Contraception最新文献

{"title":"OUTCOMES OF UNDESIRED RAPE-RELATED PREGNANCIES WITH HYDE-ONLY COMPARED TO FULL MEDICAID COVERAGE OF ABORTIONS: A COST-EFFECTIVENESS ANALYSIS","authors":"KM Schaefer,&nbsp;MI Rodriguez","doi":"10.1016/j.contraception.2024.110575","DOIUrl":"10.1016/j.contraception.2024.110575","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to estimate the cost-effectiveness and pregnancy outcomes of undesired rape-related pregnancies (RRP) when Medicaid abortion coverage is limited to Hyde restrictions compared to full Medicaid coverage of abortions.</div></div><div><h3>Methods</h3><div>We used a theoretical cohort of 80,000 individuals on Medicaid who have an undesired RRP, with cohort size determined by CDC data. We used TreeAge to model RRP outcomes when abortions are covered only by Medicaid as permitted under the Hyde amendment and compare this to outcomes when abortions are covered by Medicaid under any circumstances over a ten year span. Outcomes include cost to Medicaid, quality-adjusted life-years, Medicaid-covered abortions, out-of-pocket abortions, first trimester abortions, second trimester abortions, and uncomplicated and complicated pregnancies resulting in births. Probabilities, costs, and utilities were derived from the literature. A Medicaid perspective was assumed.</div></div><div><h3>Results</h3><div>Our model demonstrated that among RRPs, limiting abortion coverage to Hyde restrictions results in fewer Medicaid-paid abortions, more out-of-pocket abortions, and more pregnancies resulting in births compared to the counterfactual of full Medicaid abortion coverage. In a Hyde-only coverage scenario, there would be 44,228 fewer Medicaid-paid abortions – a 96% decrease relative to Medicaid-paid abortions with full coverage – and 21,577 more out-of-pocket abortions. Full Medicaid coverage of abortion in this population would avert 22,988 pregnancies with cost-savings of $313.6 million.</div></div><div><h3>Conclusions</h3><div>This study suggests that limiting Medicaid coverage of abortions to strictly Hyde Amendment exceptions decreases payment for and access to abortions for rape-related pregnancies, despite these abortions meeting Hyde criteria for federal funding. This demonstrates a failure of Medicaid to pay for 96% of abortions for undesired RRP and comes at a significantly increased cost to Medicaid.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426169","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":"USING THE INDEX OF CONCENTRATION AT THE EXTREMES TO MEASURE THE ASSOCIATION BETWEEN SPATIAL POLARIZATION AND DISTANCE TRAVELED FOR CARE IN A COLORADO CLINIC","authors":"E Dindinger,&nbsp;A Zhang,&nbsp;RH Cohen,&nbsp;J Sheeder","doi":"10.1016/j.contraception.2024.110561","DOIUrl":"10.1016/j.contraception.2024.110561","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to assess changes in geographical segregation and distance traveled for abortion, after <em>Dobbs v Jackson Women’s Health Organization</em> allowed states to implement greater abortion care restrictions, using the Index of Concentration at the Extremes (ICE), which quantifies extremes of disadvantage and privilege.</div></div><div><h3>Methods</h3><div>Data included all individuals obtaining an abortion at a university-affiliated clinic in Denver, CO between July 2021 and June 2023. We created two time periods: before (July 2021–June 2022) and after <em>Dobbs</em> (July 2022–June 2023). We compared ICE quintile distributions for individuals traveling &gt;100 and &gt;300 miles (vs. &lt;100 and &lt;300 miles, respectively) before and after <em>Dobbs</em> using chi-squared tests. We used logistic regression to determine the independent predictors of traveling &gt;100 miles and &gt;300 miles for abortion care adjusting for time period.</div></div><div><h3>Results</h3><div>We assessed 2,709 total abortions: 1,391 before and 1,318 after <em>Dobbs</em>. The proportion of individuals traveling &gt;100 miles for abortion care increased from 22.57% to 36.72% (p&lt;0.001), and those traveling &gt;300 miles increased from 16.82% to 33.69% (p&lt;0.001). In logistic regression, individuals in the most disadvantaged ICE quintile had 8.58 (adjusted OR (aOR); 95% CI [6.14 - 11.98]) times adjusted odds of traveling &gt;100 miles and 9.04 (aOR; 95% CI [6.33 - 12.90]) times adjusted odds of traveling &gt;300 miles for abortion care versus those in the least-disadvantaged ICE quintile and the odds of traveling &gt;300 miles increased by 2.52 (aOR; 95% CI [2.08 - 3.04]) post <em>Dobbs.</em></div></div><div><h3>Conclusions</h3><div>Abortion bans add to undue burden by increasing distance traveled for in-person care. These bans disproportionately impact communities already facing socioeconomic structural discrimination.