Womens Health Issues最新文献

{"title":"Maternity Care Deserts in Louisiana and Breastfeeding Initiation","authors":"Chanell O. Haley PhD ,&nbsp;Lily E. King MPH ,&nbsp;Lauren Dyer MPH ,&nbsp;Melissa G. Evans PhD ,&nbsp;Katherine P. Theall PhD ,&nbsp;Maeve Wallace PhD","doi":"10.1016/j.whi.2023.11.010","DOIUrl":"10.1016/j.whi.2023.11.010","url":null,"abstract":"<div><h3>Background</h3><p>Breastfeeding provides physical, psychological, and immunological benefits to both the mother and infant, but breastfeeding rates are suboptimal. The purpose of this study was to examine whether residing in a maternity care desert (a county with no hospital offering obstetric care and no OB/GYN or certified nurse midwife providers) was associated with lower breastfeeding rates among birthing people in Louisiana from 2019 to 2020.</p></div><div><h3>Methods</h3><p>Data provided by the March of Dimes were used to classify Louisiana parishes by level of access to maternity care. Using data on all live births provided by the Louisiana Office of Vital Records (<em>n</em> = 112,151), we fit adjusted modified Poisson regression models with generalized estimating equations and exploratory geospatial analysis to examine the association between place of residence and breastfeeding initiation and racial disparities in initiation. We conducted a secondary within-group analysis by fitting the fully adjusted model stratified by race/ethnicity for non-Hispanic white and non-Hispanic Black birthing people.</p></div><div><h3>Results</h3><p>We found that residing in a parish with limited (odds ratio [OR] = 0.87; 95% confidence interval [CI] [0.77, 0.99]) to no access (OR = 0.88; 95% CI [0.80, 0.97]) was significantly associated with lower breastfeeding initiation rates. The within-group analysis determined that both non-Hispanic Black and non-Hispanic white birthing people residing in a parish with limited or no maternity care access had lower breastfeeding initiation rates.</p></div><div><h3>Conclusion</h3><p>Reducing rural and racial inequities in breastfeeding may require structural changes and investments in infrastructure to deliver pregnancy care.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 276-282"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386723002116/pdfft?md5=7556f0e6ec68386cf136ee1e8581717b&pid=1-s2.0-S1049386723002116-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433183","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":"Increasing Urban African American Women's Readiness for Pre-exposure Prophylaxis: A Pilot Study of the Women Prepping for PrEp Plus Program (WP3+)","authors":"Gail E. Wyatt PhD ,&nbsp;Enricka Norwood-Scott BA ,&nbsp;Michele Cooley-Strickland PhD ,&nbsp;Muyu Zhang MA ,&nbsp;Amber Smith-Clapham MA ,&nbsp;Wilbert Jordan MD ,&nbsp;Honghu Liu PhD ,&nbsp;Alison B. Hamilton PhD, MPH","doi":"10.1016/j.whi.2023.11.001","DOIUrl":"10.1016/j.whi.2023.11.001","url":null,"abstract":"<div><h3>Background</h3><p>African American women are disproportionately at risk for HIV infection<span>. To increase women's readiness to consider taking pre-exposure prophylaxis (PrEP), we conducted a pilot study of Women Prepping for PrEP Plus (WP3+). Adapted from an evidence-based HIV risk reduction intervention for African American couples who are HIV-serodiscordant, WP3+ is a group-based culturally congruent program designed for African American women without HIV.</span></p></div><div><h3>Methods</h3><p>Women were screened for eligibility; if eligible, they were invited to participate in the four-session WP3+ group. Participants completed surveys at baseline (<em>n</em> = 47) and post-implementation (<em>n</em><span><span> = 28); surveys assessed demographics, HIV and PrEP knowledge, depression and posttraumatic stress (PTS) </span>symptoms<span><span>, substance use, sexual risk behaviors, health care–related discrimination, and social support. In a process evaluation, a subset of women completed </span>qualitative interviews at baseline (</span></span><em>n</em> = 35) and post-implementation (<em>n</em> = 18); the interviews were designed to converge with (e.g., on HIV and PrEP knowledge) and expand upon (e.g., unmeasured perceived impacts of WP3+) quantitative measures. To triangulate with the quantitative data, deductive qualitative analysis concentrated on women's knowledge and awareness of PrEP and HIV, their relationship dynamics and challenges, and their considerations (e.g., barriers, facilitators) related to taking PrEP; inductive analysis focused on women's experiences in the intervention.