46,870 results on '"Abortion, Induced"'
Search Results
2. Mifepristone Versus Laminaria for Cervical Ripening in Midtrimester Induction
- Published
- 2023
3. Drug Exposure During Pregnancy: A Case-Control Study from a Primary Care Database
- Author
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Ainhoa Gomez-Lumbreras, Marta Leston Vazquez, Carles Vilaplana-Carnerero, Oriol Prat-Vallverdu, Cristina Vedia, Rosa Morros, and Maria Giner-Soriano
- Subjects
abortion, induced ,abortion, spontaneous ,labor, obstetric ,live birth ,abnormalities, drug-induced ,maternal-fetal exchange ,Gynecology and obstetrics ,RG1-991 ,Public aspects of medicine ,RA1-1270 - Abstract
Objective: Drug exposure during pregnancy is frequent, even more during first trimester as pregnant women might not be aware of their condition. We used available electronic health records (EHRs) to describe the use of medications during the first trimester in pregnant women and to compare drug exposure between those women who had an abortion (either elective or spontaneous) compared to those who had live births. Materials and Methods: Case-control study of abortions, either elective or spontaneous (cases), and live birth pregnancies (controls) in Sistema d'Informaci? per al Desenvolupament de la Investigaci? en Atenci? Prim?ria (Catalan Primary Health electronic health records) from 2012 to 2020. Exposure to drugs during first trimester of pregnancy was considered to estimate the association with abortion by conditional logistic regression and adjusted by health conditions and other drugs exposure. Results: Sixty thousand three hundred fifty episodes of abortions were matched to 118,085 live birth pregnancy episodes. Cases had higher rates of alcohol intake (9.9% vs. 7.2%, p?0.001), smoking (4.5% vs. 3.6%, p?0.001), and previous abortions (9.9% vs. 7.8%, p?0.001). Anxiety (30.3% and 25.1%, p?0.001), respiratory diseases (10.6% and 9.2%, p?0.001), and migraine (8.2% and 7.3%, p?0.001), for cases and controls, respectively, were the most frequent baseline conditions. Cases had lower rate of drug exposure, 40,148 (66.5%) versus 80,449 (68.1%), p?0.001. Association with abortion was found for systemic antihistamines (adjusted odds ratio [ORadj] 1.23, 95% confidence interval [CI] 1.19?1.27), antidepressants (ORadj 1.11, 95% CI 1.06?1.17), anxiolytics (ORadj 1.31, 95% CI 1.26?1.73), and nonsteroidal anti-inflammatory drugs (ORadj 1. 63, 95% CI 1.59?1.67). Conclusions: These high rates of drug exposures during the first trimester of pregnancy highlights the relevance of informed prescription to women with childbearing potential.
- Published
- 2024
- Full Text
- View/download PDF
4. Progesterone after mifepristone: A pilot prospective single arm clinical trial for women who have changed their mind after commencing medical abortion.
- Author
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Turner, Joseph V., Garratt, Deborah, McLindon, Lucas A., Barwick, Anna, and Spark, M. Joy
- Subjects
- *
PILOT projects , *FAMILY planning , *PROGESTERONE , *ULTRASONIC imaging , *CLINICAL trials , *ORAL drug administration , *MISCARRIAGE , *ABORTION , *PREGNANCY outcomes , *RESEARCH funding , *MIFEPRISTONE , *PATIENT safety , *LONGITUDINAL method - Abstract
Aim: This pilot study aimed to assess the utility of an oral progesterone treatment protocol for women who commenced medical abortion and then changed their mind and wished instead to maintain their pregnancy. Methods: The Progesterone‐After‐Mifepristone—pilot for efficacy and reproducibility (PAMper) trial was designed as a prospective single‐arm pilot clinical trial, conducted via telehealth. Women aged 18 to 45 years in Australia who reported ingesting mifepristone within the last 72 h to initiate medical abortion and had not taken misoprostol were included. Initial contact was by a web‐based form. Following informed consent, participants were prescribed oral progesterone to be taken 400 mg twice per day for 3 days then 400 mg at night until completion of a 19 day course. Pregnancy viability was assessed by ultrasound scan after 14 days of progesterone treatment. Results: Between October 2020 and June 2021, nine women contacted the PAMper trial, of whom six enrolled and commenced progesterone treatment. These women reported ingesting mifepristone at 40–70 days of gestation, with progesterone being commenced within 5.7–72 h of mifepristone ingestion. Five participants had ongoing, live pregnancies at the primary endpoint (ultrasound at >2 weeks). One participant had a miscarriage after 9 days of progesterone treatment. There were no clinically significant adverse events. Conclusion: This small study demonstrated a clinically sound protocol for researching the use of progesterone‐after‐mifepristone for women in this circumstance. Results of this pilot study support the need for further larger scale trials in this field. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
5. Oxytocin Infusion vs. Spontaneous Follow-up for Third-stage of Labor After Second-trimester Abortion
- Author
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Ragıp Atakan Al, professor
- Published
- 2023
6. Sexual and reproductive health rights in Australia: we have much to celebrate but must not be complacent.
- Author
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Melville, Catriona and Corbin, Bonney
- Abstract
Australia has made significant progress in sexual and reproductive health rights in recent years, decriminalizing access to abortion, enabling telehealth services, and introducing safe access zones. However, the global context of reproductive rights has seen considerable erosion in other countries. The current reproductive rights backlash is not just against abortion, but against the concept of gender and human rights. Australia must continue to protect and advance sexual and reproductive health care, ensuring equitable access and embedding abortion throughout health systems. [Extracted from the article]
- Published
- 2024
- Full Text
- View/download PDF
7. Development and pilot testing of the 2019 Canadian Abortion Provider Survey
- Author
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Regina M. Renner, Madeleine Ennis, Mahan Maazi, Sheila Dunn, Wendy V. Norman, Janusz Kaczorowski, and Edith Guilbert
- Subjects
Surveys and questionnaires ,Abortion, Induced ,Health workforce ,Pilot studies ,Internet ,Delphi approach ,Medicine (General) ,R5-920 - Abstract
Abstract Background Substantial changes in abortion care regulations, available medications and national clinical practice guidelines have occurred since a 2012 national Canadian Abortion Provider Survey (CAPS). We developed and piloted the CAPS 2019 survey instrument to explore changes of the abortion provider workforce, their clinical care as well as experiences with stigma and harassment. Methods We undertook development and piloting in three phases: (1) development of the preliminary survey sections and questions based on the 2012 survey instrument, (2) content validation and feasibility of including certain content aspects via a modified Delphi Method with panels of clinical and research experts, and (3) pilot testing of the draft survey for face validity and clarity of language; assessing usability of the web-based Research Electronic Data Capture platform including the feasibility of complex skip pattern functionality. We performed content analysis of phase 2 results and used a general inductive approach to identify necessary survey modifications. Results In phase 1, we generated a survey draft that reflected the changes in Canadian abortion care regulations and guidelines and included questions for clinicians and administrators providing first and second trimester surgical and medical abortion. In phase 2, we held 6 expert panel meetings of 5–8 participants each representing clinicians, administrators and researchers to provide feedback on the initial survey draft. Due to the complexity of certain identified aspects, such as interdisciplinary collaboration and interprovincial care delivery differences, we revised the survey sections through an iterative process of meetings and revisions until we reached consensus on constructs and questions to include versus exclude for not being feasible. In phase 3, we made minor revisions based on pilot testing of the bilingual, web-based survey among additional experts chosen to be widely representative of the study population. Demonstrating its feasibility, we included complex branching and skip pattern logic so each respondent only viewed applicable questions based on their prior responses. Conclusions We developed and piloted the CAPS 2019 survey instrument suitable to explore characteristics of a complex multidisciplinary workforce, their care and experience with stigma on a national level, and that can be adapted to other countries.
