Womens Health Issues最新文献

{"title":"Association Between Out-of-Pocket Insurance Costs and Psychotherapy Utilization Among Commercially Insured Birthing Individuals","authors":"Stephanie V. Hall PhD, MPH ,&nbsp;Andrea Pangori MS ,&nbsp;Anca Tilea MPH ,&nbsp;Kara Zivin PhD, MS, MA, MFA ,&nbsp;Anna Courant MFA, MSN, RN, CPNP-PC ,&nbsp;Amy Schroeder MA ,&nbsp;A. Mark Fendrick MD ,&nbsp;Vanessa K. Dalton MD, MPH","doi":"10.1016/j.whi.2025.02.003","DOIUrl":"10.1016/j.whi.2025.02.003","url":null,"abstract":"<div><h3>Background</h3><div>Perinatal mood and anxiety disorders (PMADs) are common, burdensome, and costly pregnancy complications, yet few receive treatment. Out-of-pocket costs (OOPCs) may represent a significant barrier to PMAD treatment.</div></div><div><h3>Objectives</h3><div>In a population of commercially insured enrollees with a documented live birth, we sought to determine whether commercial insurance plans with above-median OOPCs had lower rates and amounts of psychotherapy utilization than plans with below-median OOPCs and whether utilization differed by income or mental health status.</div></div><div><h3>Methods</h3><div>This serial, cross-sectional study used Optum's de-identified Clinformatics® Data Mart Database (2016–2020). We tested associations using logistic regression predicting psychotherapy utilization. Our sample included 219,043 unique births from 199,022 enrollees in 38,512 insurance plans. We categorized all enrollees as having low or high OOPCs, income below 400% of the federal poverty level or at or above 400% federal poverty level, and claims indicating a PMAD or not.</div></div><div><h3>Results</h3><div>The median OOPC for psychotherapy rose from $49 in 2016 to $54 in 2020. Enrollees in low OOPC plans were 1.12 (95% confidence interval [1.10, 1.15]) times more likely to utilize psychotherapy than those in high OOPC plans. Lower-income enrollees with PMADs attended the same number of psychotherapy visits regardless of OOPC level (five visits for low and high OOPC plans). Higher-income enrollees attended more psychotherapy by OOPC plan level (seven visits for low OOPC plans vs. six visits for high OOPC plans).</div></div><div><h3>Discussion</h3><div>Higher OOPCs were associated with lower psychotherapy utilization among higher-income enrollees, whereas lower-income enrollees used less psychotherapy regardless of OOPC level. Reducing or eliminating cost sharing for PMADs may improve access and enhance equity.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 143-150"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693946","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":"The State of VA-funded Women Veterans’ Health Systems Research","authors":"Amanda E. Borsky DrPH, MPP ,&nbsp;Aimee Kroll-Desrosiers PhD ,&nbsp;Adriana Rodriguez PhD ,&nbsp;Karissa Fenwick PhD, MSW ,&nbsp;Jessica K. Friedman PhD, MPH, MSc ,&nbsp;Elizabeth M. Yano PhD, MSPH","doi":"10.1016/j.whi.2025.02.006","DOIUrl":"10.1016/j.whi.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>Women veterans are the fastest-growing population of new users within the Department of Veterans Affairs (VA) health care delivery system. This paper aims to characterize the scope of women's health research funded by VA Health Systems Research (HSR) over the past 10 years.</div></div><div><h3>Methods</h3><div>Ten years of data (2014–2023) were obtained from a VA financial database that captures research projects that started on or after January 1, 2014. Projects were coded for topical areas and study types.</div></div><div><h3>Results</h3><div>VA HSR funded 91 women's health studies over the past 10 years. The number of active projects grew from 7 in 2014 to 50 in 2023, with a parallel increase in total funding amount for women's health-focused research projects (nearly $570,000 in 2014 and $8.1 M in 2023). Descriptive or epidemiological studies were the most prominent study type (55% of active projects) and there was a steady increase in intervention and implementation studies. The most common topics were mental health and/or substance use (22% of projects), followed by reproductive health (13%), access/rural health (13%), other chronic conditions (12%), violence and trauma exposure (10%), primary care and prevention (8%), pain (7%), other (5%), comorbidities (3%), post-deployment health (3%), aging and long-term care (2%), and cancer (2%).</div></div><div><h3>Conclusions</h3><div>Overall, our findings indicate that HSR funding for studies focused on women veterans' health has grown over the last decade, and those studies have diversified in topics and types of study designs. As a learning health system, VA can use these findings to prioritize its future women's health research funding to meet the health needs of women veterans.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 205-218"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744265","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":"Financial, Social, and Demographic Factors Associated With Obtaining an Abortion: A Longitudinal Study in Indiana in 2021–2022","authors":"Alexandra Wollum PhD, MPH ,&nbsp;Bria Goode MPH ,&nbsp;Caitlin McKenna ,&nbsp;Megan Jeyifo ,&nbsp;Lizz Perkins ,&nbsp;Meg Sasse Stern ,&nbsp;Qudsiyyah Shariyf ,&nbsp;Tracey A. Wilkinson MD, MPH ,&nbsp;Heidi Moseson PhD, MPH","doi":"10.1016/j.whi.2025.03.001","DOIUrl":"10.1016/j.whi.2025.03.001","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to 1) characterize those who did and did not obtain an abortion and reasons why, and 2) evaluate the association between various facilitators, including financial and social support, and accessing an abortion.