Contraception最新文献

{"title":"“I WORK WITH WHAT I HAVE”: MANAGING MEDICATION ABORTION AND MISCARRIAGE IN THE UNHOUSED COMMUNITY","authors":"LE Adams,&nbsp;MJ Arzate,&nbsp;KR Barnes,&nbsp;J Karlin","doi":"10.1016/j.contraception.2024.110588","DOIUrl":"10.1016/j.contraception.2024.110588","url":null,"abstract":"<div><h3>Objectives</h3><div>We sought to provide better support to houseless individuals’ experiences with medication abortion.</div></div><div><h3>Methods</h3><div>We recruited pregnancy-capable persons from Sacramento between the ages of 18-55 who had experienced an abortion or miscarriage, were currently or previously unhoused, and spoke English. Fifteen, 30-minute interviews were conducted where participants were asked about their medication abortion or miscarriage experience, and how they would manage a medication abortion while unhoused given their experience. Inductive and deductive coding were utilized for theme development.</div></div><div><h3>Results</h3><div>Unmet needs fell into three main categories: (1) lack of access to a safe location to complete a medication abortion including hygiene facilities; (2) lack of social support including childcare and communication from their provider throughout and after the medication abortion; and (3) a lack of access to appropriate supplies including pain and bleeding management supplies.</div></div><div><h3>Conclusions</h3><div>Houseless individuals have specific experiences with medication abortion which lead to unique, and unmet, needs when compared with the general population of pregnancy-capable people. Public health providers can ensure patient-centered care by providing them with appropriate resources, such as social services and material goods, to navigate their abortion plan beyond the clinic. Next steps include offering these services and supplies to this population and assessing if the medication abortion experience is improved.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110588"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CHANGES IN BELIEFS ABOUT ABORTION SAFETY IN A NATIONALLY REPRESENTATIVE SAMPLE BETWEEN 2022 AND 2023","authors":"R Schroeder,&nbsp;L Ralph,&nbsp;A Becker,&nbsp;S Kaller,&nbsp;MA Biggs","doi":"10.1016/j.contraception.2024.110589","DOIUrl":"10.1016/j.contraception.2024.110589","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to estimate changes in beliefs about abortion safety among the US population assigned female at birth (AFAB) before and after <em>Dobbs v Jackson Women’s Health Organization</em>.</div></div><div><h3>Methods</h3><div>We administered two serial cross-sectional surveys to English- or Spanish-speaking members of a nationally-representative panel of AFAB respondents, ages 15-49, pre-<em>Dobbs</em> (December 2021/January 2022; n=6,943) and post-<em>Dobbs</em> (June/July 2023; n=3,533). We asked participants to indicate whether they agree (ranging from strongly disagree to strongly agree) “that it is usually safe for a pregnant person to end a pregnancy\", by (1) having an in-clinic abortion procedure; (2) using abortion pills obtained at a clinic or doctor’s office; and (3) using abortion pills obtained outside the formal healthcare system. Using weighted logistic regression models with year as the independent variable, we assessed changes in safety beliefs pre- to post-<em>Dobbs</em>, both overall and among subgroups.</div></div><div><h3>Results</h3><div>Between 2022 and 2023, the proportion of respondents agreeing that each abortion method was “usually safe” increased: in-clinic procedure: 57.8% to 64.1% (p&lt;0.001); in-clinic medication abortion: 52.2% to 59.6% (p&lt;0.001); and pills obtained outside of the formal healthcare system: 7.4% to 9.6% (p&lt;0.001). In stratified analyses, subgroups associated with increased endorsement of safety between years included respondents identifying as a Democrat, with no history of abortion, and who support in-clinic procedural abortion legality (p&lt;0.05 for all abortion method outcomes).</div></div><div><h3>Conclusions</h3><div>In a nationally representative sample, belief that abortion methods are safe increased between 2022 and 2023 despite increasing abortion restrictions and policies claiming abortion is unsafe. Still, public knowledge about abortion safety remains low.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110589"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PHARMACIST PERSPECTIVES ON PRESCRIBING MEDICATION ABORTION: FINDINGS FROM A QUALITATIVE STUDY OF CALIFORNIA PHARMACISTS","authors":"JJ Serpico,&nbsp;C Cohen,&nbsp;L Serrano,&nbsp;RM Beltran","doi":"10.1016/j.contraception.2024.110592","DOIUrl":"10.1016/j.contraception.2024.110592","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to explore pharmacist attitudes toward dispensing and prescribing medication abortion.