Search

Objective: To estimate the proportion of obstetrician-gynecologists (ob-gyns) who provided induced abortion in the prior year, disaggregated by surgical and medication methods, and document barriers to provision of medication abortion.Methods: In 2016-2017, we conducted a cross-sectional survey of a national sample of American College of Obstetricians and Gynecologists Fellows and Junior Fellows who were part of the Collaborative Ambulatory Research Network. We sent the survey by email, and mailed nonresponders paper surveys. We performed descriptive statistics, χ tests, and logistic regression analyses.Results: Sixty-seven percent (655/980) of Collaborative Ambulatory Research Network members responded. Ninety-nine percent reported seeing patients of reproductive age, and 72% reported having a patient in the prior year who needed or wanted an abortion. Among those seeing patients of reproductive age, 23.8% (95% CI 20.5%-27.4%) reported performing an induced abortion in the prior year; 10.4% provided surgical and medication abortion, 9.4% surgical only, and 4.0% medication only. In multivariable analysis, physicians practicing in the Midwest (adjusted odds ratio [AOR] 0.31, 95% CI 0.16-0.60) or South (AOR 0.22, 95% CI 0.11-0.42) had lower odds of provision compared with those practicing in the Northeast, whereas those practicing in an urban inner city (AOR 2.71, 95% CI 1.31-5.60) or urban non-inner-city area (AOR 2.89, 95% CI 1.48-5.64 vs midsize towns, rural areas, or military settings) had higher odds of provision. The most common reasons for not providing medication abortion were personal beliefs (34%) and practice restrictions (19%). Among those not providing medication abortion, 28% said they would if they could write a prescription for mifepristone.Conclusion: Compared with the previous national survey in 2008-2009, abortion provision may be increasing among practicing ob-gyns, although important geographic disparities persist. Few provide medication abortion, but uptake might increase if mifepristone could be prescribed. [ABSTRACT FROM AUTHOR]

Objective: To compare the proportion of medical abortions with a clinically significant adverse event among telemedicine and in-person patients at a clinic system in Iowa during the first 7 years of the service.Methods: We conducted a retrospective cohort study. We analyzed data on clinically significant adverse events (hospital admission, surgery, blood transfusion, emergency department treatment, and death) for all medical abortions performed by telemedicine or in person at a clinic system in Iowa between July 1, 2008, and June 30, 2015. Data on adverse events came from required reporting forms submitted to the mifepristone distributor. We calculated the prevalence of adverse events and 95% CIs comparing telemedicine with in-person patients. The analysis was designed as a noninferiority study. Assuming the prevalence of adverse events to be 0.3%, telemedicine provision was considered to be inferior to in-person provision if the prevalence were 0.6% or higher. The required sample size was 6,984 in each group (one-sided α=0.025, power 90%). To explore whether patients with adverse events presented to emergency departments and were not reported, we conducted a survey of the 119 emergency departments in Iowa, asking whether they had treated a woman with an adverse event in the prior year.Results: During the study period, 8,765 telemedicine and 10,405 in-person medical abortions were performed. Forty-nine clinically significant adverse events were reported (no deaths or surgery; 0.18% of telemedicine patients with any adverse event [95% CI 0.11-0.29%] and 0.32% of in-person patients [95% CI 0.23-0.45%]). The difference in adverse event prevalence was 0.13% (95% CI -0.01% to 0.28%, P=.07). Forty-two emergency departments responded to the survey (35% response rate); none reported treating a woman with an adverse event after medical abortion.Conclusion: Adverse events are rare with medical abortion, and telemedicine provision is noninferior to in-person provision with regard to clinically significant adverse events. [ABSTRACT FROM AUTHOR]

Objective: To estimate unintended pregnancy rates among a representative sample of 7,225 active-duty women in the U.S. military in 2008 and to compare these rates with 2005 and with the U.S. population.Methods: Cross-sectional data came from the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel (Health Related Behaviors Survey). For all women and by key subgroups, unintended pregnancy rates per 1,000 women were calculated and compared with rates reported in the 2005 Health Related Behaviors Survey. Univariable and multivariable logistic regression to test for associations between unintended pregnancy and key subgroups was also performed. Finally, an age-standardized unintended pregnancy rate was calculated to adjust for differences in age composition between the military and U.S. populations for better comparison with the general U.S. rate.Results: Eleven percent of women reported an unintended pregnancy in the prior 12 months. The 2008 self-reported unintended pregnancy rate was 105 per 1,000 women, an increase from 2005 (97/1,000 women). Younger, less educated, nonwhite, and married or cohabitating women had significantly higher rates of unintended pregnancy compared with their counterparts. Rates did not differ between women deployed in the prior 12 months and nondeployed women. The age-standardized rate was 78 per 1,000 women (95% confidence interval 77-79), which is 50% higher than the general U.S. population (52/1,000 women).Conclusion: Unintended pregnancy rates in the military are high and have increased in most key subgroups since the 2005 survey. Efforts are needed to help servicewomen prevent unintended pregnancy, including during deployment.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

The article presents a study which estimated unintended pregnancy rates among 7,225 active-duty women in the U.S. military in 2008. Based on cross-sectional data from the 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel, the age-standardized rate was 78 per 1,000 women, 50% higher than the general U.S. population. It concludes that unintended pregnancy rates in the military are high and have increased in most key subgroups since the 2005 survey.

The article presents a study which assessed the effectiveness of obtaining early medical abortions through telemedicine compared with the provision of face-to-face physician visits. The proportion of women who reported a successful abortion were 99% in telemedicine patients and 97% in face-to-face patients, but telemedicine patients were said to be more likely to recommend the procedure to friends. Telemedicine reportedly helps reduce the barriers to abortion access for women in the U.S.

A letter to the editor is presented commenting on a research article appearing in a 2013 issue of "Obstetrics & Gynecology" which delved on the unintended pregnancies among active-duty women in the U.S.