Contraception最新文献

{"title":"Exploring the availability and accessibility of medication abortion pills in Delhi, India: A mystery client study in community pharmacies","authors":"Anvita Dixit ,&nbsp;Dipesh Suvarna ,&nbsp;Raywat Deonandan ,&nbsp;Angel M. Foster","doi":"10.1016/j.contraception.2024.110745","DOIUrl":"10.1016/j.contraception.2024.110745","url":null,"abstract":"<div><h3>Objectives</h3><div>Although medication abortion drugs technically require a prescription in India, research suggests that they are often available directly from pharmacies. We conducted a mystery client study in the capital city of Delhi to explore the availability, accessibility, and pharmacy dispensing practices of mifepristone/misoprostol in the absence of a prescription.</div></div><div><h3>Study design</h3><div>Using two predetermined client profiles—one of an unmarried woman and one of her male partner—we visited community pharmacies in different neighborhoods. Mystery clients began the interaction with a request for “a pill to bring back” a period after a positive pregnancy test. We documented product availability, price, and outcome and assessed the quality of the client–pharmacy worker interaction. We analyzed these encounters using descriptive statistics and for themes.</div></div><div><h3>Results</h3><div>In late 2022, we made 172 visits to 86 pharmacies. Medication abortion pills were available at more than half of the pharmacy visits (<em>n</em> = 91, 53%), and our mystery clients purchased the drugs without a prescription during 22% (<em>n</em> = 37) of all visits. The woman and man clients purchased mifepristone/misoprostol on a similar number of occasions, but we assessed the pharmacy worker interactions with the man as more positive. Pharmacy workers provided varied information about the regimen, and the encounters were brief.</div></div><div><h3>Conclusions</h3><div>Medication abortion drugs appear to be available without a prescription in a sizable minority of pharmacies in Delhi, India. Our findings suggest that identifying ways to work with pharmacy workers to support their ability to provide medically accurate information about the optimal mifepristone/misoprostol regimen is warranted.</div></div><div><h3>Implications</h3><div>Pharmacy access to mifepristone/misoprostol has the potential to greatly reduce barriers to accessing abortion care in India. Despite technically requiring a prescription, medication abortion drugs are available behind the counter at a sub-set of pharmacies in Delhi. Future research on formalizing and supporting pharmacy access and exploring abortion seekers’ experiences with pharmacy access is warranted.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110745"},"PeriodicalIF":2.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of lifetime intimate partner violence on abortion method choice","authors":"Lauren Sobel ,&nbsp;Madison Bernstein ,&nbsp;Namita Arunkumar ,&nbsp;Jennifer Fortin ,&nbsp;Isabel Fulcher ,&nbsp;Youri Hwang ,&nbsp;Alisa B. Goldberg","doi":"10.1016/j.contraception.2024.110732","DOIUrl":"10.1016/j.contraception.2024.110732","url":null,"abstract":"<div><h3>Objective(s)</h3><div>To evaluate if the type of abortion patients prefer differs for those with a history of intimate partner violence (IPV) compared to those without a history of IPV.</div></div><div><h3>Study design</h3><div>We compared choice of medication versus procedural abortion between those with a history of lifetime IPV and those without a history of IPV among patients seeking abortion at 11 weeks’ gestation or less. Secondarily, we compared preferred abortion characteristics and assessed reproductive autonomy. Individuals presenting for abortion care were recruited for an anonymous, cross-sectional survey study at Planned Parenthood League of Massachusetts, Boston Health Center from September 2021 to August 2022. We required 336 subjects to detect a 20% difference in abortion method between those with a lifetime history of IPV and those without, with 80% power.</div></div><div><h3>Results</h3><div>We enrolled 342 participants and excluded six with missing data. A total of 71 individuals (21%) reported a lifetime history of IPV. A majority of individuals with a lifetime history of IPV chose procedural abortion, although their abortion method choice did not differ significantly from individuals with no history of IPV (56.3% vs 47.2%, <em>p</em> = 0.244). Individuals with a lifetime IPV history used abortion funds more frequently than those without a history of lifetime IPV (8.5% vs 1.5%, <em>p</em> = 0.047). There was no statistical difference between individuals with and without a lifetime history of IPV regarding what individuals considered important for the type of abortion they chose or reproductive autonomy.</div></div><div><h3>Conclusion(s)</h3><div>Access to procedural abortion services and abortion funds are important to meet the abortion needs of patients with a lifetime history of IPV.