Perspectives on Sexual and Reproductive Health最新文献

{"title":"Parents Matter: Associations Between Parent Connectedness and Sexual Health Indicators Among Transgender and Gender-Diverse Adolescents.","authors":"Camille Brown,&nbsp;Marla E Eisenberg,&nbsp;Barbara J McMorris,&nbsp;Renee E Sieving","doi":"10.1363/psrh.12168","DOIUrl":"https://doi.org/10.1363/psrh.12168","url":null,"abstract":"<p><strong>Context: </strong>Transgender and gender-diverse youth experience significant health disparities across numerous domains of health, including sexual health. Among general populations, parent connectedness has been strongly associated with youth sexual health.</p><p><strong>Methods: </strong>The relationships between parent connectedness and sexual health indicators were investigated among 2,168 transgender and gender-diverse youth who participated in the 2016 Minnesota Student Survey, a statewide population-based survey of ninth- and 11th-grade students. Multivariate logistic regression models, stratified by sex assigned at birth, tested associations between parent connectedness-youth's perceptions of parent caring and parent-youth communication-and eight sexual health indicators: ever having had sex, having multiple sexual partners in the past year, pregnancy involvement, substance use at last sex, partner communication about STI prevention, partner communication about pregnancy prevention, condom use at last sex and pregnancy prevention methods at last sex.</p><p><strong>Results: </strong>The level of parent connectedness was inversely associated with ever having had sex, regardless of sex assigned at birth (odds ratios, 0.6-0.8). Although level of connectedness was inversely associated with having multiple sexual partners in the past year and pregnancy involvement among transgender and gender-diverse youth assigned male at birth (0.6-0.7), these relationships were nonsignificant among transgender and gender-diverse youth assigned female at birth. Further differences in associations between parent connectedness and four sexual risk-reduction behaviors were found between youth assigned male at birth and those assigned female.</p><p><strong>Conclusions: </strong>As with other populations, parent connectedness promotes sexual health among transgender and gender-diverse youth and may provide a point of intervention.</p>","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38790695","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":"Interprofessional Abortion Opposition: A National Survey and Qualitative Interviews with Abortion Training Program Directors at U.S. Teaching Hospitals.","authors":"Ariana H Bennett,&nbsp;Lori Freedman,&nbsp;Uta Landy,&nbsp;Callie Langton,&nbsp;Elizabeth Ly,&nbsp;Corinne H Rocca","doi":"10.1363/psrh.12162","DOIUrl":"https://doi.org/10.1363/psrh.12162","url":null,"abstract":"<p><strong>Context: </strong>Hospital policies and culture affect abortion provision. The prevalence and nature of colleague opposition to abortion and how this opposition limits abortion care in U.S. teaching hospitals have not been investigated.</p><p><strong>Methods: </strong>As part of a mixed-methods study, a nationwide survey of residency and site directors at 169 accredited obstetrics-gynecology training programs was conducted in 2015-2016, and 18 in-depth interviews with program directors were conducted in 2014 and 2017. The prevalence and nature of interprofessional opposition were examined using descriptive statistics, and regional differences were investigated using logistic regression. A modified grounded theoretical approach was used to analyze interview data.</p><p><strong>Results: </strong>Among the 91% of survey respondents who reported that they or their colleagues had wanted or needed to provide abortions in the prior year, 69% faced opposition from colleagues. Most commonly, opposition came from nurses (58%), nursing administration (30%) and anesthesiologists (30%), manifesting as resistance to participating in or cooperating with procedures (51% and 38%, respectively). Fifty-nine percent of respondents had denied care to patients in the prior year because of colleagues' opposition. Respondents in the Midwest and South were more likely than those in the Northeast to deny abortion care to patients because of such opposition (odds ratios, 3.2 and 4.4, respectively). Interviews revealed how participants had to circumvent opposing colleagues, making abortion provision difficult and leading to delays in and, infrequently, denial of abortion care.</p><p><strong>Conclusions: </strong>Interprofessional opposition to abortion is widespread in U.S. teaching hospitals. Interventions are needed that prioritize patients' needs while recognizing the challenges hospital colleagues face in their abortion participation decisions.