Access To Abortion Research Articles

Frequency of self reported abortion and associated factors in Iran

ABSTRACT Background: There are few reliable Iranian-induced abortion data. The aim of this paper was to investigate the prevalence and socioeconomic characteristics of women and men who report having had or been a partner in an abortion. Materials and Methods: A cross-sectional survey of women and men aged 15–49 years referred to the health center that randomly selected from 110 health center that was used. Results: Data from 1520 women and men surveys were analyzed. One in 10 women and one in 12 men had experienced or been a partner in an abortion. In adjusted analyses, women and men in the 34–49 age group [adjusted odds ratio (AOR) 0.62, 95% (CI) 0.41, 0.96], the importance of religion in fertility (AOR = 0.42; 95% CI 0.26, 0.67), dissatisfied general health (AOR = 0.52; 95% CI 0.32, 0.87), and history of unwanted pregnancy for twice (AOR = 2.32; 95% CI 1.43, 3.77) and history of unwanted pregnancy for three-time or more (AOR = 2.69; 95% CI 1.59, 5.49) were associated with significantly increased odds of abortion. Haven’t heard of medication abortion, that is, abortion with tablets (AOR = 0.43; 95% CI 0.29, 0.67) was associated with significantly reduced odds of abortion. Conclusions: The findings contribute to scarce information about abortion in Iranian. Due to the high prevalence of abortion and the country’s population growth policy, Iranian women need a full range of sexual and reproductive health services, including contraceptive counseling and accessible abortion care.

What Hath Dobbs Wrought? Abortion activism in precarious and punitive times

ABSTRACT In June 2022, the U.S. Supreme Court in Dobbs v. Jackson Women’s Health Organization (2022) overturned Roe v. Wade (1973), abolishing the constitutional right to abortion. Significant in its radical criminalization of abortion, Dobbs reinvigorated feminist activism for reproductive justice. Digital and mobile technologies are used in innovative ways by activists to organize, educate, and dispel counter-narratives about abortion, including feminist global networks that provide medication abortion and abortion storytelling through social media and media interventions. There continue to be analogue interventions that are the legacy of the 1960’s-era Jane Collective. In this vexatious legal environment, the communication technologies that facilitate abortion activism are weaponized by restrictionist actors to not only misinform, but also, through abortion surveillance, to track and curtail access to reproductive care by tapping into and exploiting what we term the personal data economy of reproductive health. Activists are thus countering the surveillant assemblages engaged by restrictionist states whose objective is to criminalize abortion access and care across borders. This article considers the historical and current media ecology surrounding reproductive health, care and justice, the technologies that have and continue to shape it, and the array of analogue, digital, mobile and hybrid feminist activist interventions emerging post-Roe.

Vasectomy incidence in the military health system after the reversal of Roe v. Wade.

Dobbs v. Jackson Women's Health Organization (Dobbs decision) has already had profound impact on reproductive health care in the United States. Some studies have reported increased incidence of vasectomy after the Dobbs decision. The Military Health System (MHS) provides a unique opportunity to evaluate this relationship in a universally insured, geographically representative population. We conducted a retrospective cross-sectional study of vasectomies among all male beneficiaries in the MHS, ages 18 to 64, from 2018 to 2022. Beneficiaries receiving a vasectomy were identified via billing data extraction from the MHS Data Repository (MDR). Descriptive statistics of demographic factors of all those receiving a vasectomy in the study period were evaluated. Crude and multivariate logistic regression models were used to evaluate for differences in demographic variables in those receiving a vasectomy pre-Dobb's decision as compared to after the Dobb's decision. The total number of men receiving a vasectomy each month over the study period was analyzed, as were the numbers in a state immediately implementing abortion access restrictions (Texas), and one without any restrictions on abortion access (Virginia). Our analysis found that men receiving a vasectomy post-Dobbs decision were more likely to be younger, unmarried, and of junior military rank than prior to the Dobbs decision. In the months following the Dobbs decision in 2022 (June-December), there was a 22.1% increase in vasectomy utilization as compared to the averages of those months in 2018-2021. Further, it was found that the relative increase in vasectomy after the Dobbs decision was greater in Texas (29.3%) compared to Virginia (10.6%). Our findings highlight the impact of the Dobbs decision on reproductive health care utilization outside of abortion.

Brief of Amici Curiae economists in support of respondents in Dobbs v. Jackson Women's Health Organization.

