Womens Health Issues最新文献

{"title":"Socioeconomic and Racial/Ethnic Inequalities in Infertility Prevalence, Help-Seeking, and Help Received Since 1995","authors":"","doi":"10.1016/j.whi.2024.03.005","DOIUrl":"10.1016/j.whi.2024.03.005","url":null,"abstract":"<div><h3>Background</h3><p>In the United States, infertility and treatment for infertility are marked by racial/ethnic and socioeconomic inequalities. Simultaneously, biomedical advances and increased public health attention toward preventing and addressing infertility have grown. It is not known, however, whether the racial/ethnic and socioeconomic inequalities observed in infertility prevalence, help-seeking, or help received have changed over time.</p></div><div><h3>Methods</h3><p><span>Using National Survey of Family Growth data (1995 through 2017–2019 cycles), this study applied multivariable logistic regression with interaction terms to investigate whether and how racial/ethnic and socioeconomic inequalities in 1) the prevalence of infertility, 2) ever seeking help to become pregnant, and 3) use of common types of medical help (advice, testing, medication for </span>ovulation, surgery for blocked tubes, and artificial insemination) have changed over time.</p></div><div><h3>Results</h3><p>The results showed persisting, rather than narrowing or increasing, inequalities in the prevalence of infertility and help-seeking overall. The results showed persisting racial/ethnic inequalities in testing, ovulation medication use, and surgery for blocked tubes. By contrast, the results showed widening socioeconomic inequalities in testing and narrowing inequalities in the use of ovulation medications.</p></div><div><h3>Conclusions</h3><p>There is little evidence to suggest policy interventions, biomedical advances, or increased public health awareness has narrowed inequalities in infertility prevalence, treatment seeking, or use of specific treatments.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 401-408"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872990","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":"Neighborhood Racialized Economic Polarization, Home Visiting Coverage, and Adverse Birth Outcomes in a Medicaid-eligible Population","authors":"","doi":"10.1016/j.whi.2024.05.001","DOIUrl":"10.1016/j.whi.2024.05.001","url":null,"abstract":"<div><h3>Background</h3><p>Residential polarization shaped by racial segregation and concentrations of wealth (hereafter neighborhood racialized economic polarization) results in both highly deprived and highly privileged neighborhoods. Numerous studies have found a negative relationship between neighborhood racialized economic polarization and birth outcomes. We investigated whether community-informed home visiting programs achieve high rates of service coverage in highly deprived neighborhoods and can attenuate the deleterious effect of neighborhood polarization on birth outcomes.</p></div><div><h3>Methods</h3><p>We used 2016–2019 data from Michigan's statewide database that links birth records, Medicaid claims, and program participation (<em>N</em><span><span> = 211,412). We evaluated whether 1) home visiting programs achieved high rates of service coverage in highly deprived neighborhoods, 2) participation in home visiting may help to mitigate the negative relationship between neighborhood polarization and birth outcomes, and 3) the reductions in preterm birth and low birthweight were larger among Black </span>birthing individuals. Data were examined using multilevel generalized linear models and mediation analysis.</span></p></div><div><h3>Results</h3><p>The statewide home visiting program achieved higher rates of coverage in the most deprived neighborhoods (21.0% statewide, 28.3% in the most deprived vs. 10.4% in the most privileged neighborhoods). For all, home visiting participation was associated with a decrease in the relationship between neighborhood polarization and preterm birth by 6.8% (mean indirect effect, −0.008; 95% confidence interval, −0.011 to −0.005), and by 5.2% (mean indirect effect, −0.013; 95% confidence interval, −0.017 to −0.009) for low birthweight, adjusting for individual-level risk factors. The decrease was larger among Black individuals.</p></div><div><h3>Conclusions</h3><p>A statewide Medicaid-sponsored home visiting program achieved high rates of service coverage in highly deprived neighborhoods. Program participation may help to mitigate the negative relationship between neighborhood polarization and birth outcomes, and more so among Black individuals. Continued support for home visiting services is required to better engage birthing individuals in neighborhoods with concentrated deprivation and to decrease disparities.