Adverse Birth Outcomes Among Korean Women Compared to White Women in the United States

To evaluate the risk of adverse birth outcomes among US- and foreign-born Korean women compared to US-born white women, we used the 2004 US natality file to assess the risk of low birth weight (LBW), preterm delivery (PTD), and cesarean delivery (CD) among US-born (N = 943) and foreign-born Koreans (N = 11,974) compared to white women (N = 25,834). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using regression models to assess the risk of these outcomes. US-born (aOR = 0.66, 95% CI 0.43–1.02) and foreign-born Korean women (aOR 0.86, 95% CI 0.70–1.06) exhibited a lowered risk of LBW than white women, although not statistically significant. The risks of PTD and CD among Korean women were similar to white women, regardless of Korean women’s nativity status. Future research should focus on identifying the cultural factors and practices associated with decreased risk of LBW among Korean women.     

Abortion in the United States: incidence and access to services, 2005

CONTEXT: Accurate information about abortion incidence and services is necessary to monitor levels of unwanted pregnancy and women's ability to access abortion services. METHODS: All known abortion providers in the United States were contacted for information about abortion services in 2004 and 2005. This information, along with data from the U.S. Census Bureau, was used to examine national and state trends in numbers of abortions and abortion rates, proportions of counties and metropolitan areas without an abortion provider, and accessibility of abortion services. RESULTS: An estimated 1.2 million abortions were performed in the United States in 2005, 8% fewer than in 2000. The abortion rate in 2005 was 19.4 per 1,000 women aged 15-44; this rate represents a 9% decline from 2000. There were 1,787 abortion providers in 2005, only 2% fewer than in 2000. Some 87% of U.S. counties, containing 35% of women aged 15-44, did not have an abortion provider in 2005. Early medication abortion, offered by an estimated 57% of known providers, accounted for 13% of abortions (and for 22% of abortions before nine weeks' gestation). The average amount paid for an abortion at 10 weeks was $413-after adjustment for inflation, $11 less than in 2001. CONCLUSION: The numbers of abortions and the abortion rate continued their long-term decline through 2005. Reasons for this trend are unknown but may include improved access to and use of contraceptives or decreased access to abortion services.     

Adverse Pregnancy and Neonatal Outcomes Among Marshallese Women Living in the United States

Maternal and Child Health Journal - Objective Despite heterogeneity among Pacific Islanders, most studies aggregate them regardless of origin. Thus, limited information is available about perinatal...     

Abortion in the United States: barriers to access

The legalization of abortion in the United States has brought a dramatic improvement in women's health and reductions in maternal and infant mortality. For young women, low-income women, and women of color, however, access to abortion has been increasingly restricted. This article describes the obstacles to abortion access, including lack of federal funding; restrictive laws, encompassing those requiring parental consent or notification for a minor seeking an abortion, as well as those attempting to ban a certain procedure; stigmatization and marginalization of abortion; decreasing abortion services; and a shortage of providers. The article connects the erosions in rights relating to abortion to policies undermining poor women's rights in relation to having children.     

Birth Outcomes of Immigrant Women in the United States,France, and Belgium

Objectives: To compare maternal characteristics and birth outcomes of Mexico-born and native-born mothers in the United States and those of North African mothers living in France and Belgium to French and Belgian nationals. Methods: We examined information from single live birth certificates for 285,371 Mexico-born and 3,131,632 U.S.-born mothers (including 2,537,264 U.S.-born White mothers) in the United States, 4,623 North African and 103,345 Belgian mothers in Belgium, and a French national random sample consisting of 632 North African and 11,185 French mothers. The outcomes were mean birthweight, low birthweight, and preterm births. Differences between native/nationals and foreign-born mothers in each country were assessed in bivariate and multivariate analyses controlling for maternal risk factors. Results: The adjusted odds for low birthweight were lower for immigrants than native/nationals by 32% in the United States, by 32% in Belgium, and by 30% in France. The adjusted odds for preterm births were lower for immigrants compared with native/nationals by 11% in the United States and by 23% in Belgium. In France, the odds for preterm births were comparable for immigrants and naturalized mothers. Infants of immigrant mothers also had higher mean birthweights in all three countries. Conclusion: Despite their disadvantaged status, Mexico-born and North African-born women residing in the United States, France, and Belgium show good birth outcomes. These cannot be explained solely by traditional risk factors. Protective factors and selective migration may offer further clues.     