</div></div><div><h3>Methods</h3><div>Between June 2021 and April 2022, we recruited pregnant Indiana residents considering abortion through online posts, abortion funds, and abortion clinics. Respondents completed an online baseline survey and a follow-up survey 1 month later. Surveys collected information on sociodemographic characteristics, barriers and facilitators to abortion, and pregnancy outcome.</div></div><div><h3>Results</h3><div>Among 221 participants, 77% obtained an abortion within 1 month. Among online and abortion fund recruits, those who identified as Black or African American or Hispanic/Latinx and those without insurance were less likely to have had an abortion than were white and insured participants. Financial support from abortion funds and clinics and social support from peer networks were associated with higher odds of accessing abortion care 1 month later. Among participants still seeking abortion at 1 month or who had given birth, 64% reported that needing to gather money to pay for the abortion or travel expenses/lodging was a barrier to care. Among those who were no longer considering abortion at 1 month and planned to continue their pregnancy, 28% reported doing so because they did not have the money for an abortion.</div></div><div><h3>Conclusions</h3><div>In a restrictive state policy environment, receipt of financial and social support was associated with greater likelihood of obtaining abortion within a month of reporting considering or seeking it among a sample of pregnant people in Indiana.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 159-168"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052289","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":"Title X Provider Experiences With and Perceptions of Contraception Guidelines Implementation in Georgia: A Qualitative Study","authors":"Sophia C. Garbarino MPH ,&nbsp;Elizabeth Reisinger Walker PhD, MPH, MAT ,&nbsp;Melissa J. Kottke MD, MPH, MBA ,&nbsp;Hayat Mekonen BSPH ,&nbsp;Jessica M. Sales PhD","doi":"10.1016/j.whi.2025.02.004","DOIUrl":"10.1016/j.whi.2025.02.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Georgia Title X sites serve over 160,000 patients per year, providing critical contraceptive access. The U.S. Medical Eligibility Criteria and Selected Practice Recommendations for Contraceptive Use (U.S. MEC SPR) are meant to increase contraception access, but few studies have explored U.S. MEC SPR implementation. This qualitative study aimed to understand Georgia Title X providers’ experiences with and attitudes toward U.S. MEC SPR implementation.</div></div><div><h3>Study Design</h3><div>From March 2023 to December 2023, we conducted semi-structured interviews with 20 Georgia Title X providers. Participants also completed a short demographic survey. Transcripts were first assessed using rapid analysis techniques in Google Sheets, then analyzed more thoroughly with a thematic analysis approach in Dedoose. We calculated demographic descriptive statistics using SAS.</div></div><div><h3>Results</h3><div>The sample was diverse in race but not gender; all participants identified as cisgender women. Interviews revealed that most participants learned about the guidelines in medical or nursing school. Notable benefits of using the U.S. MEC SPR included facilitating patient contraceptive education and building providers’ confidence in their prescribing skills. The only reported challenges were limited user-friendliness and limited information about certain medical conditions in the U.S. MEC. Participants had mixed experiences with clinic leadership prioritizing U.S. MEC SPR use but reported similar perceived patient barriers to care.</div></div><div><h3>Conclusions</h3><div>This study suggests that the U.S. MEC SPR can help Title X providers serve clients seeking contraception, but barriers to widespread implementation remain. Efforts to increase guidelines use should consider providers’ needs and preferences along with factors impacting patient access to contraceptive care.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 188-195"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659075","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":"Sex Differences in Suicide, Lethal Means, and Years of Potential Life Lost Among Veterans With Substance Use Disorder","authors":"Amar D. Mandavia MA, PhD ,&nbsp;Anne N. Banducci PhD ,&nbsp;Tracy L. Simpson PhD ,&nbsp;Brian P. Marx PhD ,&nbsp;Sage E. Hawn PhD ,&nbsp;Justeen Hyde PhD ,&nbsp;Victoria E. Ameral PhD ,&nbsp;Rebecca E. Sistad Hall PhD ,&nbsp;Clara E. Roth BA ,&nbsp;Alexis A. Sarpong MPH ,&nbsp;Michael Davenport MA ,&nbsp;Frank Meng PhD ,&nbsp;Michael D. Stein MD ,&nbsp;Nicholas A. Livingston PhD","doi":"10.1016/j.whi.2025.02.002","DOIUrl":"10.1016/j.whi.2025.02.002","url":null,"abstract":"<div><h3>Background</h3><div>Veterans with substance use disorders (SUDs) are at elevated risk of dying by suicide. We examined sex and age differences in rates and means of suicide death among veterans with alcohol (AUD) and/or opioid use disorder (OUD) diagnoses.