</p></div><div><h3>Results</h3><p>Participants in the WP3+ intervention reported: improved proportion of condom use in the past 90 days (<em>p</em> &lt; .01) and in a typical week (<em>p</em> &lt; .05); reduced PTS symptoms (<em>p</em> &lt; .05); increased HIV knowledge (<em>p</em> &lt; .0001) and awareness of PrEP (<em>p</em> &lt; .001); and greater consideration of using PrEP (<em>p</em> &lt; .001). In interviews, participants expressed not only increased knowledge but also appreciation for learning how to protect themselves against HIV, communicate with their partners, and take charge of their health, and they expressed greater receptiveness to using PrEP as a result of the knowledge and skills they gained.</p></div><div><h3>Conclusions</h3><p>The WP3+ pilot study demonstrated preliminary efficacy and acceptability as an HIV-prevention program for African American women. A controlled trial is needed to confirm its efficacy for increasing PrEP use among African American women.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 241-249"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547416","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":"Using Administrative Claims Data to Address Maternal Health Disparities: Benefits, Pitfalls, and Methodological Solutions","authors":"Sara E. Heins PhD ,&nbsp;Toyya A. Pujol PhD","doi":"10.1016/j.whi.2024.04.002","DOIUrl":"10.1016/j.whi.2024.04.002","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 217-220"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868509","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 Toxicity Considerations in Breast Reconstruction: Recommendations for Research and Practice","authors":"Hannah Kinzer MPH ,&nbsp;Clara N. Lee MD, MPP ,&nbsp;Krista Cooksey BA ,&nbsp;Terence Myckatyn MD ,&nbsp;Margaret A. Olsen PhD, MPH ,&nbsp;Randi Foraker PhD, MA, FAHA, FAMIA, FACMI ,&nbsp;Anna Rose Johnson MD, MPH ,&nbsp;Mary C. Politi PhD","doi":"10.1016/j.whi.2024.01.005","DOIUrl":"10.1016/j.whi.2024.01.005","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 107-114"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984218","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":"Communication Preferences During Pregnancy Care Among Patients With Primary Spanish Language: A Scoping Review","authors":"Luis Rivera MD ,&nbsp;Haylie Butler BA ,&nbsp;Kevin E. Salinas MD ,&nbsp;Carrie Wade MLIS ,&nbsp;Maria Bazan MD, MPH ,&nbsp;Elysia Larson ScD, MPH ,&nbsp;Rose L. Molina MD, MPH","doi":"10.1016/j.whi.2023.08.008","DOIUrl":"10.1016/j.whi.2023.08.008","url":null,"abstract":"<div><h3>Background</h3><p>Qualified language service providers (QLSPs)—professional interpreters or multilingual clinicians certified to provide care in another language—are critical to ensuring meaningful language access for patients. Designing patient-centered systems for language access could improve quality of pregnancy care.</p></div><div><h3>Objective</h3><p>We synthesized and identified gaps in knowledge about communication preferences during pregnancy care among patients with Spanish primary language.</p></div><div><h3>Methods</h3><p>We performed a scoping review of original research studies published between 2000 and 2022 that assessed communication preferences in Spanish-speaking populations during pregnancy care. Studies underwent title, abstract, and full-text review by three investigators. Data were extracted for synthesis and thematic analysis.</p></div><div><h3>Results</h3><p>We retrieved 1,539 studies. After title/abstract screening, 36 studies underwent full-text review, and 13 of them met inclusion criteria. Two additional studies were included after reference tracing. This yielded a total of 15 studies comprising qualitative (<em>n</em> = 7), quantitative (<em>n</em> = 4), and mixed-methods (<em>n</em> = 4) studies. Three communication preference themes were identified: language access through QLSPs (<em>n</em> = 7); interpersonal dynamics and perceptions of quality of care (<em>n</em> = 9); and information provision and shared decision-making (<em>n</em><span><span> = 8). Although seven studies reported a strong patient preference to receive prenatal care from Spanish-speaking clinicians, none of the included studies assessed clinician </span>Spanish language proficiency or QLSP categorization.</span></p></div><div><h3>Conclusions</h3><p>Few studies have assessed communication preferences during pregnancy care among patients with primary Spanish language. Future studies to improve communication during pregnancy care for patients with primary Spanish language require intentional analysis of their communication preferences, including precision regarding language proficiency among clinicians.