</p>","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38795355","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":"Equitable Care for Pregnant Incarcerated Women: Infant Contact After Birth-A Human Right.","authors":"Christine Franco,&nbsp;Erika Mowers,&nbsp;Deborah Landis Lewis","doi":"10.1363/psrh.12166","DOIUrl":"https://doi.org/10.1363/psrh.12166","url":null,"abstract":"","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38756704","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":"IN MEMORIAM","authors":"","doi":"10.1363/psrh.12159","DOIUrl":"https://doi.org/10.1363/psrh.12159","url":null,"abstract":"<p>The editors of <i>Perspectives on Sexual and Reproductive Health</i> were saddened to learn that Dr. Christine Kaestle died on July 16, 2020, in Blacksburg, Virginia. Dr. Kaestle was a professor in the Department of Human Development and Family Science at Virginia Tech College of Liberal Arts and Human Sciences, and was a longtime member of the journal's Editorial Advisory Committee. She could always be relied on to share her thoughtful insights in the areas of adolescent sexual and reproductive health, gender‐based violence and sexual behavior, and was a valued participant in our publishing community. The journal editors are deeply grateful for her years of friendly and professional support. </p>","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138528304","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":"Young Women's Complex Patterns of Contraceptive Use: Findings from an Australian Cohort Study.","authors":"Melissa L Harris,&nbsp;Jacqueline Coombe,&nbsp;Peta M Forder,&nbsp;Jayne C Lucke,&nbsp;Deborah Bateson,&nbsp;Deborah Loxton","doi":"10.1363/psrh.12158","DOIUrl":"https://doi.org/10.1363/psrh.12158","url":null,"abstract":"<p><strong>Context: </strong>Unintended pregnancy is common among young women. Understanding how such women use contraceptives- including method combinations-is essential to providing high-quality contraceptive care.</p><p><strong>Methods: </strong>Data were from a representative cohort of 2,965 Australian women aged 18-23 who participated in the 2012-2013 Contraceptive Use, Pregnancy Intention and Decisions baseline survey, had been heterosexually active in the previous six months, and were not pregnant or trying to conceive. Latent class analysis was employed to characterize women's contraceptive choices; multinomial logistic regression was used to evaluate correlates of membership in the identified classes.</p><p><strong>Results: </strong>The vast majority of women (96%) reported using one or more contraceptives, most commonly short-acting hormonal methods (60%), barrier methods (38%), long-acting contraceptives (16%) and withdrawal (15%). In total, 32 combinations were reported. Four latent classes of method use were identified: no contraception (4% of women); short-acting hormonal methods with supplementation (59%, mostly the pill); high-efficacy contraceptives with supplementation (15%, all long-acting reversible contraceptive users); and low-efficacy contraceptive combinations (21%); supplementation usually involved barrier methods or withdrawal. Class membership differed according to women's characteristics; for example, women who had ever been pregnant were more likely than other women to be in the no-contraception, high-efficacy contraceptive or low-efficacy contraceptive combination classes than in the short-acting hormonal contraceptive class (odds ratios, 2.0-3.0).</p><p><strong>Conclusions: </strong>The complexity of women's contraceptive choices and the associations between latent classes and such characteristics as pregnancy history highlight the need for individualized approaches to pregnancy prevention and contraceptive care.</p>","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/psrh.12158","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38708641","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":"Barriers to and Enablers of Abortion Provision for Family Physicians Trained in Abortion During Residency.","authors":"Aleza K Summit,&nbsp;Ian Lague,&nbsp;Miranda Dettmann,&nbsp;Marji Gold","doi":"10.1363/psrh.12154","DOIUrl":"https://doi.org/10.1363/psrh.12154","url":null,"abstract":"<p><strong>Context: </strong>Although some family medicine residency programs include routine opt-out training in early abortion, little is known about abortion provision by trainees after residency graduation. A better understanding of the barriers to and enablers of abortion provision by trained family physicians could improve residency training and shape other interventions to increase abortion provision and access.</p><p><strong>Methods: </strong>Twenty-eight U.S. family physicians who had received abortion training during residency were interviewed in 2017, between two and seven years after residency graduation. The doctors, identified using databases of abortion-trained physicians maintained by residency programs, were recruited by e-mail. In phone interviews, they described their postresidency abortion provision experiences. All interviews were transcribed, coded and analyzed using Dedoose, and a social-ecological framework was employed to guide investigation and analysis.