Womens Health Issues最新文献

{"title":"Fertility Intentions and Histories Among Transgender Adults Who Started Gender-Affirming Testosterone Before Adulthood","authors":"Elizabeth R. Boskey PhD, MPH, MSSW ,&nbsp;Emile Redwood MD ,&nbsp;Til Parsa MD ,&nbsp;Frances W. Grimstad MS, MD","doi":"10.1016/j.whi.2025.02.001","DOIUrl":"10.1016/j.whi.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>As more transgender adolescents and young adults seek gender-affirming care, questions persist about how their desire for potentially fertility-affecting treatment intersects with their fertility intentions.</div></div><div><h3>Methods</h3><div>We surveyed 125 individuals born with a uterus and ovaries, living in the United States, initially prescribed gender-affirming testosterone at or before age 18, about their interest in genetically related children and history of fertility preservation and fertility-affecting procedures.</div></div><div><h3>Results</h3><div>Twenty-two percent of respondents did not want children, and 47% wanted children but did not think a genetic relationship was important. Another 8% indicated having genetically related children was important and 17% indicated they did not know. Only 47% recalled counseling about fertility preservation. Those who might want genetically related children were less satisfied when they did not recall counseling (<em>p</em> = .001). Significantly more people in the group who might want genetically related children still had one or both ovaries (100% vs. 86%; <em>p</em> = .03), desired to carry a pregnancy in the future or were unsure (30% vs. 8%; <em>p</em> = .01), and either desired to use their eggs for genetically related children or were unsure (93% vs. 26%; <em>p</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>More than one-half of individuals prescribed gender-affirming testosterone as adolescents had no interest in genetically related children. Those who were interested in genetically related children were more likely to have other fertility-preserving interests and behaviors, including potentially desiring a pregnancy and still having one or both ovaries. This finding suggests that fertility-related behaviors of individuals prescribed gender-affirming testosterone are in line with their stated goals.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 74-82"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568542","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":"Provider and Staff Perspectives on Screening and Referral for Social Determinants of Health During Perinatal Care: Implications Using the Consolidated Framework for Implementation Research","authors":"Sophia E. Allen MPH ,&nbsp;Daisy J. Goodman DNP, MPH, CNM, CARN-AP ,&nbsp;Taralyn Bielaski MPH ,&nbsp;Sophia Sisson MPH ,&nbsp;Chelsey R. Canavan MSPH ,&nbsp;Ilana Cass MD ,&nbsp;Beatrice Ngugi MSW ,&nbsp;Catherine H. Saunders PhD, MPH ,&nbsp;Alka Dev DrPH, MHS","doi":"10.1016/j.whi.2025.01.007","DOIUrl":"10.1016/j.whi.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>New federal mandates require universal screening and referral for social determinants of health (SDOHs), and evidence exists supporting its integration into primary care practice. However, implementation in maternity care remains understudied and underfunded. To inform maternal health practice, we studied clinical stakeholders' perspectives on SDOH screening and referral knowledge, priority, challenges, and opportunities across four hospital-affiliated obstetrics and gynecology clinics in New Hampshire.</div></div><div><h3>Methods</h3><div>We conducted 15 semistructured interviews and four focus groups (with 20 total group participants) to explore clinical providers’ and staff perspectives regarding the implementation of SDOH screening at their obstetrics clinics. We used the updated Consolidated Framework for Implementation Research to inform our interview and focus group guides. We identified our themes inductively using Practical Thematic Analysis.</div></div><div><h3>Results</h3><div>Participants represented nine different clinical and administrative roles. Four major themes culminated from the interviews and focus groups: 1) clinical staff identified clinic-specific workflows as critical to implementing the SDOH screening intervention; 2) clinical staff's workload and lack of training in SDOHs informed their level of commitment to SDOH screening and referral; 3) given many patients' extensive psychosocial needs, clinical staff wanted dedicated resources and time to respond to screening results; and 4) clinical staff perceived that SDOH screening impacts the patient experience, with the potential to decrease stigma depending on how screening results are discussed.</div></div><div><h3>Conclusions</h3><div>Despite unanimous support for addressing SDOHs within maternity care, participants perceived persistent challenges to effectively implementing SDOH screening and providing adequate referrals. They recommended that screening for SDOHs in vulnerable populations be accompanied by clear guidance and leadership, equitable distribution of resources and staff time between implementing clinics, and continuous quality improvement efforts.