</div></div><div><h3>Methods</h3><div>We studied a cohort of veterans with AUD and/or OUD diagnoses who received Veterans Health Administration care and died of any cause between January 2016 and December 2020. We assessed the risk of suicide death and lethal means by sex, age, and their interaction.</div></div><div><h3>Results</h3><div>Among veterans with AUD and/or OUD, 119,693 died of any cause during the study period. Suicides represented 4.5% of all deaths (<em>n</em> = 5,419), with women being 2.25 times (95% confidence interval [CI], 1.97–2.55) more likely to die by suicide than men and dying at significantly younger ages than men. Suicide deaths accounted for 21.28 and 32.25 years of potential life lost for men (mean age, 52.92 ± 14.81 years) and women (mean age, 47.65 ± 11.52 years), respectively. Intentional poisoning was the most common means of suicide death for both men and women. Women were 2.08 times (95% CI, 1.61–2.71) more likely to die by poisoning-related suicide than men. Men were 1.73 times (95% CI, 1.13–2.77) more likely to die by firearms-related suicide than women.</div></div><div><h3>Conclusion</h3><div>Among veterans diagnosed with AUD and/or OUD, women were more likely to die by suicide, at a younger age, than men. Poisoning was the primary means of suicide death for men and women. These national-level data highlight the urgency of suicide risk assessment and prevention among women veterans with substance use disorder.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 196-204"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671420","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":"Markers of Maternal Morbidity: Research Recommendations for Severe Perineal Lacerations, Severe Maternal Morbidity, and Other Complications","authors":"Suzan L. Carmichael PhD, MS ,&nbsp;Peiyi Kan MS ,&nbsp;Jonathan M. Snowden PhD","doi":"10.1016/j.whi.2025.02.005","DOIUrl":"10.1016/j.whi.2025.02.005","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 139-142"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711630","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":"Assessing the Provision of Person-Centered Contraceptive Care at Publicly Supported Clinics Providing Contraceptive Services in the United States","authors":"Jennifer Mueller MPH,&nbsp;Priscille Osias BA,&nbsp;Madeleine Haas BA,&nbsp;Alicia VandeVusse PhD","doi":"10.1016/j.whi.2025.03.003","DOIUrl":"10.1016/j.whi.2025.03.003","url":null,"abstract":"<div><h3>Introduction</h3><div>We sought to understand the extent to which the contraceptive care provided at publicly supported family planning clinics in the United States aligns with aspects of person-centered care.</div></div><div><h3>Materials and Methods</h3><div>We conducted a descriptive study with a national sample of U.S. family planning clinics between November 2022 and December 2023. We measured person-centeredness by the scope of services offered, including the extent to which providers solicit and prioritize patients’ contraceptive intentions, preferences, and goals; the dispensing protocols for various contraceptive methods; and the availability of social services such as intimate partner violence screening and housing insecurity support. We fielded an online survey to a sample of 2,146 clinics, and our analytic sample was 422 clinics.</div></div><div><h3>Results</h3><div>Our results highlight that most publicly supported family planning clinics provide contraception using counseling protocols that support patient-centeredness, such as assessing patients’ contraceptive preferences during contraceptive counseling. However, we found statistically significant variation by clinic type within many of these measures, with a higher proportion of Planned Parenthood clinics following patient-centered protocols than other clinic types, particularly federally qualified health centers and community health centers.</div></div><div><h3>Conclusions</h3><div>Publicly supported family planning clinics provide contraception using some person-centered care protocols, although there is room for improvement. Furthermore, person-centered practices vary by clinic type. More research should be done with patients to assess additional elements of person-centered contraceptive care.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 169-179"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031886","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":"Smoking Cessation Programs for Women in Non-reproductive Contexts: A Systematic Review","authors":"Alexa Gruber BHSc ,&nbsp;Alexa Braverman BSc ,&nbsp;Wayne K. deRuiter PhD ,&nbsp;Terri Rodak MA, MISt ,&nbsp;Lorraine Greaves PhD ,&nbsp;Nancy Poole PhD ,&nbsp;Monica Parry MEd, MSc, NP-Adult, PhD ,&nbsp;Monika Kastner PhD ,&nbsp;Diana Sherifali RN, PhD, CDE ,&nbsp;Carly Whitmore RN, PhD ,&nbsp;Andrew Sixsmith PhD ,&nbsp;Sabrina Voci PhD ,&nbsp;Nadia Minian PhD ,&nbsp;Laurie Zawertailo PhD ,&nbsp;Peter Selby MBBS, MHSc ,&nbsp;Osnat C. Melamed MD, MSc","doi":"10.1016/j.whi.2025.01.003","DOIUrl":"10.1016/j.whi.2025.01.003","url":null,"abstract":"<div><h3>Background</h3><div>Women's smoking and cessation behaviors are influenced by various sex- and gender- (SaG) related factors; however, most smoking cessation programs that do not target pregnant women follow a gender-neutral approach. We aimed to systematically review the literature on smoking cessation programs for women outside reproductive contexts to assess their effectiveness and how they address SaG-related barriers.