- Published
- 2023
- Full Text
- View/download PDF
8. Characterizing two models for abortion care in Argentina pre-Law 27.610: 2016–2019
- Author
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Erika E. Atienzo, Belén Grosso, Ruth Zurbriggen, David Zambrano, María Vivas, Brianna Keefe-Oates, Caitlin Gerdts, and Alexandra Wollum
- Subjects
Abortion, Induced ,Healthcare Models ,Self-Managed Abortion ,Argentina ,Public aspects of medicine ,RA1-1270 - Abstract
ABSTRACT OBJECTIVE Explore the use of two abortion care models in Argentina over the period 2016–2019: pro-rights private medical service providers and abortion accompaniment (via self-management and via health institutions); and compare the profile of who accesses these models and when. METHODS We used data from accompaniment collectives in the Socorristas en Red and private service providers. We estimated annual abortion rates via these service models and compared the profile of the populations by type of service and gestational age (2019) using descriptive statistics and chi-square tests. RESULTS In 2016, 37 people per 100,000 women of reproductive age obtained accompanied self-managed abortions, and the number increased to 111 per 100,000 in 2019, a threefold increase. The rate of abortions via care providers was 18 per 100,000 in 2016 and 33 in 2019. Higher proportions of those who obtained abortion via care providers were 30 years or older. A higher proportion of those accompanied were 19 years or younger; 11% of those who obtained accompanied self-managed abortions were more than 12 weeks gestation compared with 7% among those who had accompanied abortions via health institutions and 0.2% among those who had abortions with private providers. A higher proportion of those who accessed accompanied abortions after 12 weeks gestation had lower educational levels, did not work or have social security coverage, had more past pregnancies, and attempted to terminate their pregnancies prior to contacting the Socorristas compared to those who had accompanied abortions at 12 weeks or earlier. CONCLUSIONS In Argentina, prior to Law 27.610 models of care guaranteed access to safe abortion. It is important to continue making visible and legitimizing these models of care so that all those who decide to have an abortion, whether inside or outside health institutions, have safe and positive experiences.
- Published
- 2023
- Full Text
- View/download PDF
9. Misoprostol Dose and Timing Before Surgical Abortion at 13 to 16 Weeks' Gestation: a Randomized Trial
- Published
- 2021
10. Development and pilot testing of the 2019 Canadian Abortion Provider Survey.
- Author
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Renner, Regina M., Ennis, Madeleine, Maazi, Mahan, Dunn, Sheila, Norman, Wendy V., Kaczorowski, Janusz, and Guilbert, Edith
- Subjects
- *
ABORTION , *ABORTIFACIENTS , *TEST validity , *DELPHI method , *CLINICAL medicine , *INTERNET surveys - Abstract
Background: Substantial changes in abortion care regulations, available medications and national clinical practice guidelines have occurred since a 2012 national Canadian Abortion Provider Survey (CAPS). We developed and piloted the CAPS 2019 survey instrument to explore changes of the abortion provider workforce, their clinical care as well as experiences with stigma and harassment. Methods: We undertook development and piloting in three phases: (1) development of the preliminary survey sections and questions based on the 2012 survey instrument, (2) content validation and feasibility of including certain content aspects via a modified Delphi Method with panels of clinical and research experts, and (3) pilot testing of the draft survey for face validity and clarity of language; assessing usability of the web-based Research Electronic Data Capture platform including the feasibility of complex skip pattern functionality. We performed content analysis of phase 2 results and used a general inductive approach to identify necessary survey modifications. Results: In phase 1, we generated a survey draft that reflected the changes in Canadian abortion care regulations and guidelines and included questions for clinicians and administrators providing first and second trimester surgical and medical abortion. In phase 2, we held 6 expert panel meetings of 5–8 participants each representing clinicians, administrators and researchers to provide feedback on the initial survey draft. Due to the complexity of certain identified aspects, such as interdisciplinary collaboration and interprovincial care delivery differences, we revised the survey sections through an iterative process of meetings and revisions until we reached consensus on constructs and questions to include versus exclude for not being feasible. In phase 3, we made minor revisions based on pilot testing of the bilingual, web-based survey among additional experts chosen to be widely representative of the study population. Demonstrating its feasibility, we included complex branching and skip pattern logic so each respondent only viewed applicable questions based on their prior responses. Conclusions: We developed and piloted the CAPS 2019 survey instrument suitable to explore characteristics of a complex multidisciplinary workforce, their care and experience with stigma on a national level, and that can be adapted to other countries. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
11. New Abortion Bans Will Increase Existing Health and Economic Disparities
- Author
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Diana Greene Foster
- Subjects
Pregnancy ,Abortion, Legal ,Public Health, Environmental and Occupational Health ,Humans ,Abortion, Induced ,Female - Published
- 2024
12. Population Group Abortion Rates and Lifetime Incidence of Abortion: United States, 2008-2014
- Author
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Rachel K. Jones and Jenna Jerman
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,genetic structures ,Population ,Ethnic group ,Abortion ,AJPH Research ,Health Services Accessibility ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Age Distribution ,Population Groups ,Pregnancy ,medicine ,Ethnicity ,Prevalence ,Humans ,030212 general & internal medicine ,education ,skin and connective tissue diseases ,reproductive and urinary physiology ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Marital Status ,business.industry ,Public health ,Incidence (epidemiology) ,Incidence ,Racial Groups ,Public Health, Environmental and Occupational Health ,Abortion, Induced ,medicine.disease ,United States ,National Survey of Family Growth ,embryonic structures ,Abortion, Legal ,Income ,Marital status ,Educational Status ,Female ,sense organs ,business ,Demography - Abstract
To assess the prevalence of abortion among population groups and changes in rates between 2008 and 2014.We used secondary data from the Abortion Patient Survey, the American Community Survey, and the National Survey of Family Growth to estimate abortion rates. We used information from the Abortion Patient Survey to estimate the lifetime incidence of abortion.Between 2008 and 2014, the abortion rate declined 25%, from 19.4 to 14.6 per 1000 women aged 15 to 44 years. The abortion rate for adolescents aged 15 to 19 years declined 46%, the largest of any group. Abortion rates declined for all racial and ethnic groups but were larger for non-White women than for non-Hispanic White women. Although the abortion rate decreased 26% for women with incomes less than 100% of the federal poverty level, this population had the highest abortion rate of all the groups examined: 36.6. If the 2014 age-specific abortion rates prevail, 24% of women aged 15 to 44 years in that year will have an abortion by age 45 years.The decline in abortion was not uniform across all population groups.
