Contraception最新文献

{"title":"TRENDS IN MISOPROSTOL PRESCRIBING AND DISPENSING ACROSS NORTH CAROLINA PHARMACIES","authors":"L Joudeh,&nbsp;C Muir,&nbsp;V Miller,&nbsp;A Schultz","doi":"10.1016/j.contraception.2025.111119","DOIUrl":"10.1016/j.contraception.2025.111119","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this study is to assess misoprostol dispensing practices across North Carolina pharmacies. We sought to identify trends in misoprostol dispensing in low access healthcare counties, rural counties, and by pharmacy type.</div></div><div><h3>Methods</h3><div>We used a secret-shopper approach to assess whether pharmacies dispense misoprostol. The secret-shopper called in the role of clinic staff. Chi-squared tests and Fisher’s exact tests were used for statistical analysis.</div></div><div><h3>Results</h3><div>Of the 100 counties in North Carolina, 94 (94%) counties were contacted. Ninety-nine (99%) counties had a chain pharmacy represented and 95 (95%) had an independent pharmacy represented. Some 173 (77.6%) pharmacies dispensed misoprostol, 12 (5.4%) had conditional dispensing practices, and 38 (17.0%) did not dispense misoprostol. Chain pharmacies were more likely to dispense misoprostol 96 (55.5%) compared to independent pharmacies 77 (44.5%) (p&lt;0.0001). Chain pharmacies were also more likely to be in urban areas 72 (53.2%) compared to rural areas 55 (46.8%) (p&lt;0.01). There was no difference in the proportion of pharmacies dispensing misoprostol in rural vs urban counties (p=0.935). There was no difference in proportion of pharmacies dispensing status by low access healthcare counties vs. counties not designated as low access (p=0.518). The most common reasons for not dispensing misoprostol were unavailable in stock (18) and expense of stocking for limited use (5).</div></div><div><h3>Conclusions</h3><div>Independent pharmacies were less likely to dispense misoprostol. Given that independent pharmacies are more likely to serve rural communities and racial and ethnic minorities, further research and interventions are needed to expand access to misoprostol through independent pharmacies.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111119"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278392","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":"DUAL LOYALTY, MEDICAL ETHICS, AND ABORTION BANS","authors":"W Arey,&nbsp;M Heisler,&nbsp;T McHale,&nbsp;H Miller,&nbsp;L Green,&nbsp;P Shah","doi":"10.1016/j.contraception.2025.111106","DOIUrl":"10.1016/j.contraception.2025.111106","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to examine clinicians’ experiences of dual loyalty, defined as conflict between professional duties to a patient and obligations to the interests of a third party such as the state, when providing care under restrictive abortion bans.</div></div><div><h3>Methods</h3><div>We conducted semi-structured interviews with clinicians providing care in Louisiana a year post-<em>Dobbs v Jackson Women’s Health Organization</em> (May to November 2023) and in Florida (July to August 2024) after the six-week abortion ban went into effect. In this secondary thematic analysis, we examined the code for participants’ responses about experiences of dual loyalty.</div></div><div><h3>Results</h3><div>We interviewed 30 healthcare workers and trainees in Louisiana and 25 in Florida; the analytic sample contained 48 participants who described an experience of dual loyalty. Participants described having to deny care to patients that they had the knowledge and skills to care for as a primary example of dual loyalty. Many noted that this was necessary to protect the care that they could offer, by complying with the law to not lose their licenses. Participants also described interference with their medical judgment and having to deviate from the standard of care. Several participants highlighted conflicted thoughts about having to break the law to adhere to their medical ethics. Participants often described feeling moral distress from being unable to adhere to medical ethics.</div></div><div><h3>Conclusions</h3><div>Participants’ experiences of dual loyalty highlight a moral obligation to provide abortion care, which is being negatively impacted by abortion bans. This could be seen as a new form of conscientious objection, where clinicians object to abortion bans as being antithetical to medical ethics.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111106"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277844","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 PRICE OF LATER ABORTION CARE IN THE US","authors":"TA Weitz,&nbsp;M Wilson Schwartz","doi":"10.1016/j.contraception.2025.111115","DOIUrl":"10.1016/j.contraception.2025.111115","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to document the price of abortion care after 23 weeks of pregnancy.