A pillar of Mississippi's argument in Dobbs v. Jackson Women's Health was that there is no evidence of "societal reliance" on abortion, meaning no reason to believe that access to abortion impacts the ability of women to participate in the economic and social life of the nation. Led by economist Caitlin Myers and attorney Anjali Srinivasan, more than 150 economists filed an amicus brief seeking to assist the Court in understanding that this assertion is erroneous. The economists describe developments in causal inference methodologies over the last three decades, and the ways in which these tools have been used to isolate the measure of the effects of abortion legalization in the 1970s and of abortion policies and access over the ensuing decades. The economists argue that there is a substantial body of well-developed and credible research that shows that abortion access has had and continues to have a significant effect on birth rates as well as broad downstream social and economic effects, including on women's educational attainment and job opportunities. What follows is a reprint of this brief.

The effects of post-Dobbs abortion bans on fertility

The U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization sparked the most profound transformation of the landscape of abortion access in 50 years. We provide the first estimates of the effects of near-total abortion bans on fertility using a pre-registered synthetic difference-in-differences design applied to newly released provisional natality data for the first half of 2023. The results indicate that states with abortion bans experienced an average increase in births of 2.3 percent relative to if no bans had been enforced.

Rates of Female Sterilization, Vasectomy, and LARC Placement Before and After the Dobbs Decision: A Retrospective Cohort Study [ID 2683404

INTRODUCTION: Immediately after the Dobbs decision in Ohio, abortion was restricted after detection of a fetal heartbeat. The objective of this study was to characterize changes in utilization of long-acting reversible contraception (LARC) and permanent sterilization (PS) after the abrupt enactment of restrictive abortion legislation. METHODS: We conducted a retrospective cohort study of female and male patients aged 15–55 who underwent permanent sterilization (tubal ligation, salpingectomy, vasectomy) or LARC placement (IUD, contraceptive implant) at a large Northeast Ohio hospital system from January 1, 2022 to December 31, 2022; 6 months before and after Dobbs. Contraception procedure volumes were compared, and patient characteristics were assessed. RESULTS: Pre-Dobbs, 4,247 procedures were identified among females, including 725 (17.1%) PS and 7,449 (81.3%) LARC. Post-Dobbs, the total number of female procedures increased by 15.5% (4,916) and there was a significant increase in the proportion of PS procedures, representing 20.1% of all female procedures (P<.001). Males showed a similar trend, with vasectomies rising from 1,193 to 1,590 procedures. Post-Dobbs, patients undergoing procedures were younger (women, 30.9 years [24.5, 36.8] versus 31.5 [25.2, 36.9]; P=.011; men, 36.6 years [32.9, 39.6] versus 37.2 [34.2, 40.4]; P<.001). Among patients undergoing procedures post-Dobbs, the proportion that reported single relationship status significantly increased for women (57.4% versus 55.9%; P=.028) and men (23.0% versus 18.1%; P=.002). CONCLUSION: This study demonstrates increased utilization of LARC and PS following the Dobbs decision. This rise in PS and demographic changes implies concerns about abortion access, especially among younger reproductive-aged patients. Further research is warranted to understand the driving factors behind these trends.

Assessing Pregnant Patients' Postpartum Contraceptive Plans After the SCOTUS Dobbs Decision in a Highly Restrictive State [ID 2683439

INTRODUCTION: The June 2022 SCOTUS Dobbs decision removed federal protection to abortion access. In August 2022, a Tennessee trigger law made ending a pregnancy for any reason a felony. We hypothesized that this change would result in more pregnant patients desiring highly effective (long-acting or permanent) contraceptive methods after delivery. METHODS: This retrospective cohort analysis used electronic health records to capture demographic and pregnancy data for pregnant patients admitted for delivery in one East Tennessee hospital. Documented contraceptive plans chosen during pregnancy were categorized as highly effective (long acting or permanent) or moderate/least effective. Data were extracted from July 2019 to April 2020 (baseline) and compared to July 2022 to April 2023 (post-Dobbs). Chi-squared tests and binary logistic regression were conducted in SPSS. RESULTS: One-half (50.6%) of 7,489 records analyzed were post-Dobbs; 90.4% had a documented contraception plan upon hospital admission. Record of choosing a highly effective contraception plan during pregnancy decreased significantly baseline to post-Dobbs (47.2% to 39.6%; P<.001). Logistic regression was used to further analyze the relationship between the Dobbs decision and highly effective contraception plan desired postpartum. Patients who delivered after the Dobbs decision had lower odds (adjusted odds ratio 0.726; 95% CI [0.652, 0.809]; P<.001) of having highly effective contraception plans after controlling for age, number of living children, race/ethnicity, and insurance. CONCLUSION: A lower percentage of patients from the post-Dobbs cohort desired highly effective contraception after delivery. Further investigation should explore these surprising results. Regardless, patients should participate in patient-centered contraceptive counseling during prenatal care to make informed decisions after delivery.