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 340-349"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285027","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":"Contraceptive Attitudes and Beliefs of Women With Sickle Cell Disease: A Qualitative Study","authors":"","doi":"10.1016/j.whi.2024.03.007","DOIUrl":"10.1016/j.whi.2024.03.007","url":null,"abstract":"<div><h3>Objectives</h3><p><span>We aimed to qualitatively explore factors influencing contraceptive use in women living with </span>sickle cell disease (SCD).</p></div><div><h3>Study Design</h3><p>We conducted a semi-structured qualitative study using data from interviews with reproductive-aged women with SCD. The Theory of Planned Behavior, which describes an individual's attitudes, subjective norms, and perceived behavioral control as drivers of a health behavior, served as a framework for data collection and thematic analysis.</p></div><div><h3>Results</h3><p>We analyzed interviews from 20 participants. Attitudes toward contraception showed skepticism regarding hormonal contraception<span> and concern about adverse effects of contraception related to SCD. The role of subjective norms in contraceptive choice depended on whether participants possessed trusted sources of information, such as health care providers, family, and friends, or whether they relied on themselves alone in their contraceptive decision-making. The influence of health care providers was complicated by inconsistent and sometimes conflicting counseling. Finally, with regard to participants’ perceived control in their contraceptive choices, some were motivated to alleviate menstrual pain or prevent SCD-related pregnancy risks, but many reported feeling disempowered in contraceptive decision-making settings because of ways that healthcare providers exerted pressure or responded to participants’ demographic characteristics.</span></p></div><div><h3>Conclusions</h3><p><span>Women living with SCD are influenced by many factors similar to those documented for other populations when making decisions about contraception. However, SCD amplifies both the importance and risks of contraception and may also complicate individuals' autonomy and contraceptive access. Hematology and </span>reproductive health<span> providers should recognize the risk of coercion, maximize patients’ reproductive agency, and coordinate reproductive health counseling for patients with SCD.</span></p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 409-416"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870301","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":"Pregnancy Care Utilization, Experiences, and Outcomes Among Undocumented Immigrants in the United States: A Scoping Review","authors":"","doi":"10.1016/j.whi.2024.02.001","DOIUrl":"10.1016/j.whi.2024.02.001","url":null,"abstract":"<div><h3>Background</h3><p>Undocumented immigrants face many barriers in accessing pregnancy care, including language differences, implicit and explicit bias, limited or no insurance coverage, and fear about accessing services. With the national spotlight on maternal health inequities, the current literature on undocumented immigrants during pregnancy requires synthesis.</p></div><div><h3>Objective</h3><p>We aimed to describe the literature on pregnancy care utilization, experiences, and outcomes of undocumented individuals in the United States.</p></div><div><h3>Methods</h3><p>We performed a scoping review of original research studies in the United States that described the undocumented population specifically and examined pregnancy care utilization, experiences, and outcomes. Studies underwent title, abstract, and full-text review by two investigators. Data were extracted and synthesized using descriptive statistics and content analysis.</p></div><div><h3>Results</h3><p>A total of 5,940 articles were retrieved and 3,949 remained after de-duplication. After two investigators screened and reviewed the articles, 29 studies met inclusion criteria. The definition of undocumented individuals varied widely across studies. Of the 29 articles, 24 showed that undocumented status and anti-immigrant policies and rhetoric are associated with lower care utilization and worse pregnancy outcomes, while inclusive health care and immigration policies are associated with higher levels of prenatal and postnatal care utilization as well as better pregnancy outcomes.