</div></div><div><h3>Methods</h3><div>We selected experimental studies published between June 1, 2009, and June 7, 2023, that describe smoking cessation interventions designed exclusively for women. Two independent reviewers extracted study characteristics, intervention effectiveness, strategies to address SaG-related factors, and the studies’ approach to gender equity using the gender integration continuum. We searched multiple databases to comprehensively identify relevant studies for inclusion. The protocol was registered with PROSPERO #CRD42023429054.</div></div><div><h3>Results</h3><div>Twenty-five studies were selected and summarized using a narrative synthesis. Of these, nine (36%) found a greater reduction in smoking in the intervention group relative to the comparison group. Nine studies addressed women's concerns about post-cessation weight gain; however, in only one of these did the intervention group show a greater likelihood of quitting smoking relative to the comparison group. In contrast, three of four studies tailored for women facing socioeconomic disadvantage, and three of four studies designed for women with medical comorbidities, reported a greater reduction in smoking behaviors in the intervention relative to the comparison group. Ten studies relied solely on counseling and did not provide participants with smoking cessation pharmacotherapy. Overall, studies addressed individual and community-level barriers to quitting, including post-cessation weight gain, lack of social support, psychological distress, and cultural influences. All but one study avoided using harmful gender norms to promote cessation.</div></div><div><h3>Conclusions</h3><div>Strategies that address SaG-related barriers to quitting may improve cessation outcomes among women, particularly when tailored to meet the unique needs of specific groups such as those facing socioeconomic disadvantage. Future studies should combine best practices in smoking cessation treatment—behavioral counseling and pharmacotherapy—with new knowledge on how SaG factors influence motives for smoking and barriers to quitting. Such an approach could lead to more effective and equitable smoking cessation interventions for women.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 123-137"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450685","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":"Remembering Susan F. Wood, a Champion of Evidence-Based Policy for Women's Health","authors":"Liz Borkowski MPH,&nbsp;Karen A. McDonnell PhD","doi":"10.1016/j.whi.2025.02.008","DOIUrl":"10.1016/j.whi.2025.02.008","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 63-64"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568544","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":"“On the OB Side of Things, It's Completely Disconnected”: Early Implementation of Medicaid Accountable Care Organizations and Health Care in the Perinatal Period","authors":"Laura B. Attanasio PhD ,&nbsp;Kimberley H. Geissler PhD","doi":"10.1016/j.whi.2024.12.002","DOIUrl":"10.1016/j.whi.2024.12.002","url":null,"abstract":"<div><h3>Objective</h3><div>More than 40% of U.S. birthing people are covered by Medicaid. Accountable Care Organizations (ACOs) are increasingly common in state Medicaid programs and may influence maternal health, quality of care, and outcomes. However, there has been limited examination of how Medicaid ACOs operate in the context of perinatal care. Our objective was to explore how individuals in ACO leadership have approached program design to address maternal health and how these programs have shaped health care utilization and maternal health from the perspective of postpartum ACO beneficiaries and clinicians.</div></div><div><h3>Methods</h3><div>We conducted virtual semi-structured interviews with three key stakeholder groups in Massachusetts (ACO leaders, maternity care clinicians, and Medicaid ACO members who had given birth within the past 6–24 months) between November 2021 and May 2023. Purposive sampling aimed to achieve variation in geographic location (members and clinicians) and race/ethnicity (members). Interviews were recorded, professionally transcribed, and analyzed iteratively using thematic analysis.</div></div><div><h3>Principal Findings</h3><div>Thirty-three interviews were conducted: four with ACO leaders, 15 with maternity care clinicians, and 14 with ACO members. Maternity care clinicians did not perceive that ACO implementation had substantially impacted perinatal health care. Interviews with ACO leadership suggested that the lack of perceived impact may be partially explained by competing priorities; the Massachusetts Medicaid ACOs generally did not focus on maternal health during the initial implementation period. Postpartum ACO members were largely unaware of ACOs.</div></div><div><h3>Conclusions</h3><div>Lack of explicit attention to the perinatal population in Medicaid financing and delivery system reforms may reduce the potential impact in improving outcomes.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 89-96"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081770","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}