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 164-171"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41216219","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":"Associations Between Head Injury, Strangulation, Cardiometabolic Health, and Functional Disability Among Female Survivors of Intimate Partner Violence","authors":"Michelle M. Pebole PhD, MA ,&nbsp;Katherine M. Iverson PhD ,&nbsp;Catherine B. Fortier PhD ,&nbsp;Kimberly B. Werner PhD ,&nbsp;Jennifer R. Fonda PhD, MA ,&nbsp;Alyssa Currao MPH ,&nbsp;James W. Whitworth PhD ,&nbsp;Regina E. McGlinchey PhD ,&nbsp;Tara E. Galovski PhD","doi":"10.1016/j.whi.2023.11.002","DOIUrl":"10.1016/j.whi.2023.11.002","url":null,"abstract":"<div><h3>Objective</h3><p>Head injury<span><span><span> and strangulation are highly prevalent in intimate partner violence (IPV) contexts, but there is little research examining the potential implications of these injuries on physical health and </span>functional status. This pilot study explored the extent to which injury type (head injury, strangulation) and severity (no injury, subconcussive head injury, </span>traumatic brain injury; no strangulation, strangulation, strangulation with loss of consciousness) were associated with biomarkers of cardiometabolic health and self-reported functioning among female survivors of IPV.</span></p></div><div><h3>Methods</h3><p><span><span>Participants were 51 individuals assigned female at birth who experienced IPV during their lifetime and screened positive for probable </span>posttraumatic stress disorder<span> (PTSD) on the PTSD Checklist for </span></span><em>DSM-5</em> (average age = 32.6 years, SD = 7.1).</p></div><div><h3>Results</h3><p><span>Head injury was associated with statistically significant increases in blood glucose levels (</span><em>p</em> = .01, <em>d</em><span> = 1.10). Shifts toward more high-risk values with moderate-strong effect sizes were also found in high-density lipoprotein, low-density lipoprotein, and waist-to-hip ratio (</span><em>p</em>s: .06–.13; <em>d</em>s: 0.51–1.30). Strangulation was associated with increased cholesterol levels, with a moderate effect size (<em>p</em> = .20, <em>d</em><span> = 0.59). Regression models accounting for age, education, PTSD symptoms, childhood trauma, strangulation, and head injuries predicted functional disability status (</span><em>R</em>² = 0.37, <em>p</em> &lt; .01) and several of its associated domains: cognition (<em>R</em>² = 0.34, F(8,42) = 2.73, <em>p</em> = .01), mobility (<em>R</em>² = 0.47, F(8,42) = 4.82, <em>p</em> &lt; .001), and participation in society (<em>R</em>² = 0.33, F(8,42) = 2.59, <em>p</em> = .02).</p></div><div><h3>Conclusions</h3><p>Findings suggest the need to develop integrated treatments<span> that address physical health comorbidities among female survivors of IPV with a history of head injury to improve daily function and quality of life.</span></p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 208-216"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812242","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":"Characteristics of U.S. Abortion Patients Who Obtained Care Out of State Prior to the Overturning of Roe v. Wade","authors":"Sarah M. Axelson MSW ,&nbsp;Riley J. Steiner PhD, MPH ,&nbsp;Rachel K. Jones PhD","doi":"10.1016/j.whi.2023.10.003","DOIUrl":"10.1016/j.whi.2023.10.003","url":null,"abstract":"<div><h3>Context</h3><p>In light of the <span><em>Dobbs v. Jackson </em><span>Women's Health</span><em> Organization</em></span> decision overturning <em>Roe v. Wade,</em> the number of people who need to travel out of state for abortion is increasing as several states impose abortion bans. Better understanding the characteristics of patients who obtained out-of-state abortions before the decision can provide a reference point for future research and inform efforts to improve abortion access.</p></div><div><h3>Methods</h3><p>We used data from the 2014 Abortion Patient Survey, administered by the Guttmacher Institute, to examine the prevalence and characteristics of patients obtaining nonhospital abortions outside of their state of residence. We examined bivariate and multivariable associations between selected characteristics and obtaining an abortion out of state.