Birth control methods in the United States

U.S. women have fewer birth control options than do women in other developed countries. Reliance on sterilization helps many couples make up for their lack of choices, but high rates of sterilization among relatively young women are a cause for concern, given the chance of later regret. Although pill use is very high among young women, it falls dramatically among those in their 30s and, often unnecessarily, is minimal among those over 35. The IUD is most appropriate for older women in mutually monogamous relationships who have completed their families, and its availability has been limited in recent years because of liability problems. Although barrier methods are widely used by women of all ages, they are less effective than the pill or IUD. It is fair to conclude that given U.S. women's sometimes long intervals of exposure to the risk of unintended pregnancy, too few safe and effective reversible contraceptives are available in the United States. The addition of an acceptable new method would certainly lead to a reduction in unintended pregnancies, but many potentially useful new methods will not be developed in this century unless the amount of money invested in contraceptive research and development is substantially increased.     

Biomarkers of Exposure to Phthalate Mixtures and Adverse Birth Outcomes in a Puerto Rico Birth Cohort

Background: Humans are exposed to complex mixtures of phthalate chemicals from a range of consumer products. Previous studies have reported significant associations between individual phthalate metabolites and pregnancy outcomes, but mixtures research is limited.Objectives: We used the Puerto Rico Testsite for Exploring Contamination Threats longitudinal pregnancy cohort to investigate associations between phthalate metabolite mixtures and pregnancy outcomes.Methods: Women (n=462 carrying females, n=540 carrying males) provided up to three urine samples throughout gestation (median 18, 22, and 26 wk), which were analyzed for 13 phthalate metabolites. Pregnancy outcomes including preterm birth (PTB), spontaneous PTB, small and large for gestational age (SGA, LGA), birth weight z-score, and gestational age at delivery were abstracted from medical records. Environmental risk scores (ERS) were calculated as a weighted linear combination of the phthalates from ridge regression and adaptive elastic net, which are variable selection methods to handle correlated predictors. Birth outcomes were regressed on continuous ERS. We assessed gestational average and visit-specific ERS and stratified all analyses by fetal sex. Finally, we used Bayesian kernel machine regression (BKMR) to explore nonlinear associations and interactions between metabolites.Results: Differences in metabolite weights from ridge and elastic net were apparent between birth outcomes and between fetal sexes. An interquartile range increase in gestational average phthalate ERS was associated with increased odds of PTB [male oddsratio(OR)=1.56; 95% confidence interval (CI): 1.08, 2.27; female OR=1.91; 95% CI: 1.23, 2.98], spontaneous PTB (male OR=2.32; 95% CI: 1.46, 3.68; female OR=2.00; 95% CI: 1.04, 3.82), and reduced gestational age at birth (male β=−0.39 wk, 95% CI: −0.62, −0.15; female β=−0.29 wk, 95% CI: −0.52, −0.05). Analyses by study visit suggested that exposure at ∼22 wk (range 20–24 wk) was driving those associations. Bivariate plots from BKMR analysis revealed some nonlinear associations and metabolite interactions that were different between fetal sexes.Discussion: These results suggest that exposure to phthalate mixtures was associated with increased risk of early delivery and highlight the need to study mixtures by fetal sex. We also identified various metabolites displaying nonlinear relationships with measures of birth weight. https://doi.org/10.1289/EHP8990     

