Womens Health Issues最新文献

{"title":"Health Care Provider Willingness to Recommend Self-collected Tests for Human Papillomavirus: A Mixed Methods Examination of Associated Factors","authors":"","doi":"10.1016/j.whi.2024.05.005","DOIUrl":"10.1016/j.whi.2024.05.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Cervical cancer disproportionately affects those who are underscreened. Human papillomavirus self-collection is a promising tool to expand screening.</p></div><div><h3>Objective</h3><p>Study objectives were to examine 1) factors (provider characteristics and practice type) associated with and 2) attitudes (perceived benefits and concerns) toward using human papillomavirus self-collection for cervical cancer screening in clinical practice.</p></div><div><h3>Methods</h3><p>This study had a mixed method design; prior to regulatory approval of self-collection, we conducted a national survey and interviews of health care providers who perform cervical cancer screening. Quantitative measures included provider and practice characteristics, willingness to recommend, and preferences related to self-collection. Qualitative interviews further elucidated provider perspectives.</p></div><div><h3>Results</h3><p>A total of 1,251 providers completed surveys, and 56 completed interviews. Among survey respondents, 33.4% reported they were likely to offer self-collection, 28.6% were unsure, and 38.0% reported they were unlikely. Most would offer self-collection either in the clinic or at home per patient preference. Male participants, advanced practice providers, internal and family physicians, and those practicing in academic medical center, hospital, or community health settings were more likely than female participants, obstetrician–gynecologist physicians, and those in private practice to indicate they were likely to offer self-collection. Concerns expressed in both surveys and interviews included the adequacy of sample collection and the ability to follow up. Respondents felt that self-collection would be particularly beneficial for those who did not have access to clinician-collected screening, as well as for patients who may have difficulty with pelvic examinations for any reason.</p></div><div><h3>Conclusion</h3><p>Providers considered human papillomavirus self-collection to be a way to expand access for patients with health care barriers and pelvic examination difficulties. They had concerns related to sample adequacy and follow-up after abnormal results.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 506-517"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S104938672400046X/pdfft?md5=c5441a8749618b400d13b2c195289b1e&pid=1-s2.0-S104938672400046X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499241","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":"Development and Evaluation of a Novel Approach to Patient-Centered Contraceptive Counseling","authors":"Katharine O. White MD, MPH ,&nbsp;Kelly M. Treder MD, MPH ,&nbsp;Placidina Fico MPH ,&nbsp;Elizabeth Raskin MPH, MSW ,&nbsp;Natasha M. Lerner DrPH, MPA","doi":"10.1016/j.whi.2024.06.003","DOIUrl":"10.1016/j.whi.2024.06.003","url":null,"abstract":"<div><h3>Objectives</h3><p>We aimed to develop and evaluate a novel model, PHI CARE, that provides a standardized framework for shared decision-making in contraceptive counseling.</p></div><div><h3>Methods</h3><p>We developed the PHI CARE model with national experts, piloted it at three family planning clinics, and finalized it following additional patient and clinician review. We recruited pregnancy-capable people for an evaluation study via simulated contraceptive counseling and identified salient themes through inductive and deductive coding.</p></div><div><h3>Results</h3><p>Participants (<em>n</em> = 12) felt that counseling with the PHI CARE model was an improvement over previous counseling experiences and led to feelings of empowerment; participants did not feel pressured to decide about method use, felt in control during the conversation, and appreciated the absence of assumptions about their desires around pregnancy. Despite the standardized format, participants felt the counseling was individualized, “values-based,” and tailored to their preferences.</p></div><div><h3>Conclusion</h3><p>PHI CARE is a model to support clinicians and counselors in operationalizing the principles of shared decision-making in contraceptive counseling. Through standardization, PHI CARE allows for a more individualized experience for patients and addresses many critiques of traditional counseling.</p></div><div><h3>Practice Implications</h3><p>PHI CARE is a memorable, brief tool that can be used for patient-centered contraceptive counseling in any clinical encounter.