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted among 30 practicing licensed California pharmacists from October 2022 to July 2023. Participants were recruited through snowball sampling with a focus on attaining a diverse sample. Twenty-nine interviews were analyzed. Key themes were identified using Hamilton’s (2019) Rapid Qualitative Analysis Approach.</div></div><div><h3>Results</h3><div>Five key themes emerged: (1) pharmacists strongly supported pharmacist-dispensed medication abortion; (2) pharmacists expressed qualified support for pharmacist-prescribed medication abortion; (3) pharmacists were concerned about legality and liability in the abortion context; (4) pharmacists both endorsed and critiqued abortion stigma; and (5) pharmacists articulated various visions of their appropriate role in care provision. Almost all pharmacists supported dispensing medication abortion. While most expressed some support for prescribing medication for abortion, many expressed concerns, primarily around the themes of legality/liability and abortion stigma, as well as two prescribing sub-themes: training needs and logistical/operational barriers. Pharmacists lacked clarity around legality and desired legal protections, including for providing medication abortion to out-of-state patients. Pharmacists expressed concerns about protestors or community backlash and endorsed the belief that abortion patients may need mental health counseling, which they did not feel equipped to provide. Some pharmacists highlighted their role as accessible healthcare providers with increasing responsibility, while others emphasized having distinct roles from prescribing providers. Overall, pharmacists emphasized providing non-judgmental care, including dispensing medication for abortion without questioning the patient’s or prescribing provider’s judgment.</div></div><div><h3>Conclusions</h3><div>Our results provide preliminary evidence that a meaningful portion of pharmacists may be open to prescribing medication abortion, if expressed concerns are addressed.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110592"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TRENDS IN OUT-OF-STATE ABORTIONS IN OREGON FOLLOWING THE DOBBS COURT DECISION","authors":"M Fuerst,&nbsp;A Mandelbaum,&nbsp;E Nacev,&nbsp;M Rodriguez","doi":"10.1016/j.contraception.2024.110571","DOIUrl":"10.1016/j.contraception.2024.110571","url":null,"abstract":"<div><h3>Objectives</h3><div>This study looks at how out-of-state travel for abortion care changed in the state of Oregon following the <em>Dobbs v Jackson Women’s Health Organization</em> decision on June 24, 2022.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study using data from the Oregon Health Authority (OHA), which collects information on all abortions performed in Oregon. Our sample included all medication and procedural abortions between January 1, 2015 and September 30, 2023. For the post-<em>Dobbs</em> cohort, we compared in-state with out-of-state residents using standard bivariate analyses. We then conducted an interrupted time series analysis to trend the proportion of out-of-state residents following <em>Dobbs</em>.</div></div><div><h3>Results</h3><div>Our sample included 66,253 abortions. In the post-<em>Dobbs</em> cohort, out-of-state residents were significantly more likely to have a procedural vs. a medication abortion (51.65% vs. 46.7%) and be at higher gestational ages at the time of their procedure. Our ITS analysis estimated that the number of out-of-state residents would increase by 2.61% (95% CI, 1.2–3.93%). After <em>Dobbs,</em> out-of-state residents came to Oregon from 24 US states with a wide geographical spread.</div></div><div><h3>Conclusions</h3><div>The <em>Dobbs</em> decision increased the proportion of individuals traveling from out-of-state to Oregon for abortion care. These individuals were more likely to have a procedural abortion and to be at more advanced gestational ages. As the post-<em>Roe v Wade</em> abortion landscape continues to evolve, it is important to understand the demographics and needs of those traveling for abortion care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110571"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ABORTION CARE IN THE EMERGENCY DEPARTMENT: A NATIONAL SURVEY OF EMERGENCY MEDICINE PHYSICIANS’ PERSPECTIVES","authors":"AM Kempf,&nbsp;MR Singer,&nbsp;M Haas-Kogan,&nbsp;A