- Published
- 2024
13. Over the Precipice Into a Post
- Author
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Herminia, Palacio
- Subjects
Pregnancy ,Abortion, Legal ,Humans ,Women's Rights ,Abortion, Induced ,Female ,Supreme Court Decisions ,United States - Published
- 2024
14. Barriers Push People into Seeking Abortion Care Later in Pregnancy
- Author
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Ushma D. Upadhyay
- Subjects
Pregnancy ,Public Health, Environmental and Occupational Health ,Humans ,Abortion, Induced ,Female ,Health Services Accessibility - Published
- 2024
15. Telemedicine Provision of Medication Abortion
- Author
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Daniel Grossman
- Subjects
Pregnancy ,Public Health, Environmental and Occupational Health ,Humans ,Abortion, Induced ,Female ,Health Services Accessibility ,Telemedicine - Published
- 2024
16. Collapse of the Abortion Care Infrastructure: There Aren't Enough Hands to Fill the Gaps
- Author
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Caitlin Gerdts, Anna Rupani, Kamyon Conner, and Sachiko Ragosta
- Subjects
Pregnancy ,Public Health, Environmental and Occupational Health ,Humans ,Abortion, Induced ,Female ,Health Services Accessibility - Published
- 2024
17. Telemedicine, Medication Abortion, and Access After
- Author
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Jenifer E, Allsworth
- Subjects
Pregnancy ,Abortion, Legal ,Humans ,Abortion, Induced ,Female ,Supreme Court Decisions ,Telemedicine ,United States - Published
- 2024
18. The Growing Importance of Self-Managed and Telemedicine Abortion in the United States: Medically Safe, but Legal Risk Remains
- Author
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Patty Skuster and Heidi Moseson
- Subjects
Pregnancy ,Self-Management ,AJPH Open-Themed Research ,Abortion, Legal ,Public Health, Environmental and Occupational Health ,Humans ,Abortion, Induced ,Female ,Telemedicine ,United States - Abstract
Objectives. To examine demand for abortion medications through an online telemedicine service in the United States. Methods. We examined requests from US residents to the online telemedicine abortion service Women on Web (WoW) between October 15, 2017, and August 15, 2018. We calculated the population-adjusted rate of requests by state and examined the demographics, clinical characteristics, and motivations of those seeking services, comparing those in states with hostile versus supportive abortion policy climates. Results. Over 10 months, WoW received 6022 requests from US residents; 76% from hostile states. Mississippi had the highest rate of requests (24.9 per 100 000 women of reproductive age). In both hostile and supportive states, a majority (60%) reported a combination of barriers to clinic access and preferences for self-management. Cost was the most common barrier (71% in hostile states; 63% in supportive states; P
- Published
- 2024
19. Developing and Testing Interventions to Address Conscientious Objection to Abortion Care in Mexico and South Africa
- Published
- 2020
20. Gabapentin for Pain Control After Osmotic Dilator Insertion and Prior to D&E Procedure: a Randomized Controlled Trial (GABA)
- Author
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Society of Family Planning
- Published
- 2020
21. Abortion Criminalization: A Public Health Crisis Rooted in White Supremacy
- Author
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Taylor Riley, Yasaman Zia, Goleen Samari, and Mienah Z. Sharif
- Subjects
Pregnancy ,Abortion, Legal ,Public Health, Environmental and Occupational Health ,Humans ,Abortion, Induced ,Female ,Public Health ,Supreme Court Decisions ,United States - Abstract
The Supreme Court decision to overturn Roe v. Wade and the growing onslaught of state laws that criminalize abortion are part of a long history of maintaining White supremacy through reproductive control of Black and socially marginalized lives. As public health continues to recognize structural racism as a public health crisis and advances its measurement, it is imperative to explicate the connection between abortion criminalization and White supremacy. In this essay, we highlight how antiabortion policies uphold White supremacy and offer concrete strategies for addressing abortion criminalization in structural racism measures and public health research and practice. (Am J Public Health. 2022;112(11):1662–1667. https://doi.org/10.2105/AJPH.2022.307014 )
- Published
- 2024
22. Dutch GPs' views on prescribing mifepristone and misoprostol: a mixed-methods study.
- Author
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Schellekens, Julia EAP, Houtvast, Claire SE, Leusink, Peter, Kleiverda, Gunilla, and Gomperts, Rebecca
- Subjects
MISOPROSTOL ,MIFEPRISTONE ,ABORTION ,ABORTION laws ,ABORTION clinics - Abstract
Background: The World Health Organization has indicated that GPs can safely and effectively provide mifepristone and misoprostol for medical termination of pregnancy (TOP). Dutch GPs are allowed to treat miscarriages with mifepristone and misoprostol, but few do so. Current Dutch abortion law prohibits GPs from prescribing these medications for medical TOP. Medical TOP is limited to the specialised settings of abortion clinics and hospitals. Recently, the House of Representatives debated shifting abortion to the domain of primary care, following the example of France and the Republic of Ireland. This would improve access to sexual and reproductive health care, and increase choices for women. Nevertheless, little is known about GPs' willingness to provide medical TOP and miscarriage management. Aim: To gain insight into Dutch GPs' willingness to prescribe mifepristone and misoprostol for medical TOP and miscarriages, as well as the anticipated barriers. Design and setting: Mixed-methods study among Dutch GPs. Method: A questionnaire provided quantitative data that were analysed using descriptive methods. Thematic analyses were performed on qualitative data collected through in-depth interviews. Results: The questionnaire was sent to 575 GPs; the response rate was 22.1% (n = 127). Of the responders, 84.3% (n = 107) were willing to prescribe mifepristone and misoprostol, with 58.3% (n = 74) willing to provide this medication for both medical TOP and miscarriage management. A total of 57.5% (n = 73) of participants indicated a need for training. The main barriers influencing participants' willingness to provide medical TOP and miscarriage management were lack of experience, lack of knowledge, time constraints, and a restrictive abortion law. Conclusion: Over 80.0% of responders were willing to prescribe mifepristone and misoprostol for medical TOP or miscarriages. Training, (online) education, and a revision of the abortion law are recommended. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
23. Prenatal diagnosis of craniorachischisis totalis
- Author
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Paulina Costa, Andreia Fontoura Oliveira, and António Baptista Vilaça
- Subjects
Anencephaly ,Fetus ,Pregnancy ,Prenatal Diagnosis ,Humans ,Abortion, Induced ,Female ,General Medicine ,Neural Tube Defects - Abstract
Craniorachischisis totalis (anencephaly with total open spina bifida) is the most severe form of neural tube defects. The exact aetiology of neural tube defects remains poorly understood. We report a case of a primigravida in her 20s with a fetus in which craniorachischisis totalis was diagnosed during the first-trimester ultrasound at 11 weeks of gestation. The parents opted for pregnancy termination and the diagnosis was confirmed postnatally. Besides the lack of folic acid supplementation during preconception, no other risk factor was found. This case highlights the importance of the first-trimester ultrasound in the diagnosis of severe malformations. The right diagnosis is crucial for future prenatal counselling, yet investigation is still required to better understand the aetiology behind neural tube defects and assess the possibility of underlying genetic features, thus enabling better counselling.
- Published
- 2024
24. Paracervical Versus Intracervical Lidocaine
- Author
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Jessica Kingston, Clinical Professor
- Published
- 2019
25. Abortion Restrictions Threaten Miscarriage Management In The United States.
- Author
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Nobles J, Hwang S, Bennett E, and Jacques L
- Subjects
- Humans, United States, Female, Pregnancy, Adult, Health Services Accessibility, Abortifacient Agents, Steroidal therapeutic use, Abortion, Legal, Abortion, Spontaneous, Mifepristone therapeutic use, Abortion, Induced
- Abstract
Miscarriage and abortion require similar clinical management. Restrictions placed on abortion threaten the quality of miscarriage care, a policy spillover that affects many Americans. We combined vital statistics with life-table parameters to estimate that 1,034,000 miscarriages occur annually, including nearly 400,000 in US states with abortion bans. Attempts to restrict mifepristone access further threaten miscarriage management.
- Published
- 2024
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26. Roe v. Wade Overturned: The Association of Acculturation with Interest in and Awareness of Hospital Services for Family Planning Among Hispanic Women.