</p><p><strong>Results: </strong>Although many of the physicians were motivated to provide abortion care, only a minority did so. Barriers to and enablers of abortion provision were found on all levels of the social-ecological model-legal, institutional, social and individual-and included state-specific laws and restrictions on federal funding; religious affiliation or policies prohibiting abortion within particular health systems; mentorship, colleagues' support and the stigma of being an abortion provider; and geographic location, time management and individuals' prioritization of abortion provision.</p><p><strong>Conclusions: </strong>Clinical training alone may not be sufficient for family medicine physicians to overcome the barriers to postresidency abortion provision. To increase abortion provision and access, organizations and advocates should work to strengthen enablers of provision, such as strong mentorship and support networks.</p>","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/psrh.12154","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38485539","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":"Anticipatory Counseling About Miscarriage Management in Catholic Hospitals: A Qualitative Exploration of Women's Preferences.","authors":"Erin E Wingo,&nbsp;Jocelyn M Wascher,&nbsp;Debra B Stulberg,&nbsp;Lori R Freedman","doi":"10.1363/psrh.12157","DOIUrl":"https://doi.org/10.1363/psrh.12157","url":null,"abstract":"<p><strong>Context: </strong>Catholic hospitals represent a large and growing segment of U.S. health care. Because these facilities follow doctrines that restrict reproductive health services, including miscarriage management options when a fetal heartbeat is present, it is critical to understand whether and how women would want to learn about miscarriage treatment restrictions from providers.</p><p><strong>Methods: </strong>From May 2018 to January 2019, semistructured interviews were conducted with 31 women aged 21-44 who had had exposure to religious-based health care; all were drawn from a nationally representative survey sample. Participants responded to a hypothetical scenario regarding the anticipatory disclosure of miscarriage management policy during routine prenatal care. Responses were inductively coded and thematically analyzed using modified grounded theory to understand women's attitudes and considerations related to receiving anticipatory miscarriage management information.</p><p><strong>Results: </strong>Respondents supported the routine disclosure of miscarriage management policies during prenatal care. Some expressed concern that this might increase patient anxiety during pregnancy, but most felt that the information would serve to prepare and empower patients, and likened the topic to other anticipatory health information provided during prenatal care. Identified themes related to how providers can disclose this information (including the need for a precautionary framing to reduce patient stress), sharing the rationale for institutional policy, and the importance of provider neutrality to ensure patient autonomy.</p><p><strong>Conclusions: </strong>To respect patient autonomy, health care providers working in Catholic hospitals should routinely discuss institutional miscarriage management policies with patients, and anticipatory counseling should give patients the balanced information they need to decide where to go for care should pregnancy complications arise.</p>","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/psrh.12157","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38708640","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":"Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.","authors":"Mary A Ott,&nbsp;Caitlin Bernard,&nbsp;Tracey A Wilkinson,&nbsp;Brownsyne Tucker Edmonds","doi":"10.1363/psrh.12156","DOIUrl":"https://doi.org/10.1363/psrh.12156","url":null,"abstract":"In the United States, policies and practices enacted in response to the COVID-19 pandemic— such as social distancing, sheltering in place, shifting to telemedicine and limiting care to ‚essential‛ procedures—are widening gaps in sexual and reproductive health (SRH) outcomes and access to services. As obstetricians-gynecologists, pediatricians and adolescent medicine specialists who are frontline providers of SRH services, we are seeing firsthand the documented decreases in access to SRH education, abortion and contraceptives (particularly long-acting reversible contraceptives, or LARCs), and increases in reports of gender-based violence.1–4 These trends have disproportionately affected minoritized and marginalized groups, including adolescents, people of color, those living in poverty, immigrants and undocumented individuals, and those living in rural areas.5,6 In this viewpoint, we provide a clinician’s perspective on the gaps in services