</div></div><div><h3>Implications</h3><div>Providing both medication and procedural abortion and creating a trauma-informed environment are central to supporting individuals with a history of IPV. Safeguarding abortion fund access is important individuals with a history of IPV.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110732"},"PeriodicalIF":2.8,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the SB 8 Texas abortion ban on pregnancy duration at time of abortion in a large volume Colorado clinic","authors":"Eva Dindinger ,&nbsp;Kate Coleman-Minahan ,&nbsp;Jeanelle Sheeder ,&nbsp;Nancy Z Fang","doi":"10.1016/j.contraception.2024.110731","DOIUrl":"10.1016/j.contraception.2024.110731","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess changes in type of abortion, gestational duration, and changes in the proportion of out-of-state residents at a university-affiliated clinic in Denver, Colorado after Texas passed Senate Bill 8 (SB 8) that banned abortion after embryonic cardiac activity can be detected.</div></div><div><h3>Study design</h3><div>We reviewed records of all visits of patients obtaining an abortion ≤22 weeks and 6 days gestation between January 2019 and June 2022. We created two time periods: before SB 8 (January 2019–August 2021) and after SB 8 (September 2021–June 2022). We assessed changes in type of abortion, gestational duration, and the proportion of out-of-state residents. We determined the odds of a second-trimester abortion (≥13 weeks and 0 day) after SB 8 using logistic regression models adjusted for gravida, parity, age, and the proportion of out-of-state residents.</div></div><div><h3>Results</h3><div>There were 3844 abortions: 2875 before and 969 after SB 8. Second trimester abortions increased from 16.8% to 24.4% for Colorado residents and from 19.5% to 33.5% for out-of-state residents (<em>p</em> &lt; 0.001). The proportion of patients that were Texas residents increased from 1.2% to 17.7% after SB 8 (<em>p</em> &lt; 0.001). The adjusted odds of a second trimester abortion nearly doubled overall (adjusted odds ratio [aOR] 1.86 95% CI 1.55–2.23) and for Colorado residents (aOR,1.76, 95% CI, 1.44–2.16, respectively), and more than doubled for out-of-state residents (aOR, 2.34, 95% CI,1.53–3.59).</div></div><div><h3>Conclusions</h3><div>Laws that ban abortion early in pregnancy delay care and increase abortions occurring later in pregnancy, not only for people forced to seek care out of state, but for residents of states with abortion access.</div></div><div><h3>Implications</h3><div>Our data suggests that abortion bans may increase wait times, gestational duration, and force people to travel great distances for care. As more states ban abortion or restrict abortion, surrounding states where abortion is protected may need to meet the needs of those traveling in addition to their in-state residents.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110731"},"PeriodicalIF":2.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549486","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":"Society of Family Planning Committee Statement: Contraception and body weight","authors":"Noor Zwayne ,&nbsp;Elizabeth Lyman ,&nbsp;Ashley Ebersole ,&nbsp;Jessica Morse ,&nbsp;with the assistance of Elise Boos and Antoinette Nguyen on behalf of the Clinical Affairs Committee, and Monica Skoko Rodríguez","doi":"10.1016/j.contraception.2024.110725","DOIUrl":"10.1016/j.contraception.2024.110725","url":null,"abstract":"<div><div>Understanding the relationship between contraception and body weight is an important clinical consideration. Body weight and size has the potential to affect fertility and the effectiveness of some contraceptive methods, although historically this association has not been applied within a person-centered context that would allow individuals to select their preferred contraceptive method. Further, individuals with higher body weights and larger sizes have unmet contraceptive care and counseling needs. This document aims to provide evidence-based, person-centered, and equity-driven recommendations that destigmatize contraceptive care across all body weights. Clinicians should: provide person-centered, unbiased contraceptive care, including counseling pregnant-capable individuals on their risk of pregnancy based on sexual practices and contraceptive use regardless of body weight or size; utilize evidence-based and person-centered contraceptive counseling to offer the full range of contraceptive methods regardless of body weight or size; counsel patients about any risks and benefits associated with body weight and size to assist in their selection of contraceptive methods, including emergency contraception; counsel individuals about the potential for weight change, particularly weight gain, associated with contraceptive methods as a possible factor in decision-making; and counsel individuals regarding the potential impact of weight management approaches, such as bariatric surgery and glucagon-like peptide 1 (GLP-1) agonists, on contraceptive efficacy.