- Author
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Lee D, Fogel J, Arce L, Idriss M, Thomas M, and Fatehi M
- Subjects
- Humans, Female, Adult, New York City, Young Adult, Pregnancy, Health Knowledge, Attitudes, Practice, Abortion, Induced, Adolescent, Language, Contraception, Acculturation, Hispanic or Latino psychology, Family Planning Services
- Abstract
Introduction: The overturning of Roe v. Wade impacted family planning services in many areas of the United States (US). Our study investigates the association of acculturation with interest in and awareness of family planning hospital services of contraception and elective termination of pregnancy among Hispanic women. Methods: We surveyed 306 Hispanic women at a public hospital in a Long Island suburb of New York City. Predictor variables were acculturation (language, media, ethnic social relations) measured by the Short Acculturation Scale for Hispanics and years lived in the US. Outcome variables were interest in and awareness of hospital services of family planning for elective abortion and non-elective non-abortion family planning methods. Results: For interest in hospital services, both language and ethnic social relations acculturation were significantly positively associated with almost all family planning methods whether abortion or non-abortion. However, media acculturation and years lived in the US were significantly positively associated with abortion but not the non-abortion methods. For awareness of hospital services, only language acculturation was significantly positively associated with abortion and some nonelective non-abortion family planning methods. Conclusion: We recommend that healthcare providers and hospitals should be aware of acculturation levels when providing counseling and information about family planning methods to Hispanic women., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
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27. Intimate Partner Violence Detected during Abortion-Related Visits: A Systematic Review of Screenings and Interventions.
- Author
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Sabloak T, Ryan I, Nahi S, Eucalitto P, Simon MA, and Premkumar A
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- Humans, Female, Pregnancy, United States, Intimate Partner Violence, Abortion, Induced, Mass Screening
- Abstract
Objective: To perform a systematic review of screening tools and interventions focused on reducing adverse health outcomes associated with intimate partner violence (IPV) at abortion-related visits., Study Design: Studies were eligible if they included individuals seeking pregnancy options health care services in the United States, screening for or implementation of an intervention for IPV, and were published in English after the year 2000. The primary outcomes were to summarize screening tools, interventions studied, and if interventions led to individuals being connected to IPV-related resources. Secondary outcomes included patient responses to the IPV-related interventions and any other outcomes reported by the studies (PROSPERO #42021252199)., Results: Among 4,205 abstracts identified, nine studies met inclusion criteria. The majority ( n = 6) employed the ARCHES (Addressing Reproductive Coercion in Health Settings) tool for identification of IPV. Interventions included provider-facilitated discussions of IPV, a safety card with information about IPV and community-based resources, and referral pathways to directly connect patients with support services. For the primary outcome, IPV-related interventions were shown to better inform patients of available IPV-related resources as compared to no intervention at all. For the secondary outcomes, screening and intervening on IPV were associated with improvements in patient perception of provider empathy (i.e., caring about safety) and safer responses by patients to unhealthy relationships., Conclusion: Screening for and intervening on IPV at abortion-related visits are associated with positive outcomes for patient safety and the patient-provider relationship. However, data on effective tools for identifying and supporting these patients are extremely limited. This review emphasizes the unmet need for implementation and evaluation of IPV-specific interventions during abortion-related clinical encounters., Key Points: · The abortion visit offers a crucial setting to address IPV among a highly affected population.. · This study reviews others that analyzed interventions and associated outcomes for IPV at abortion-related visits.. · Appropriate interventions for IPV can improve patient-provider relationships and connect patients to essential resources.., Competing Interests: None declared., (Thieme. All rights reserved.)
- Published
- 2024
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28. Permanent and long-acting reversible contraception volumes at a multihospital system in Ohio before and after Dobbs.
- Author
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Mitchell JA, Yao M, Maeda R, Lappen JR, and Brant AR
- Subjects
- Humans, Female, Retrospective Studies, Ohio, Adult, Adolescent, Young Adult, Male, Middle Aged, Abortion, Induced, Intrauterine Devices statistics & numerical data, Pregnancy, Contraception methods, Drug Implants, Long-Acting Reversible Contraception statistics & numerical data, Sterilization, Tubal statistics & numerical data, Vasectomy
- Abstract
Objectives: Immediately following the Dobbs decision, Ohio prohibited abortion after the detection of fetal cardiac activity. We aimed to characterize changes in the uptake of long-acting reversible contraception (LARC) and permanent contraception following the abrupt enactment of restrictive abortion legislation., Study Design: We conducted a retrospective cohort study using electronic medical record data of patients aged 15 to 55 who underwent permanent contraception (tubal ligation, vasectomy) or LARC placement (intrauterine device, contraceptive implant) at a multihospital system in northeast Ohio from January 1, 2022 to Decemeber 31, 2022, 6 months before and after Dobbs. We compared procedure volumes and patient characteristics., Results: We identified 4247 tubal ligation and LARC procedures pre-Dobbs, including 725 (17.1%) permanent contraception and 3522 (82.9%) LARC. Post-Dobbs, the total number of tubal ligation and LARC procedures increased by 15.8% (4916), and there was a significant increase in the proportion of permanent contraception, (p < 0.001). Vasectomy volume increased by 33.3% post-Dobbs, from 1193 to 1590 procedures. Compared to pre-Dobbs, patients undergoing contraceptive procedures post-Dobbs were younger (tubal ligation and LARC, 30.9 median years [24.5, 36.8] vs 31.5 [25.2, 36.9], p = 0.011; vasectomy, median 36.6 years [32.9, 39.6] vs 37.2 [34.2, 40.4], p < 0.001) and more likely to report single relationship status (57.4% vs 55.9% for tubal ligation and LARC, p = 0.028% and 23.0% vs 18.1% for vasectomy, p = 0.002)., Conclusions: This study demonstrates increased uptake of contraceptive procedures following the Dobbs decision. This rise in permanent contraception suggests a relationship between abortion policy and contraceptive decision-making, especially among younger patients., Implications: Increased permanent and long-acting reversible contraception procedures following Dobbs reveal shifting contraceptive choices, particularly among younger individuals, indicating a connection between abortion policy and reproductive decisions., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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29. Pregnancy, abortion, and birth control methods' complicity with breast cancer occurrence.
- Author
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Rakoczy K, Kaczor J, Sołtyk A, Jonderko L, Sędzik M, Lizon J, Lewandowska A, Saczko M, and Kulbacka J
- Subjects
- Humans, Female, Pregnancy, Risk Factors, Contraception methods, Breast Neoplasms, Abortion, Induced
- Abstract
Reproductive factors play significantly important roles in determining the breast cancer (BC) risk. The impact of pregnancy, abortion, and birth control methods on tumor development remains unclear. It has been found that early full-term pregnancies in young women can lower their lifetime risk of developing the type of cancer in question. However, having a first full-term pregnancy at an older age can increase this risk. The relationship between pregnancy and breast cancer (BC) is, however, much more complicated. Both induced and spontaneous abortions lead to sudden changes in hormonal balance, which could cause different effects on sensitive breast epithelial cells, making abortion a potential risk factor for breast cancer. The influence of hormonal contraception on carcinogenesis is not comprehensively understood, and therefore, more exhaustive analysis of existing data and further investigation is needed. This review explores how the mentioned reproductive factors affect the risk of breast cancer (BC), focusing on the molecular mechanisms that contribute to its complexity. By comprehending this intricate network of relationships, we can develop new strategies for predicting and treating the disease., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
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- 2024
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30. Expanding access, reducing burdens, and improving person-centred care in abortion.
- Author
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Moseson H and Gerdts C
- Subjects
- Humans, Female, Pregnancy, Patient-Centered Care, Health Services Accessibility, Abortion, Induced
- Published
- 2024
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31. Medical abortion: Taking first tablet at home after 12 weeks of pregnancy is safe, study reports.
- Author
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Iacobucci G
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- Humans, Female, Pregnancy, Misoprostol administration & dosage, Abortifacient Agents, Nonsteroidal administration & dosage, Mifepristone administration & dosage, Mifepristone adverse effects, Self Administration, Abortion, Induced, Pregnancy Trimester, First
- Published
- 2024
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32. Local anaesthesia for pain control in surgical abortion before 14 weeks of pregnancy: a systematic review.
