Womens Health Issues最新文献

{"title":"Impacts of Medicaid Expansion on Contraceptive Use Among Women in Neighborhoods of Racialized Socioeconomic Deprivation in the United States.","authors":"Alice F Cartwright, Gustavo Angeles, Jessica Su, Maeve Wallace, Siân Curtis, Ilene S Speizer","doi":"10.1016/j.whi.2025.07.002","DOIUrl":"10.1016/j.whi.2025.07.002","url":null,"abstract":"<p><strong>Introduction: </strong>Medicaid expansion has the potential to increase access to contraception and improve women's health, although existing research examining state-level variation provides mixed evidence. The neighborhood context plays a crucial role in understanding the effects of Medicaid expansion on contraceptive use, as structural inequalities within neighborhoods may shape access to health care and reproductive services.</p><p><strong>Materials and methods: </strong>We used a unique restricted dataset of 13,224 female respondents ages 15-44 years interviewed in the 2011-2019 waves of the National Survey of Family Growth (NSFG). We merged these data with indicators of state Medicaid expansion status and respondents' neighborhood context, operationalized as Index of Concentration at the Extremes (ICE) scores. We used quasi-experimental difference-in-differences models to assess if Medicaid expansion impacted provider-dependent contraceptive use and method type differentially by neighborhood-level context. We used multivariable linear probability and multinomial logistic regression models adjusting for individual and community covariates and state/region fixed effects.</p><p><strong>Results: </strong>Living in a Medicaid expansion state was associated with significant increases in provider-dependent contraceptive method use among respondents in the most deprived neighborhoods (17.9 percentage points, 95% CI [9.0, 26.9], by 2017-2019). Specifically, long-acting reversible contraception (LARC) use increased 7.6 percentage points (95% CI [0.6-14.7]) and use of no method or barrier/coital methods declined 17.5 percentage points (95% CI [-26.3, -8.7]) among those in the most deprived neighborhoods by 2017-2019.</p><p><strong>Conclusions: </strong>Changes in state-level policies can have major impacts on health systems, but the example of Medicaid expansion underscores the differential impacts on people with less access to health resources, such as those living in structurally disadvantaged neighborhoods. Ultimately, further expansion of Medicaid could facilitate access to the full range of contraceptive methods and advance population health equity in additional U.S. states.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859781","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":"Differences in Contraceptive Method Discontinuation and Contraceptive Method Preferences by Disability Status.","authors":"Zoe H Pleasure, Laura D Lindberg","doi":"10.1016/j.whi.2025.06.004","DOIUrl":"10.1016/j.whi.2025.06.004","url":null,"abstract":"<p><strong>Background: </strong>Contraceptive care delivery to people with disabilities must be contextualized within the U.S. history of stratified reproduction and eugenics. Significant sexual and reproductive health inequities have been documented between people with disabilities and those without disabilities in family planning service receipt and contraceptive method use. Little research has examined how discontinuation of contraception or dissatisfaction with contraceptive methods may differ for people with disabilities.</p><p><strong>Objective: </strong>This study assesses differences in contraceptive desires and experiences between disabled and nondisabled individuals.</p><p><strong>Methods: </strong>Our sample included self-identified female respondents from the 2011-2019 National Survey of Family Growth. We examined demographic and sexual and reproductive health differences between disabled and nondisabled respondents based on self-report of disabilities. Unadjusted and adjusted logistic regression models estimated differences in contraceptive method discontinuation due to dissatisfaction and method choice based on cost.</p><p><strong>Results: </strong>Differences by disability status were found for reports of fecundity and the contraceptive method used in the past 12 months. In both unadjusted and adjusted models, significantly more disabled people than nondisabled people reported having discontinued their method because of dissatisfaction and having wanted to use a different method if cost were not an issue.</p><p><strong>Conclusions: </strong>Self-reported disabilities are associated with contraceptive method dissatisfaction and unmet contraceptive preferences. Efforts are needed to tailor person-centered clinical care that is responsive to this population's reproductive wants and needs.