Abstract
Objectives: To evaluate rural Colorado women's perceived access to and preferences for receiving reproductive health care services in their communities. Methods: We conducted a cross-sectional, online survey of English and Spanish-speaking women 18-45 years old who are registered to vote in rural Colorado zip codes. Eligible participants were recruited with postcard mailings. Survey questions assessed experiences, beliefs, and preferences regarding facets of reproductive health care, including contraception, miscarriage, and abortion. We performed descriptive and bivariate statistics. Results: Respondents (n=373) had a mean age of 33 years (SD=7.0) and were majority white (86%) and insured (90%;24% publicly insured) from a representative distribution of rural zip codes. Most (74%) noted barriers to obtaining reproductive health care in their communities, with an average of 3.4 barriers cited per person. The most common barriers were too few providers in their communities (83%) and long distance to obtain care (68%). Many (48%) had used telemedicine, primarily (77%) since the COVID-19 pandemic. About half (54%) of respondents were somewhat or very interested in using telemedicine for reproductive health care services. Interest in telemedicine did not significantly differ by perceived barriers to accessing care (p=0.19) or previous use of telemedicine (p=0.11). Conclusions: Most reproductive-aged, rural Colorado women endorsed barriers to obtaining reproductive health care in their communities. While many rural women are interested in using telemedicine for reproductive health care, many are not. Our findings indicate that additional innovative solutions are needed to improve access to care in rural communities.
Highlights
By race, rates of loss to follow-up and delayed follow-up in patients presenting with a pregnancy of unknown location (PUL)
We reviewed 474 charts of patients diagnosed with PUL from September 2019 to January 2021
56% of non-White patients (n=237) experienced delays in care compared to 35% of White patients (n=17; p
Summary
We aimed to evaluate the association between implicit racial bias and willingness to remove an intrauterine device (IUD) upon patient request. Methods: We recruited obstetrician-gynecology (Ob-Gyn) and family medicine (FM) residents and attendings via national residency listservs. We collected demographic information and randomized participants to view a clinical vignette associated with either a picture of a black or white patient who requested IUD removal. After selecting their management, participants completed a validated racial Implicit Associated Test (IAT). 278 (76.7%) were Ob-Gyn, 83 (22.9%) were FM, and 262 (71.4%) were residents. Participants who were randomized to the clinical vignette with the black patient were more likely to leave the IUD in place if they had a stronger racial preference for white people, as determined by the IAT.
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