 2014; 54:428-34. [PMID: 24332398 DOI: 10.1016/j.jadohealth.2013.09.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/27/2013] [Accepted: 09/28/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE Despite the prevalence of laws requiring parental involvement in minors' abortion, little is known about the effect of parental involvement on minors' abortion decision making and anticipated coping after abortion. METHODS We analyzed data from medical charts and counseling needs assessment forms for 5,109 women accessing abortion services at a clinic in 2008, 9% (n = 476) of whom were minors aged 17 years and under. We examined differences in abortion characteristics, including parental and partner involvement, between minors and adults, and used multivariate logistic regression models to examine predictors of parental involvement and support, confidence in the decision, and anticipated poor coping among minors. RESULTS Most minors reported that their mothers (64%) and partners (83%) were aware of their abortion. Younger age was associated with increased odds of maternal awareness and reduced odds of partner awareness. Compared with adults, minors were more likely to report external pressure to seek abortion (10% vs. 3%), and mothers were the most common source of pressure. Minors overall had high confidence in their decision and anticipated feeling a range of emotions post-abortion; minors who felt pressure to seek abortion were less likely to report having confidence in their decision (odds ratio = .1) and more likely to report anticipating poor coping (odds ratio = 5.6). CONCLUSIONS Most minors involve parents and partners in their decision making regarding abortion, and find support from these individuals. For a minority, experiencing pressure or lack of support reduces confidence in their decision and increases their likelihood of anticipating poor coping after an abortion.
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Affiliation(s)
- Lauren Ralph
- Division of Epidemiology, University of California, Berkeley, California.
| | - Heather Gould
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, California
| | | | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, California
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Affiliation(s)
- Lauren Ralph
- Division of Epidemiology, University of California Berkeley, Berkeley, CA 94704, USA.
| | - Sandra McCoy
- Division of Epidemiology, University of California Berkeley, Berkeley, CA 94704, USA
| | - Timothy Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Nancy Padian
- Division of Epidemiology, University of California Berkeley, Berkeley, CA 94704, USA
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Minnis AM, Marchi K, Ralph L, Biggs MA, Combellick S, Arons A, Brindis CD, Braveman P. Limited socioeconomic opportunities and Latina teen childbearing: a qualitative study of family and structural factors affecting future expectations. J Immigr Minor Health 2014; 15:334-40. [PMID: 22678305 DOI: 10.1007/s10903-012-9653-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The decrease in adolescent birth rates in the United States has been slower among Latinas than among other ethnic/racial groups. Limited research has explored how socioeconomic opportunities influence childbearing among Latina adolescents. We conducted in-depth interviews with 65 pregnant foreign- and US-born Latina women (31 adolescents; 34 adults) in two California counties. We assessed perceived socioeconomic opportunities and examined how family, immigration and acculturation affected the relationships between socioeconomic opportunities and adolescent childbearing. Compared with women who delayed childbearing into adulthood, pregnant adolescents described having few resources for educational and career development and experiencing numerous socioeconomic and social barriers to achieving their goals. Socioeconomic instability and policies limiting access to education influenced childbearing for immigrant adolescents. In contrast, family disintegration tied to poverty figured prominently in US-born adolescents' childbearing. Limited socioeconomic opportunities may play a large role in persistently high pregnancy rates among Latina adolescents.
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Affiliation(s)
- Alexandra M Minnis
- Women's Global Health Imperative, RTI International, 114 Sansome Street, Suite 500, San Francisco, CA 94121, USA.
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Biggs MA, Ralph L, Minnis AM, Arons A, Marchi KS, Lehrer JA, Braveman PA, Brindis CD. Factors Associated With Delayed Childbearing: From the Voices of Expectant Latina Adults and Teens in California. Hispanic Journal of Behavioral Sciences 2010. [DOI: 10.1177/0739986309353000] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There has been limited research on the protective factors that help Latinas delay childbearing until adulthood. In-depth interviews were conducted with 65 pregnant Latina teenage and adult women in California who were about to have their first child. Lack of or inconsistent birth control use as teens was attributed to wanting or ambivalence toward childbearing, concern about contraceptive side effects and infertility, and/or inadequate contraceptive information. Parental influence was cited as the primary reason for avoiding teen childbearing, as well as the feeling that a baby would have interfered with life plans. Close parental supervision and positive relationships with parents appeared to protect some adults from teen childbearing. The findings from this study point to the need to improve Latinos’ birth control knowledge and strengthen parents’ ability to establish supportive relationships with their children.