Pelletier,&nbsp;AB Friedman,&nbsp;S Easter,&nbsp;DA Bartz","doi":"10.1016/j.contraception.2024.110594","DOIUrl":"10.1016/j.contraception.2024.110594","url":null,"abstract":"<div><h3>Objectives</h3><div>The emergency department is a common setting of unintended pregnancy diagnoses, particularly for patients with limited access to healthcare. Reproductive health services can be provided in the emergency setting to expand care for this population, especially important post <em>Dobbs v Jackson Women’s Health Organization</em>. This study seeks to assess emergency medicine physicians’ current knowledge, attitudes, and practices, before and after <em>Dobbs,</em> related to pregnancy options counseling, referrals, and provision of induced abortion in the emergency department.</div></div><div><h3>Methods</h3><div>We surveyed a sample of emergency medicine physicians at a national meeting regarding knowledge, attitudes, and practices related to reproductive healthcare delivery. Kruskall-Wallis tests were used to evaluate differences between abortion restrictive and permissive states and chi-squared tests were used to compare proportions between the two groups. Thematic analysis was used to review qualitative responses.</div></div><div><h3>Results</h3><div>A total of 252 emergency medicine physicians completed the survey, 218 (86.5%) from abortion permissive and 30 (11.9%) from abortion restrictive states. Most (n=178, 70.6%) supported abortion provision in the emergency department if legally allowed although only about half (n=131, 52.0%) report ever prescribing medication abortion pills. Only 27 (10.7%) report possessing enough knowledge or having received adequate training to independently prescribe medication abortion.</div></div><div><h3>Conclusions</h3><div>Abortion can and should be provided in the emergency department, especially in an attempt to expand access to reproductive healthcare after the <em>Dobbs</em> decision. While most emergency medicine physicians support the provision of abortion care this setting, they do not routinely provide it due to a variety of factors including lack of knowledge, lack of training, and legal/institutional restrictions.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110594"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASSESSING THE IMPACT OF HEALTH EQUITY-INFORMED QUALITY IMPROVEMENT ON CONTRACEPTIVE CARE SCREENING, COUNSELING, AND PROVISION","authors":"EE Wingo,&nbsp;D Hessler-Jones,&nbsp;L Gibson,&nbsp;S Goetsch-Avila,&nbsp;R Kriz,&nbsp;C Dehlendorf","doi":"10.1016/j.contraception.2024.110576","DOIUrl":"10.1016/j.contraception.2024.110576","url":null,"abstract":"<div><h3>Objectives</h3><div>Improving contraceptive care quality is crucial to optimizing people’s reproductive health and achieving reproductive health equity. We assessed the impact of a health equity-focused quality improvement learning collaborative (QILC) on the quality of contraceptive care at community health centers (CHCs) through innovative, person-centered performance measurement.</div></div><div><h3>Methods</h3><div>We developed a nine-month QILC comprising monthly learning sessions on reproductive health equity and person-centered contraceptive care, supporting resources and strategies, peer-learning opportunities, and technical assistance. CHCs collected Person-Centered Contraceptive Counseling (PCCC) measure surveys from patients pre-post QILC to assess contraceptive counseling. CHCs implemented a novel health service needs-based contraception screening question, the Self-Identified Need for Contraception (SINC), into their EHRs. EHR data were extracted to calculate standardized electronic clinical quality measures (eCQMs) of contraceptive use. To assess intervention impact, we compared PCCC scores, percentage of eligible patients screened with SINC, and contraceptive use before and after the QILC.</div></div><div><h3>Results</h3><div>Baseline PCCC scores ranged from 30% to 94%. At endline, 6 of 10 CHCs improved their PCCC score (Δ 2% to 24%) and four of those surpassed the 80% benchmark for high-quality care. At baseline, few patients were screened with SINC (range: &lt;1% - 36%). Across sites, median increase in percentage of eligible patients screened was 10% (range: &lt;1% - 46%). Sites observed an increase in eCQMs for use of most or moderately effective contraceptive methods (mdn change: 2%; range: [&lt;1% -9%).</div></div><div><h3>Conclusions</h3><div>Participation in an equity-focused and performance measures-driven QILC led to increased person-centered screening for contraceptive need and improved contraceptive counseling.