</p></div><div><h3>Conclusions</h3><p>The small, heterogeneous literature on undocumented immigrants and pregnancy care is fraught with inconsistent definitions, precluding comparisons across studies. Despite areas in need of further research, the signal among published studies is that undocumented individuals experience variable access to pregnancy care, heightened fear and stress regarding their status during pregnancy, and worse outcomes compared with other groups, including documented immigrants.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 370-380"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140140886","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":"Delays in Care by Race, Ethnicity, and Gender Before and During the COVID-19 Pandemic Using Cross-Sectional Data From the National Institutes of Health's All of Us Research Program","authors":"","doi":"10.1016/j.whi.2024.02.003","DOIUrl":"10.1016/j.whi.2024.02.003","url":null,"abstract":"<div><h3>Purpose</h3><p>Delays in receiving medical care are an urgent problem. This study aims to determine whether the odds of, and reasons for, experiencing care delays differ by gender, race-ethnicity, and survey completion before versus during the COVID-19 pandemic.</p></div><div><h3>Methods</h3><p>We conducted a cross-sectional analysis of survey data from participants age ≥18 in the National Institutes of Health's All of Us Research Program collected from May 6, 2018, to January 1, 2022. Logistic regressions were performed to assess the association of gender, race-ethnicity, and survey completion date with any of nine reasons for delaying care in the past 12 months.</p></div><div><h3>Results</h3><p>Of 119,983 participants, 37.8% reported delaying care in the past 12 months. After adjusting for employment status, education, income, marital status, health insurance, and age, women of every race-ethnicity and Black and other race-ethnicity men were more likely than white men to report delays in care: Asian women (odds ratio [OR] 1.23; 95% confidence interval [CI] [1.13, 1.34]), Black men (OR 1.15; 95% CI [1.05, 1.25]) and women (OR 1.46; 95% CI [1.38, 1.54]), Hispanic women (OR 1.36; 95% CI [1.28, 1.44]), white women (OR 1.55; 95% CI [1.50, 1.60]), and other race-ethnicity men (OR 1.15; 95% CI [1.05, 1.27]) and women (OR 1.79; 95% CI [1.67, 1.91]). A small but statistically significant difference was seen in reports of care delays for non-pandemic-related reasons during versus before the COVID-19 pandemic (OR 0.88; 95% CI [0.83, 0.93]).</p></div><div><h3>Conclusions</h3><p>In this study of a diverse group of U.S. participants, women and Black and other race-ethnicity men were more likely than white men to report delays in care, both before and during COVID-19. Addressing care delays may be necessary to ameliorate health disparities by race-ethnicity and gender.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 391-400"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859381","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":"A Multipronged Approach to Caring for Women Veterans With Military Environmental Exposures","authors":"","doi":"10.1016/j.whi.2024.05.002","DOIUrl":"10.1016/j.whi.2024.05.002","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 325-330"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421454","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":"Young Women's Perspectives on Being Screened for Hereditary Breast and Ovarian Cancer Risk During Routine Primary Care","authors":"Mady Head MS, LCGC ,&nbsp;Betty Cohn MBE ,&nbsp;Karen J. Wernli PhD, MS ,&nbsp;Lorella Palazzo PhD ,&nbsp;Kelly Ehrlich MS ,&nbsp;Abigail Matson BA ,&nbsp;Sarah Knerr PhD, MPH","doi":"10.1016/j.whi.2024.01.004","DOIUrl":"10.1016/j.whi.2024.01.004","url":null,"abstract":"<div><h3>Purpose</h3><p>The U.S. Preventive Services Task Force recommends screening women to identify individuals eligible for genetic counseling based on <em>a priori</em> hereditary breast and ovarian cancer syndrome (HBOC) risk (i.e., risk assessment). However, risk assessment has not been widely integrated into primary care. This qualitative study explored young women's views on implementing routine HBOC risk assessment with a focus on equity and patient-centeredness.</p></div><div><h3>Methods</h3><p>We conducted group discussions with young women (aged 21–40 years) receiving care in an integrated health care system. Discussion groups occurred in two phases and used a modified deliberative approach that included a didactic component and prioritized developing consensus. Twenty women participated in one of three initial small group discussions (phase one). All 20 were invited to participate in a subsequent large group discussion (phase two), and 15 of them attended.