March 2021: Power Updates Edition
There are plenty of articles, publications, and stories published every month. In an effort to help you distinguish fact from fiction, save time in your already busy day, and share news you may not have otherwise seen, here are nine stories from the last month we thought you might find interesting:
Historically, female sterilization (or permanent contraception) is more likely to occur among women of color, people with less education, and those with lower incomes than white women, the highly educated, or those with higher incomes. Analyzing data between 2006-2017 from the annual National Survey of Family Growth, researchers found that overall, the use of long-active reversible contraception, such as IUDs and the implant, increased while sterilization rates decreased. This study’s findings support previous research, which found significant disparities; sterilization has been disproportionately used among those with lower incomes and lower education levels.
Pregnancy and Birth
After adding a pregnancy intention screening tool to the electronic health record (EHR) of nearly 200 community health centers across the country, this study analyzed the uptake of its use after three years. While more than 96% of clinics used the tool at least once, the results showed a fairly low consistent use of the tool; of the nearly 290,000 people eligible, only 39% received screening. Medical assistants, used the tool most, making up nearly 47% of users. Adding an EHR-integrated pregnancy intention screening tool provides a standardized way to screen for pregnancy intention. More research is needed to understand the clinic-level factors for increasing utilization of these tools as well as their impact on health outcomes.
Young people in foster care are more than twice as likely to become pregnant by age 17 than those who are not in foster care. And nearly half of those pregnant by age 17 become pregnant again by age 19. To better understand the reproductive parenthood decisions of some of the 400,000 youth in foster care in the US, this study surveyed 81 participants age 18-25 about their education opportunities and supportive relationships. The survey asked and answered four questions:
- What are the sexual behaviors and beliefs of foster care youth?
- More than half of respondents had sex at age 14 or younger, and while men had more partners than women, the average number of partners was seven. Those who had sex for the first time at a later age were likely to have fewer partners than those who had sex earlier.
- How do foster youth obtain information about and support around reproductive health, pregnancy, and parenting?
- More than 90% of participants believed that men and women share equal responsibility for preventing pregnant. However, inconsistent use of birth control was reported—indicating a gap between belief and action—only 22.2% of people always use birth control and 27.2% never use a method of contraception.
- How do foster care youth plan and prepare for pregnancy?
- The vast majority (87.6%) of respondents had had between one and two pregnancies, and 30% were currently pregnant. Forty-one percent said that they felt unprepared for their first pregnancy despite nearly 47% also reporting ‘definitely’ having the support of friends and 42.5% ‘definitely’ having the support of family.
- What are her perceptions and characteristics of foster care youth parenting relationships?
- A little more than half of participants were married or living with the parent of their youngest child. And 62.1% reported having a ‘very good’ or ‘excellent’ co-parenting relationship. However, for those not living with or married to their co-parent, only 7.7% reported receiving and 3.7% reported paying child support.
Researchers directed 100 people of reproductive age to use the internet to search for information surrounding the safety abortion and cesarean delivery as well as the risks of both to fertility. Forty-six percent of respondents rated their confidence in finding health information online as high prior to searching and 44% rated it as medium. On average participants spent nearly 16 of an allotted 30 minutes to search for information and 86% reported finding it easy to get their questions answered. After their online research 92% felt that abortion was safe and not likely to cause infertility, compared to only 70% prior to searching. However, searching for the same information around cesarean delivery did not change participants beliefs around safety and infertility.
In November and again in December of 2018, the Ohio House and Senate passed a ban on abortion after six weeks of gestation. While the governor vetoed both attempts, when a new governor took office in January 2019, the state legislation passed the ban again and it was signed into law. Though a federal court prevented the law from going into effect, researchers wondered how its passage affected people’s perception of abortions legality. In an eight-month series of surveys it was found that while the majority of people understood abortion to still be legal, more people every month believed it to be illegal and their views did not change over time. This finding has potentially drastic implications for the effectiveness of legislation—whether it goes into effect or not—to impact people’s understanding of the legality of abortion services and in turn limit seeking abortion care.
Sexual and Reproductive Health
To better address the unique sexual and reproductive health needs of young people, the authors of this study implemented a small-scale initiative at a federally qualified health center (FQHC). Their program had six specific strategies to improve adolescent care, and based on its success, the team identified five things with broad implications for practice, including the importance of cross-sector collaboration and community support and how specialized staff training led to greater support of future clinic changes around adolescent sexual and reproductive health services.
This commentary explores existing racial-ethnic gaps in various elements of reproductive health, including contraceptive use, Pap tests, mammograms, maternal mortality, and unintended pregnancy. Using a decade of data pulled from previously published research around the highlighted subjects, the authors found disparities in each category and discuss specific policy-based as well as provider- and community of color-led solutions.
Acknowledging the effect of social and structural detriments of health, this commentary recaps a meeting with a diverse group of stakeholders in the world of maternal and child health. the multidisciplinary group created a new framework dedicated to reproductive and sexual health equity with six principles, which include centering the needs of communities and redistributing power to marginalized individuals and asking providers and public health systems to recognize historical and current harms related to reproductive and sexual health.
Researchers spoke to 22 Black women between age 18 and 29 to learn about their lived experiences around patient-provider encounters. Through these conversations they learned seven key things:
- Silence around sex impedes engagement in care.
- When patients and providers are of the same race, patients are more protected from harm.
- Providers are seen as a source of discouragement and misinformation.
- Frustration is a normal feeling during family planning care visits.
- Shared decision making is rare and information around the decision-making process was limited.
- Medical mistrust is pervasive and part of Black consciousness.
- Meaningful and empathic patient-provider encounters are elusive.