Abortion incidence and access to services in the United States, 2008

CONTEXT: The incidence of abortion has declined nearly every year between 1990 and 2005, but this trend may be ending, or at least leveling off. Access to abortion services is a critical issue, particularly since the number of abortion providers has been falling for the last three decades. METHODS: In 2009 and 2010, all facilities known or expected to have provided abortion services in 2007 and 2008 were contacted, including hospitals, clinics and physicians’ offices. Data on the number of abortions performed were collected and combined with population data to estimate national and state‐level abortion rates. Abortion incidence, provision of early medication abortion, gestational limits, charges and antiabortion harassment were assessed by provider type and abortion caseload. RESULTS: In 2008, an estimated 1.21 million abortions were performed in the United States. The abortion rate increased 1% between 2005 and 2008, from 19.4 to 19.6 abortions per 1,000 women aged 15–44; the total number of abortion providers was virtually unchanged. Small changes in national abortion incidence and number of providers masked substantial changes in some states. Accessibility of services changed little: In both years, 35% of women of reproductive age lived in the 87% of counties that lacked a provider. Fifty‐seven percent of nonhospital providers experienced antiabortion harassment in 2008; levels of harassment were particularly high in the Midwest (85%) and the South (75%). CONCLUSIONS: The long‐term decline in abortion incidence has stalled. Higher levels of harassment in some regions suggest the need to enact and enforce laws that prohibit the more intrusive forms of harassment.     

Abortion incidence and services in the United States in 2000

CONTEXT: Nearly half of unintended pregnancies and more than one-fifth of all pregnancies in the United States end in abortion. No nationally representative statistics on abortion incidence or on the universe of abortion providers have been available since 1996.
METHODS: In 2001-2002, The Alan Guttmacher Institute (AGI) conducted its 13th survey of all known U.S. abortion providers, collecting information for 1999, 2000 and the first half of 2001. Trends were calculated by comparing the survey results with data from previous AGI surveys.
RESULTS: From 1996 to 2000, the number of abortions fell by 3% to 1.31 million, and the abortion rate declined 5% to 21.3 per 1,000 women 15–44. (In comparison, the rate declined 12% between 1992 and 1996.) The abortion ratio in 2000 was 24.5 per 100 pregnancies ending in abortion or live birth, 5% lower than in 1996. The number of abortion providers decreased by 11% to 1,819 (46% were clinics, 33% hospitals and 21% physicians' offices); clinics provided 93% of all abortions in 2000. In that year, 34% of women aged 15-44 lived in the 87% of counties with no provider, and 86 of the nation's 276 metropolitan areas had no provider. About 600 providers performed an estimated 37,000 early medical abortions during the first six months of 2001; these procedures represented approximately 6% of all abortions during that period. Abortions performed by dilation and extraction were estimated to account for 0.17% of all abortions in 2000.
CONCLUSIONS: Abortion incidence and the number of abortion providers continued to decline during the late 1990s but at a slower rate than earlier in the decade. Medical abortion began to play a small but significant role in abortion provision.     

Abortion services in the United States, 1984 and 1985

In 1984 and 1985, the number of abortions, the abortion rate and the abortion ratio stayed at approximately the same levels as in the previous three years. Just under 1.6 million abortions were performed, about three percent of women of reproductive age obtained an abortion, and about 30 percent of pregnancies (excluding those ending in stillbirths and miscarriages) were terminated by abortion. However, the number of abortion providers declined by five percent between 1982 and 1985, and the geographic distribution of abortion services continued to be markedly uneven. Eighty-two percent of all U.S. counties--50 percent of those classified as metropolitan and 91 percent of those classified as nonmetropolitan--lacked an abortion provider in 1985. The long-term trend away from hospital abortions persisted during the period: Eighty-seven percent of the abortions performed in 1985 were done in nonhospital facilities, an increase of five percentage points over the 1982 level. Although abortion clinics constituted only 15 percent of all providers, they were responsible for 60 percent of the procedures performed in 1985. Among all abortion facilities, only 43 percent provided services to women after the 12th week of pregnancy. Abortion clinics were far more likely to offer second-trimester procedures than were other types of abortion providers (75 percent, compared with 13-50 percent). As of mid-1986, charges for a first-trimester nonhospital abortion ranged from $75 to nearly $900. The average amount paid was $213. In 1985, only 39 percent of nonhospital abortion facilities accepted state reimbursement for abortions provided to low-income women, and only 55 percent of facilities offered some reduction in charges to such women.     