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110576"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE ASSOCIATION OF INSERTION METHODS ON IMMEDIATE POSTPARTUM INTRAUTERINE DEVICE EXPULSION RATES: A RETROSPECTIVE COHORT STUDY","authors":"EM Perkins,&nbsp;J Federspiel,&nbsp;D Bhattacharya,&nbsp;S de los Reyes","doi":"10.1016/j.contraception.2024.110634","DOIUrl":"10.1016/j.contraception.2024.110634","url":null,"abstract":"<div><h3>Objectives</h3><div>We sought to evaluate the method of immediate postpartum IUD (ppIUD) insertion (manual versus ring forceps) and expulsion rate within six weeks postpartum.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of patients who had a singleton vaginal delivery and had an immediate ppIUD inserted at Rush University from January 2014 to September 2023. Subjects were excluded if they had a postpartum hemorrhage, no insertion data available, or did not have documentation of postpartum follow up. The primary outcome was rate of expulsion within six weeks postpartum. The rate of expulsion was compared by method of insertion, either using a manual technique versus using ring forceps. Univariable analyses were performed for the association between baseline maternal characteristics and the primary outcome.</div></div><div><h3>Results</h3><div>A total of 219 participants met eligibility with 117 immediate ppIUDs inserted manually and 102 inserted with ring forceps. Baseline maternal demographics were similar across study groups. In unadjusted analysis, expulsion rate in patients who had IUDs placed using ring forceps was significantly higher as compared to manual insertion (30.4% vs 16.2%, p =0.01). After adjusting for factors determined a priori (estimated blood loss, body mass index, GA at delivery, multiparity, type of IUD), ring forceps continued to be significantly more likely to result in expulsion (adjusted OR (aOR) 2.45, CI 1.28-4.90).</div></div><div><h3>Conclusions</h3><div>Insertion of immediate ppIUD with ring forceps was associated with a significantly increased rate of expulsion within six weeks postpartum when compared with manual insertion.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110634"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DIFFERENCES IN TYPES OF CHALLENGES EXPERIENCED BY SEXUAL MINORITY AND HETEROSEXUAL PATIENTS SEEKING ABORTION CARE","authors":"M Bornstein,&nbsp;A Norris Turner,&nbsp;S Bostic,&nbsp;T Odum,&nbsp;K Rivlin,&nbsp;D Bessett","doi":"10.1016/j.contraception.2024.110601","DOIUrl":"10.1016/j.contraception.2024.110601","url":null,"abstract":"<div><h3>Objectives</h3><div>Although sexual minorities are equally or more likely to need an abortion as heterosexual women, little research examines their experiences seeking abortion care. This study examines differences in challenges faced by sexual minority and heterosexual patients seeking abortion.</div></div><div><h3>Methods</h3><div>We analyzed survey data from 1,833 individuals who sought an abortion at 25 clinics in the Midwest from April 2020 to April 2022. We examined the types and number of challenges related to seeking abortion overall, and by sexual identity (sexual minority vs. heterosexual). We conducted negative binomial regression to quantify differences in number of challenges by sexual identity, controlling for factors commonly associated with challenges seeking abortion.</div></div><div><h3>Results</h3><div>A fifth of participants identified as a sexual minority (19%). Most participants, regardless of sexual identity, faced at least one challenge (90%), with sexual minority participants experiencing a mean of 3.8 challenges compared to 3.0 for heterosexual participants (p&lt;0.001). Sexual minorities were more likely than heterosexual participants to face nearly every challenge presented, including cost (73% vs. 64%; p&lt;0.01), transportation (19% vs. 12%; p&lt;0.001), emotional burden (40% vs. 29%; p&lt;0.001), and keeping the pregnancy/abortion secret (40% vs. 31%; p&lt;0.01). Controlling for other factors, sexual minorities faced significantly more challenges than heterosexual participants (aIRR=1.20; p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Sexual minorities may need additional and tailored support when seeking an abortion, including financial, logistical, and emotional support specific to their circumstances. Addressing inequalities within society, as well as within reproductive healthcare, will help ensure that abortion is accessible to all, including those who identify as sexual minorities.