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 116-122"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531947","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":"Obstetrician-Gynecologist Perspectives and Counseling Practices on the U.S. Medicaid Waiting Period for Permanent Contraception","authors":"Suzanna Larkin MPH ,&nbsp;Brooke W. Bullington BA ,&nbsp;Kristen A. Berg PhD, CRC ,&nbsp;Kari White PhD ,&nbsp;Margaret Boozer MD ,&nbsp;Tania Serna MD, MPH ,&nbsp;Emily S. Miller MD, MPH ,&nbsp;Jennifer L. Bailit MD, MPH ,&nbsp;Kavita Shah Arora MD, MBE, MS","doi":"10.1016/j.whi.2025.01.002","DOIUrl":"10.1016/j.whi.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Created to protect patients from coercive sterilization, the federally mandated 30-day waiting period for patients with Medicaid desiring permanent contraception is a known barrier to permanent contraception fulfillment. Existing research does not explicitly explore how physicians interpret and operationalize the consent policy, how they counsel regarding the waiting period, or whether physicians believe the policy should be revised. The purpose of this paper is to better understand obstetrician-gynecologist (OB-GYN) feelings, thoughts, and counseling practices around the waiting period as key stakeholders in counseling and provision of permanent contraception care.</div></div><div><h3>Basic Procedures</h3><div>We interviewed 81 postpartum people with a documented desire for permanent contraception and 61 OB-GYNs who delivered their infants at four hospitals across the United States. Interviews were audio-recorded, transcribed, and analyzed using rapid qualitative analysis and thematic content analysis.</div></div><div><h3>Main Findings</h3><div>Forty-seven physicians (70.2%) expressed negative feelings toward the Medicaid waiting period policy and 14 (20.9%) expressed neutral/mixed feelings. Physicians often viewed the Medicaid sterilization consent policy as inequitable and reported feeling that the waiting period hinders patient autonomy. Several physicians suggested that the waiting period needs revision. Physicians cited several barriers related to the implementation of the waiting period, including a lack of prenatal care or the conversation not being initiated. Physicians mentioned various approaches to counseling around the waiting period, either explicitly or inexplicitly explaining the policy. Last, physicians discussed differing interpretations around the waiting period policy.</div></div><div><h3>Principal Conclusions</h3><div>Physicians in our sample largely do not favor the current Medicaid sterilization waiting period. However, physicians report varying approaches to clinical counseling as well as beliefs regarding policy revision. Revision to the policy should be informed by the lived experience and expertise of the various stakeholders, including patients, clinicians, and policymakers.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 83-88"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450683","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":"Economic Insecurities and Mental Health Among Low-Income Pregnant People in the Central Valley Region of California","authors":"Neha Zahid MPH ,&nbsp;Bridgette Blebu PhD, MPH ,&nbsp;Jennifer Felder PhD ,&nbsp;Charles E. McCulloch PhD ,&nbsp;Brittany D. Chambers PhD ,&nbsp;Venise C. Curry MD ,&nbsp;Kristin Carraway MPH ,&nbsp;Daisy León-Martínez MD ,&nbsp;Kimberly Coleman-Phox MPH ,&nbsp;Miriam Kuppermann PhD, MPH ,&nbsp;Deborah Karasek PhD, MPH","doi":"10.1016/j.whi.2025.01.006","DOIUrl":"10.1016/j.whi.2025.01.006","url":null,"abstract":"<div><h3>Background</h3><div>The association between economic insecurity and mental health among low-income pregnant people is understudied. We examined the relationship between economic insecurity and perinatal stress, anxiety, and depressive symptoms among a low-income, racially/ethnically diverse study population, and differentiated associations by nativity status.</div></div><div><h3>Methods</h3><div>We used cross-sectional data from the EMBRACE Study that enrolled Medi-Cal (California's Medicaid program) eligible pregnant people in the Central Valley region of California. Economic insecurity was assessed through measures of food insecurity, low financial well-being, inability to pay an emergency expense, inability to pay bills, fear of eviction, and history of homelessness. We examined the association of these measures with perceived stress (Perceived Stress Scale), generalized anxiety symptoms (Generalized Anxiety Disorder-7), and depressive symptoms (Patient Health Questionnaire-9), adjusting for age, relationship status, and education level. We also examined effect measure modification by nativity among the Latinx population. We report the estimated differences and 95% confidence intervals for each exposure and outcome.