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"141 ","pages":"Article 110725"},"PeriodicalIF":2.8,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483228","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":"IMPROVING CARE FOR INDIVIDUALS WITH HIGHER BODY MASS INDEX (BMI) UNDERGOING INDUCTION TERMINATION","authors":"M Fuerst,&nbsp;K Prewitt,&nbsp;B Garg,&nbsp;S Ramanadhan,&nbsp;L Han","doi":"10.1016/j.contraception.2024.110584","DOIUrl":"10.1016/j.contraception.2024.110584","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to examine the association of body mass index (BMI) with time to delivery for those undergoing induction of labor for pregnancy termination in the second or third trimester.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study including all patients with a singleton pregnancy undergoing induction termination at a single academic medical center over a 14-year period (1/2020-2/2024). Our primary outcome was time to fetal expulsion from the first medication given. BMI was categorized into four groups (&lt;18.5, 18.5-25, 25-30, and &gt;30). Kruskal-Wallis tests were used to compare median time to delivery among the BMI groups; and multivariable logistic regression models were used to assess the association of BMI with time to delivery ≥24 hours.</div></div><div><h3>Results</h3><div>Of the 428 charts reviewed, 393 patients met inclusion criteria. Of these, 290 (73.7%) had a BMI greater than 25. The median time to expulsion was significantly different among BMI categories (9 hours for BMI &lt; 18.5, 12 hours for BMI 18.5-25, 14 hours for BMI 25-30, and 20 hours for individuals with BMI &gt;30, p&lt;0.001). After adjusting for maternal age, gestational age, history of cesarean section and prior vaginal deliveries, individuals with a BMI &gt;30 had 6.74 times the odds (95%CI 3.24-14.00) of having a time to expulsion ≥24 hours compared to BMI 18.5-25.</div></div><div><h3>Conclusions</h3><div>We found individuals had a significantly longer time to delivery in second and third trimester induction terminations for patients with BMI &gt;30. Induction protocols may need to be adjusted to provide equitable care for individuals with higher BMI.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110584"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426120","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":"RACE AND ETHNICITY REPORTING AND REPRESENTATION IN US CONTRACEPTIVE CLINICAL TRIALS FROM 2007-2024","authors":"N Fang,&nbsp;J Sheeder","doi":"10.1016/j.contraception.2024.110578","DOIUrl":"10.1016/j.contraception.2024.110578","url":null,"abstract":"<div><h3>Objectives</h3><div>Contraceptive clinical trials inform policy and practice changes, yet participants are often non-representative of the US population. We aimed to characterize race and ethnicity reporting among completed contraceptive trials.</div></div><div><h3>Methods</h3><div>We queried ClinicalTrials.gov for all completed trials (2007–2024) with keywords “contraception” or “contraceptive.” We extracted all race and ethnicity participant data. If this was not reported, we manually reviewed linked publications. We categorized trials as “representative” or “non-representative” of the US population if the proportion of non-White participants were within 30% of the 2020 Census estimates. We described and compared trial characteristics for reporting and representation using chi-squared tests (IBM SPSS Version 29). The study included only publicly available data and was deemed exempt by the Colorado Multiple Institutional Review Board.</div></div><div><h3>Results</h3><div>We reviewed 129 trials meeting initial inclusion criteria; 55 were excluded for including non-US sites or the study was not related to contraception, leaving 74 for the final analysis. Most reported race or ethnicity (85.1%) and occurred in the West region (32.4%); 43.2% evaluated pharmacokinetics, safety, or efficacy. 68.9% were non-representative of the US population. Of those, 82.4% had overrepresentation of non-White participants. Trial phase, funder type, completion year, contraceptive method, and study type did not differ between “representative” and “non-representative” studies.</div></div><div><h3>Conclusions</h3><div>Race and ethnicity of participants in contraceptive trials are not representative of the US. Deliberate and thoughtful recruitment strategies are needed to ensure that contraceptive trials are diverse, inclusive, have adequate representation, and are not unintentionally over-recruiting populations with historical mistreatment within the research community.