Determinants of demand: method selection and provider preference among US women seeking abortion services

BACKGROUND: Medication abortion has the potential to increase abortion availability, primarily through new provider networks; however, without a better understanding of how and why women make decisions regarding both their abortion method and their provider, expansion efforts may be misguided and valuable resources may be wasted. STUDY DESIGN: We undertook an exploratory study to investigate method and provider preferences. Semistructured one-on-one interviews were conducted with 205 abortion clients at three family planning clinics. RESULTS: Study participants greatly preferred the clinic setting for their abortion; the majority of women in the study would not have gone to their regular physician if they had been given the option. In addition, method choice trumps provider choice for the majority of women who would have preferred their regular provider. Participants who chose the aspiration procedure were more likely to have previous knowledge about the medication method. Travel time was not a predictor of preferring one's regular physician over the clinic. CONCLUSIONS: Expanding provider networks via the private sector is unlikely to be a panacea. In addition to these efforts, more attention may need to be paid to addressing logistic barriers to access. Physicians offering abortion services need to let their patients know they offer such services prior to their patients' need for them. Questions remain regarding the information being circulated about medication abortion.     

Abortion risk and decisionmaking among young people in urban Cameroon

This study examines the use of induced abortion among Cameroonian adolescents and young women, based on biographical data collected in 1997 among young women and men residing in Yaoundé. Results suggest a high prevalence of abortion during adolescence and early adulthood (35 percent of all pregnancies reported). Although most clandestine abortions were performed by a physician or a nurse, the prevalence of abortion performed by nonmedical personnel or using unsafe methods is still high, and postabortion health complications are reported for about one-fourth of all abortions. Logistic regression models are used to examine the effect of women's, partners', and relationships' characteristics at the time of pregnancy on the odds that a pregnancy will be terminated through abortion. The analysis shows a significant effect of school enrollment, parity, and stability and social acknowledgment of the sexual relationship on the risk of having an abortion. Young men's involvement in decisions and their motivations concerning abortion are also examined.     

Abortion restrictions in the state of Georgia: Anticipated impact on people seeking abortion

ObjectiveTo explore the impact of restrictive abortion policies in the state of Georgia on the lives of people seeking abortion and how they would manage unwanted pregnancies.Study designWe conducted a cross sectional study of English and Spanish-speaking people seeking abortion from three high-volume outpatient abortion clinics in Atlanta, Georgia from April 2019 through August 2019. Participants completed a multiple-choice questionnaire. We used bivariable and multivariable analysis to explore relationships between demographic characteristics and how people would manage their unwanted pregnancies if abortion were illegal in the state. Two researchers (EC and SC) conducted qualitative analysis on free response answers and coded them by key emotion.ResultsOf the 382 participants, 312 (81.9%) considered at least one way to end their pregnancy if abortion were illegal in Georgia: 252 (66.1%) by traveling to another state, 85 (22.3%) by self-management with medications and/or herbs, and 32 (8.4%) considered self-harm behaviors. When asked how they would feel about not being able to have a desired abortion, 94% reported negative emotions, ranging from “scared” to “enslaved.”ConclusionsLimiting access to legal abortion in Georgia would negatively impact the lives of people seeking abortion and has the potential to drive individuals to seek more costly and risky alternatives to end their pregnancy.ImplicationsRestricting abortion in Georgia may cause medically unnecessary delays in care, increased travel time, cost and negative emotional responses to people seeking abortion. Mitigating strategies include legislative challenges to restrictive laws as well as harm reduction education.     

Abortion barriers and perceptions of gestational age among women seeking abortion care in the latter half of the second trimester

Objective

Later second-trimester abortion (gestational age ≥ 19 weeks) is higher risk, more expensive and more difficult to access than abortion earlier in pregnancy. We sought to enumerate barriers to care described by women seeking abortion in the latter half of the second trimester. We also assessed the accuracy of later second-trimester abortion patients’ perceptions of their pregnancies’ gestational ages.

Study Design

A retrospective analysis of data from 232 women served by a referral program for women seeking abortion care between 19 and 24 weeks of gestational age was performed. Data collected included demographics, pregnancy history, gestational age by ultrasound, perceived gestational age, barriers to abortion care experienced and time lapsed from pregnancy recognition to presentation for care.