</div></div><div><h3>Results</h3><div>In our sample of 674 participants, we observed associations between economic insecurity and mental health. Among the 24 models, 15 showed medium to large effects (&gt;0.35 standard deviation differences) and only three showed negligible effect sizes. Across all outcomes, we observed a stronger relationship between economic insecurity and mental health for U.S.-born Latinx people compared with their foreign-born (93% Mexico-born) counterparts.</div></div><div><h3>Conclusion</h3><div>We found low-income pregnant people experience significant economic insecurities that may impact mental health adversely. Programs that increase economic supports during pregnancy may serve as important maternal mental health interventions, especially among racial/ethnic minoritized groups.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 105-115"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469270","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":"Disability-Related Disparities in Screening for Intimate Partner Violence During the Perinatal Period: A Population-Based Study","authors":"Kathryn Laughon PhD, RN, FAAN ,&nbsp;Rosemary B. Hughes PhD ,&nbsp;Genevieve Lyons MSPH ,&nbsp;Kana Roarty BSN, RN ,&nbsp;Jeanne Alhusen PhD, CRNP, RN, FAAN","doi":"10.1016/j.whi.2024.12.001","DOIUrl":"10.1016/j.whi.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Persons with disabilities are at higher risk of experiencing intimate partner violence (IPV) during the perinatal period than persons without disabilities. Although screening for IPV during the perinatal period is recommended by many organizations, little is known about screening rates for IPV by disability status.</div></div><div><h3>Methods</h3><div>Our objective was to compare rates of IPV screening during the perinatal period among persons with and without disabilities in the United States. A cross-sectional sample of 43,837 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication, and self-care. We conducted a secondary analysis of nationally representative data from the 2018–2020 Pregnancy Risk Assessment Monitoring System.</div></div><div><h3>Results</h3><div>During pregnancy, respondents with disabilities had a lower odds of IPV screening as compared with respondents without disabilities (adjusted odds ratio .83, 95% confidence interval [.70, .99]). Despite similar screening rates in the 12 months before conception and postpartum among respondents with and without disabilities who attended health care visits, those with disabilities were less likely to receive pregnancy-related care during pregnancy (<em>p</em> &lt; .0001) and in the postpartum period (<em>p</em> &lt; .0001) and thus missed opportunities to be screened.</div></div><div><h3>Conclusion</h3><div>Our findings demonstrate a need for health care providers to collaborate with policy makers, disability advocates, and researchers to reduce the disparities people with disabilities face in accessing health care, including screening for IPV during the perinatal period. Such efforts are essential for maximizing the health and safety of pregnant persons and new parents with disabilities and their children during the perinatal period.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 97-104"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956907","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":"Addressing Weight Stigma in Perinatal Care: Strategies for Health Care Providers and Organizations","authors":"Natalie M. Papini PhD ,&nbsp;Taniya S. Nagpal PhD ,&nbsp;Anna R. Whelan MD, FACOG ,&nbsp;Tiffany A. Moore Simas MD, MPH, MEd ,&nbsp;Molly E. Waring PhD","doi":"10.1016/j.whi.2024.11.002","DOIUrl":"10.1016/j.whi.2024.11.002","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 1","pages":"Pages 3-6"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899450","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":"Abortion Provision at New York State Regional Perinatal Centers Following Implementation of the Reproductive Health Act","authors":"Gopika R. Krishna MD ,&nbsp;Julia E. Kohn PhD, MPA ,&nbsp;Roselle Bleck MD, MPH ,&nbsp;Carolyn L. Westhoff MD, MSc","doi":"10.1016/j.whi.2024.10.001","DOIUrl":"10.1016/j.whi.2024.10.001","url":null,"abstract":"<div><h3>Objective</h3><div>Signed in 2019, New York State's Reproductive Health Act enabled expansion of abortion care up to 28 weeks for any indication. This study aimed to describe how implementation of the New York State Reproductive Health Act affected abortion provision among the state's regional perinatal centers (RPCs)—tertiary referral centers for complex pregnancies that may care for patients seeking abortion later in pregnancy. A secondary objective was to identify barriers to and facilitators of expanding abortion care.