</p></div><div><h3>Results</h3><p>Six percent of abortion patients traveled out of state for care. Among patients who obtained their abortion out of state, more than half (56.9%) were non-Hispanic (NH) white, 26.6% were non-Hispanic Black, and 10.2% were Hispanic. Two-fifths (43.9%) resided in the South, one-third (34.3%) resided in the Midwest, 15% resided in the Northeast, and 7% resided in the West. More than one-third (38.2%) had family incomes below 100% of the federal poverty level (FPL), and two-thirds (67.7%) paid out of pocket; only 3% used Medicaid. Profiles of out-of-state abortion patients differed from in-state abortion patients by all characteristics except age. In adjusted analyses, NH Black (adjusted odds ratio [AOR]: 0.76; 95% confidence interval [CI]: 0.61–0.96), NH Asian, South Asian, and Asian Pacific Islander (AOR: 0.37; 95% CI: 0.20–0.67), and Hispanic (AOR: 0.46; 95% CI: 0.33–0.64) patients had lower odds of traveling out of state compared with their NH white counterparts. Compared with those paying for their abortion with private insurance, those who paid out of pocket had higher odds of traveling out of state (AOR: 1.75; 95% CI: 1.29–2.37) and those paying with Medicaid had lower odds (AOR: 0.27; 95% CI: 0.15–0.47).</p></div><div><h3>Conclusion</h3><p>Given the observed differences by race/ethnicity and method of payment for abortion, people of color and those without resources to pay out of pocket may especially benefit from efforts to support access to abortion care via interstate travel as an increasing number of states ban abortion.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 142-147"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812278","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":"Early Childcare Precarity and Subsequent Maternal Health","authors":"Carol Duh-Leong MD, MPP ,&nbsp;Caitlin F. Canfield PhD ,&nbsp;Anne E. Fuller MD, MS ,&nbsp;Rachel S. Gross MD, MS ,&nbsp;Nancy E. Reichman PhD","doi":"10.1016/j.whi.2023.10.002","DOIUrl":"10.1016/j.whi.2023.10.002","url":null,"abstract":"<div><h3>Purpose</h3><p>We examined prospective associations between early childcare precarity, or the security and reliability of childcare arrangements, and subsequent maternal health.</p></div><div><h3>Study Design</h3><p><span>We conducted a secondary analysis of survey responses from mothers of 2,836 children in the Future of Families and Child Wellbeing study. We assessed the following childcare measures: insecure childcare, insecure childcare with missed work, inadequate childcare, and emergency childcare support. We used linear and </span>logistic regression models with robust standard errors to examine associations between these measures when the index child was age 3 and maternal health outcomes (overall health, depression, and parenting stress) later when the child was age 9. We then examined additive experiences of childcare measures across child ages 1 and 3 on maternal health outcomes.</p></div><div><h3>Results</h3><p><span>Early inadequate childcare was associated with higher odds of later poor maternal overall health (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.11–2.41). All early childcare precarity measures were associated with higher odds of maternal depression (insecure childcare [aOR, 1.64; 95% CI, 1.23–2.18]; insecure childcare with missed work [aOR, 1.58; 95% CI, 1.13–2.22]; and inadequate childcare [aOR, 1.75; 95% CI, 1.22–2.51]). Emergency childcare support was associated with lower odds of adverse maternal health outcomes (poor overall health [aOR, 0.65; 95% CI, 0.48 to 0.88]; depression [aOR, 0.73; 95% CI, 0.54 to 0.99]; and parenting stress [</span><em>B</em> −0.45; 95% CI, −0.80 to −0.10]). Prolonged experiences had stronger associations with maternal health than shorter experiences.</p></div><div><h3>Conclusion</h3><p><span>Early childcare precarity has long-term adverse associations with maternal health, and emergency childcare support seems to be favorable for maternal health. These findings highlight childcare precarity as a social determinant of </span>women's health for researchers, clinicians, and decision-makers.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 115-124"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136399715","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":"Effects of Georgia's Medicaid Family Planning Waiver on Pregnancy Characteristics and Birth Outcomes","authors":"Gery P. Guy Jr. PhD, MPH ,&nbsp;E. Kathleen Adams PhD, MS ,&nbsp;Sara K. Redd PhD, MSPH ,&nbsp;Anne L. Dunlop MD, MPH","doi":"10.1016/j.whi.2023.11.004","DOIUrl":"10.1016/j.whi.2023.11.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Medicaid family planning waivers can increase access to health care<span><span> services and have been associated with lower rates of unintended pregnancy, which is associated with a higher risk of negative birth outcomes such as </span>preterm birth and low birthweight. The objective of this study was to test the effect of Georgia's Medicaid family planning waiver, Planning for Healthy Babies (P4HB), on pregnancy characteristics and birth outcomes.