Results

Difficulty deciding whether to terminate (44.8%), financial barriers to care (22.0%) and the patient having recently realized she was pregnant (21.6%) were the most common delaying barriers cited. Nearly half (46.6%) of women underestimated their own gestational ages by greater than 4 weeks. Risk factors for experiencing at least 3 months time lapsed from pregnancy recognition to program referral included difficulty deciding whether to terminate [odds ratio (OR) 4.08, 95% confidence interval (CI) 2.51–8.70] and nonwhite race/ethnicity (OR 2.04, 95% CI 1.16–3.57).

Conclusions

Women seeking abortion care in the latter half of the second trimester encounter many of the same barriers previously identified among other abortion patient populations. Because many risk factors for delayed presentation for care are not amenable to intervention, abortion must remain available later in the second trimester.

Implications

Women presenting for abortion in the later second trimester are delayed by structural and individual-level barriers, and many substantially underestimate their own gestational age. Removing financial barriers may help reduce abortion delay; however, many risk factors are nonmodifiable, underscoring the need to ensure access to later second-trimester abortion.     

Unreimbursed expenses for medical care among urban elderly people

Out-of-pocket medical expenditures were examined among a sample of 400 low-to-moderate income Medicare recipients living in the Bronx for a twelve month period in 1986–87. Using three different measures of magnitude, the most significant expenses were for Medicare and private insurance premiums, medications, and dental care. The mean percent of per capita income spent out-of-pocket for medical care (including health care premiums) was 11.0%. Elderly people who spend over 12% of their own income on medical care include those in the poorest health, those with annual incomes under $15,000, people living with spouses or others, and those using a private physician as a primary source of medical care.Cynthia Thomas, Ph.D. is Senior Research Associate, Howard R. Kelman, Ph.D. is Director, Division of Health Services Organization & Policy, Department of Epidemiology and Social Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467. Portions of these data were presented at the American Public Health Association Annual Meeting, New Orleans, Louisiana, October 18–22, 1987. Supported by grants from the United Hospital Fund of New York and the National Institute on Aging (PO1 AGO3424 and RO1AGO8125)The authors would like to thank Lourdes Foley and Irene Young for their patient and careful preparation of the data for analysis.     

人工流产人群中性传播感染状况调查

近年来,随着性传播疾病的迅速蔓延,育龄妇女感染的机会越来越多,且要求终止妊娠的也日趋增多。我们对住院人工流产人群进行了性病感染情况的调查,研究性病检查和治疗的必要性,以提高人工流产手术的安全性。     

Risk factors for requiring long-term care among middle-aged and elderly people

OBJECTIVE: The purpose of this study is to clarify risk factors for requiring long-term care and all-cause mortality among middle-aged and elderly people. METHODS: The subjects were 2292 residents (759 males and 1,533 females) living in rural areas and attending health checkups during 1989-1993. Using the data obtained, we examined risk factors for long-term care needs and all-cause mortality. The observation period was from health checkups to March 2002 for all-cause mortality and to September 2002 for long-term care. The Cox' proportional hazards model was used to assess for both outcomes. RESULTS: Although all-cause mortality was two and a half times as high among males as among females, there were no differences between the sexes in the rate for requiring long-term care. In thirty five percent of cases needing long-term care, this was attributable to cerebrovascular diseases, in 24% to dementia, and in 9% to fracture. Risk factors significantly associated with higher all-cause mortality were age, low BMI, low total cholesterol, liver dysfunction, and smoking among males and females, as well as urine sugar among males and anemia among females. Risk factors significantly associated with requiring long-term care were age, hypertension and urine sugar among males, and age, anemia and urine sugar among females. CONCLUSIONS: This study shows that control of hypertension and diabetes mellitus is important for avoiding necessity for long-term care.     

Abortion among adolescents

For some adolescents, pregnancy means happiness and fulfillment. However, for most of them, it means a sad moment, characterized by fear and despair, as this is an unplanned situation and the abortion seems the only alternative. This retrospective study aimed at finding out the epidemiological profile of the adolescents admitted at the Clériston Andrade General Hospital, in Feira de Santana, Bahia, that were submitted to a curettage from January 1995 to December 1997. The results showed the need for educative programs in order to prevent unplanned pregnancies.     