Abortion services in the United States, 1981 and 1982

The U.S. abortion rate remained essentially stable in 1981 and 1982, after rising each year between 1973 and 1980. The increases had been due to widening availability of abortion services and rising unintended pregnancy rates caused by several factors, among them a shift from use of the pill and the IUD to use of less effective methods. The stabilization of the abortion rate since 1980 is the culmination of a pattern of smaller annual increases in the rate in previous years. There were 1.57 million legal abortions reported in the United States in 1982. About three percent of U.S. women of reproductive age obtained an abortion, and about 26 percent of all pregnancies were terminated by abortion during that year. There are still wide gaps in the geographic availability of abortion services. Seventy-eight percent of all U.S. counties--containing 28 percent of women aged 15-44--had no identified provider of abortion services in 1982. Only two percent of abortions were performed in nonmetropolitan counties in that year, although 26 percent of women of reproductive age live in such counties. Fully 87 percent of nonmetropolitan counties had no abortion providers at all in 1982. Despite the concentration of abortion services in urban areas, 47 percent of metropolitan counties also had no abortion service providers in 1982. Abortion services are most available, and rates are highest, in states on the East and West coasts. In 1982, 82 percent of abortions were performed in nonhospital facilities: 56 percent in clinics which specialize in abortion services, 21 percent in other kinds of clinics and five percent in physicians' offices.(ABSTRACT TRUNCATED AT 250 WORDS)     

Abortion services in the United States, 1987 and 1988

A 1989 survey by The Alan Guttmacher Institute shows that 1.6 million abortions were performed in the United States in 1988, a number that has remained relatively unchanged since 1980. More than 98 percent of abortions in 1987-1988 were performed in metropolitan areas. Although 51 percent of metropolitan counties have no provider of abortion services, 93 percent of nonmetropolitan counties are without a provider. The lack of abortion services in nonmetropolitan areas has been intensified by a 13 percent reduction since 1985 in the number of hospitals that offer abortion services. The number of nonhospital facilities providing abortion services increased by four percent, however, and specialized clinics provided 64 percent of all abortions performed in 1988.     

Acculturation and Adverse Birth Outcomes in a Predominantly Puerto Rican Population

Introduction Latinas in the United States on average have poorer birth outcomes than Whites, yet considerable heterogeneity exists within Latinas. Puerto Ricans have some of the highest rates of adverse outcomes and are understudied. The goal of this study was to determine if acculturation was associated with adverse birth outcomes in a predominantly Puerto Rican population. Methods We conducted a secondary analysis of Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011. A convenience sample of pregnant Latina women were recruited from a tertiary care hospital in Massachusetts. Acculturation was measured in early pregnancy; directly via the Psychological Acculturation Scale, and via proxies of language preference and generation in the United States. Birth outcomes (gestational age and birthweight) were abstracted from medical records (n = 1362). Results After adjustment, psychological acculturation, language preference, and generation was not associated with odds of preterm birth. However, every unit increase in psychological acculturation score was associated with an increase in gestational age of 0.22 weeks (SE = 0.1, p = 0.04) among all births. Women who preferred to speak Spanish (β = ?0.39, SE = 0.2, p = 0.02) and who were first generation in the US (β = ?0.33, SE = 0.1, p = 0.02) had significantly lower gestational ages than women who preferred English or who were later generation, respectively. Similarly, women who were first generation had babies who weighed 76.11 g less (SE = 35.2, p = 0.03) than women who were later generation. Discussion We observed a small, but statistically significant adverse impact of low acculturation on gestational age and birthweight in this predominantly Puerto Rican population.     

