Womens Health Issues最新文献

{"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}

{"title":"Hispanic Women's Perceptions of Neural Tube Defects and Folic Acid Supplementation: A Qualitative Study","authors":"Roxanne Mirabal-Beltran PhD ,&nbsp;Katherine Monogue-Rines RN ,&nbsp;Kylie Riva RN ,&nbsp;Nandi Dube ,&nbsp;Pamela Donohue ScD, MS","doi":"10.1016/j.whi.2023.08.006","DOIUrl":"10.1016/j.whi.2023.08.006","url":null,"abstract":"<div><h3>Introduction</h3><p><span>In the United States, the prevalence of neural tube defects (NTDs) is higher among infants born to Hispanic women compared with those born to non-Hispanic women. The purpose of this study is to investigate perceptions of NTDs and the use of </span>folic acid and folate as a preventive measure among Hispanic women.</p></div><div><h3>Methods</h3><p>Purposive sampling was used to recruit Hispanic women from a prenatal clinic in a Northeastern metropolitan city. In-depth interviews were conducted by native Spanish-speaking researchers using a semistructured interview guide. Thematic analysis was used to develop themes related to a priori domains.</p></div><div><h3>Findings</h3><p><span>The study sample consisted of 26 Hispanic women representing nine countries of origin. Four themes were revealed: dietary sources of folic acid<span>, awareness of folic acid supplementation and </span></span>fortification, preferences for receiving health information, and factors in decision-making concerning an NTD diagnosis.</p></div><div><h3>Conclusions</h3><p><span>This study highlights the importance of early and targeted educational interventions sensitive to the cultural needs of this population. Results suggest that current NTD health education efforts may not be sufficient to increase our participants’ knowledge of NTD. Additionally, the disparity may be multimodal, potentially influenced by insufficient understanding of prenatal folic acid use and the role of religiosity in decision-making during pregnancy. If Hispanic women are more likely to continue pregnancies affected by NTDs, this factor could be a part of NTD disparities. Exploring factors beyond supplementation and fortification that might influence rates of NTDs at </span>birth in the U.S. Hispanic population can help to inform prevention efforts.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 172-179"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41216220","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":"“Something Has to Be Done to Make Women Feel Safe”: Women Veterans’ Recommendations for Strengthening the Veterans Crisis Line for Women Veterans","authors":"Melissa E. Dichter PhD, MSW ,&nbsp;Aneeza Z. Agha MA ,&nbsp;Lindsey L. Monteith PhD ,&nbsp;Lauren S. Krishnamurti PhD ,&nbsp;Katherine M. Iverson PhD ,&nbsp;Ann Elizabeth Montgomery PhD","doi":"10.1016/j.whi.2023.12.002","DOIUrl":"10.1016/j.whi.2023.12.002","url":null,"abstract":"<div><h3>Objective</h3><p>Women represent 15% of veteran callers to the Veterans Crisis Line (VCL); there has been little research identifying the experiences and needs of women veterans who use the VCL. The objective of this study was to identify women veterans’ experiences with and recommendations for strengthening VCL services for women.</p></div><div><h3>Method</h3><p>We conducted qualitative interviews with 26 women veterans across the United States who had contacted the VCL in the preceding year. Interviews were conducted by telephone in 2022 and were audio recorded and transcribed. A team-based content analysis approach was used to identify participants’ concerns around contacting the VCL and recommendations for strengthening the service.</p></div><div><h3>Results</h3><p>Interviews revealed women veterans’ concerns with regard to contacting the VCL related to responder gender, appropriateness of VCL services for veterans not at imminent risk for suicide, and potential consequences of contacting the VCL. Key recommendations included letting veterans select the gender of the responder who takes their call, providing more information to potential callers about what to expect from VCL calls, and raising awareness about and maintaining options for caller anonymity.</p></div><div><h3>Conclusions</h3><p>This study uniquely focused on women veterans’ experiences and perspectives, in their own voices. Findings point to trauma-informed approaches supporting women veteran callers to the VCL and may also hold implications for other similar crisis hotline services.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 180-185"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418296","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":"Mifepristone Use Among Obstetrician-Gynecologists in Massachusetts: Prevalence and Predictors of Use","authors":"Emily Newton-Hoe MPH, MPA ,&nbsp;Alice Lee MD ,&nbsp;Jennifer Fortin MPH ,&nbsp;Alisa B. Goldberg MD, MPH ,&nbsp;Elizabeth Janiak ScD ,&nbsp;Sara Neill MD, MPH","doi":"10.1016/j.whi.2023.11.007","DOIUrl":"10.1016/j.whi.2023.11.007","url":null,"abstract":"<div><h3>Objectives</h3><p>We estimated the prevalence of mifepristone use for evidence-based indications among obstetrician-gynecologists in independent practice in Massachusetts and explored the demographic and practice-related factors associated with use.