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426320","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 POST-DOBBS ANALYSIS OF IN- VS. OUT-OF-STATE ABORTION TRAVEL EXPERIENCE IN MASSACHUSETTS AND ILLINOIS","authors":"OL Thornton,&nbsp;IR Fulcher,&nbsp;J Ospina,&nbsp;P Kumar,&nbsp;H Dismer,&nbsp;M Landeau,&nbsp;AB Goldberg,&nbsp;E Janiak","doi":"10.1016/j.contraception.2024.110580","DOIUrl":"10.1016/j.contraception.2024.110580","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to describe differences in demographics and travel-related costs between in-state residents and out-of-state travelers who received abortion care after <em>Dobbs v Jackson Women’s Health Organization</em>.</div></div><div><h3>Methods</h3><div>We conducted a multi-site cross-sectional survey of patients who received abortion care at three clinics in Massachusetts and Illinois in 2023. Survey questions were derived from validated measures and included demographics, state of residence, and out-of-pocket expenses. Participants were recruited and surveyed on-site during their appointment. We compared characteristics between in-state and out-of-state participants using chi-squared tests.</div></div><div><h3>Results</h3><div>The overall enrollment rate in the study was 81%, with 148 in-state residents and 111 out-of-state travelers. A plurality of participants (35%) were between 18 and 24 years old, 32% identified as Black, 35% as White, and 75% as heterosexual or straight. There were no demographic differences between in-state residents and out-of-state travelers. However, out-of-state participants were more likely to lose at least one day of wages due to abortion-related travel (56.7% vs 40.6%, p&lt;0.001). The average out-of-pocket travel cost for abortion care was $33.32 for in-state individuals compared to $294.50 for out-of-state travelers (p&lt;0.001). For out-of-state travelers, airfare contributed to the largest share of expenses (41.3%), followed by accommodations (17.5%) and gas and parking (16.6%).</div></div><div><h3>Conclusions</h3><div>People traveling from out-of-state for abortion care missed more days of work and spent significantly more out-of-pocket on travel-related expenses compared to in-state individuals. Our findings highlight financial barriers to abortion access faced by people in abortion ban states. Abortion funds, clinics, and policymakers must urgently support initiatives to reduce prohibitive travel costs for abortion care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426340","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":"BEYOND BOUNDARIES: NAVIGATING CHALLENGES AND CHARTING THE FUTURE OF REPRODUCTIVE HEALTHCARE IN THE POST-ROE LANDSCAPE","authors":"TMH Hoang,&nbsp;R DeLuna,&nbsp;E Albertson,&nbsp;A Wong,&nbsp;T Ferrera,&nbsp;A Santoyo,&nbsp;C Ivaturi","doi":"10.1016/j.contraception.2024.110598","DOIUrl":"10.1016/j.contraception.2024.110598","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to explore the challenges of reproductive healthcare providers post <em>Roe v Wade</em>. We aim to amplify stakeholders’ recommendations and voice to design sustainable solutions to address challenges in reproductive care.</div></div><div><h3>Methods</h3><div>Semi-structured protocol and reflexive thematic analysis were used to conduct and analyze focus groups. To date, our sample included a total sample of 25 participants, who self-identified as reproductive healthcare providers across the US and either worked or currently work in a state where abortion provision is legal.</div></div><div><h3>Results</h3><div>Major themes showed that providers relying on internal networks and/or online professional groups for social support, since local community support was often lacking. Providers also expressed concern for personal safety in clinical setting, and some discussed their process to move to less restrictive states, where they have more peers and clinic support with lower burden of care coordination. Providers reported increased personal and staff burnout because of higher demand and burden of care coordination while maintaining the safety and continuous care for patients. Providers discussed feeling uncertainty about the future of abortion care given the changing geopolitical landscape and its implications on future training. Most providers expressed hope for future clinicians including community building using online resources/groups, commitment to the cause, and continued resistance.</div></div><div><h3>Conclusions</h3><div>This study has implication to improve support for our family planning communities. Potential solutions can include increasing social and practical support as well as utilizing technology and safe online spaces to facilitate coordination of care and increase resources for all stakeholders.