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 473-479"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386724000501/pdfft?md5=b6c737f0f4edf1eca622b2a7e3094126&pid=1-s2.0-S1049386724000501-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761704","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":"Health and Health Care Use of American Indian/Alaska Native Women Veterans: A Scoping Review","authors":"Mary K. Good PhD ,&nbsp;Heather Davila PhD ,&nbsp;Daniel Ball PhD ,&nbsp;Skye O'Neill MS ,&nbsp;Heather Healy MA, MLS ,&nbsp;Michelle A. Mengeling PhD","doi":"10.1016/j.whi.2024.07.003","DOIUrl":"10.1016/j.whi.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><p>American Indian/Alaska Native (AI/AN) women serve in the U.S. military, use Veterans Health Administration (VA) health care, and reside in rural areas at the highest rates compared with other women veterans. However, little is known about their unique health care needs, access, and health care use.</p></div><div><h3>Objective</h3><p>We assessed the existing literature on the health and health care use of U.S. AI/AN women veterans.</p></div><div><h3>Methods</h3><p>Online databases were searched to identify studies. Study characteristics extracted included health care topic, study design, overall sample size and number of AI/AN women veterans, and funding source. We screened 1,508 publications for inclusion; 28 publications were ultimately retained.</p></div><div><h3>Results</h3><p>Health care access and use were the most common health care research topics (39%), followed by mental health (36%) and physical health (25%). Few studies considered the impact of rurality. Most studies found significant differences between AI/AN women veterans and other women veterans or AI/AN men veterans. Publication dates ranged from 1998 to 2023, with 71% published after 2010. The majority of studies (75%) were secondary analyses of extant health care data. More than three-quarters of studies (82%) were funded federally (e.g., VA). Many studies were based on VA administrative data, resulting in a gap in knowledge regarding AI/AN women veterans who are not eligible for, or choose not to use, VA health care.</p></div><div><h3>Conclusion</h3><p>Research to inform the health and health care of AI/AN women veterans is limited, especially in terms of known AI/AN and women veterans' prevalent health concerns (e.g., diabetes, hypertension), women's health and reproduction, and how AI/AN women veterans access, use, and confront barriers to health care. Moreover, there is scarce research specific to cultural, tribal, and regional factors that likely affect access and use of particular health care systems or that can affect perspectives on illness that impact long-term treatment adherence and patient outcomes.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 455-464"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082193","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":"Leveraging a Longitudinally Linked Dataset to Assess Recurrence of Severe Maternal Morbidity","authors":"Hafsatou Diop MD, MPH ,&nbsp;Eugene R. Declercq PhD ,&nbsp;Chia-Ling Liu RN, ScD, MPH ,&nbsp;Xiaohui Cui ScD ,&nbsp;Ndidiamaka Amutah-Onukagha PhD, MPH ,&nbsp;Audra R. Meadows MD, MPH ,&nbsp;Howard J. Cabral PhD, MPH","doi":"10.1016/j.whi.2024.06.002","DOIUrl":"10.1016/j.whi.2024.06.002","url":null,"abstract":"<div><h3>Objectives</h3><p>Among those with a severe maternal morbidity (SMM) event and a subsequent birth, we examined how the risk of a second SMM event varied by patient characteristics and intrapartum hospital utilization.</p></div><div><h3>Methods</h3><p>We used a Massachusetts population-based dataset that longitudinally linked in-state births, hospital discharge records, prior and subsequent births, and non–birth-related hospital utilizations for birthing individuals and their children from January 1, 1999, to December 31, 2018, representing 1,460,514 births by 907,530 birthing people. We restricted our study sample to 2,814 people who had their first SMM event associated with a singleton birth and gave birth a second time within the study period. Our outcome measure was recurrence of SMM in the second birth. We calculated the prevalence of SMM at second birth, compared SMM conditions between births, and estimated the adjusted risk ratios and 95% confidence intervals for having an SMM event at second birth among those who had an SMM at the first birth. We also examined overall hospital utilization including inpatient admissions, emergency room visits, and observational stays, and hospital utilization by interpregnancy intervals (IPIs) between the first and second birth.