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Renner R, Ennis M, McKercher A, Henderson JT, and Edelman A
- Abstract
Background: Abortions are common and associated with procedural pain. We aimed to evaluate benefits and harms of local anaesthesia given for pain control during surgical abortion at less than 14 weeks' gestation., Methods: We searched a systematic review on local anaesthesia for pain control for surgical abortion at less than 14 weeks' gestation using uterine aspiration. We searched multiple databases through December 2022. We evaluated study quality using the Cochrane Risk of Bias 2 (RoB2) instrument and assessed the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Outcomes included intraoperative pain (with dilation, aspiration or procedure), patient satisfaction and adverse events., Results: Thirteen studies with 1992 participants met the inclusion criteria and the majority were judged as low risk of bias. Intervention protocols were heterogeneous, limiting meta-analysis. A 20 mL 1% lidocaine paracervical block (PCB) reduced pain with dilation compared with sham PCB (mean difference (MD) -37.00, 95% CI -45.64 to -28.36) and aspiration (MD -26.00, 95% CI -33.48 to -18.52; 1 randomised controlled trial (RCT), n=120; high-certainty evidence). A PCB with 14 mL 1% chloroprocaine was associated with a slight reduction in pain during aspiration compared with normal saline PCB injected at two or four sites (MD -1.50, 95% CI -2.45 to -0.55; 1 RCT, n=79; high-certainty evidence). Other RCTs compared a range of local anaesthetic types, PCB techniques and topical anaesthetics. Participants reported moderately high satisfaction with any type of pain control and studies reported few adverse events that were rarely medication-related., Conclusion: RCT evidence supports PCB efficacy but was inconsistent and of low certainty for topical anaesthesia., Competing Interests: Competing interests: RR has been involved with several studies included in this review. These studies did not receive pharmaceutical funding. ME: none. AMK: none. JTH: none. AE has been involved with several studies included in this review. These studies did not receive pharmaceutical funding., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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33. COVID-19 pandemic exacerbation of disparities in access to public abortion services in Mexico.
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Kravitz E, Saavedra-Avendaño B, and Darney BG
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Background: We describe clients in Mexico City's public abortion programme, Interrupción Legal de Embarazo (ILE), during the COVID-19 pandemic and test whether the pandemic exacerbated inequities in access., Methods: We conducted a cohort study of all abortions in the ILE programme from 1 January 2019 to 30 June 2022. We compared patients from within and outside the Mexico City Metropolitan area (ZMVM) by pandemic stage (pre-, acute-, mid- and late-COVID periods) and assessed changes in client characteristics (adolescent age, education, weeks' gestation) by place of residence (ZMVM vs outside the ZMVM) using linear probability models clustered on state., Results: We included 45 031 abortions. The proportion of abortions to women who travelled from outside the ZMVM decreased from 6.5% pre-COVID to 4.4%-4.8% in in the acute, mid- and late-COVID periods. The adjusted probability of being an adolescent who travelled from outside the ZMVM dropped between pre-COVID (14.4%, 95% CI 12.7% to 16.1%) and mid-COVID (9.3%, 95% CI 7.9% to 10.7%). The proportion of abortions to women with a high school education stayed fairly flat among those travelling, while it rose among those residing in the ZMVM. The adjusted probability of presenting at 11 gestational weeks or greater was higher among women residing in the ZMVM in the pre-pandemic period; this flipped during all pandemic stages, with a higher probability of presenting at 11 weeks or greater among those who travelled from outside the ZMVM., Conclusions: The COVID-19 pandemic exacerbated existing disparities in who can access ILE services. To reduce inequities in access to essential health services, public sector abortion services should be made available in all Mexican states., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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34. Management of breast engorgement after second-trimester abortion or loss: a survey of current practice patterns.
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Henkel A and Shaw KA
- Abstract
Competing Interests: Competing interests: None declared.
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- 2024
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35. Acceptability of home-based medical abortion among Hong Kong women undergoing an abortion: a cross-sectional study.
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Lui ID, Lo SST, and Quan J
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Competing Interests: Competing interests: None declared.
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- 2024
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36. 'What's a D and C between friends?' Space, intimacy and the medicalisation of unmotherhood in modernist literature.
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Schnur K
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- Humans, Female, Marriage, Friends, Stillbirth psychology, Narration, Pregnancy, History, 20th Century, Male, Abortion, Induced, Illegitimacy, Medicine in Literature, Literature, Modern history
- Abstract
This essay theorises what 'unmotherhood'-or, living outside of motherhood-means within the specific context of 'the modern'. Unmotherhood is an actively constructed state; it is explored through the parameters of agentive choice, social pressure and state control; and at the turn-of-the-20th-century novels articulate this state through specific vocabularies of contemporaneous phenomena of modernity. I look to four novels representative of four forms of unmotherhood: Tess Slesinger's The Unpossessed depicts a somewhat voluntary abortion; H.D.'s Asphodel (and its sister novel Bid Me to Live ) are fictional representations of the author's own stillbirth; Jean Rhys's Good Morning, Midnight depicts a woman's life in the wake of her newborn son's death and Nella Larsen's Quicksand is a narrative dependent on the protagonist's refusal to marry because of her equation of marriage with conception. Reading these narratives together affords us the opportunity to consider what 'unmotherhood' means as a constructed state in and of itself, beyond the presumed negative, passive state of the 'not' or the 'not yet'. Through this analysis, I define 'unmotherhood' as: (1) a state mediated through medical knowledge, objects, spaces and authority figures; (2) an experience narrated through vocabularies pulled from phenomena closely associated with 20th-century modernity and (3) a role dynamically shaped through compulsory heterosexuality embedded in familial relationships. In these three ways, my analysis of the selected novels defines unmotherhood as a permanent, transient, chosen, enforced and-contradictory as it all may be-a legible and definable experience., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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37. Measuring availability of and facility readiness to deliver comprehensive abortion care: experiences and lessons learnt from integrating abortion into WHO's health facility assessments.
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Johnston HB, Footman K, Ali MM, Aly EA, Asmani C, Asrat SG, Atweam DK, Awais S, Ayiasi RM, Boamah MO, Chooye O, Doe R, Droti B, Elamin H, Fofie C, Gholbzouri K, Hadush A, Hemachandra N, Hien Y, Kasolo FC, Kipruto H, Lainez YB, Natseri N, Onyiah PA, Orach CG, Ouangare A, Ouedraogo L, Sentumbwe-Mugisa O, Sheffel A, Siyam A, Ssendyona M, Thom E, Tingueri RK, Traoré S, Uzma Q, Venter W, and Ganatra B
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- Humans, Female, Pregnancy, Health Facilities standards, Health Services Accessibility, Abortion, Induced, World Health Organization
- Abstract
Routine assessment of health facility capacity to provide abortion and post-abortion care can inform policy and programmes to expand access and improve quality. Since 2018, abortion and/or post-abortion care have been integrated into two WHO health facility assessment tools: the Service Availability and Readiness Assessment and the Harmonised Health Facility Assessment. We discuss lessons learnt through experiences integrating abortion into these standardised tools. Our experiences highlight the feasibility of including abortion in health facility assessments across a range of legal contexts. Factors facilitating the integration of abortion include cross-country collaboration and experience sharing, timely inputs into tool adaptations, clear leadership, close relationships among key stakeholders as in assessment coordination groups, use of locally appropriate terminology to refer to abortion and reference to national policies and guidelines. To facilitate high-quality data collection, we identify considerations around question sequencing in tool design, appropriate terminology and the need to balance the normalisation of abortion with adequate sensitisation and education of data collectors. To facilitate appropriate and consistent analysis, future work must ensure adequate disaggregation of recommended and non-recommended abortion methods, alignment with national guidelines and development of a standardised approach for measuring abortion service readiness. Measurement of abortion service availability and readiness should be a routine practice and a standardised component of health facility assessment tools. Evidence generated by health facility assessments that include abortion monitoring can guide efforts to expand access to timely and effective care and help normalise abortion as a core component of sexual and reproductive healthcare., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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- 2024
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38. Crisis management: pathways to crisis pregnancy centers.
