Perspectives on Sexual and Reproductive Health最新文献

{"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":"52 3","pages":"181-190"},"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":"52 3","pages":"151-159"},"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":"52 3","pages":"171-179"},"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":"52 3","pages":"145-149"},"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":"52 3","pages":"161-170"},"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":"52 2","pages":"69-73"},"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}

{"title":"COVID-19 Abortion Bans and Their Implications for Public Health.","authors":"Rachel K Jones,&nbsp;Laura Lindberg,&nbsp;Elizabeth Witwer","doi":"10.1363/psrh.12139","DOIUrl":"https://doi.org/10.1363/psrh.12139","url":null,"abstract":"The American Public Health Association (APHA) has long recognized that access to abortion is a fundamental right and an important component of comprehensive sexual and reproductive health care. 1 However, under the guise of trying to protect the U.S. public during the COVID-19 pandemic, a number of states have called this right into question. Some politicians have attempted to exploit the current public health crisis to further prohibit or limit access to abortion care, claiming that it is nonessential and that medical resources and personal protective equipment (PPE) need to be redirected to other medical needs and procedures. It is too soon to measure the public health impact of these new and proposed abortion bans. Indeed, even trying to identify the states in which these bans are in eff ect is a moving target, as many states’ attempts to undermine abortion care have been blocked by litigation that has forced these controversial eff orts into the courts. But we can draw on what we know from prior attempts to ban or otherwise limit access to abortion in the United States to anticipate the public health impact of these policies. In this viewpoint, we focus on a well-established body of scientifi c evidence to identify the potential public health implications of the bans on both the individuals seeking abortions and the clinics that provide this care.","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":"52 2","pages":"65-68"},"PeriodicalIF":5.8,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/psrh.12139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37934806","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":"Intimate Partner Violence Perpetration and Victimization Among Young Adult Sexual Minorities.","authors":"Alison D Swiatlo, Nicole F Kahn, Carolyn T Halpern","doi":"10.1363/psrh.12138","DOIUrl":"10.1363/psrh.12138","url":null,"abstract":"<p><strong>Context: </strong>Intimate partner violence (IPV) among sexual minority young adults has been understudied, and victimization and perpetration estimates are needed.</p><p><strong>Methods: </strong>Data on 13,653 women and men aged 24-32 who participated in Wave 4 of the National Longitudinal Study of Adolescent to Adult Health were used to examine associations between sexual orientation and IPV perpetration and victimization in respondents' current or most recent relationship. Logistic regression analyses were used to identify associations between respondent characteristics and three IPV categories (physical violence, threatened violence and forced sex).</p><p><strong>Results: </strong>Some 94% of males and 80% of females identified as 100% heterosexual; 4% of males and 16% of females as mostly heterosexual; 1% of males and 2% of females as bisexual; and 2% of males and females as either mostly homosexual or 100% homosexual. Compared with their heterosexual counterparts, mostly heterosexual women were more likely to report having perpetrated or been a victim of physical IPV (odds ratios, 1.9 and 1.6, respectively), having threatened violence (2.0) and having been a victim of threatened violence and forced sex (1.6 for each); mostly heterosexual males were more likely to have been a perpetrator or victim of physical IPV (3.1 and 1.8, respectively) and a perpetrator of forced sex and threatened violence (2.0 and 1.8, respectively). Bisexual males had elevated odds of physical violence victimization (3.3) and forced sex victimization (4.9) and perpetration (5.0).</p><p><strong>Conclusions: </strong>Some sexual minority groups are disproportionately affected by IPV, indicating a need for increased prevention efforts and for studies exploring the mechanisms underlying these differences.</p>","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":"52 2","pages":"97-105"},"PeriodicalIF":5.8,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669537/pdf/nihms-1581210.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37981439","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 Sexual and Reproductive Health of Adolescents and Young Adults During the COVID-19 Pandemic.","authors":"Laura D Lindberg,&nbsp;David L Bell,&nbsp;Leslie M Kantor","doi":"10.1363/psrh.12151","DOIUrl":"https://doi.org/10.1363/psrh.12151","url":null,"abstract":"The COVID-19 public health crisis is having rapid and pro-found eff ects on how people around the world are living their lives. Adolescents and young adults (AYA) aged 12–24 in the United States are at low risk for hospitalization and death from COVID-19 compared with other age-groups. * However, the disease may aff ect other aspects of their physical, mental and social health. Sexual and reproductive health (SRH) touches upon all of these domains, and involves intimate relationships, sexual activity, contraceptive use and abortion care. Evidence of the SRH impacts of previous large-scale disruptions in the United States, including natural disasters 1 and the 2008 recession, 2 suggests that the current pandemic will have serious and sustained eff ects on young people. AYA will experience the current pandemic in ways that refl ect their unique developmental and cohort situations. 3 In this viewpoint, we review potential immedi-ate and longer term impacts of the COVID-19 pandemic on the SRH needs and behaviors of AYA, and provide direct evidence of COVID-19 impacts where available.","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":"52 2","pages":"75-79"},"PeriodicalIF":5.8,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/psrh.12151","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38046052","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":"Reproductive Autonomy Is Nonnegotiable, Even in the Time of COVID-19.","authors":"Leigh Senderowicz,&nbsp;Jenny Higgins","doi":"10.1363/psrh.12152","DOIUrl":"https://doi.org/10.1363/psrh.12152","url":null,"abstract":"The COVID-19 pandemic has swept across the world, altering nearly every facet of contemporary life and causing behavioral and socioeconomic changes that seemed unthinkable a few months ago. The increased risks for human health include not just the dangers posed by the virus itself, but also the upheaval to the broader health care and societal landscapes, which has threatened access to critical sexual and reproductive health services. In this viewpoint, we describe how the pandemic has already posed challenges to reproductive autonomy in both the United States and globally, and then offer insights on how it may do so in the future. We conclude with a call not only to resist a rollback of access to reproductive health care during this pandemic, but to center a broad conception of reproductive autonomy in sexual and reproductive health research, policies and programs moving forward.","PeriodicalId":47632,"journal":{"name":"Perspectives on Sexual and Reproductive Health","volume":"52 2","pages":"81-85"},"PeriodicalIF":5.8,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/psrh.12152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38100664","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}