September 2022: Power Updates Edition
There are plenty of articles, publications, and stories published every month. 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:
Using data from the 2012-2019 Pregnancy Risk Assessment Monitoring System, this study examined associations between Medicaid expansion under the Affordable Care Act and postpartum contraceptive use and pregnancy. Medicaid expansion was associated with 3.6% increase in use of any postpartum contraception, reflecting a 7% increase in LARC use, a 3.1% decrease in short-acting method use and, a 3.9% decrease in non-prescription birth control use. By race/ethnicity, increases in LARC use were only significant for non-Hispanic white and Black respondents. Decreases in early postpartum pregnancy were only observed among Black respondents.
Study authors interviewed 78 key informants, including clinicians, operations staff, and administrators, at 11 hospitals in the US about inpatient postpartum contraceptive care in 2017-2018. Interviews addressed how to improve contraceptive care, reduce reproductive health injustices, and increase patient-centeredness. While many participants strove to provide patient-centered care that emphasized autonomy and avoided paternalism, some also demonstrated negative biases. Many also recognized the role of structural inequities in health disparities but relied solely on individual-level solutions.
Pregnancy and Birth
This study assessed potential disparities in receipt of counseling and referral regarding pregnancy options (i.e., abortion, adoption, and parenting) among Black patients. Based on data from a patient survey administered at 14 publicly funded clinics within a statewide family planning system in the US, pregnant, Black patients’ intention to continue pregnancy did not differ from non-Black patients, however they were more likely to want a referral for abortion care or adoption and not receive it than non-Black patients. Black patients were also more likely to want and not receive access to resources such as transportation help, childcare, or financial support.
This study compared access to early pregnancy confirmation between crisis pregnancy centers (CPCs), which aim to convince people not to have abortions, and to abortion facilities. Researchers conducted a mystery shopper calls with 445 CPCs and geographically paired abortion facilities and found that CPCs were more likely to have same-day appointments for pregnancy testing than abortion facilities (68.5% vs. 37.2%) and were more likely to offer free pregnancy testing (98.0% vs. 16.6%), highlighting a need to improve access to pregnancy confirmation in medical settings, including abortion clinics.
Since much existing literature on barriers to abortion care focuses on states with restrictive laws/policies, this study sought to understand barriers abortion seekers face to timely care in California, which has supportive abortion policies. Researchers conducted individual in-depth interviews with 17 patients who visited three or less clinics and/or encountered more than two weeks between seeking and obtaining their abortion. Findings suggest three main barriers to timely abortion care: problems with insurance coverage and prior authorization; the need for multiple appointments due to inadequate screening; and referral delays.
Given that abortion is often underreported in survey research, this cognitive interviewing study tested six sets of newly developed abortion survey questions and ten question introductions. Interviews were conducted with 64 cisgender women in Wisconsin and New Jersey. Findings suggest several approaches that may be useful, such as including abortion in a list of other sexual and reproductive health care services and asking about ever having had an abortion rather than number of abortions. Asking about friends’ and family members’ abortions first to prime respondents and naming abortion methods did not appear to improve reporting.
This study examined associations between state Medicaid coverage for abortion and access to abortion care. Using data from 2,579 patients enrolled in Medicaid participating in Guttmacher Institute’s 2014 Abortion Patient Survey, researchers found that patients who lived in states with Medicaid coverage for abortion were less likely to wait less than 14 days between deciding to have an abortion and obtaining care, have an abortion after 10 weeks of gestations, and travel more than an hour to a clinic.
Sexual and Reproductive Health
This study involved a series of in-depth, individual interviews with 12 female participants age 18-45 to explore how preconception women engagement with digital health resources. Participants were already engaging with digital health resources and had expectations that these resources be evidence-based, easy to access, and reliable. Participants were open to use of chatbots and virtual assistants, but highly valued authentic human interactions and preferred information from peers with similar lived experiences over additional online information.
This article presents the Georgia Medication Abortion Project, implemented by the reproductive justice organization SisterLove and Emory University Center for Reproductive Health Research in the Southeast from 2018-2022, as a case study to illustrate principles of community-led research for reproductive justice. The authors propose the following seven principles:
- Center the marginalized community members most affected by sexual and reproductive health (SRH) inequities as leaders of research.
- Facilitate equitable, collaborative partnership through all phases of SRH research.
- Honor multiple ways of knowing (experiential, cultural, and empirical) for knowledge justice and cross-directional learning across the team.
- Build on strengths (not deficits) within the community.
- Implement the tenets of reproductive justice including structural-level analysis and the human rights framework.
- Prioritize disseminating useful findings to community members first then to other audiences.
- Take action to address social and reproductive injustices.