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805065","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":"Demand for Medication Abortion Through Telehealth Before and After the Dobbs v. Jackson Supreme Court Decision in States Where Abortion Is Legal.","authors":"Anna E Fiastro, Elissa Brown, Rebecca Gomperts, Emily M Godfrey","doi":"10.1016/j.whi.2025.06.003","DOIUrl":"https://doi.org/10.1016/j.whi.2025.06.003","url":null,"abstract":"<p><strong>Objective: </strong>The provision of medication abortion through telehealth accounts for an increasing share of total abortions in the United States, offering a private and affordable option for patients in both restrictive and supportive states. This study compares demand for telehealth medication abortion before and after the U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization (Dobbs) in states where abortion access is protected, to understand how patients seeking care in supportive states may have been impacted by the landmark decision.</p><p><strong>Methods: </strong>We compared the volume of patients receiving medication abortion from a U.S.-based telehealth service in 18 states, the sociodemographic characteristics of patients, and self-reported reasons for choosing telehealth before and after the Dobbs decision using electronic medical records from March 24, 2022-September 24, 2022. All states examined support legal access to abortion; results were stratified to compare two levels of protective abortion policies.</p><p><strong>Results: </strong>A total of 6,296 patients received medication abortion through telehealth during the study period. Daily demand increased by 74%, from an average of 25.0 patients per day in the pre-Dobbs period to 43.4 patients per day post-Dobbs (difference 18.4; 95% confidence interval [15.4, 21.5]; p < .001). No sociodemographic differences were observed between patient populations before and after the Dobbs decision. Comfort and privacy were the most frequently selected reasons for choosing telehealth in both time periods. Concern over legal restrictions was more frequently cited after the Dobbs decision. A larger increase in demand (88%) was observed in states with fewer protections post-Dobbs compared with states with the most protective policies (68%) (p < .001).</p><p><strong>Conclusions: </strong>Demand for telehealth medication abortion increased after the Dobbs decision in states where abortion remained legal. Telehealth provides an essential pathway to access safe and effective abortion care for a broad range of patients across different policy environments.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769196","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":"Use of Preabortion Ultrasonography Among Telehealth Medication Abortion Patients.","authors":"Sylvie T Wilson, Lisa Peters, Leah R Koenig, Suzanne O Bell, Ushma D Upadhyay","doi":"10.1016/j.whi.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.whi.2025.06.002","url":null,"abstract":"<p><strong>Background: </strong>Since 2020, some clinicians have offered telehealth medication abortion care that does not require ultrasonographic screening for eligible patients. However, some telehealth medication abortion patients nonetheless obtain ultrasonography.</p><p><strong>Objective: </strong>This study aims to understand which patients obtain ultrasonography before telehealth medication abortion, their reasons for ultrasonography, and where they obtain it.</p><p><strong>Study design: </strong>Using data from the California Home Abortion by Telehealth (CHAT) Study, a cohort study of patients using telehealth abortion services in 2021 and 2022, participants were asked whether they had pre-abortion ultrasonographic imaging, reasons for the ultrasonography, and where they obtained it. We analyzed these responses using chi-squared tests, Fisher's exact tests, and multivariable logistic regression.</p><p><strong>Results: </strong>Among 1,775 participants, 11% (n = 194) obtained ultrasonography before their abortion. In the multivariable model, participants who were younger, were food insecure, had a pregnancy duration of 35 days (5 weeks) or more, or were unsure of their pregnancy duration were significantly more likely to obtain pre-abortion ultrasonography. The most common reason for ultrasonography was to assess pregnancy duration (69%). Most participants obtained imaging at a clinic (41%) or at an emergency room or hospital (27%), although some obtained imaging at crisis pregnancy centers (14%). Of those who obtained ultrasonography, 8% were referred by their telehealth provider; the remainder sought ultrasonography on their own initiative.</p><p><strong>Conclusion: </strong>Hospitals, clinics, and imaging facilities can create policies to increase the accessibility of ultrasonography for those who desire or require pre-abortion ultrasonography.