</div></div><div><h3>Methods</h3><div>From January to May 2023, we recruited clinicians from the 17 New York RPCs, including family planning specialists, maternal–fetal medicine specialists, and genetic counselors. Respondents completed an online survey. We then invited respondents to complete an in-depth interview. We calculated descriptive statistics to characterize the study population and summarize survey responses. We analyzed qualitative interview data using thematic analysis.</div></div><div><h3>Results</h3><div>Twenty-nine respondents completed the survey, representing 16 of 17 New York State RPCs. Seventeen respondents, representing 11 RPCs, completed an interview. All institutions provided abortion care. Twenty-three of 29 survey respondents (79%) reported barriers to providing abortion for any indication after 24 weeks from last menstrual period (LMP). Eighteen of 29 (62%) reported barriers to providing abortion after 24 weeks LMP for maternal or fetal indications. The most commonly reported barriers in the survey results were staff resistance and institutional policy. During interviews, respondents identified staff discomfort, restrictive institutional policies, and lack of clarity around policy as barriers, while highlighting advocates and collaboration within their institutions as facilitators to expansion of abortion services later in pregnancy.</div></div><div><h3>Conclusions</h3><div>RPCs in New York State face barriers in providing abortion, especially after 24 weeks LMP, even though they are ideally situated to provide such care. These barriers exist despite the legality of abortion after 24 weeks in New York and policy efforts to expand access to abortion.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 1","pages":"Pages 7-13"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733385","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":"Psychological and Social Predictors of Poverty: Differences Between Lesbian and Bisexual Women","authors":"Bianca D.M. Wilson PhD ,&nbsp;Andy Lin PhD ,&nbsp;Lauren J.A. Bouton MA","doi":"10.1016/j.whi.2024.10.004","DOIUrl":"10.1016/j.whi.2024.10.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Research has demonstrated that sexual minority populations are more likely to experience poverty than sexual majority populations and that many of these disparities are driven by specific sexual minority subgroups, including cisgender bisexual women. Yet, little is known about the factors associated with economic insecurity that explain the intragroup differences in economic outcomes among sexual minorities, particularly among those of the same gender (i.e., cisgender bisexual vs. lesbian women).</div></div><div><h3>Methods</h3><div>We used a U.S. national probability sample of non-transgender sexual minority adults to assess the relationship between poverty and demographic (age, race/ethnicity, education), psychological (psychological distress, self-acceptance, felt stigma, and experienced discrimination), and social (outness, partnership and parental status, partner gender, and gender expression) characteristics for each subgroup of women, lesbian/gay (n = 324) and bisexual (n = 355). We calculated odds ratios and adjusted odds ratios (AORs) estimated from logistic regression models that relate risk factors to poverty.</div></div><div><h3>Results</h3><div>Race/ethnicity (i.e., identifying as Black) and education (i.e., having a high school diploma or less) were associated with living in poverty for both groups. The role of minority stressors, such as outness, everyday discrimination, and internalized homophobia did not strongly predict poverty for either group. However, reports of experienced stigma related to one's sexual orientation and masculine gender expression were associated with poverty among lesbians but not for bisexual women, and having children was a strong predictor of poverty for bisexual women but not lesbians.</div></div><div><h3>Conclusions</h3><div>These findings suggest that policy, advocacy, and service interventions should consider tailoring approaches to address poverty for bisexual and lesbian women differently.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 1","pages":"Pages 28-38"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787234","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":"“Neither Side Really Knows… What an Abortion Is Like”: A Qualitative Analysis of Medical Students’ Experiences With Second-Trimester Procedural Abortions","authors":"Kathryn Crofton MD,&nbsp;Rachel Flink-Bochacki MD, MPH,&nbsp;Brooke Zaiz MD,&nbsp;Johanna Bringley DO","doi":"10.1016/j.whi.2024.09.006","DOIUrl":"10.1016/j.whi.2024.09.006","url":null,"abstract":"<div><h3>Objectives</h3><div>Medical students value abortion education; however, there has been little study regarding participation in second-trimester procedures, which are less common yet receive significant societal attention. We aimed to explore medical students’ perceptions of participation in second-trimester procedural abortions to optimize this educational experience.