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426349","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":"DESIGN SPECIFICATIONS FOR AN ADOLESCENT-CENTERED CONTRACEPTION CARE COMPANION CREATED FOR AND WITH ADOLESCENTS AND PRIMARY CARE CLINICIANS","authors":"AJ Hoopes,&nbsp;BA Hawryluk,&nbsp;A Kiser,&nbsp;LB Brewer,&nbsp;SE Wiehe,&nbsp;JM Maslowsky","doi":"10.1016/j.contraception.2024.110638","DOIUrl":"10.1016/j.contraception.2024.110638","url":null,"abstract":"<div><h3>Objectives</h3><div>Contraceptive care in primary care settings often centers adults and thus is not tailored to adolescents’ unique sexual, cognitive, and social development. We aimed to determine design specifications and features of a developmentally appropriate web-based contraception care tool for adolescents and clinicians in the primary care setting.</div></div><div><h3>Methods</h3><div>We used human-centered design to engage with adolescents aged 14–17 and primary care clinicians. A team of designers led 1:1 interviews and design sessions, employing techniques such as journey mapping, collage, alien artifact, and bad design charrette. A structured analysis identified key themes, which were synthesized into design specifications and priority features through consensus.</div></div><div><h3>Results</h3><div>Adolescents (n=27) expressed desire for a tool to learn about contraception earlier in adolescence, prior to their need for contraception, and to help them talk to providers about contraception. Clinicians (n=47) expressed desire for a tool with information about adolescent contraceptive preferences and questions before the appointment to help tailor the visit. Design specifications included offering high-level educational content with access to more detail if desired; using non-pressuring, easy to understand, inclusive language; and providing discreet, mobile-optimized access without log-in requirements. Priority features were a tool that evolves throughout adolescence and builds confidence in discussing contraception with others, knowing one’s options, and making informed choices.</div></div><div><h3>Conclusions</h3><div>Adolescents want more information about contraception earlier in adolescence, and more in-depth conversations with clinicians about contraceptive options. Clinicians want to provide more patient-centered care within the constraints of a primary care environment. A web-based contraception care companion holds promise to support both sets of goals.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426354","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 KNOWLEDGE OF ABORTION LEGALITY FOLLOWING DOBBS","authors":"MF Gallo,&nbsp;A Underwood,&nbsp;M Smith,&nbsp;E Warren,&nbsp;A Norris Turner","doi":"10.1016/j.contraception.2024.110593","DOIUrl":"10.1016/j.contraception.2024.110593","url":null,"abstract":"<div><h3>Objectives</h3><div>We analyzed two independent waves of a population-representative survey of adult, reproductive-age women in Ohio to assess beliefs about legality of abortion and 11 other reproductive health practices in the state<em>.</em> Abortion was legal in Ohio until 22 weeks of gestation during both waves; however, during a brief period between waves, abortion was restricted to about 6 weeks of gestation.</div></div><div><h3>Methods</h3><div>We used logistic regression to compare the prevalence of believing abortion is illegal in Ohio pre-<em>Dobbs</em> (October 2018–June 2019; n=2,516) vs. post-<em>Dobbs</em> (September 2022–August 2023; n=2,421). We also measured beliefs about legality of 11 other practices post-<em>Dobbs</em> and identified correlates of holding these beliefs.</div></div><div><h3>Results</h3><div>Higher fractions of women believed that abortion was illegal in 2022-2023 compared to 2018-2019 (40.5% versus 10.1%, respectively; p&lt;0.001). At both times, many reported not knowing the legal status (28.7% and 26.5%, respectively). Similarly, substantial percentages of women in 2022-2023 reported not knowing the legality of practices such as using assisted reproductive technology (17.3%), traveling out of state to obtain an abortion (44.3%), obtaining medical care during or after miscarriage (21.3%), or receiving care for ectopic pregnancy (27.7%). Women with higher socioeconomic status had higher odds of knowing abortion was legal in Ohio post-<em>Dobbs</em>.</div></div><div><h3>Conclusions</h3><div>Despite being legal, 40.5% of adult, reproductive-age women in Ohio in 2022-2023 believed abortion was illegal in the state, a large increase from pre-<em>Dobbs</em>. Rapid changes in state-level abortion laws following <em>Dobbs</em> could have caused confusion about the legality of abortion and introduced concerns about the legality of other reproductive health practices.