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110601"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A QUALITATIVE EXPLORATION OF THE IMPACT OF ABORTION RESTRICTIONS ON PEOPLE WITH HIGH-RISK PREGNANCIES IN GEORGIA: EAR ON GA","authors":"AG Maples,&nbsp;P Goedken,&nbsp;V Larrivey,&nbsp;V Walke,&nbsp;N Verma","doi":"10.1016/j.contraception.2024.110620","DOIUrl":"10.1016/j.contraception.2024.110620","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to assess what barriers people with high-risk pregnancies face while attempting to access abortion care in Georgia, and understand how House Bill (HB) 481, which bans most abortions in the state after fetal cardiac activity, has affected these care-seeking journeys.</div></div><div><h3>Methods</h3><div>We conducted a qualitative study using semi-structured Zoom interviews with people with high-risk pregnancies seeking abortion care at hospital and independent clinic sites in Atlanta, GA. The interviews focused on participant’s journeys attempting to access abortion care within or outside the state after HB481 went into effect. We transcribed, coded, and analyzed the interviews, and are presenting a subset of themes.</div></div><div><h3>Results</h3><div>We interviewed 18 people from January 2023 through January 2024. Participants with high-risk pregnancies often described a lack of understanding of how HB481 would impact their ability to access abortion care in Georgia, and discussed ways in which they felt their specific abortion was necessary and should qualify for care under the law. As participants attempted to access abortion care post-HB481, many described feeling betrayed and abandoned by the government, healthcare system, their individual support networks, and even God and/or the universe. Participants shared how HB481 exacerbated their suffering as they attempted to navigate the “best” of multiple “bad” options available to them.</div></div><div><h3>Conclusions</h3><div>Our results indicate that, even when abortion bans include exceptions for “medical emergency” and “medically futile pregnancy,” people with high-risk pregnancies face additional barriers to accessing care that exacerbate suffering and lead to feelings of betrayal and abandonment.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110620"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SELF-MANAGED, BUT NOT ALONE: THE HEALTHCARE NEEDS OF SELF-MANAGED MEDICATION ABORTION USERS","authors":"E Sully,&nbsp;I DoCampo,&nbsp;S Cech,&nbsp;A Aiken,&nbsp;J Scott","doi":"10.1016/j.contraception.2024.110610","DOIUrl":"10.1016/j.contraception.2024.110610","url":null,"abstract":"<div><h3>Objectives</h3><div>Post-<em>Dobbs v Jackson Women’s Health Organization</em>, self-managed medication abortion (SMMA) is increasingly common in the US (Aiken et al 2024). This analysis assesses whether, and why, SMMA users seek medical attention post-SMMA. It also explores how user demographics and abortion policy environment influence treatment-seeking post-SMMA.</div></div><div><h3>Methods</h3><div>From July 2023-February 2024, we surveyed SMMA users in Florida, Indiana, and Louisiana about their abortion experiences and treatment-seeking behaviors. An additional round of data will be collected from May-August 2024. We recruited respondents through seven SMMA providers; analyses will also incorporate Aid Access client follow-up data. We examine three dimensions of post-SMMA care: (1) any post-abortion care, (2) care for symptoms requiring medical attention or additional abortive interventions and (3) adverse events requiring treatment. We assess treatment-seeking by user demographics via multivariate regression; we also compare treatment-seeking before and after abortion bans in Indiana and Florida relative to Louisiana, where abortion policy was static throughout the study.</div></div><div><h3>Results</h3><div>Data from 2023 fielding (n=154) indicate high SMMA efficacy (95%) and infrequent complications. 39% of respondents sought medical attention post-SMMA—85% to verify their pregnancy had ended. Black individuals, and parents, were significantly more likely to seek treatment than others. Final findings will incorporate data from Aid Access, May-August 2024 survey data, and estimates of the impact of abortion bans on treatment-seeking.</div></div><div><h3>Conclusions</h3><div>A sizeable proportion of users sought treatment after SMMA, despite high efficacy and low rates of complications. Policymakers, advocates, and providers should ensure that SMMA users can safely access desired medical attention, regardless of state policy environment.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110610"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}