</div></div><div><h3>Study Design</h3><div>We conducted qualitative semi-structured interviews with third- and fourth-year medical students who voluntarily participated in second-trimester dilation and evacuation cases. We coded interviews inductively and performed thematic content analysis until thematic saturation was reached.</div></div><div><h3>Participants</h3><div>We interviewed 25 medical students, including 16 third-year and nine fourth-year students. Most participants were female (64%) and white (58%) and had no prior abortion care experience (80%).</div></div><div><h3>Results</h3><div>Four major themes emerged: 1) students felt unprepared for second-trimester procedural abortions and were unable to find adequate educational resources for preparation; 2) students experienced complex emotional reactions to the procedures, often finding the experience more challenging than expected; 3) students observed implicit expectations and biases in the learning environment; and 4) students highly valued their involvement in abortion procedures, noting that participation was important for their future practice and allowed acquisition of essential clinical skills.</div></div><div><h3>Conclusions</h3><div>Medical students value the educational opportunity to participate in second-trimester procedural abortions; however, most feel unprepared for the technical and emotional aspects, despite utilizing available educational resources. To maximize educational experience and psychological safety, educators should develop specialized training resources. This could strengthen physician knowledge and comfort with abortion care in the future, ultimately improving patient care.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 1","pages":"Pages 14-19"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606944","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":"“Just Google It”: A Qualitative Study of Reproductive-Age Women's Stigmatizing Experiences When Accessing Buprenorphine for Opioid Use Disorder","authors":"Dominique Bulgin PhD, RN ,&nbsp;Velma McBride Murry PhD ,&nbsp;Tamarra McElroy MPH ,&nbsp;David Schlundt PhD ,&nbsp;Kemberlee Bonnet MA ,&nbsp;Stephen W. Patrick MD, MPH, MS","doi":"10.1016/j.whi.2024.10.003","DOIUrl":"10.1016/j.whi.2024.10.003","url":null,"abstract":"<div><h3>Introduction</h3><div>The opioid crisis is increasingly impacting women, and access to buprenorphine to treat opioid use disorder (OUD) is limited by the number of providers authorized to dispense it. Stigma can represent an additional barrier to accessing medication for OUD. Qualitative data were analyzed from a randomized simulated patient field experiment of calls to outpatient buprenorphine-waivered providers.</div></div><div><h3>Objectives</h3><div>Our primary objective was to analyze descriptions of barriers women encountered when seeking buprenorphine to treat OUD to account for differential experiences based on pregnancy status, race/ethnicity, and insurance status. Our secondary objective was to identify potential intervention strategies to improve access to medications for OUD.</div></div><div><h3>Methods</h3><div>The Health Stigma and Discrimination framework was applied to guide our study of barriers encountered by women seeking OUD treatment. Callers representing vocal features of white, Hispanic, and Black women and simulating ages 25–30 were randomized to represent combinations of public/private insurance and pregnant/not pregnant characteristics. Callers contacted 5,944 buprenorphine-waivered providers requesting to make an appointment to obtain medications to treat OUD. There were 15,358 free-text comments in response to the prompt “Please give an objective play-by-play of the description of what happened in this conversation.” Data were coded and analyzed using an iterative inductive-deductive approach. We consulted six community experts, women who had sought treatment for OUD, to inform our study findings and identify patient-driven solutions to address barriers.</div></div><div><h3>Results</h3><div>Findings revealed that experiences of interpersonal stigma were connected to systemic barriers such as stigmatizing behaviors within institutional cultures and normative practices. Key results indicate that race/ethnicity, pregnancy status, and insurance status influence experiences of stigma. For instance, Black and Hispanic callers reported experiencing race-based microaggressions, and pregnant women faced additional judgment and reduced access to treatment. Qualitative findings and community experts’ insights underscored the necessity for the adoption of anti-stigma policies and practices that facilitate easier access to medications for OUD across socioecological levels.</div></div><div><h3>Conclusions</h3><div>The findings demonstrate a need for multilevel interventions to improve women's access to medications for OUD.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 1","pages":"Pages 45-53"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740958","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}