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110578"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426166","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":"URGENT, EMERGENT, OR JUST MISSED? GEOPOLITICAL VARIATIONS IN THE MANAGEMENT OF EARLY PREGNANCY LOSS IN US EMERGENCY DEPARTMENTS","authors":"ED Lantos,&nbsp;LS Benson,&nbsp;R Sangara,&nbsp;P Garza,&nbsp;M Pearlman Shapiro,&nbsp;BT Nguyen","doi":"10.1016/j.contraception.2024.110626","DOIUrl":"10.1016/j.contraception.2024.110626","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to describe geopolitical variations in Emergency Medicine (EM) providers’ treatment of early pregnancy loss (EPL) and evaluated their attitudes toward directly managing EPL, with attention to the influence of post-<em>Dobbs v Jackson Women’s Health Organization</em> restrictions.</div></div><div><h3>Methods</h3><div>We distributed a nationwide anonymous survey to emergency medicine clinicians using specialty-specific listservs and social media platforms, exploring experience and comfort with EPL diagnosis and management, as well as relevant institutional and structural barriers, inclusive of state abortion restrictions. We examined associations between state restrictions and emergency medicine resources via bivariate analysis.</div></div><div><h3>Results</h3><div>Most participants (n=203) identified as female (56.6%), non-Hispanic White (69.0%), attendings (73.6%), in urban settings (82.7%) and abortion-permissive states (60.8%). Most reported comfort diagnosing (93.0%) and counseling (86%) about EPL. However, only 39.7% consistently counseled on all management options--expectant, medication, procedural. Participants in abortion-permissive states were significantly more likely to consistently offer comprehensive counseling (44.2% vs. 32.7%, p=0.02) and reported increased access to on-site Ob-Gyn consultation (49.6% vs. 27.5%, p=0.002). Regardless of restrictions, only 16.2% consistently prescribed mifepristone-misoprostol; fewer (3.5%) performed manual uterine aspiration. 49.7% felt stable patients experiencing EPL should not receive treatment in the ED; 48.7% felt Ob-Gyns should manage EPL; 44.0% reported that arranging follow-up was a barrier to management. The majority (78.1%) endorsed the importance of more training on medication management of EPL.</div></div><div><h3>Conclusions</h3><div>Less than 20% of emergency medicine clinicians consistently offer EPL treatment. On-site Ob-Gyn consultations remain an essential resource, though less accessible in abortion-restrictive states. Training emergency medicine providers to treat EPL and improving access to follow-up could improve care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110626"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426172","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":"WHERE’S THE SPACE FOR JOY? A CALL FOR EXPANDED MEASUREMENT OF POSITIVE EMOTIONS AND ATTITUDES ASSOCIATED WITH ABORTION","authors":"A Bell,&nbsp;J Williams,&nbsp;S Banks,&nbsp;K Giles,&nbsp;A Gubrium","doi":"10.1016/j.contraception.2024.110625","DOIUrl":"10.1016/j.contraception.2024.110625","url":null,"abstract":"<div><h3>Objectives</h3><div>The study explored Black women’s abortion experiences and their responses to an existing abortion stigma scale.</div></div><div><h3>Methods</h3><div>Following a six-week virtual digital storytelling workshop that aimed to reduce internalized abortion stigma, 14 self-identified Black women aged 19–66, from California and Indiana participated in a one-hour interview and in four 90-minute focus group discussions (FGDs) conducted via Zoom. During the FGDs, participants completed the Individual Level Abortion Stigma (ILAS) scale and reflected on its contents. The interviews and FGDs were audio-recorded, transcribed, and analyzed thematically using Dedoose.</div></div><div><h3>Results</h3><div>Participants reported that receiving the ILAS scale prior to starting the digital storytelling workshop would have negatively affected their participation. More specifically, participants said that it would have led to feeling unsafe, lack of trust, and emotional guardedness. Respondents described positive emotions related to their abortion that are not captured in the ILAS or other validated measures, including feelings of relief, joy, pride, and gratitude. Participants also reported positive outcomes of terminating the pregnancy, such as finishing post-secondary school, ending harmful romantic relationships, and family planning for the future. Participants noted the need for a measure to better capture these positive aspects. At least one participant believed that the measure should be specific to Black women.</div></div><div><h3>Conclusions</h3><div>Use of scales such as the ILAS, while important, focus on the negative aspects associated with abortion and may actually introduce stigma. Our findings highlight the need for robust measures that are culturally responsive and capture both positive and negative impacts of abortion.