and outcomes between these and more privileged groups, and make recommendations to narrow these gaps, both now and in the future. In some cases, the gaps in access to SRH services have been an unintended effect of COVID-19–related policies. For example, access to SRH services at federally qualified health centers and community-based clinics has been limited because of budgetary constraints, A cc ep te d A rti cl e","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/psrh.12156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38395519","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":"Association of Pregnancy Contexts with Depression and Low Social Support in Early Pregnancy.","authors":"Lisbet S Lundsberg,&nbsp;Abigail S Cutler,&nbsp;Nancy L Stanwood,&nbsp;Kimberly A Yonkers,&nbsp;Aileen M Gariepy","doi":"10.1363/psrh.12155","DOIUrl":"https://doi.org/10.1363/psrh.12155","url":null,"abstract":"<p><strong>Context: </strong>Research into the relationship between pregnancy intention and perinatal depression or low social support is limited. Women's perspectives on pregnancy and their associations with perinatal depression could help in developing targeted efforts for screening and intervention.</p><p><strong>Methods: </strong>In 2014-2015, 161 women seeking pregnancy testing or abortion care at clinics in New Haven, Connecticut, were surveyed. They were asked about pregnancy context (intentions, planning, wantedness, desirability, timing and happiness), and the Edinburgh Depression Screen (EDS) and the Modified Kendler Social Support Index (MKSSI) were used to identify possible antenatal depression and low social support, respectively. Multivariable logistic regression analysis was employed to examine associations between pregnancy context and these outcomes.</p><p><strong>Results: </strong>On average, participants were 27 years old and at nine weeks' gestation. One-fifth reported a previous diagnosis of depression or anxiety, and 22% and 33% screened positive for depression (EDS scores of 13 or higher and 10 or higher, respectively); 52% received low social support (MKSSI score of 3.2 or less). Regression analysis found that pregnancies described as unintended, poorly timed or undesired were associated with depression at the higher cutoff (odds ratios, 3.2-4.5); all unfavorable pregnancy measures were associated with depression at the lower cutoff. Ambivalence regarding pregnancy timing, intention, wantedness and desirability was associated with increased odds of depression by either EDS score. Unplanned pregnancies and those about which the woman was ambivalent were associated with low social support.</p><p><strong>Conclusions: </strong>Findings support the need to screen women for depression early in pregnancy and to integrate assessments of pregnancy context into the evaluation of potential risk factors.</p>","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/psrh.12155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38482056","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":"COVID-19 and Immigrants' Access to Sexual and Reproductive Health Services in the United States.","authors":"Sheila Desai,&nbsp;Goleen Samari","doi":"10.1363/psrh.12150","DOIUrl":"https://doi.org/10.1363/psrh.12150","url":null,"abstract":"In recent months, some of the impacts of the coronavirus disease 2019 (COVID-19) on sexual and reproductive health (SRH) care needs, decisions and access across the globe have become evident.1,2 In the United States, the Trump administration has unjustly blamed migrants for the COVID-19 pandemic, exploiting this public health crisis to further its long-standing xenophobic agenda and prompting a de facto shutdown of the U.S. immigration system. Yet immigrant communities—particularly those of color—are among the hardest hit by this virus, largely as a result of intersecting inequities based on migration status, race and socioeconomic position, all of which contribute to unequal access to quality health care.3 The perilous health impact of COVID-19 on immigrants in the country has been highlighted by the fact that Latinx individuals, one-third of whom are immigrants,4 are becoming infected and hospitalized at substantially higher rates than are U.S.-born white individuals.5 Noticeably absent from the public discussion is an intersectional consideration of how the public health response to the pandemic may affect access to SRH care for immigrants in the United States. Immigrants represent 14% (44.4 million people) of the U.S. population and account for 17% of women of reproductive age and 23% of births.6 Although immigrants’ SRH is not currently well documented, many immigrant groups face intractable social, economic and political barriers to obtaining A cc ep te d A rti cl e","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/psrh.12150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38039635","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}