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Kissling A, Warren E, Gursahaney P, Norris AH, and Gallo MF
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- Humans, Female, Pregnancy, Adult, Ohio, Interviews as Topic, Counseling, Pregnant Women psychology, Ambulatory Care Facilities, Young Adult, Health Services Accessibility, Abortion, Induced, Qualitative Research, Social Support
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Crisis pregnancy centers (CPCs) provide social support, material aid, and counseling against abortion. We evaluated the perspectives of CPC clients to understand how they found the CPC that they attended for services. In 2019, we conducted in-depth interviews with 21 clients of 10 CPCs in Ohio, who were recruited from the CPC ( n = 9) or an abortion clinic ( n = 12), to understand their experiences attending the center. This analysis focused on the ways in which pregnant people end up as clients at a CPC seeking assistance instead of attending another setting, such as a medical center. We identified two pathways through which clients find CPCs. First, in the internet pathway , clients needing abortion services found CPCs via internet search for pregnancy symptoms, abortion care, or ultrasound services. Second, in the social safety network pathway , clients needing material aid found CPCs through recommendations from trusted others and due to the proximity of CPCs to their homes. Structural conditions influence the pathways clients pursue, such as the need for healthcare services and material aid. Future research should further explore the demographics of those who attend CPCs and motivations for attendance.
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- 2024
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39. The role of doulas and community birth workers in abortion and contraception care: An international scoping review.
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Heggie C, Tong L, Heran A, Bhambhani I, McKibbon S, and Paynter M
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- Humans, Female, Pregnancy, Midwifery, Professional Role, Family Planning Services, Abortion, Induced, Contraception, Doulas, Health Services Accessibility
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Objectives: Equitable and safe access to abortion and contraception is essential to protecting reproductive autonomy. Despite this, barriers to access remain. Nonclinical support people, may be able to facilitate access to abortion and contraception services and care, but evidence on the scope and efficacy of doulas in abortion and contraception care is lacking. The aim of this scoping review was to synthesize what is known about the role of doulas in abortion and contraception care., Study Design: We followed the Joanna Briggs Institute methodology for scoping reviews. A clinical librarian performed an initial search of all relevant databases. Three reviewers independently screened the titles and abstracts for assessment against the inclusion and exclusion criteria. The populations of interest included doulas, and/or untrained birth attendants and birth companions, and patients who use doula services. The concept of interest was the doula and the context was access to abortion or contraception., Results: Our review identified relevant studies conducted in different countries, published between 1976 and 2023. Studies broadly focused on three key themes: doulas performing procedural abortions, doulas supporting abortion care, and doulas supporting contraception. Outcomes of interest included client outcomes, barriers to access, doula training, and attitudes., Conclusions: Doulas have the potential to improve client satisfaction and mitigate barriers to accessing abortion and contraception services. Further research is needed to identify the training needs of doulas, the potential for their integration into interdisciplinary care teams, and the role in supporting medication abortion., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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40. Sexual Violence, Disclosure Pattern, and Abortion and Post-Abortion Care Services in Displaced People's Camps in Africa: A Scoping Review.
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Adekola PO and Adedini SA
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- Female, Humans, Pregnancy, Africa, Disclosure, Refugee Camps, Abortion, Induced, Refugees psychology, Sex Offenses statistics & numerical data
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Violent social and political conflicts have caused several challenges to internally displaced persons (IDPs), especially girls and young women, among which is sexual violence (SV). Despite extensive records on SV in humanitarian contexts, studies to assess the level, examine the disclosure pattern (DP) and evaluate the availability of abortion care in these settings have received inadequate attention. This scoping review sought to synthesise the current African-based research on SV, DP, and abortion and post-abortion care (APAC) in humanitarian contexts. We conducted a systematic search of five databases: MEDLINE, PubMed, Scopus, Embase and Google Scholar, where the articles retrieved met the criteria for inclusion. The review adhered to PRISMA guidelines and the Critical Appraisal Skills Programme (CASP), containing ten questions to help confirm the validity of the research design and the originality of the results in comparison with similar studies. A series of inclusion and exclusion criteria were applied after the search, and 35 eligible articles from ten African countries with evidence of sexual violence, disclosure patterns, and APAC in camp settings were included in the study. Results described situations of SV in humanitarian settings in Africa as "terrible", "bad", "an epidemic", and "severe" as girls were used as sex objects, for profile enhancement and as a weapon of war. We also found that the illegality of APAC in Africa is causing a high occurrence of clandestine abortions in conflict contexts. Disclosing SV among IDPs in Africa did not follow a clear-cut pattern but was generally determined by socio-demographic characteristics. Sexual health is a fundamental right of all, as enshrined in SDG 3, which makes this topic a major public health issue. We therefore conclude that although disclosure may aggravate stigmatisation in some instances due to adverse reactions, it is still crucial to the healing processes.
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- 2024
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41. Barriers and enablers to the implementation of immediate postpartum and post-abortion family planning service integration in primary health care units of Wolaita Zone, Southern Ethiopia: A baseline study for implementation research.
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Meskele M, Sadamo FE, Angore BN, Dake SK, Mekonnen W, Kebede AT, Adinew YM, Shikur B, Assegid M, Firdu N, Seid S, and Seifu A
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- Humans, Ethiopia, Female, Adult, Pregnancy, Postpartum Period, Adolescent, Young Adult, Male, Qualitative Research, Focus Groups, Family Planning Services, Primary Health Care organization & administration, Abortion, Induced
- Abstract
Introduction: Evidence indicates that postpartum and post-abortion women accept family planning at a higher rate when offered timely at appropriate sites. Therefore, this study explored barriers and enablers of postpartum and post-abortion family planning utilization in primary health care units of Wolaita Zone, Southern Ethiopia, from June 20 to July 25, 2022., Methods: We used a case study strategy of qualitative research using both the Consolidated Framework for Implementation Research (CFIR) and Gender, Youth, and Social Inclusion (GYSI) frameworks was conducted from June to July 2022. We conducted 41 in-depth and key informant interviews and six focus group discussions. We also used Open Code software version 4.02 for coding and further analysis and applied a framework analysis., Results: The analysis of this study identified barriers and enablers of postpartum and post-abortion family planning service uptake in five CFIR domains and four GYSI components. The barriers included misconceptions and sole decision-making by husbands, cultural and religious barriers, and healthcare providers paying less attention to adolescents and husbands, which prevented them from using immediate postpartum and postabortion family planning services. The health facilities were not adequately staffed; there was a shortage and delay of supplies and infrastructure, trained staff turnover, and poor accountability among service providers. The existence of community structure, equal access and legal rights to the service, and having waivered services were enablers for postpartum and post-abortion family planning service uptake., Conclusion and Recommendation: The current study identified various barriers and enablers to the uptake of postpartum and post-abortion family planning. Therefore, there is a need for high-impact interventions such as targeting male partners and girls, ensuring infrastructure, supplies, and equipment, building staff capacity, and making decisions jointly., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Meskele et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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42. Intersectionality in Developing a Virtual Community of Practice Platform on Abortion.