</p></div><div><h3>Results</h3><p>There were 2,814 birthing people with at least one birth after the first SMM singleton birth. Among those, 198 (7.0%) had a subsequent SMM. The percentage of people with a second SMM event varied by age, race/ethnicity, insurance, IPI, and history of hypertension at first case of SMM (all <em>p</em> &lt; .05). Between births, people with a second SMM event had significantly higher proportions of inpatient admissions (60.1% vs. 33.2.0%; <em>p</em> &lt; .001), emergency room visits (71.7% vs. 57.7%; <em>p</em> &lt; .001), and observational stays (35.4% vs. 19.5%; <em>p</em> &lt; .001) compared with those who did not experience a second SMM event.</p></div><div><h3>Conclusion</h3><p>Hospital utilization after a birth with SMM might indicate an elevated risk of a second SMM event. Providers should counsel their patients about prevention and warning signs.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 498-505"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386724000495/pdfft?md5=267cf052258bbff73e84ebc9b945fa8f&pid=1-s2.0-S1049386724000495-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635001","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":"Does a Welcoming Environment Influence Women Veterans’ Primary Care Experiences?","authors":"Danielle E. Rose PhD, MPH ,&nbsp;Melissa M. Farmer PhD ,&nbsp;Sabine M. Oishi PhD, MSPH ,&nbsp;Ruth S. Klap PhD ,&nbsp;Bevanne A. Bean-Mayberry MD, MHS ,&nbsp;Ismelda Canelo MPA ,&nbsp;Donna L. Washington MD, MPH ,&nbsp;Elizabeth M. Yano PhD, MPH","doi":"10.1016/j.whi.2024.07.002","DOIUrl":"10.1016/j.whi.2024.07.002","url":null,"abstract":"<div><h3>Background</h3><p>A welcoming environment may influence patient care experiences, and it may be particularly relevant for underrepresented groups, such as women veterans at Veterans Health Administration (VA) facilities where they represent only 8–10% of patients. Challenges to ensuring a welcoming environment for women veterans may include unwelcome comments from male veterans and staff or volunteers and feeling unsafe inside or outside VA facilities. We assessed associations between reports of gender-related environment of care problems and patient-reported outcomes.</p></div><div><h3>Procedures</h3><p>We merged national patient-reported outcomes from women veterans (<em>n</em> = 4,961) using Consumer Assessment of Health Plans &amp; Systems Patient Centered Medical Home (CAHPS-PCMH) survey composite measures with Women Veteran Program Managers' reports of gender-related environment of care problems (<em>n</em> = 127, 2016–2017) at VA facilities. We performed multilevel bivariate logistic regressions to assess associations between Women Veteran Program Managers' reports of large/extreme problems and likelihood of women veterans’ optimal ratings of primary care experiences (access, coordination, comprehensiveness, provider communication, and overall rating of primary care provider). We adjusted for patient-, site-, and area-level characteristics, and clustering of patients within VA facilities, and we applied design weights to address nonresponse bias in the patient data. Response rates were 40% for women veterans and 90% for Women Veteran Program Managers.</p></div><div><h3>Main Findings</h3><p>Few (&lt;15%) Women Veteran Program Managers reported large/extreme environment of care problems. Women veterans obtaining care at those sites were less likely to rate provider communication and comprehensiveness (psychosocial health assessed) as optimal.</p></div><div><h3>Principal Conclusions</h3><p>Ensuring a welcoming environment may improve women veterans' primary care experiences.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 540-548"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093980","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":"Birth Outcomes Among First Nations Birthing Parents Incarcerated While Pregnant: A Linked Administrative Data Study From Manitoba, Canada","authors":"","doi":"10.1016/j.whi.2024.06.001","DOIUrl":"10.1016/j.whi.2024.06.001","url":null,"abstract":"<div><h3>Background</h3><p>In Canada, colonial policies have resulted in health inequities between First Nations and other Canadians. These policies contribute to overrepresentation of First Nations in the criminal legal system, where incarcerated people and their infants face elevated health risks. We investigated the association between prenatal incarceration and adverse birth outcomes among First Nations and other birthing parents in Manitoba, Canada.