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110625"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426173","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":"DISTANCE TRAVELED TO OBTAIN ABORTION CARE IN SOUTHERN ILLINOIS BEFORE AND AFTER THE DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION DECISION","authors":"J Trevino,&nbsp;R Paul,&nbsp;E King,&nbsp;J Reeves,&nbsp;D Eisenberg,&nbsp;T Madden","doi":"10.1016/j.contraception.2024.110569","DOIUrl":"10.1016/j.contraception.2024.110569","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to examine changes in one-way driving distance for people seeking abortion care at a single site before and after the <em>Dobbs v Jackson Women’s Health Organization</em> decision, and to identify factors associated with traveling ≥250 miles.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of abortions performed at a single abortion clinic in Southern Illinois for 12 months pre- and post-<em>Dobbs</em> using electronic scheduling data. We compared patient characteristics and one-way driving distance using chi-square. We used a multivariable logistic regression to identify factors associated with a one-way driving distance ≥250 miles.</div></div><div><h3>Results</h3><div>In total, 12,920 abortions occurred from June 2021 to June 2023: 4,666 pre-<em>Dobbs</em> and 8,254 post-<em>Dobbs</em>. The median one-way driving distance increased from 20 miles (IQR 14-118) to 142 miles (IQR 17-312) (<em>p</em>&lt;0.001). Post-<em>Dobbs</em>, a smaller proportion of patients traveled &lt;25 miles, while the absolute number remained stable: 2,617 (56.1%) vs. 2,891 (35.0%). Post-<em>Dobbs</em>, the number of patients traveling ≥250 miles increased by 701% (488 to 3,469). The proportion of out-of-state patients receiving abortions increased from 66.6% to 83.0% (<em>p</em>&lt;0.001). Post-<em>Dobbs</em>, patients traveling≥250 miles for an abortion were more likely to be ≥12 weeks gestational duration (adjusted OR (aOR) 2.94, 95%CI 2.63-3.29), of Hispanic origin (aOR 2.78, 95%CI 2.20-3.51), and self-pay for their procedure (aOR 9.59, 95%CI 8.00-11.48).</div></div><div><h3>Conclusions</h3><div>Post-<em>Dobbs</em>, we observed a seven-fold increase in patients traveling≥250 miles for care at a single independent abortion clinic in Southern Illinois. These findings highlight the increased barriers to abortion access caused by restrictive legislation in the US.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110569"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426182","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":"LIMITS OF PUBLIC POLICY TO CHANGE INDIVIDUALS’ CONSIDERATION OF ABORTION IN THE US SOUTHWEST","authors":"DG Foster,&nbsp;E Gonzalez,&nbsp;LJ Ralph,&nbsp;CH Rocca","doi":"10.1016/j.contraception.2024.110591","DOIUrl":"10.1016/j.contraception.2024.110591","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to understand abortion decision making and the extent to which unsupportive social/economic policies might contribute to people having abortions who might otherwise choose childbearing</div></div><div><h3>Methods</h3><div>As part of a longitudinal cohort study in the US Southwest, we prospectively followed 2,015 participants aged 15-34 years, recruited between 2019-2022 from 23 healthcare facilities, for one year until incident pregnancy (n=382) and through pregnancy decision-making. Participants having abortions reported the circumstances under which they might have decided to continue the pregnancy and raise the child.</div></div><div><h3>Results</h3><div>Among the 95 people who had an abortion, only 15% said nothing would have led them to decide to carry the pregnancy to term. About 71% indicated at least one circumstance related to social/economic status. For instance, 58% might have chosen to give birth if they had more money, of whom 1 in 5 said they would need less than $5,000. Housing was a major consideration, with 47% of women reconsidering abortion if they had their own or a better place to live. However, the vast majority (90%) also indicated circumstances that are immutable to social/economic policy such as if they were older (39%), finished with school (28%), married (27%), in better health (26%), or if their other children did not need their attention (21%). Only one participant exclusively indicated circumstances that could be addressed with economic policies, such as housing, childcare, and financial support.</div></div><div><h3>Conclusions</h3><div>Results suggest that more supportive social/economic policies could help improve reproductive autonomy but would unlikely significantly reduce need for abortion.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110591"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426341","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}