</div></div><div><h3>Methods</h3><div>We identified 131 healthcare facilities that publicly advertised offering post-23-week abortion care in August 2024. From November 6, 2024 to April 7, 2025, undergraduate research assistants (RAs) posed as mystery clients to inquire about the price of care. They called each facility twice for each two-week pregnancy period at/above 23 weeks (ie, 23-25 weeks; 25-27 weeks). We calculated the range, mean and median price for each two-week difference.</div></div><div><h3>Results</h3><div>RAs made 522 calls, successfully connecting with facility personnel 418 times (80%). RAs successfully obtained information on the service price in 55% of calls (n=228). In response to 189 calls, RAs obtained a specific price and in 39 calls RAs obtained a price range. Specific prices ranged from $1,054-$82,670 (median $3,000) for 23-week abortions (n=131), $1,959-$12,195 (median $6,500) for 25-week abortions (n=23), $5,585-$13,900 (median $9,500) for 27-week abortions (n=17), $9,800-$16,800 (median $11,400) for 29-week abortions (n=7), 14,500-$19,800 (median $19,000) for 31-week abortions (n=7), and $15,500-$19,000 (median $15,500) for 33-week abortions (n=3).</div></div><div><h3>Conclusions</h3><div>One of the most recognized barriers to abortion care is needing to raise the money to pay for the abortion, yet little public data exist on the price of abortion later in pregnancy. This study sought to fill this information gap. We provide information on the range of prices for care over two-week gestational durations. Unfortunately, later abortion care price transparency is still limited as almost half of all calls to facilities that publicly advertised offering this care did not result in price information.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111115"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277931","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":"“LIKE A BUSINESS TRANSACTION”: BLACK WOMEN’S TRUST IN ABORTION HEALTHCARE IN OHIO","authors":"SE Bostic,&nbsp;H Sihra,&nbsp;A Norris Turner,&nbsp;D Bessett,&nbsp;T Odum","doi":"10.1016/j.contraception.2025.111085","DOIUrl":"10.1016/j.contraception.2025.111085","url":null,"abstract":"<div><h3>Objectives</h3><div>Growing research has examined the prevalence of medical mistrust among Black people and its impact on healthcare access, adherence, and outcomes. However, trust in the context of abortion has been seldom studied. These preliminary findings shed light on Black women’s conceptualizations of trust in their experiences with abortion and reproductive healthcare with the emergent theme of abortion as transactional.</div></div><div><h3>Methods</h3><div>We are conducting semi-structured, in-depth interviews with Black women in Ohio, asking them to describe their abortion and reproductive healthcare experiences. We used an iterative, inductive coding approach to analyze interview transcripts, allowing for insights from early interviews to inform ongoing data collection and refinement of codes.</div></div><div><h3>Results</h3><div>Many participants describe their abortion experience as being “like a business transaction,” with providers “just doing their job,” and the clinic “feeling like an assembly line” where “nothing moves without the payment,” highlighting the impersonal, bureaucratic, and commodified aspects of their care. Preliminary findings indicate transactional abortion experiences, with themes of clinical detachment, emotional distance, and perceived commodification of care. However, these experiences were not monolithic; some participants also reported moments of emotional connection and validation within clinical settings, reflecting the negotiation of trust and necessity under constrained circumstances of limited choice for care, resources, and time.</div></div><div><h3>Conclusions</h3><div>These initial findings complicate binary notions of medical trust and mistrust, suggesting that Black women navigate abortion care through nuanced and conditional forms of trust. Understanding these negotiations offers crucial insight into how reproductive healthcare systems can better address the specific needs and experiences of Black women.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111085"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278122","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":"RACIAL DISCRIMINATION AND PERSON-CENTERED CONTRACEPTIVE CARE IN THE US SOUTHEAST","authors":"AA Luke,&nbsp;A Newton-Levinson,&nbsp;S Narasimhan,&nbsp;MD Livingston,&nbsp;C Gary,&nbsp;S Parikh,&nbsp;JM Sales,&nbsp;SK Redd,&nbsp;WS Rice","doi":"10.1016/j.contraception.2025.111070","DOIUrl":"10.1016/j.contraception.2025.111070","url":null,"abstract":"<div><h3>Objectives</h3><div>We assessed how lifetime experiences of general and stereotype-based racial discrimination during family planning care relate to patient perceptions of person-centered care during their most recent family planning visit.