Late Childbearing and Changing Risks of Adverse Birth Outcomes in Korea

This study aimed to examine whether the relative importance of maternal age as a correlate of adverse birth outcomes has changed and to investigate if social inequalities in birth outcomes have widened during the past decade when the marriage and fertility related social environment has undergone tremendous change in Korea. Probabilities of adverse birth outcomes (prematurity and intrauterine growth retardation [IUGR]) were estimated with multinomial logistic regression models, utilizing the Korean birth registration data of 1995 and 2005. The main effects of maternal age and parental socioeconomic characteristics were compared between two study years, net of infant sex, birth order, and plurality. The association between maternal age and adverse birth outcomes, relative to the maternal and parental social characteristics, has clearly diminished between 1995 and 2005. During this period, differences in prematurity and IUGR by maternal age have also diminished, while those by parental social characteristics, particularly maternal education, have substantially widened. The intensified overall socioeconomic polarization since the economic crisis of the late 1990s is most likely responsible for the increased social inequality in adverse birth outcomes in Korea. A massive structural change in macro-economic conditions and culture during the study period may have modified the relationship between maternal age and birth outcomes.     

The Status of Women's Reproductive Rights and Adverse Birth Outcomes

BackgroundReproductive rights—the ability to decide whether and when to have children—shape women's socioeconomic and health trajectories across the life course. The objective of this study was to examine reproductive rights in association with preterm birth (PTB; <37 weeks) and low birth weight (LBW; <2,500g) across states in the United States.MethodsAnalysis included records for all live births in the United States in 2012 grouped by state. A reproductive rights composite index score was assigned to records from each state based on the following indicators for the year before birth (2011): mandatory sex education, expanded Medicaid eligibility for family planning services, mandatory parental involvement for minors seeking abortion, mandatory abortion waiting periods, public funding for abortion, and percentage of women in counties with abortion providers. Scores were ranked by tertile with the highest tertile reflecting states with strongest reproductive rights. We fit logistic regression models with generalized estimating equations to estimate the odds ratios and 95% confidence intervals for PTB and LBW associated with reproductive rights score controlling for maternal race, age, education, and insurance and state-level poverty.ResultsStates with the strongest reproductive rights had the lowest rates of LBW and PTB (7.3% and 10.6%, respectively) compared with states with more restrictions (8.5% and 12.2%, respectively). After adjustment, women in more restricted states experienced 13% to 15% increased odds of PTB and 6% to 9% increased odds of LBW compared with women in states with the strongest rights.ConclusionsState-level reproductive rights may influence likelihood of adverse birth outcomes among women residents.     

Predictors of Abortion Counseling Receipt and Helpfulness in the United States

BackgroundLittle is known about women's expectations, needs, and experiences with abortion counseling and the factors that influence their experiences.MethodsThis study sought to investigate individual- and facility-level factors that influenced women's reports of receiving abortion counseling and the helpfulness of counseling. Data were drawn from quantitative interviews with 718 patients recruited from 30 abortion facilities, and 27 interviews with facility informants in the United States.FindingsSixty-eight percent of participants reported receiving counseling; reports varied by facility. Almost all participants who reported receiving counseling described counseling as helpful: 40% extremely, 28% quite, 17% moderately, 10% a little, and 4% not at all. Nearly all (99%) reported that their counselor communicated support for whatever decision they made. No individual-level factors predicted counseling receipt or helpfulness. Facility informant reports that it is their role to counsel patients about emotional issues was positively associated with women's reports of counseling receipt (p < .001). Women at facilities subject to laws requiring provision of specific information and/or state-approved, written materials had lesser odds of finding counseling helpful, compared with women at facilities not subject to such laws (p < .01).ConclusionsLegal mandates that regulate abortion counseling do not seem to be helpful to women. More research is needed to understand the effects of abortion counseling and whether policies regulating counseling have a deleterious effect on women.