</span></p></div><div><h3>Materials and Methods</h3><p><span>We used the Pregnancy Risk Assessment Monitoring System (PRAMS) survey data in pre- (2008–2009) and two post-periods (2012–2013; 2017–2019). We identified those likely eligible for P4HB in Georgia (</span><em>n</em> = 1,967) and 10 comparison states (<em>n</em><span> = 13,449) and tested for effects using state and year fixed effects difference-in-differences modeling.</span></p></div><div><h3>Results</h3><p>P4HB was associated with a 13.3 percentage-point (pp) decrease in unintended pregnancy in the immediate post-period (<em>p</em> &lt; .01) and an 11.4 pp decrease in the later post-period (<em>p</em> &lt; .05). For the immediate post-period, P4HB was also associated with a 29.2 pp increase in the probability of prepregnancy contraception (<em>p</em><span> &lt; .001) and a 1.1 pp decrease in the probability of a very low birthweight (VLBW) birth (</span><em>p</em> &lt; .01). The reduction in VLBW birth was significant for non-Hispanic Black mothers (−3.9 pp; <em>p</em> &lt; .05) but not for mothers of other races/ethnicities.</p></div><div><h3>Discussion</h3><p><span>Medicaid family planning waivers are an important structural policy intervention that can improve reproductive </span>health care<span>, particularly in states without Medicaid expansion. These waivers may also help address long-standing racial/ethnic disparities in access to reproductive health care and, potentially, adverse pregnancy and birth outcomes. However, the initial increase in pregnancies among people using contraception indicates that care must be taken to ensure that recipients have access to effective methods of contraception and receive counseling on effective use in order to avoid unintended consequences as more individuals try to prevent a pregnancy.</span></p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 125-134"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812282","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":"“I Wasn't Expecting That Question”: Responses to Requests for Abortion Referral at College Student Health Centers","authors":"Priyanka Anand MD ,&nbsp;Licia Bravo BS ,&nbsp;Sarah Gutman MD, MSPH ,&nbsp;Arden McAllister MPH ,&nbsp;Shimrit Keddem PhD ,&nbsp;Sarita Sonalkar MD, MPH","doi":"10.1016/j.whi.2023.12.003","DOIUrl":"10.1016/j.whi.2023.12.003","url":null,"abstract":"<div><h3>Background</h3><p>Women 18–24 years of age have the highest proportion of unintended pregnancies of any age group, and thus represent a significant population in need of abortion services. Prior research indicated that only half of college student health centers provide appropriate abortion referrals. Our objective was to better understand the referral experience and barriers to abortion referral at college student health centers.</p></div><div><h3>Procedures</h3><p>We conducted a “secret caller” study at all 4-year colleges in Pennsylvania between June 2017 and April 2018, using a structured script requesting abortion referral. Calls were transcribed, coded using an iteratively developed codebook, and analyzed for themes related to barriers and facilitators of abortion referral.</p></div><div><h3>Main Findings</h3><p>A total of 202 completed transcripts were reviewed. Themes that emerged were knowledge, experience, and comfort with abortion referral; support, empathy, and reassurance<span><span>; coercion; misleading language; questioning the caller's </span>autonomy; and institutional policy against referral. Most staff lacked knowledge and comfort with abortion referral. Although some staff members made supportive statements toward the caller, others used coercive language to try to dissuade the caller from an abortion. Many staff cited religious institutional policies against abortion referral and expressed a range of feelings about such policies.</span></p></div><div><h3>Conclusions</h3><p>Abortion referrals at student health centers lack consistency. Staff members frequently did not have the knowledge needed to provide appropriate abortion referrals, used coercive language in responding to requests for referrals, and perpetuated abortion stigma. Some health staff used coercive or evasive language that further stigmatized the caller's request for an abortion referral. College health centers should improve training and resources around abortion referral to ensure they are delivering appropriate, high-quality care.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 148-155"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139513983","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}