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426443","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":"WHEN STATE POLICY CLASHES WITH OPINION: POST-DOBBS INCREASES IN SUPPORT FOR ABORTION AMONG OHIO WOMEN","authors":"MH Smith,&nbsp;A Underwood,&nbsp;E Warren,&nbsp;A Norris Turner,&nbsp;M Gallo","doi":"10.1016/j.contraception.2024.110608","DOIUrl":"10.1016/j.contraception.2024.110608","url":null,"abstract":"<div><h3>Objectives</h3><div>The <em>Dobbs v Jackson Women’s Health Organization</em> decision granted states more authority in regulating abortion care. In the 12 weeks following <em>Dobbs</em>, Ohio enacted a six-week ban despite public support for abortion in the state. We assessed changes in abortion support post-<em>Dobbs</em> among women in Ohio, an abortion-restrictive state that recently passed a ballot initiative aimed at protecting access to care.</div></div><div><h3>Methods</h3><div>We used two independent, cross-sectional waves of a representative survey of adult reproductive age Ohio women to compare abortion attitudes before and after <em>Dobbs</em>. NORC collected this data from October 2018-June 2019 (pre-<em>Dobbs</em>) and September 2022-August 2023 (post-<em>Dobbs</em>). We assessed abortion attitudes using four measures: whether someone should be arrested for abortion, whether abortion should be available, whether abortion is acceptable, and pro-life/pro-choice identity. We created a scale combining these measures and calculated 95% confidence intervals comparing pre- and post-<em>Dobbs</em> results.</div></div><div><h3>Results</h3><div>All measures showed statistically significant increases in abortion support post-<em>Dobbs</em>. Comparing pre- and post-<em>Dobbs</em> results, 58% versus 77% felt abortion should be available, 68% versus 85% felt someone should not be arrested for abortion, 26% vs. 46% felt that abortion was acceptable in all circumstances, and 40% vs. 59% identified as pro-choice. From our combined scale, 25% vs. 43% of respondents were supportive across all four measures.</div></div><div><h3>Conclusions</h3><div>Women in Ohio, an abortion-restrictive state, have shown consistent support for abortion, which increased following <em>Dobbs</em>. These findings provide necessary context for the recent success of the November 2023 reproductive rights ballot initiative. They also underscore the important relationship between policy and opinion.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426515","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":"COMPARISON OF SAFETY AND EFFICACY BETWEEN TELEMEDICINE AND CLINIC-BASED MEDICATION ABORTION AT A SINGLE ACADEMIC CENTER","authors":"R Patil,&nbsp;R Woofter,&nbsp;J Gipson,&nbsp;M Sudhinaraset","doi":"10.1016/j.contraception.2024.110605","DOIUrl":"10.1016/j.contraception.2024.110605","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite the rise in telemedicine medication abortion rates in the US, there is limited evidence comparing this model (NTMA) to traditional clinic-based medication abortion (CBMA). We aim to further the evidence around safety and efficacy of telemedicine medication abortion by comparing NTMA to CBMA to address the growing demand for abortion access.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study comparing safety and efficacy outcomes using electronic medical records for patients who either had a CBMA(n=800) or NTMA(n=171) up to 77 days of gestation between June 1, 2018 and December 31, 2022, at a large academic health center in California. Secondary outcomes included comparing completion rates of post-treatment follow-up and assessing the four-week home pregnancy test results for NTMA patients.</div></div><div><h3>Results</h3><div>A total of 91% of CBMA and 92% of NTMA patients had successful abortions without surgical intervention (p&gt;0.05). After controlling for covariates, successful abortion rates did not statistically significantly differ by modality [adjusted OR (aOR) 1.10, p&gt;0.05]. Less than 1% of both groups experienced an adverse event (p&gt;0.05), with no missed ongoing or missed ectopic pregnancies for either modality. A greater proportion of NTMA patients completed a first follow-up visit compared to CBMA patients, although this difference was not statistically significant [aOR 1.78, p&gt;0.05]. Approximately 18% of NTMA patients had positive pregnancy tests at a four-week follow-up appointment.</div></div><div><h3>Conclusions</h3><div>NTMA is an equally safe and effective abortion care model as CBMA. If not already offered, the provision of telemedicine medication abortion should be considered to meet the growing demand for abortion access.