Womens Health Issues最新文献

{"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}

{"title":"Interest in and Support for Alternative Models of Medication Abortion Provision Among Patients Seeking Abortion in the United States","authors":"","doi":"10.1016/j.whi.2024.03.003","DOIUrl":"10.1016/j.whi.2024.03.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Medication abortion is safe and effective, but restrictions still limit patients from accessing this method. Alternative models of medication abortion provision, namely advance provision, over-the-counter (OTC), and online, could help improve access to care for some, although there is limited evidence about abortion patients’ interest in these models.</p></div><div><h3>Methods</h3><p>Between 2017 and 2019, we administered a cross-sectional survey to abortion patients at 45 clinics across 15 U.S. states to explore their interest in and support for advance provision, OTC, and online abortion access. We assessed relationships between sociodemographic characteristics and interest in and support for each model using bivariate logistic regressions and present perceived advantages and disadvantages of each model, as described by a subset of participants.</p></div><div><h3>Results</h3><p>Among 1,965 people enrolled, 1,759 (90%) initiated the survey. Interest in and support for advance provision was highest (72% and 82%, respectively), followed by OTC (63% and 72%) and online access (57% and 70%). In bivariate analyses, non-Hispanic Black and Asian/Pacific Islander respondents expressed lower interest and support for the online model and Alaska Native/Native American respondents expressed higher interest in an OTC model, as compared with white respondents. Among 439 participants naming advantages and disadvantages of each model, the most common advantages included convenience and having the abortion earlier. The most common disadvantages were not seeing a provider first and possibly taking pills incorrectly.</p></div><div><h3>Conclusions</h3><p>Although most abortion patients expressed interest in and support for alternative models of medication abortion provision, variation in support across race/ethnicity highlights a need to ensure that abortion care service models meet the needs and preferences of all patients, particularly people from historically underserved populations.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 381-390"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386724000239/pdfft?md5=23e6190e7b1838eff0d99ad2101f123d&pid=1-s2.0-S1049386724000239-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866937","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":"Florida Doulas’ Perspectives on Their Role in Reducing Maternal Morbidity and Health Disparities","authors":"","doi":"10.1016/j.whi.2024.01.003","DOIUrl":"10.1016/j.whi.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Maternal mortality rates continue to rise in the United States. Considerable </span>racial disparities<span> exist, as Black women face two to three times the risks of dying from pregnancy-related complications compared with white women. </span></span>Doulas have been associated with improved maternal outcomes. This study aimed to 1) investigate Florida doulas’ perspectives and influence on severe maternal morbidity/mortality and related inequities, as well as 2) identify opportunities for actionable change. The social ecological model, which acknowledges how individual, interpersonal, institutional, community, and public policy factors intersect, informed our analysis.</p></div><div><h3>Methods</h3><p>This qualitative study included seven online in-depth interviews and seven focus groups with doulas (<em>N</em><span><span> = 31) in Florida. Interview guides investigated how doulas perceive their role in the context of a) maternal morbidity and b) </span>health disparities.</span></p></div><div><h3>Results</h3><p><span><span>Doulas<span> associated maternal morbidity and </span></span>health disparities with Black pregnant people, identifying racism as a major contributor. Doulas identified their role as one that most often intersects with the individual and interpersonal levels of the social ecological model. Doulas report providing positive social surveillance and </span>emotional support<span><span>, contributing education and resources, and championing for advocacy in health care<span> settings. Actionable steps recommended by doulas to further mitigate health disparities include the integration of implicit bias training into doula certification programs, increasing </span></span>public health funding to bolster a doula workforce that can serve racial and ethnic communities, establishing doula–hospital partnerships to improve relational communication, providing tailored resources for clients featuring representative messaging, and doulas’ continued engagement in positive social surveillance of their clients.</span></p></div><div><h3>Conclusions</h3><p><span><span>Doulas perceived their role as integral to mitigating maternal morbidity and </span>health disparities, particularly in the context of supporting and advocating for </span>birthing persons on all levels of the social ecological model. Equitable access to doulas for low-income and/or minoritized populations may be one key strategy to improve maternal health equity.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 417-428"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Accessing Paid Parental Leave Among Birthing Parents With Perinatal Health Complications: A Multiple-Methods Study","authors":"","doi":"10.1016/j.whi.2024.02.002","DOIUrl":"10.1016/j.whi.2024.02.