Youth-led Research to Improve Abortion Access and Experience: Results from the CART-Access Project

Youth-led Research to Improve Abortion Access and Experience: Results from the CART-Access Project

Evaluating participant engagement in a preconception cohort study in relation to the Dobbs decision.

On June 24th, 2022, the United States (US) Supreme Court's ruling in Dobbs v. Jackson, etal. (hereafter, the Dobbs decision) removed federal-level protections for induced abortion, sparking concerns about reproductive rights and health privacy. Although other pregnancy outcomes (e.g. spontaneous abortion, ectopic pregnancy) are not explicit targets of post-Dobbs abortion bans, study participants may be worried about how their reproductive health data are used by researchers in the post-Dobbs era. To evaluate the extent to which the Dobbs decision influenced participant's engagement in a preconception cohort study. We leveraged data spanning 20 weeks before and after the Dobbs decision (4 February 2022, to 11 November 2022) from US participants in Pregnancy Study Online (PRESTO), an internet-based prospective preconception cohort study of couples attempting conception. We categorised participants' state-level abortion access by residential location: banned or restricted rights; limited access; and protected rights. We evaluated three participant engagement outcomes: follow-up questionnaire completion; report of a pregnancy; and clicking on the invitation link for a fertility-tracking app. We fit separate linear regression models and restricted cubic splines to compare outcome prevalence before and after the Dobbs decision by state-level abortion category. A total of 585 newly enrolled participants and 1247 already-enrolled participants received 2802 invitations to complete a follow-up questionnaire. In states with limited or protected abortion rights, we observed little change in participant engagement. In states with banned or restricted abortion rights, however, we observed a 27.12 percentage point reduction (95% confidence interval -43.68, -10.51) in the prevalence of clicking on the invitation link for the fertility-tracking app comparing the post- versus pre-Dobbs periods. There was some evidence of reduced participant engagement after the Dobbs decision in states with banned or restricted abortion rights, indicating potentially deleterious effects on the conduct of reproductive health studies.

The making of clandestinity: “strategic ignorance” in abortion practices in Latin America

ABSTRACT Abortion is a “public secret” in Latin America. It is highly restricted across most of the continent and yet millions of abortions take place every year. We use the sociological framework of “strategic ignorance” to argue that convenient not knowing, erasure, and concealment simultaneously prevent and facilitate abortions in Latin America. By drawing on interviews with people involved in abortion activism and access across the continent, we examine three sets of actors: the state, abortion providers, and individuals seeking abortions. When wielded by the state, strategic ignorance reproduces the status quo of the criminalization of abortion; however, when wielded by abortion providers and individuals seeking abortions, it creates the conditions for “clandestine” abortions to be procured without prosecution. Strategic ignorance is therefore mobilized by the powerful as well as the less powerful who are resisting state control of their fertility and reproductive lives.

Interest in and Support for Alternative Models of Medication Abortion Provision Among Patients Seeking Abortion in the United States

IntroductionMedication abortion is safe and effective, but restrictions still limit patients from accessing this method. Alternative models of medication abortion provision, namely advance provision, over-the-counter (OTC), and online, could help improve access to care for some, although there is limited evidence about abortion patients’ interest in these models. MethodsBetween 2017 and 2019, we administered a cross-sectional survey to abortion patients at 45 clinics across 15 U.S. states to explore their interest in and support for advance provision, OTC, and online abortion access. We assessed relationships between sociodemographic characteristics and interest in and support for each model using bivariate logistic regressions and present perceived advantages and disadvantages of each model, as described by a subset of participants. ResultsAmong 1,965 people enrolled, 1,759 (90%) initiated the survey. Interest in and support for advance provision was highest (72% and 82%, respectively), followed by OTC (63% and 72%) and online access (57% and 70%). In bivariate analyses, non-Hispanic Black and Asian/Pacific Islander respondents expressed lower interest and support for the online model and Alaska Native/Native American respondents expressed higher interest in an OTC model, as compared with white respondents. Among 439 participants naming advantages and disadvantages of each model, the most common advantages included convenience and having the abortion earlier. The most common disadvantages were not seeing a provider first and possibly taking pills incorrectly. ConclusionsAlthough most abortion patients expressed interest in and support for alternative models of medication abortion provision, variation in support across race/ethnicity highlights a need to ensure that abortion care service models meet the needs and preferences of all patients, particularly people from historically underserved populations.