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Affiliation(s)
| | - Lauren Ralph
- University of California, San Francisco, CA, USA
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Ralph L, Brindis C, Shields WC. Mandating parental involvement in adolescents' abortion: implications of a short-sighted policy. Contraception 2006; 73:211-3. [PMID: 16413852 DOI: 10.1016/j.contraception.2005.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Accepted: 10/20/2005] [Indexed: 10/25/2022]
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Ralph L, Twiss MR. Comparative toxicity of thallium(I), thallium(III), and cadmium(II) to the unicellular alga Chlorella isolated from Lake Erie. Bull Environ Contam Toxicol 2002; 68:261-268. [PMID: 11815797 DOI: 10.1007/s001280247] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2001] [Accepted: 09/25/2001] [Indexed: 05/23/2023]
Affiliation(s)
- L Ralph
- Department of Chemistry, Biology, and Chemical Engineering, Ryerson Polytechnic University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
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Freiburger GA, Ralph L. Electronic reserves: the changing landscape of instructional support. Bull Med Libr Assoc 1998; 86:17-25. [PMID: 9549008 PMCID: PMC226321] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
During the spring 1996 academic semester, the University of Maryland Health Sciences Library implemented an electronic course-reserve system as a pilot project with the university's School of Nursing. The pilot project has been very successful because of thorough planning and the effectiveness of the system, which enables library users to retrieve assigned readings easily. This success inspired the staff to begin expanding the scope of the pilot project to include other schools and limited remote access. This paper describes the planning and implementation process, the issues that needed to be resolved, the response to the project, and future plans. Particular attention is paid to issues of copyright and cost recovery.
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Affiliation(s)
- G A Freiburger
- Kornhauser Health Sciences Library, University of Louisville, Kentucky, USA
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Jensen-Pippo KE, Whitcomb KL, DePrince RB, Ralph L, Habberfield AD. Enteral bioavailability of human granulocyte colony stimulating factor conjugated with poly(ethylene glycol). Pharm Res 1996; 13:102-7. [PMID: 8668656 DOI: 10.1023/a:1016089503186] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The focus of this paper is to demonstrate that pegylation of a therapeutic protein, recombinant human granulocyte colony stimulating factor (PEG-G-CSF), results in an increase in stability and in retention of in vivo bioactivity when administered by the intraduodenal route and may, therefore, be a suitable form of the protein for inclusion in an oral delivery formulation. METHODS The ability of PEG-G-CSF to elicit a therapeutic response from the enteral route was investigated by two methods of intraduodenal dosing in an in vivo model to determine the optimal dosing method: by slow, constant infusion, or by a single bolus administration. RESULTS Circulating levels of the proteins confirmed that PEG-G-CSF was delivered into the systemic circulation from the enteral route and that biological activity was retained. Bioavailability from the enteral route by the constant infusion method was calculated from the intravenous administration of the proteins to be between 1.8 and 3.5% while un-modified G-CSF failed to elicit a quantifiable response by this method. Bolus administration of PEG-G-CSF also resulted in biological activity although responses were short lived and significantly lower than with the pegylated formulation. CONCLUSIONS The possible mechanisms of enteral delivery of PEG-G-CSF are discussed. Our results indicate that oral delivery of pegylated G-CSF may be possible and in fact, preferable to using the un-modified form of the therapeutic.
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Affiliation(s)
- K E Jensen-Pippo
- Department of Pharmacology, Amgen Inc., Thousand Oaks, California 91320, USA
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Abstract
Gross anatomy of the masseter muscle was studied in eight rabbits using a 2.34 tesla MRI-device. Anatomy was displayed and assessed consistent with previous dissectional findings. It is concluded that MRI, applied as described in the present study, is suitable for assessment of masseter morphology in experimental studies on the rabbit.
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Affiliation(s)
- L Ralph
- Department of Stomatognathic Physiology and Experimental Research, University of Lund, Malmö, Sweden
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