</p></div><div><h3>Findings</h3><p>Key themes and recommendations were as follows. Risk assessment should be accessible, contextualized, and destigmatized to encourage participation and reduce anxiety, particularly for women who do not know their family history. Providers conducting risk assessments must be equipped to address women's informational needs, relieve emotionality, and plan next steps after positive screens. Finally, to minimize differential screening uptake, health care systems must prioritize equity in program design and contribute to external educational and outreach efforts.</p></div><div><h3>Conclusion</h3><p>Young women see pragmatic opportunities for health systems to optimize HBOC screening implementation.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 268-275"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050742","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":"“How Do I Prepare for This?” Patient Perspectives on Providers’ Employment-related Support During Pregnancy","authors":"Julia M. Goodman PhD, MPH ,&nbsp;Annette M. Crawford MPH, MPA, MSc ,&nbsp;Erika K. Cottrell PhD, MPP ,&nbsp;Jeanne-Marie Guise MD, MA, MPH, MBA","doi":"10.1016/j.whi.2024.01.002","DOIUrl":"10.1016/j.whi.2024.01.002","url":null,"abstract":"<div><h3>Background</h3><p>Health care providers can offer employment-related support to pregnant patients by providing information about occupational risks and benefits, discussing adjustments, and/or completing paperwork to help patients obtain accommodations or benefits, but little research has examined whether and how this support is provided.</p></div><div><h3>Methods</h3><p>We conducted interviews with 20 adults who had been employed while pregnant within the 5 years preceding data collection. Eligible participants had low incomes, were hourly wage earners, or were employed in service or retail occupations. Applied thematic analysis was used to identify emergent themes.</p></div><div><h3>Results</h3><p>People who had been employed while pregnant described a range of experiences during that time, including physical and psychological demands from work, lack of access to appropriate accommodations, difficulties combining breastfeeding with work, and work-related challenges accessing health care. Participants described four primary roles that health care providers played: 1) completing paperwork needed to apply for benefits or receive work modification; 2) providing information about how to mitigate employment-related risks; 3) providing referrals to social or medical services; and 4) advocating for patients to ensure receipt of accommodations, resources, and information. Strategies identified by patients that could be enacted within health care to help them better navigate the work-pregnancy interface include increasing appointment flexibility, providing information about work-related risks and benefits programs and referrals to legal support, and helping providers to understand and support their patients’ individual work-related concerns.</p></div><div><h3>Conclusions</h3><p>Health care providers have a critical role to play in supporting employed pregnant people to achieve flexibility in managing their work and to be active participants in discussions about recommended workplace accommodations.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 291-302"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933636","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":"Endometriosis and Disability: Analysis of Federal Court Appeals of Social Security Disability Insurance and Supplemental Security Income Claims by Individuals Suffering From Endometriosis","authors":"Martha Grace Cromeens JD, PhD, RN ,&nbsp;Kathleen Knafl PhD, FAAN ,&nbsp;Whitney R. Robinson PhD, MSPH ,&nbsp;Erin T. Carey MD, MSCR ,&nbsp;Zakiya Haji-Noor PhD, MPH ,&nbsp;Suzanne Thoyre PhD, RN, FAAN","doi":"10.1016/j.whi.2023.11.008","DOIUrl":"10.1016/j.whi.2023.11.008","url":null,"abstract":"<div><h3>Background</h3><p>Endometriosis, a chronic noncancerous gynecologic condition commonly characterized by disruptive physical and psychosocial symptoms, can be disabling. Individuals in the United States with endometriosis who are unable to work before retirement age can apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). Given the multi-step process of disability review, it is important to better understand how disability decisions are made. This study aimed to examine approaches and rationales of U.S. federal appeals courts reviewing SSDI and/or SSI claims involving endometriosis-related issues of appeal.</p></div><div><h3>Methods</h3><p>We searched Westlaw and Nexis Uni records, available as of January 2021, for federal appeals of SSDI and SSI claims including endometriosis as an impairment. Two independent reviewers screened full-text cases and extracted data. Framework Analysis was applied to courts’ rationales regarding endometriosis-related issues of appeal.