</p></div><div><h3>Methods</h3><p>Using linked whole-population administrative data, we identified all live births (2004–2017) in which the birthing parent (First Nations <em>n</em> = 1,449; other Manitoban <em>n</em> = 278) was prenatally incarcerated and compared them to birthing parents who were postnatally incarcerated (First Nations <em>n</em> = 5,290; other Manitoban <em>n</em> = 790) or not incarcerated (First Nations <em>n</em> = 19,950; other Manitoban <em>n</em> = 3,203). We used generalized linear models adjusted for measured confounders with propensity score weighting to calculate risk differences and 95% confidence intervals for adverse birth outcomes among those prenatally versus postnatally incarcerated in each group.</p></div><div><h3>Results</h3><p>Low birthweight births were more likely among First Nations birthing parents who were prenatally (vs. postnatally) incarcerated (risk difference 1.59, 95% CI [.79, 2.38]) but less likely among other Manitoban birthing parents (risk difference −2.33, 95% CI [−4.50, −.16]) who were prenatally (vs. postnatally) incarcerated. Among First Nations, prenatal incarceration was also associated with large-for-gestational-age births, low Apgar scores, and no breastfeeding (vs. postnatal incarceration), as well as preterm births (vs. no incarceration). Among other Manitobans, prenatal incarceration was also associated with small-for-gestational-age births, low Apgar scores, and no breastfeeding (vs. postnatal incarceration), as well as preterm births (vs. no incarceration).</p></div><div><h3>Conclusions</h3><p>The findings suggest that incarceration may contribute to intergenerational systems of oppression by compromising birth outcomes among First Nations and other birthing parents in Canada and underscore the need to both improve care for pregnant people who are incarcerated and invest in alternatives to incarceration.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 488-497"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386724000483/pdfft?md5=d4b2ee895cdafd16c655bc5a6f4329b9&pid=1-s2.0-S1049386724000483-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545398","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":"Navigating Miscarriage Management Post-Dobbs: Health Risks and Ethical Dilemmas","authors":"","doi":"10.1016/j.whi.2024.05.004","DOIUrl":"10.1016/j.whi.2024.05.004","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 449-454"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386724000458/pdfft?md5=63eea5d90ad24e6b29c3e4d256e92e3d&pid=1-s2.0-S1049386724000458-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141459958","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 Impact of Immigration Policy Changes on Preterm Birth Rates in Texas: An Examination of Border and Nonborder Regions","authors":"","doi":"10.1016/j.whi.2024.03.006","DOIUrl":"10.1016/j.whi.2024.03.006","url":null,"abstract":"<div><h3>Background</h3><p>Our study examined the acute and sustained impact of immigration policy changes announced in January 2017 on preterm birth (PTB) rates among Hispanic and non-Hispanic white women in Texas's border and nonborder regions.</p></div><div><h3>Methods</h3><p>Using Texas birth certificate data for years 2008 through 2020, we used a multiple group interrupted time series approach to explore changes in PTB rates.</p></div><div><h3>Results</h3><p>In the nonborder region, the PTB rate among Hispanic women of any race was 8.64% in 2008 and was stable each year before 2017 but increased by .29% (95% CI [.12, .46]) annually between 2017 and 2020. This effect remained statistically significant even when compared with that of non-Hispanic white women (<em>p</em> = .014). In the border areas, the PTB rate among Hispanic women of any race was 11.67% in 2008 and remained stable each year before and after 2017. No significant changes were observed when compared with that of non-Hispanic white women (<em>p</em> = .897). In Texas as a whole, the PTB rate among Hispanic women of any race was 10.16% in 2008 and declined by .07% (95% CI [−.16, −.03]) per year before 2017, but increased by .16% (95% CI [.05, .27]) annually between 2017 and 2020. The observed increase was not statistically significant when compared with that of non-Hispanic white women (<em>p</em> = .326).</p></div><div><h3>Conclusions</h3><p>The January 2017 immigration policies were associated with a sustained increase in PTB among Hispanic women in Texas's nonborder region, suggesting that geography plays an important role in perceptions of immigration enforcement. Future research should examine the impact of immigration policies on maternal and child health<span>, considering geography and sociodemographic factors.