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Abdulai AF, Czerniak E, Duong C, Mehta A, Chiu R, Stroulia E, and Norman WV
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- Humans, Female, Pregnancy, Focus Groups, Canada, Internet, Health Services Accessibility, Community of Practice, Abortion, Induced
- Abstract
Abortion is an essential healthcare service in many countries including Canada. The number of people who seek abortion is disproportionately higher among equity-deserving populations. Yet the knowledge needed to provide evidence-based, culturally safe, and gender-affirming abortion services remain limited among healthcare professionals. Using an intersectional lens, we conducted focus group discussions with 14 healthcare professionals to understand how an abortion web-based platform, which is currently under development, can be adapted to meet the needs of equity deserving populations. The findings revealed the need for multi-lingual resources on abortion, information on funding coverage for undocumented migrants, educational resources on Indigenous cultural safety and gender-affirming practices, and a mapping tool to locate providers or pharmacists. Beyond presenting clinical guidelines on web platforms, this study revealed important considerations for the design of web platforms that can help advance access to abortion for equity-deserving populations.
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- 2024
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43. Promoting long-acting reversible contraception among post-abortion clients with a provider-comparison intervention: a cluster randomized controlled trial in Nepal.
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Barofsky J, Spring H, Gartoulla P, Shrestha R, Sapkota S, McElwee E, Church K, Datta S, and Livingston K
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- Humans, Nepal, Female, Adult, Young Adult, Adolescent, Pregnancy, Health Promotion methods, Long-Acting Reversible Contraception statistics & numerical data, Abortion, Induced
- Abstract
Background: Although long-acting reversible contraception (LARC) is more effective and longer lasting than short-acting methods, uptake remains low among post-abortion clients. Using a stepped-wedge, cluster-randomized trial, we evaluate the impact of a provider-level peer-comparison intervention to encourage choice of LARC in Nepal among post-abortion clients., Methods: The intervention used prominently displayed monthly posters comparing the health clinic's previous month performance on LARC uptake against peer clinics. To understand how the intervention affected behavior, while ensuring voluntarism and informed choice, we used mystery client visits, in-depth provider interviews, and client exit survey data. The trial examined 17,680 post-abortion clients in 36 clinics in Nepal from July 2016 to January 2017. The primary outcome was the proportion of clients receiving LARCs. Statistical analysis used ordinary least squares (OLS) regression with ANCOVA estimation to assess the intervention's impact on LARC uptake while controlling for client- and clinic-level characteristics., Results: The intervention increased LARC use among post-abortion clients by 6.6% points [95% CI: 0.85 to 12.3, p-value < 0.05], a 29.5% increase in LARC use compared to control clinics. This effect persisted after the formal experiment ended. Analysis of provider and client experiences showed that the behavioral intervention generated significant change in providers' counseling practices, motivated the sharing of best practices. Quality of care indicators either remained stable or improved., Conclusion: We find that a provider-level behavioral intervention increases LARC uptake among post-abortion clients. This type of intervention represents a low-cost option to contribute to reducing unmet need for contraception through provider behavior change., (© 2024. The Author(s).)
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- 2024
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44. Self-performed Rh typing: a cross-sectional study.
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Dethier D, Tschann M, Roman M, Chen JJ, Soon R, and Kaneshiro B
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Objective: To evaluate whether patients are capable and willing to self-administer and interpret an EldonCard test to determine their Rh status., Methods: This was a cross-sectional study in Honolulu, HI, USA of pregnancy-capable people aged 14-50 years who did not know their blood type and had never used an EldonCard. Participants independently completed EldonCard testing, determined their Rh type and answered a survey on feasibility and acceptability. Separately, a blinded clinician recorded their interpretation of the participant's EldonCard. When available, we obtained blood type from the electronic health record (EHR). We measured Rh type agreement between participant, clinician and EHR, as well as participant comfort and acceptability of testing., Results: Of the 330 total participants, 288 (87.3%) completed testing. Patients and clinicians had 94.0% agreement in their interpretation of the EldonCard for Rh status. Patient interpretation had 83.5% agreement with EHR while clinician and EHR had 92.3% agreement. Sensitivity of EldonCard interpretation by patient and clinician was 100%. Specificity was 83.2% for patients and 92.2% for clinicians. Two patients (of 117) had Rh-negative blood type in the EHR. The vast majority of participants found the EldonCard testing easy (94.4%) and felt comfortable doing the testing (93.7%). Participants with lower education levels felt less confident (p=0.003) and less comfortable with testing (p=0.038); however, their ability to interpret results was similar to others (p=0.051)., Conclusions: Patient-performed Rh typing via the EldonCard is an effective and acceptable option for patients, and could be used as a primary screening test for Rh status., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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45. French Parliament ratifies the inclusion in the French Constitution of "guaranteed freedom" for abortion: but does this really prevent future restrictions?
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Faucher P
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- Humans, France, Female, Pregnancy, Abortion, Legal legislation & jurisprudence, Abortion, Legal methods, Abortion, Legal trends, Abortion, Legal statistics & numerical data, Freedom, Abortion, Induced legislation & jurisprudence, Abortion, Induced methods, Abortion, Induced trends
- Abstract
Competing Interests: Competing interests: None declared.
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- 2024
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46. Seeking support for abortion online: a qualitative study of women's experiences.
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Wilson-Lowe RV, Purcell C, Lewis R, and McDaid L
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- Humans, Female, Adult, Middle Aged, Pregnancy, Scotland, Young Adult, Internet, Social Media statistics & numerical data, Social Media trends, Qualitative Research, Abortion, Induced psychology, Abortion, Induced methods, Social Support, Social Stigma
- Abstract
Introduction: Social support can mitigate the impact of stress and stigma before or after an abortion. However, stigma anticipation can limit access to in-person support. Informal online spaces can offer opportunities to address unmet support needs including supplementing in-person support lacking within stigmatised contexts. While earlier studies have explored content of posts comprising personal accounts of abortion, little is known about the nuances of how and to what end online spaces are navigated., Methods: Semi-structured interviews were conducted remotely (online or by telephone) with 23 women living in Scotland (aged 20-54 years) recruited through social media and online advertisements. Reflexive thematic analysis was supported by NVivo12 software., Results: Key themes: obtaining support that was unavailable from in-person networks; preparation for abortion; reducing feelings of isolation. The majority of participants independently searched online for accounts of abortion, with only three receiving any signposting to specific resources. Without guidance, finding relevant, supportive content was not straightforward. The search process was additionally complicated by the prevalence of abortion stigma online, which generated an additional burden at a potentially challenging time. Those who received direction towards particular resources reported primarily positive online experiences., Conclusions: While online content could address perceived in-person support gaps, the process of finding supportive content without guidance can be complex. Online searching may also expose women to stigmatising material and interactions. Signposting by abortion services towards well-moderated and trustworthy online resources could be constructive in limiting exposure to stigma and misinformation, while allowing those seeking it to access better support., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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- 2024
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47. Patient experiences of undergoing abortion with and without an ultrasound scan in Britain.