</div></div><div><h3>Methods</h3><div>People of color aged 18-44 living in Southern states who can become pregnant and sought family planning services in the past year (n=339) completed a cross-sectional survey from August to September 2024. Patient-centered care was measured dichotomously, using Dehlendorf's four-item scale with “excellent” ratings on all items. Racial discrimination was assessed using a seven-item version of the Bird-Bogart scale, examined as a count of discrimination types (0-7) and as two subscales (general and stereotype discrimination). We conducted descriptive, bivariate, and multivariable logistic regression analyses adjusting for sociodemographic variables.</div></div><div><h3>Results</h3><div>Some 71.7% of respondents reported at least one type of discrimination during lifetime family planning care, while 24.8% of respondents reported excellent patient-centered care. Each additional discrimination type experienced was associated with 33% lower odds of excellent person-centered care (aOR=0.67; 95% CI, 0.58-0.77), when we adjusted for sociodemographics. Analysis of discrimination subscales revealed that both general healthcare (aOR=0.56; 95% CI, 0.46-0.67) and stereotype-based discrimination (aOR=0.50; 95% CI, 0.36-0.69) were associated with lower odds of excellent person-centered care.</div></div><div><h3>Conclusions</h3><div>Lifetime experience of racial discrimination in family planning settings is significantly associated with reduced odds of reporting excellent patient-centered care at the most recent family planning visit. These findings highlight the need for structural interventions to address racism within family planning care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111070"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278229","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":"BLEEDING EXPERIENCE AFTER MEDICATION ABORTION PRIOR TO FETAL CARDIAC ACTIVITY","authors":"AK Hoover,&nbsp;AE Heyse,&nbsp;MA Cohen,&nbsp;P Goedken,&nbsp;C Cwiak","doi":"10.1016/j.contraception.2025.111074","DOIUrl":"10.1016/j.contraception.2025.111074","url":null,"abstract":"<div><h3>Objectives</h3><div>The purpose is to elucidate the bleeding experience after very early medication abortion in the setting of an abortion ban at fetal cardiac activity. The aims are to characterize the duration and quantity of bleeding and cramping, symptoms, and efficacy.</div></div><div><h3>Methods</h3><div>This is a prospective cohort study. A survey was administered prior to abortion initiation. Follow-up surveys were administered via text message daily for three days, weekly for four weeks, and once at six weeks. Chart abstraction was performed to obtain demographic and follow-up data.</div></div><div><h3>Results</h3><div>Some 250 participants were enrolled. At baseline, 73% of respondents reported typically moderate menses and 76% reported pregnancy symptoms. On days 1-3, participants reported bleeding at rates of 84.4%, 95.6%, and 98.4%, respectively. Less than half of respondents reported bleeding heavier than menses. Cramping on days 1-3 was noted at rates of 88.0%, 86.7%, and 79.2%, respectively. More than half of respondents reported cramping heavier than with menses on days one and two. At one week, 93.2% reported continued bleeding, with 24.0% heavier, 30.0% like, and 46.0% lighter than menses; 51.6% reported cramping, and 65.2% reported pregnancy symptoms resolved. At two weeks, 51.9% reported bleeding, 29.9% reported cramping, and 65.6% reported pregnancy symptoms resolved. At six weeks, approximately 73.0% of respondents had resumed menses while 11.3% had a positive pregnancy test.</div></div><div><h3>Conclusions</h3><div>Bleeding with medication abortion prior to fetal cardiac activity was similar to menses while cramping was heavier. Bleeding, cramping, and pregnancy symptoms had resolved by two weeks in most patients. Patient counseling on expectations should be adjusted accordingly.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111074"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278316","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":"DOCTORS, FAMILY, OR PEERS? WHO TEENS SEEK WHEN NAVIGATING CONTRACEPTIVE SIDE EFFECTS","authors":"EK Wanyonyi,&nbsp;V Manthena,&nbsp;M Quasebarth,&nbsp;S Knifton,&nbsp;J Klugman,&nbsp;K Rivlin,&nbsp;L Hasselbacher","doi":"10.1016/j.contraception.2025.111077","DOIUrl":"10.1016/j.contraception.2025.111077","url":null,"abstract":"<div><h3>Objectives</h3><div>Peers and cultural norms play critical roles in shaping adolescent attitudes. We explored spheres of influence in adolescent contraceptive decision making around side effects.