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Even in the small number of U.S. states with paid parental leave (PPL) programs, studies have found awareness of PPL remains low and unevenly distributed among parents. Moreover, little is known about whether parents with perinatal health complications have unmet needs in obtaining information about and support for accessing parental leave during that time. This study aims to address this research gap. Given the strong evidence linking paid leave with improvements in maternal and infant health, it is critical to evaluate access among vulnerable populations.</p></div><div><h3>Methods</h3><p><span>We used a multiple methods approach, including a subset of the 2016–2017 Bay Area Parental Leave Survey of Mothers (analytic sample = 1,007) and interview data from mothers who stayed at a neonatal intensive care unit in 2019 (</span><em>n</em><span><span><span> = 7). All participants resided at that time in California, a state that offers PPL. The independent variable for the survey analysis was a composite measure of perinatal complications, quantified as binary with a value of 1 if respondents reported experiencing any of the four complications: poor maternal </span>mental health<span> during or after pregnancy, premature birth, or poor infant health. </span></span>Dependent variables<span> for the survey analysis measured lack of support or information for accessing PPL. We used linear probability models to assess the relationship between perinatal complications<span> and PPL support. Thematic analysis was conducted with the interview data to understand how perinatal complications shape the process of accessing PPL.</span></span></span></p></div><div><h3>Results</h3><p>Survey results revealed that parents with perinatal complications had a lower understanding of PPL benefits and low overall support for accessing leave, including from employers, compared with parents without perinatal complications. From interviews, we learned that perinatal complications present unique challenges to parents navigating PPL. There were multiple entities involved in managing leave and providing information, such as the benefits coordinator and employers. Supervisors were reported as providers of critical emotional and financial support.</p></div><div><h3>Conclusions</h3><p>Taken together, the findings from surveys and interviews suggest that health care and human resources personnel should be better equipped to provide information and support, particularly to those who experience perinatal complications and might struggle to complete paperwork while facing health challenges.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 331-339"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859263","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":"United States Doula Programs and Their Outcomes: A Scoping Review to Inform State-Level Policies","authors":"","doi":"10.1016/j.whi.2024.03.001","DOIUrl":"10.1016/j.whi.2024.03.001","url":null,"abstract":"<div><h3>Background</h3><p>The field of maternal health has advanced significantly over the past decades. However, the United States continues to have poor outcomes in comparison with other industrialized nations. With emerging evidence on the promise of doula care, states are including doula care under their Medicaid programs.</p></div><div><h3>Methods</h3><p>We conducted a scoping review across four academic databases and gray literature published between January 1, 2012, and March 10, 2022, to describe the landscape of literature on U.S. doula programs and their outcomes in order to inform state policy makers considering laws or programs related to doula care.</p></div><div><h3>Findings</h3><p>Of 740 records identified, 100 met inclusion criteria. Outcomes fell into four areas: birthing people's outcomes, infant outcomes, systems of care and implementation, and cross-cutting issues. Data on outcomes related to doula care in the literature were predominantly clinical, even though doulas are not clinical providers. Although some studies have found associations between doula care and improved clinical outcomes for birthing people and infants, the evidence is limited due to small sample sizes, study methodology, or conflicting conclusions. Doula outcomes are underexplored in the literature, with mainly qualitative data describing low levels of diversity and equity within the doula workforce and ineffective payment models. When cost-effectiveness estimates have been calculated, they largely rely on savings realized from averted cesarean births, preterm births, and neonatal intensive care unit admissions.</p></div><div><h3>Conclusions</h3><p>As state Medicaid programs expand to include doula care, policymakers should be aware of the limitations in the evidence as they plan for successful implementation, such as the narrow focus on certain clinical outcomes to quantify cost savings and conflicting conclusions on the impact of doula care. An important consideration is the impact of the reimbursement rate on the adoption of doula care, which is why it is important to engage doulas in compensation determinations, as well as the development of improved metrics to untangle the components that contribute to maternal health outcomes in the United States.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 350-360"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386724000215/pdfft?md5=1b5bbb128ae26b1b8ef8b1d1de055cf1&pid=1-s2.0-S1049386724000215-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899252","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}