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426198","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":"NAVIGATING PREGNANCY OF UNKNOWN LOCATION MANAGEMENT AFTER DOBBS: A SURVEY OF RYAN PROGRAMS IN THE US","authors":"MV Smith,&nbsp;J Turk,&nbsp;R Mercier,&nbsp;J Steinauer,&nbsp;K Vinekar","doi":"10.1016/j.contraception.2024.110629","DOIUrl":"10.1016/j.contraception.2024.110629","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to assess the impact of state and institutional policies in managing pregnancies of unknown location (PUL) at US Ryan residency programs.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional electronic survey of all US Ryan residency program directors (n=113) in March–April 2024. Using Guttmacher state abortion restriction classifications, we compared the perceived influence of institutional and state policies on PUL management among Ryan programs in restrictive vs. non-restrictive abortion climates. Provision of diagnostic uterine aspiration (UA) for undesired PUL was a secondary outcome. We compared response proportions with Fisher’s exact tests.</div></div><div><h3>Results</h3><div>Sixty-eight (60%) Ryan program directors responded from 31 states. Of these, 26 (38.2%) were from states with restrictive abortion policies. Six programs (8.8%) changed PUL management after the <em>Dobbs v Jackson Women’s Health Organization</em> decision. Compared to programs in protective states, programs in restrictive states were more likely to report that state policy “severely” or “somewhat” inhibits their ability to care for patients with PULs (50% vs. 2.4%, p&lt;0.001), rarely or never offer diagnostic uterine aspiration (30.8% vs. 7.1%, p=0.02), and identify institutional leadership as a barrier to offering diagnostic UAs (19.2% vs. 2.4%, p=0.03). The most frequently cited institutional barriers to providing diagnostic UA were staffing and faculty comfort/willingness, which did not differ significantly by state abortion climate.</div></div><div><h3>Conclusions</h3><div>State abortion policy may impact the options available to patients with PULs. Programs should work to address barriers to providing diagnostic uterine aspiration in the setting of undesired PULs.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426201","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":"RESTORING, PROTECTING, AND EXPANDING ABORTION ACCESS IN THE US: SEEKING CONSENSUS THROUGH THE DELPHI METHOD","authors":"S Pickering,&nbsp;M Manze,&nbsp;JV Lazarus,&nbsp;D Romero","doi":"10.1016/j.contraception.2024.110586","DOIUrl":"10.1016/j.contraception.2024.110586","url":null,"abstract":"<div><h3>Objectives</h3><div>The <em>Dobbs v Jackson Women’s Health Organization</em> decision exacerbated inequitable access to abortion in the US. Agreement is needed on which strategies should be prioritized to restore, protect, and expand abortion access.</div></div><div><h3>Methods</h3><div>We convened a multidisciplinary, geographically diverse Delphi panel of clinical, research, policy, legal, and advocacy experts to reach consensus (ie, agreement <u>&gt;</u>67%) on recommended actions. Using feedback from three rounds of surveys, and input from a select expert advisory group (n=10), we iteratively refined the consensus points.</div></div><div><h3>Results</h3><div>The panel (n=85) developed 25 consensus statements and 32 recommendations for action in states with protected, mixed, or restricted access to abortion based on categorizations by the Guttmacher Institute. In states with <em>protected</em> access, key recommendations (ie, &gt;70% agreement) were to incorporate abortion into primary care and expand clinical services to include all types of abortion. In states with <em>mixed access</em>, key recommendations were to establish pathways for patients seeking abortion, lobby for Medicaid coverage of abortion, expand clinical services to include all types of abortion, and build broad coalitions for abortion access. In states with <em>restricted</em> access to abortion, the key recommendations were to combat gerrymandering and voter suppression, train emergency room staff in abortion care, establish protections against criminalization, and flip state legislatures.</div></div><div><h3>Conclusions</h3><div>This Delphi study identified actionable priorities in addressing inequitable access to abortion in states with varied policy environments. It also highlights areas where more strategic discussions are needed (eg, the utility of boycotts in states with abortion bans).</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426708","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}