关爱服务对女性流产后避孕方法选择的影响

目的 研究流产后关爱服务(PAC)对患者流产后避孕方法选择的影响.方法 采用方便抽样法抽取2015年4月至2016年2月于西安交通大学第一附属医院接受人工流产的患者154例,对进行人工流产的患者按来院顺序编号并按奇偶数分为干预组和对照组各77例.在流产前,对干预组患者提供流产后关爱服务,为对照组患者实施常规健康教育;两组患者接受人工流产后,通过返院咨询和电话咨询等形式,对其避孕方法和是否再次意外妊娠情况于流产后1、3、6、9个月共进行4次随访.结果 干预前,两组患者采用的避孕方法主要是不安全避孕法(干预组占71.4%,对照组占61.0%)及常规避孕法(干预组占27.3%,对照组占39.0%),差异均无统计学意义(均P>0.05).干预后1、3、6、9个月时,干预组患者的常规避孕率由干预前的27.3%迅速降低到2.6%,并在之后的随访中逐渐提高;而对照组患者的常规避孕率由干预前的39.0%增加到81.8%,并维持较高水平.干预组患者的高效避孕率由干预前的1.3%显著增长到97.4%,并保持较高水平;对照组患者的高效避孕率缓慢增长到5.2%.干预组患者的不安全避孕率由干预前的71.4%显著降低到1.3%,并保持较低水平,而对照组患者的不安全避孕率由干预前的61.0%缓慢降低到15.6%.两组患者的3种避孕方法在1、3、6、9个月随访时差异均有统计学意义(χ2=12.48~138.45,均P<0.05).结论 流产后关爱服务能提高患者的高效避孕率.经过流产后关爱服务咨询,在后续的随访中,需要巩固女性的科学避孕知识和强化其意识,维持避孕效果.     

流产保健的心理治疗方法探讨

人工流产是计划生育失败后所采取的补救措施,会给受术者造成严重的心理刺激,对手术效果、术后的康复产生不同的影响。我国从20世纪90年代开始出现对人工流产的社会和心理作用的研究,一项研究表明,人工流产对84％的受术妇女产生不同程度的心理压力。研究证实,人工流产妇女的心态对术中出血量及康复有直接影响,因此,做好受术者心理护理十分必要。     

社区老年人居家养老选择现状及影响因素分析

目的 了解河北省唐山市社区老年人居家养老方式选择现状及其影响因素,为更好地建立社区居家养老服务体系提供参考依据。方法 于2012年10月-2013年1月采用随机整群抽取方法对在唐山市路南、路北区抽取的2个社区共724名≥60岁社区老年人进行问卷调查。结果 唐山市724名社区老年人中,228人（31.5%）倾向于选择居家养老;496名非居家养老老年人中,218人（44.0%）选择自我养老,193人（38.9%）选择子女养老,85人（17.1%）选择机构养老;多因素非条件logistic回归分析结果显示,子女全部在身边、患≥2种慢性病、有抑郁状态的社区老年人更倾向于选择居家养老,月收入≥3 800元的社区老年人更倾向于选择非居家养老。结论 社区老年人居家养老方式受多种因素影响,主要包括患慢性病数量、月平均收入、子女在身边情况、是否抑郁等。     

流产后关爱服务在城市女性高效避孕措施落实中的作用

目的:通过对比接受传统人工流产服务和流产后关爱(PAC)服务的城市户籍女性的高效避孕措施落实情况,探讨PAC效果。方法:选取上海市普陀区妇幼保健院计划生育科门诊人工流产女性787例,其中接受人工流产的同时给予PAC服务女性400例为观察组,接受传统人工流产服务的女性387例为对照组,对比两组女性高效避孕措施术后立即使用情况和6个月后续用情况。结果:女性高效避孕措施术后立即使用情况观察组高于对照组(P0.05);两组第6个月COC使用率均低于术后COC立即使用率(P0.01),而术后IUD使用率无差异(P0.05)。结论:PAC可有效提高女性流产后高效避孕措施使用率,但随着时间推移,使用COC的女性明显减少,应加强COC的宣传,探索更有效的PAC措施。