</div></div><div><h3>Methods</h3><div>We conducted semi-structured interviews exploring experiences with contraception from December 2023 to September 2024 among adolescents aged 13 to 18. We recruited via flyers in Illinois clinics providing adolescent reproductive healthcare, snowball sampling, and targeted social media. Interviews examined side effect experiences and who adolescents sought support from when navigating side effects. Interviews were transcribed and qualitatively analyzed for themes using Dedoose.</div></div><div><h3>Results</h3><div>We interviewed 27 adolescent participants (41% Black, 37% White, 19% multiracial, 11% Hispanic or Latino). Adolescents described family members (parents, siblings, cousins, aunts) as holding the strongest influence over their contraceptive decision making related to side effects, especially when a family member had a negative experience. Adolescent participants sought advice from family members when experiencing a side effect, managing side effects, and deciding whether they should continue a method based on their side effect experiences. Respondents also continued or switched contraceptive methods based on provider recommendations and described relying less on peer advice, since many stated their peers were not yet using contraception. Many shared concerns about encountering misinformation on social media, though some reported supplementing side effect information gained from a parent or provider with user experiences shared on social media.</div></div><div><h3>Conclusions</h3><div>Given the significant role that family members play in influencing adolescent experiences with navigating contraception, educational interventions should incorporate family members into contraceptive counseling while continuing to center individual privacy and autonomy.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111077"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278317","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":"AWARENESS OF ABORTION PILLS-BY-MAIL OPTIONS AMONG PATIENTS TRAVELING OUT-OF-STATE FOR ABORTION","authors":"AL Woodcock,&nbsp;A Gero,&nbsp;S Elliott,&nbsp;C Sexsmith,&nbsp;T Proaño,&nbsp;DK Turok,&nbsp;J Sanders","doi":"10.1016/j.contraception.2025.111122","DOIUrl":"10.1016/j.contraception.2025.111122","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to understand if patients who traveled out-of-state for abortion care were aware of abortion medication by mail options and explore predictors of awareness.</div></div><div><h3>Methods</h3><div>From September 2024 to February 2025, we recruited patients who traveled out of their home state to receive an abortion at 15 Planned Parenthood clinics in Oregon, Washington, and Utah. Eligible participants were aged 18 or older and spoke English or Spanish. Survey questions included awareness of the option for medication abortion pills by mail and reasons for participants’ decision to travel for abortion. We assessed differences in and predictors of awareness of pills by mail using chi-squared test for categorical data and logistic regression.</div></div><div><h3>Results</h3><div>The final analytic sample included 113 respondents. Most participants, 82 (73%), identified their gestational age to be &lt;11 weeks. A minority of participants were aware of pills by mail (n=41, 36.9%) and most (34/41, 83%) desired a medication abortion. Among those who were aware, 21 (59%) learned about the pills by mail option online and 10 (22%) from social media; only five (12%) learned of this option from a healthcare provider. Participants provided no dominant reason for traveling. Those aware of pills by mail were more likely to complete the survey in Spanish (OR, 3.66; 95% CI, 1.03-13.10) and have public health insurance vs. no insurance (OR, 3.85; 95% CI, 1.25-11.86).</div></div><div><h3>Conclusions</h3><div>Most participants traveling out of state for abortion were unaware of pill by mail options despite being &lt;11 weeks’ gestation. A majority of those aware of the option still wanted a medication abortion in person.