</span></p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 361-369"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899197","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":"Latent Profiles of Disordered Eating Among Veterans: Associations With Mental Health Concerns","authors":"","doi":"10.1016/j.whi.2024.03.002","DOIUrl":"10.1016/j.whi.2024.03.002","url":null,"abstract":"<div><h3>Background</h3><p>Varying patterns in eating disorder<span> (ED) classification are evident and may impact ED treatment and prevention. However, investigations of patterns of heterogeneity in ED presentations have been limited to civilian samples, despite the high prevalence of EDs in military personnel and veterans. The present study aimed to explore ED-related symptom patterns, including emotional overeating, in women veterans.</span></p></div><div><h3>Methods</h3><p><span><span>Participants were 407 women veterans using health care<span> services at a large Veterans Affairs<span> health care system who completed </span></span></span>mental health<span><span> measures via surveys. Latent profile analyses were used to explore distinct ED symptom patterns (binge eating, purging, heavy exercise, positive and negative emotional overeating, dietary restraint, and shape/weight concerns). Subsequent auxiliary models explored associations with mental health concerns (depressive symptoms, </span>posttraumatic stress disorder, anxiety, </span></span>alcohol misuse, substance misuse), adjusting for age, race and ethnicity, and service branch.</p></div><div><h3>Results</h3><p>A four-class solution demonstrated the best model fit, characterized as follows: 1) Low ED Concerns, 2) Moderate Dietary Restraint/Negative Emotional Eating, 3) High Binge/Emotional Eating, and 4) High ED Concerns. Although all profiles had moderate or higher levels of negative emotional overeating, the High Binge/Emotional Eating and High ED Concerns profiles were distinct in levels of dietary restraint and had the highest probabilities of positive emotional overeating. The High ED Concerns profile also had the most severe mental health concerns relative to the other profiles.</p></div><div><h3>Conclusions</h3><p>The identification of unique ED symptom patterns in women veterans can inform prevention and intervention efforts.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 437-448"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858943","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":"Experiences and Perceptions of Maternal Autonomy and Racism Among BIPOC Veterans Receiving Cesarean Sections","authors":"","doi":"10.1016/j.whi.2024.04.001","DOIUrl":"10.1016/j.whi.2024.04.001","url":null,"abstract":"<div><h3>Background</h3><p>Previous studies of pregnant veterans enrolled in Department of Veterans Affairs<span> (VA) care reveal high rates of cesarean sections among racial/ethnic minoritized groups, particularly in southern states. The purpose of this study was to better understand contributors to and veteran perceptions of maternal autonomy and racism among veterans receiving cesarean sections.</span></p></div><div><h3>Methods</h3><p>We conducted semi-structured interviews to understand perceptions of maternal autonomy and racism among 27 Black, Indigenous, People of Color (BIPOC) veterans who gave birth via cesarean section using VA maternity care benefits.</p></div><div><h3>Results</h3><p><span>Our study found that a substantial proportion (67%) of veterans had previous cesarean sections, ultimately placing them at risk for subsequent cesarean sections. More than 60% of veterans with a previous cesarean section requested a labor after cesarean (LAC) but were either refused by their provider or experienced complications that led to another cesarean section. Qualitative findings revealed the following: (1) differences in treatment by veterans’ race/ethnicity may reduce maternal agency, (2) many veterans felt unheard and uninformed regarding birthing<span> decisions, (3) access to VA-paid doula care may improve maternal agency for BIPOC veterans during labor and birth, and (4) BIPOC veterans face substantial challenges related to </span></span>social determinants of health.</p></div><div><h3>Conclusion</h3><p>Further research should examine veterans’ perceptions of racism in obstetrical care, and the possibility of VA-financed doula care to provide additional labor support to BIPOC veterans.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 429-436"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959829","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}