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709452","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":"Addressing Racism and Discrimination in the Design of Physical Activity Interventions for Black Women: Insights and Recommendations From an Academic and Community Partnership.","authors":"Rodney P Joseph, LaTanya Mathis, Iyana Harris, Shawntele M Howie-Carlson, Kanika Jones, Darlene Little, Dawn Augusta","doi":"10.1016/j.whi.2025.06.001","DOIUrl":"https://doi.org/10.1016/j.whi.2025.06.001","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683408","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":"Patterns of Antepartum Care in Ontario Before and During a Time of COVID-19 and Virtual Care: A Population-Based Study.","authors":"Stephanie C Lapinsky, Nancy N Baxter, Rinku Sutradhar, Karl Everett, Joan Porter, Mark H Yudin, Eliane M Shore, Howard Berger, Douglas M Campbell, John W Snelgrove, Andrea N Simpson","doi":"10.1016/j.whi.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.whi.2025.05.002","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic resulted in changes to the way health care was delivered, including expansion of virtual care. We aimed to understand differences in antepartum care delivery prior to and during the pandemic.</p><p><strong>Methods: </strong>We conducted a population-based retrospective cohort study of people 15-50 years with an in-hospital birth at 20+ weeks' gestation in Ontario, Canada, across two time periods: December 1, 2020-November 30, 2022 (pandemic), and December 1, 2017-November 30, 2019 (pre-pandemic). Outcomes were total number and timing of antepartum visits, ultrasounds, and acute care encounters. Outcomes were compared between cohorts, and between those who did and did not receive virtual care during the pandemic. Regression modeling was used to examine associations between pregnancy during the pandemic and rates of outcomes.</p><p><strong>Results: </strong>A total of 228,551 pandemic and 218,126 pre-pandemic births were included. Median number of antepartum visits was 10 (6-13) in the pandemic period and 9 (4-12) pre-pandemic (standardized difference (StD): 0.32), corresponding to a relative rate of 1.21 (95% CI [1.20, 1.21]). Significantly more individuals in the pandemic had >11 visits, with no differences in acute care encounters and only a small increase in health care costs (<10%). Those in the pandemic cohort were more likely to have their initial visit during the first trimester (79.3% vs. 66.5%, StD: 0.29). Those receiving virtual care were more likely to live in an urban area and be more materially advantaged.</p><p><strong>Interpretation: </strong>Pregnancy during the pandemic was associated with in an increased rate of ambulatory antepartum visits and increased care in the first trimester.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601906","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":"\"Am I Truly Invisible?\": Black Women's Experiences of and Coping With Intersectional Invisibility in Uterine Fibroid Treatment.","authors":"Arianne N Malekzadeh, Ami R Zota, Myla Lyons, Tamara Taggart","doi":"10.1016/j.whi.2025.05.005","DOIUrl":"10.1016/j.whi.2025.05.005","url":null,"abstract":"<p><strong>Background: </strong>Black women are disproportionately burdened by uterine leiomyomas (fibroids) and face intersectional invisibility wherein their needs are ignored in health care settings owing to sexism and racism. Our objective was to elucidate Black women's experiences in fibroid treatment and the strategies they use to protect their health and counter their intersectional invisibility.</p><p><strong>Methods: </strong>We recruited participants from the Fibroids Observational Research on Genes and the Environment (FORGE) Study. We conducted semistructured individual interviews (average length, 45 minutes) on Black women's experiences in fibroid treatment. We analyzed the transcripts using a thematic analytical approach and intersectionality, a critical analytical framework that allows for the examination of how sexism and racism intersect to influence health inequities.</p><p><strong>Results: </strong>Participants were 16 Black women aged 30-52 years who were seeking fibroid treatment in Washington, DC. Our analysis revealed that participants experience gendered racism (the intersection of sexism and racism) in fibroid treatment, mirroring a historical and ongoing pattern of how Black women are treated in health care settings, and that they manage their intersectional invisibility by engaging in strategies characteristic of the superwoman schema: projecting strength, suppressing emotions, resisting being dependent, and striving to succeed despite limited resources. Participants also highlighted that their ideal fibroid-related care would include a holistic approach and social support.</p><p><strong>Conclusions: </strong>Our findings emphasize that Black women's intersectional invisibility extends to fibroid treatment, reflecting the social-structural inequities that they face in health care settings more broadly. Attendance to Black women's voices in research and practice can help to decrease their intersectional invisibility and subsequently improve their fibroid treatment and related health outcomes.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592687","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":"Beneath the Incision: Variation in Low-Risk Cesareans Among Asian and Pacific Islander Subgroups in the United States.","authors":"Louise Marie Roth, Jennifer Hyunkyung Lee, Theresa M Morris","doi":"10.1016/j.whi.