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111122"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278389","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":"COLLECTIVE IMPACT APPROACH: LESSONS FROM SOUTH CAROLINA’S CONTRACEPTIVE ACCESS INITIATIVE","authors":"AJ Khoury,&nbsp;KE Beatty,&nbsp;LM Ventura,&nbsp;D Quesenberry,&nbsp;R Adelli,&nbsp;A Weber,&nbsp;MG Smith","doi":"10.1016/j.contraception.2025.111138","DOIUrl":"10.1016/j.contraception.2025.111138","url":null,"abstract":"<div><h3>Objectives</h3><div>Choose Well, a statewide contraceptive access initiative in South Carolina, adopted a collective impact framework to enhance contraceptive access through collaboration, funding, and infrastructure support. This study evaluates facilitators, challenges, and lessons learned reported by leadership and staff implementing Choose Well and program grantees in federally qualified health center (FQHC) systems. This study is novel in examining implementation of a statewide contraceptive access initiative through collective impact principles: common agenda, shared measurement, mutually reinforcing activities, continuous communication, and backbone support.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted in 2022-2023, at the end of the initial six years of program implementation, with Choose Well staff (n=8) and FQHC administrators/clinicians (n=19) to explore implementation experiences, facilitators, and challenges. Using qualitative content analysis guided by the collective impact framework, data were triangulated to integrate perspectives from both groups.</div></div><div><h3>Results</h3><div>Facilitators of successful implementation included a shared vision for contraceptive access; shift to contraceptive equity and an expanded funding model; tailored clinic-level implementation with direct support; multi-channel communication through partner convenings and a web-based platform for training, resources, and collaborative communication; and clinic workflow and electronic medical record enhancements to improve efficiency. Challenges included delays in shared measurement development, variability in data reporting, and limited capacity for tracking contraceptive service metrics. Competing priorities within FQHCs and staff turnover further impacted shared measurement and learning/improvement opportunities.</div></div><div><h3>Conclusions</h3><div>Collective impact principles can advance statewide contraceptive access initiatives. Shared measurement challenges require investments in data infrastructure and training. Future initiatives should emphasize bidirectional communication, flexible implementation strategies, and sustainable infrastructure to enhance service delivery.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111138"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277856","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":"HOW EARLIER ABORTION PROVISION CONTRIBUTED TO INCREASED ABORTION INCIDENCE 2017-2020","authors":"AJ Stevenson,&nbsp;L Root","doi":"10.1016/j.contraception.2025.111108","DOIUrl":"10.1016/j.contraception.2025.111108","url":null,"abstract":"<div><h3>Objectives</h3><div>National abortion incidence increased 2017-2020. We describe how the shift to earlier abortion contributed to this increase.</div></div><div><h3>Methods</h3><div>We build national pregnancy life tables for 2017-2020 based on published national statistics on pregnancy exits (deliveries, abortions, reported pregnancy loss, miscarriage rate schedules, and deaths during pregnancy). Using cause-deleted life tables in which abortion is removed as a cause of exit, we estimate the fraction of abortions at each week gestation that, if not terminated, would end in miscarriage by each subsequent week of pregnancy. From this we estimate the number of 2020 abortions that would have ended in miscarriage before the pregnant person accessed abortion, had gestational duration of abortions remained constant 2017-2020. By varying our assumptions, we test the sensitivity of our results and generate a range of estimates.</div></div><div><h3>Results</h3><div>If abortions had not occurred at earlier gestational durations between 2017 and 2020, some 10,000-20,000 pregnancies that ended in abortion in 2020 would have ended in miscarriage before the pregnant person could successfully access abortion. Therefore, abortion incidence increased by 1-2 percentage points between 2017 and 2020 just due to the shift to earlier gestational durations at abortion. Thus, 15-30% of the overall increase in abortion 2017-2020 could be due to abortions occurring at earlier gestational durations.</div></div><div><h3>Conclusions</h3><div>As abortions occur at earlier gestational durations, abortion incidence increases simply because fewer pregnancies end in miscarriage before abortion is accessed. Stable abortion incidence over a period when abortion is increasingly accessed earlier in pregnancy may reflect declining success securing wanted abortions.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"151 ","pages":"Article 111108"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277842","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}