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Blaylock R, Lohr PA, Hoggart L, and Lowe P
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- Humans, Female, United Kingdom, Pregnancy, Adult, Patient Satisfaction, Decision Making, Young Adult, Abortion, Induced psychology, Abortion, Induced methods, Qualitative Research, Ultrasonography, Prenatal methods, Ultrasonography, Prenatal statistics & numerical data, Ultrasonography, Prenatal standards, Ultrasonography, Prenatal psychology
- Abstract
Background: Routine ultrasound scanning to determine gestational age and pregnancy location has long been part of pre-abortion assessment in Britain, despite not being legally required or recommended in national clinical guidelines. To support implementation of fully telemedical abortion care (implemented in Britain in April 2020), the Royal College of Obstetricians and Gynaecologists (RCOG) issued clinical guidance for an 'as-indicated' approach to pre-abortion ultrasound, removing the need for a clinic visit. We aimed to understand patient experiences of ultrasound in abortion care by conducting a qualitative study with individuals who had abortions with and without an ultrasound scan., Methods: Between November 2021 and July 2022, we recruited patients who had a medical abortion at home without a pre-procedure ultrasound at 69 days' gestation or less at British Pregnancy Advisory Service (BPAS), and also had at least one other abortion with an ultrasound from any provider in Britain. We conducted interviews using a semi-structured interview guide to explore our participants' experiences and conducted reflexive thematic analysis., Results: We recruited 24 participants and included 19 interviews in our analysis. We developed three themes from our data. These were 'Ultrasound scans and their relationship with autonomy and decision-making', 'Intrusive and out of place: the ultrasound as an inappropriate technology' and 'Towards preference-centred, quality care'., Conclusions: Further research and user-testing of strategies to improve the scan experience should be undertaken. Patient testimonies on the negative impact of ultrasound scans in abortion care should reassure providers that omitting them according to patient preference is a positive step towards providing patient-centred care., Competing Interests: Competing interests: Patricia Lohr is the Medical Director of British Pregnancy Advisory Service. There are no other competing interests., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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48. Self-managed medication abortion trajectories: results from a prospective observational study in Argentina, Nigeria and Southeast Asia.
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Pleasants EA, Jayaweera RT, Egwuatu I, Nmezi S, Kristianingrum IA, Zurbriggen R, Grosso B, Bercu C, Motana R, Gerdts C, and Moseson H
- Subjects
- Humans, Female, Prospective Studies, Adult, Pregnancy, Nigeria, Argentina, Young Adult, Self-Management methods, Self-Management statistics & numerical data, Self-Management psychology, Asia, Southeastern, Abortifacient Agents therapeutic use, Adolescent, Patient Acceptance of Health Care statistics & numerical data, Patient Acceptance of Health Care psychology, Abortion, Induced methods, Abortion, Induced statistics & numerical data, Abortion, Induced psychology
- Abstract
Objectives: Time is a crucial factor in abortion-seeking because options for care change with pregnancy duration, and most people prefer to access abortion care early in pregnancy. We aimed to collect data on the timing of steps in accompanied self-managed abortion-seeking experiences in legally restrictive settings., Methods: In this prospective, observational, cohort study we recruited callers from three abortion accompaniment groups in Argentina, Nigeria and a country in Southeast Asia. Participants completed a baseline survey before starting a self-managed medication abortion (SMA) and two follow-up surveys (approximately 1 and 3 weeks after taking medication). Primary outcomes of interest included: (1) time from abortion decision to contacting the hotline, (2) time from contacting the hotline to obtaining pills and (3) time from obtaining pills to taking the first dose. We explored relationships between participant characteristics and each of these outcomes and evaluated differences in overall abortion time using survival analyses., Results: Between July 31, 2019 and October 01, 2020 we enrolled 1352 eligible callers; 1148 provided data for this analysis. After deciding to have an abortion, participants took 12.2 days on average (95% CI: 11.6, 12.9) to start medications for abortion. On average, participants at later pregnancy durations progressed through the SMA process more quickly (<4 weeks: 20.9 days, 4 weeks: 11 days, 5-6 weeks: 10.1 days, 7-9 weeks, 10.4 days, 10+ weeks: 9.1 days; p<0.001)., Conclusions: Overall, participants accessed accompaniment group support and started abortion regimens quickly and at relatively early pregnancy durations. SMA with accompaniment provided a time-efficient route for obtaining abortions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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49. What do Australian primary care clinicians need to provide long-acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice.
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Srinivasan S, James SM, Kwek J, Black K, Taft AJ, Bateson D, Norman WV, and Mazza D
- Abstract
Background: Uptake of long-acting reversible contraception (LARC) is lower in Australia compared with other high-income countries, and access to early medical abortion (EMA) is variable with only 11% of general practitioners (GPs) providing EMA. The AusCAPPS (Australian Contraception and Abortion Primary Care Practitioner Support) Network is a virtual community of practice established to support GPs, nurses and pharmacists to provide LARC and EMA in primary care. Evaluating participant engagement with AusCAPPS presents an opportunity to understand clinician needs in relation to LARC and EMA care., Methods: Data were collected from July 2021 until July 2023. Numbers of online resource views on AusCAPPS were analysed descriptively and text from participant posts underwent qualitative content analysis., Results: In mid-2023 AusCAPPS had 1911 members: 1133 (59%) GPs, 439 (23%) pharmacists and 272 (14%) nurses. Concise point-of-care documents were the most frequently viewed resource type. Of the 655 posts, most were created by GPs (532, 81.2%), followed by nurses (88, 13.4%) then pharmacists (16, 2.4%). GPs most commonly posted about clinical issues (263, 49% of GP posts). Nurses posted most frequently about service implementation (24, 27% of nurse posts). Pharmacists posted most about health system and regulatory issues (7, 44% of pharmacist posts)., Conclusions: GPs, nurses and pharmacists each have professional needs for peer support and resources to initiate or continue LARC and EMA care, with GPs in particular seeking further clinical education and upskilling. Development of resources, training and implementation support may improve LARC and EMA provision in Australian primary care., Competing Interests: Competing interests: SMJ is a Board Director for the Australian Primary Healthcare Nurses Association. DB has provided education for clinicians at sessions sponsored by Bayer, Mayne Pharma and Besins Healthcare. DM has received research grant funding and honoraria from Bayer and Organon, and has been a member of advisory boards for Bayer and Organon., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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50. Prenatal diagnosis of a de novo 10p12.1p11.23 microdeletion encompassing the WAC gene in a fetus associated with bilateral hydronephrosis and right clubfoot on prenatal ultrasound.
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Chen CP, Chen CY, Wu FT, Pan YT, Wu PS, and Wang W
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- Humans, Female, Pregnancy, Adult, Abortion, Induced, Clubfoot genetics, Clubfoot diagnostic imaging, Ultrasonography, Prenatal, Chromosome Deletion, Amniocentesis, Hydronephrosis genetics, Hydronephrosis diagnostic imaging, Chromosomes, Human, Pair 10 genetics
- Abstract
Objective: We present prenatal diagnosis of de novo 10p12.1p11.23 microdeletion encompassing the WAC gene in a fetus associated with bilateral hydronephrosis on prenatal ultrasound., Case Report: A 40-year-old, gravida 2, para 1, woman underwent amniocentesis at 17 weeks of gestation because of advanced maternal age. Amniocentesis revealed a karyotype of 46,XY. Level II ultrasound at 22 weeks of gestation revealed bilateral hydronephrosis and right clubfoot. At 23 weeks of gestation, repeat amniocentesis revealed the result of arr [GRCh37] 10p12.1p11.23 (26,182,512-29,826,276) × 1 dn with a 3.6-Mb microdeletion of 10p12.1p11.23 encompassing the genes of MYO3A, GAD2, APBB1IP, PDSS1, ABI1, ANKRD26, YME1L1, MASTL, ACBD5, PTCHD3, RAB18, MKX, ODAD2, MPP7, WAC and BAMBI. The pregnancy was subsequently terminated, and a malformed fetus was delivered with facial dysmorphism of low-set ears, broad forehead and flat nasal bridge. Array comparative genomic hybridization (aCGH) analysis of umbilical cord confirmed a 3.6-Mb 10p12.1p11.23 microdeletion encompassing WAC., Conclusion: Application of aCGH is useful in the pregnancy with a normal fetal karyotype and abnormal fetal ultrasound., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2024. Published by Elsevier B.V.)
- Published
- 2024
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