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.whi.2025.05.003","url":null,"abstract":"<p><strong>Background: </strong>Quality initiatives aim to reduce primary cesarean rates in pregnancies with low clinical risk. These cesarean rates vary significantly by race-ethnicity in the United States. This study analyzes differences in low-risk primary cesareans between Asian/Pacific Islander (API) individuals and other pan-ethnic groups and among API subgroups in the United States.</p><p><strong>Methods: </strong>We used data on all recorded births in the United States from 2010 to 2020 to analyze primary cesareans in the lowest risk NTSV (nulliparous, term, singleton, vertex) and MTSV (multiparous, term, singleton, vertex) pregnancies by race-ethnicity. We used logistic regression to compare API births with births among other pan-ethnic groups (N = 22,212,076) and to analyze variation across API subgroups (N = 1,663,167).</p><p><strong>Results: </strong>API births had lower risk-adjusted odds of a primary cesarean than most other pan-ethnic groups. Among API subgroups, Indian and some Pacific Islander groups had higher adjusted odds of a primary cesarean, whereas Chinese, Korean, Filipino, and, especially, Japanese groups had lower odds. Foreign-born API birthing people had higher odds than U.S.-born API birthing people (NTSV odds ratio [OR] = 1.17, 95% confidence interval [CI] [1.16, 1.19], and MTSV OR = 1.11, 95% CI [1.10, 1.13]).</p><p><strong>Conclusions: </strong>Although odds of a low-risk primary cesarean were slightly lower in API births than in births among most other pan-ethnic groups, this concealed significant variation among API subgroups and between foreign-born and U.S.-born API birthing people. These disparities suggest inequities in access to quality care and possible discrimination against some API groups, leading to unnecessary overtreatment. Efforts to reduce disparities should recognize differences across subgroups and potential barriers to culturally appropriate care.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592688","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":"Safety Net Clinic Utilization for Sexual and Reproductive Health Services Among U.S.- and Foreign-Born Mexican-Origin Women.","authors":"Blair G Darney, Biani Saavedra-Avendaño, Emily R Boniface, Laura E Jacobson, Kate Coleman-Minahan, Evelyn Fuentes-Rivera, Fernando Riosmena","doi":"10.1016/j.whi.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.whi.2025.05.004","url":null,"abstract":"<p><strong>Objective: </strong>We describe utilization of sexual and reproductive health (SRH) services at safety net clinics (Title X and other publicly funded health care organizations) and private health care settings among U.S.- and foreign-born Mexican-origin women living in the United States. We also test whether nativity is associated with source of SRH care, adjusting for other factors.</p><p><strong>Data sources and study setting: </strong>We pooled four waves of the National Survey of Family Growth (NSFG)-2011-2013, 2013-2015, 2015-2017, and 2017-2019-and included in our sample women who received SRH services in the previous 12 months.</p><p><strong>Study design: </strong>We compared SRH service utilization and source (safety net clinics [Title X and non-Title X public] vs. private) between U.S.-born and foreign-born Mexican-origin women. We used multivariable regression to test whether nativity was associated with source of care.</p><p><strong>Principal findings: </strong>Our sample included n = 1,923 (N = 4,446,577) Mexican-origin women aged 15-44, 42.9% of whom were foreign born. Foreign-born women of Mexican origin were more likely to be uninsured (43.8% vs. 13.4% among the U.S. born) and had a significantly higher adjusted probability of using safety net clinics to access preventive SRH services compared with Mexican-American women (42.2%; 95% CI [35.5, 48.9%] vs. 27.6%; 95% CI [22.9, 32.2%]).</p><p><strong>Conclusions: </strong>Safety net clinics such as Title X and other publicly funded health care organizations play an important role in access to preventive SRH care among Mexican-origin women living in the United States, especially for foreign-born women.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565405","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":"Engaging Rural Women Veterans in Mental Health Research: A Call to Action","authors":"Alexandra B. Caloudas PhD ,&nbsp;Juinell B. Williams PhD ,&nbsp;Giselle Day MPH ,&nbsp;Rajinder Sonia Singh PhD ,&nbsp;Mary Shapiro PhD ,&nbsp;Amanda McCorkindale PsyD ,&nbsp;Deleene Menefee PhD ,&nbsp;Jan A. Lindsay PhD ,&nbsp;Derrecka Boykin PhD","doi":"10.1016/j.whi.2025.03.004","DOIUrl":"10.1016/j.whi.2025.03.004","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 4","pages":"Pages 225-229"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020591","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}