</p></div><div><h3>Methods</h3><p><span>We used data from a cross-sectional survey administered to Massachusetts obstetrician-gynecologists identified from the American Medical Association Physician Masterfile. We measured the prevalence of mifepristone use for four clinical scenarios: </span>early pregnancy<span> loss, medication abortion, cervical preparation before dilation and evacuation<span> procedures, and cervical preparation before induction of labor. Multivariate regression was used to calculate the odds of mifepristone use for these scenarios based on practice type, years in practice, physician sex, and history of medication abortion training.</span></span></p></div><div><h3>Results</h3><p>A total of 198 obstetrician-gynecologists responded to the survey (response rate = 29.0%); this analysis was limited to 158 respondents who were not in residency or fellowship. Overall, 46.0% used mifepristone for early pregnancy loss and 38.6% for medication abortion. Fewer used mifepristone for cervical preparation before dilation and evacuation (26.0%) or before induction of labor (26.4%). Respondents in academic practice settings, with more years in practice, of female sex, and with sufficient medication abortion training were significantly more likely to use mifepristone for one or more evidence-based clinical indications.</p></div><div><h3>Conclusions</h3><p>Sufficient medication abortion training during residency significantly predicts whether obstetrician-gynecologists use mifepristone in practice. The U.S. Supreme Court's overturning of <em>Roe v. Wade</em><span> will allow state-level abortion bans and restrictions to be in effect, which will reduce exposure to abortion training during residency. Increasing training in and utilization of mifepristone are critical for equitable access to reproductive health services. Further interventions may need to be developed to increase mifepristone use in nonacademic practice settings.</span></p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 135-141"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138832350","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":"Changes in Commercial Insurance Claims for Contraceptive Services During the Beginning of the COVID-19 Pandemic—United States, January 2019–September 2020","authors":"Kathryn M. Curtis PhD,&nbsp;Aniket D. Kulkarni MBBS, MPH,&nbsp;Antoinette T. Nguyen MD, MPH,&nbsp;Lauren B. Zapata PhD,&nbsp;Katherine Kortsmit PhD, MPH,&nbsp;Ruben A. Smith PhD,&nbsp;Maura K. Whiteman PhD","doi":"10.1016/j.whi.2023.10.004","DOIUrl":"10.1016/j.whi.2023.10.004","url":null,"abstract":"<div><h3>Objective</h3><p>We describe changes in commercial insurance claims for contraceptive services during the beginning of the COVID-19 pandemic.</p></div><div><h3>Methods</h3><p><span><span><span>We analyzed commercial insurance claims using IQVIA PharMetrics Plus data from more than 9 million U.S. females aged 15–49 years, enrolled during any month, January 2019 through September 2020. We calculated monthly rates of outpatient claims for intrauterine devices (IUDs), implants, and </span>injectable contraception and monthly rates of pharmacy claims for </span>contraceptive pills, patches, and rings. We used Joinpoint </span>regression analysis<span> to identify when statistically significant changes occurred in trends of monthly claims rates for each contraceptive method. We calculated monthly percentages of claims for contraceptive counseling via telehealth.</span></p></div><div><h3>Results</h3><p>Monthly claims rates decreased for IUDs (−50%) and implants (−43%) comparing February 2020 with April 2020 but rebounded by June 2020. Monthly claims rates for injectables decreased (−19%) comparing January 2019 with September 2020, and monthly claims rates for pills, patches, and rings decreased (−22%) comparing July 2019 with September 2020. The percentage of claims for contraceptive counseling occurring via telehealth was low (&lt;1%) in 2019, increased to 34% in April 2020, and decreased to 9–12% in June–September 2020.</p></div><div><h3>Conclusions</h3><p><span>Substantial changes in commercial insurance claims for contraceptive services occurred during the beginning of the COVID-19 pandemic, including transient decreases in IUD and implant claims and increases in telehealth contraceptive counseling claims. Contraceptive claims data can be used by decision makers to identify service gaps and evaluate use of interventions like telehealth to improve contraceptive access, including during </span>public health emergencies.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 2","pages":"Pages 186-196"},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812276","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}