</p></div><div><h3>Results</h3><p>Eighty-seven appeals addressed an endometriosis-related issue. Three themes—evidence, treatment, and time—were identified across the decisions. The courts' discussions across themes exposed rationales and evidentiary requirements that posed challenges for claimants with endometriosis. The courts found subjective reports of symptoms insufficient evidence of impairment and positive responses to treatments to indicate cures or prevent claimants from demonstrating the necessary continuous 12 months of impairment. Some courts expected claimants to use treatments such as contraception or hysterectomy without addressing the risks of such treatments or the fact that they might have been counter to claimants’ needs and preferences.</p></div><div><h3>Conclusions</h3><p>Individuals with endometriosis face evidentiary obstacles and common misconceptions about disease, diagnosis, and treatment in disability claims. SSDI and SSI endometriosis claims are systematically disadvantaged, particularly among those without access to care. The health care, policy, and legal systems can leverage the findings in this study to create a more equitable disability application and review system for those with chronic pain conditions such as endometriosis.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 221-231"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991498","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":"Facilitators and Barriers to Breastfeeding Among Veterans Using Veterans Affairs Maternity Care Benefits","authors":"Jill Inderstrodt PhD, MPH ,&nbsp;Krysttel C. Stryczek MA ,&nbsp;Sara E. Vargas PhD ,&nbsp;Jennifer N. Crawford PhD ,&nbsp;Taylor Hooker MS, CTRS, NBC-HWC ,&nbsp;Aimee R. Kroll-Desrosiers PhD ,&nbsp;Valerie Marteeny MS ,&nbsp;Kate F. Wallace MPH ,&nbsp;Kristin Mattocks PhD, MPH","doi":"10.1016/j.whi.2023.12.005","DOIUrl":"10.1016/j.whi.2023.12.005","url":null,"abstract":"<div><h3>Introduction</h3><p><span>U.S. veterans of childbearing age represent one of the fastest growing populations using Veterans Affairs<span><span> (VA) health care. The VA does not provide </span>obstetric care<span><span><span> directly but pays for VA-enrolled veterans to obtain outside obstetric care. The VA also provides </span>maternity care coordination (MCC) services, including </span>lactation support. Breastfeeding benefits mothers and babies; however, previous research shows that veteran mothers quit </span></span></span>exclusive breastfeeding<span> earlier than the American Academy of Pediatrics<span> and World Health Organization recommendation of 6 months. This study aimed to understand facilitators and barriers to breastfeeding among a cohort of veterans who used VA maternity care benefits.</span></span></p></div><div><h3>Methods</h3><p>Qualitative data from an open-ended question from a national sample of postpartum veterans using VA pregnancy benefits were coded using deductive and inductive content analysis within a matrix framework. Quantitative data were used to contextualize the responses.</p></div><div><h3>Results</h3><p>Four themes emerged from the data: (1) impacts on health of baby/mother; (2) the ability to breastfeed; (3) early postnatal experiences breastfeeding; and (4) cost/convenience. Among those who responded to the open-ended breastfeeding question (329/669), most participants (<em>n</em><span> = 316; 96%) attempted breastfeeding their current baby. Respondents who did not initiate breastfeeding or who discontinued breastfeeding earlier than planned cited diverse reasons. These included low milk supply, poor latch, nipple pain, mental health factors, and low confidence in their ability to continue breastfeeding. Participants cited the MCC program as a facilitator to breastfeeding, and non-VA hospital experiences were mentioned as barriers.</span></p></div><div><h3>Conclusion</h3><p>Veterans in this cohort of 329 veterans who responded to an open-ended breastfeeding question wanted and attempted to breastfeed; however, barriers such as lactation challenges and unsupportive health care providers made it difficult to continue the practice. As the MCC program grows to include more lactation professionals, MCCs may address barriers such as lactation challenges and unsupportive non-VA health care providers. Further program development should focus on addressing these challenges prenatally.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 3","pages":"Pages 309-316"},"PeriodicalIF":3.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703774","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}