An assessment of clinical outcomes of medication abortion without pretreatment ultrasonography in Planned Parenthood, United States, 2020–2021

ObjectivesRoutine ultrasound before medication abortion (MAB) may create an impediment to expanding abortion access. This study examines clinical outcomes of MAB without pretreatment ultrasound evaluation at Planned Parenthood health centers in multiple states. Study designWe conducted a secondary analysis of data from 23 US-based Planned Parenthood affiliates that provided MAB without pretreatment ultrasound for eligible patients from March 2020 to December 2021. Affiliates aggregated electronic health record data from MABs at ≤77 days gestation (based on self-report of last menstrual period) without a pretreatment ultrasound (N = 18,041). Among MABs with known outcomes (N = 9821), we calculated the incidence rates and 95% confidence intervals (CI) for completed abortion, ongoing pregnancy, subsequent procedure, emergency department/hospital visits associated with MAB, ectopic pregnancies, and gestational duration greater than 77 days. ResultsAmong MABs with known outcomes, 96.3% had a complete abortion (95% CI = 95.9%–96.7%), and 2.0% had an ongoing pregnancy (95% CI = 1.7%–2.3%). Four percent had a subsequent procedure (95% CI = 3.6%–4.4%), and 2.3% had a documented emergency department/hospital visit (95% CI = 2.0%–2.6%). Less than 1% had a confirmed ectopic pregnancy (0.15%, 95% CI = 0.09%–0.25%) and had a gestational duration later identified to be greater than 77 days (0.13%, 95% CI = 0.05%–0.29%). ConclusionsOur calculated incidence rates of clinical outcomes align with rates from the previous literature on MAB and from the emerging literature on MAB without pretreatment ultrasonography. Findings from this analysis suggest that MAB without pretreatment ultrasound is safe and effective for eligible patients. ImplicationsThis large US study found that medication abortion without pretreatment ultrasonography results in similar clinical outcomes to prepandemic models that include pretreatment ultrasonography. Medication abortion without a pretreatment ultrasound may be adopted by abortion providers seeking to expand options for their patients as access to abortion continues to erode.

Patient experiences using public and private insurance coverage for abortion in Illinois: Implementation successes and remaining gaps.

Insurance coverage for abortion in states where care remains legal can alleviate financial burdens for patients and increase access. Recent policy changes in Illinois required Medicaid and some private insurance plans to cover abortion care. This study explores policy implementation from the perspectives of patients using their insurance to obtain early abortion care. Between July 2021 and February 2022, we interviewed Illinois residents who recently sought abortion care at ≤11 weeks of pregnancy. We also interviewed nine key informants with experience providing or billing for abortion or supporting insurance policy implementation in Illinois. We coded interview transcripts in Dedoose and developed code summaries to identify salient themes across interviews. Most participants insured by Illinois Medicaid or eligible for enrollment received full coverage for their abortions; most with private insurance did not and faced challenges learning about coverage status. Some opted not to use insurance, often citing privacy concerns. Participants who benefited from abortion coverage expressed relief, gave examples of other financial challenges they could prioritize, and described feeling in control of their abortion experience. Those without coverage described feeling stressed, uncertain, and constrained in their decision-making. When abortion was fully covered by insurance, it reduced financial burdens and enhanced reproductive autonomy. Illinois Medicaid policy-with seamless enrollment options and appropriate reimbursement rates-offers a model for improving abortion access in other states. Further investigation is needed to determine compliance among private insurance companies and increase transparency.

Willingness of Pharmacists to Prescribe Medication Abortion in California

Nearly half of US states have restricted abortion access. Policy makers are exploring pathways to increase access to abortion and reproductive health care more broadly. Since 2016, California pharmacists could prescribe hormonal birth control, providing an opportunity to learn about the implementation of pharmacist-provided reproductive health care. To explore the feasibility of broadening pharmacist scope of practice to include prescribing medication abortion. A cross-sectional online survey was conducted from October 11 to December 20, 2022, among a convenience sample of California licensed community pharmacists to examine their attitudes toward, knowledge of, and confidence in prescribing hormonal birth control and reports of pharmacy-level practices. Descriptive analyses and log-binomial regression models were used to compare medication abortion and contraceptive provision attitudes by pharmacist and pharmacy characteristics. Among the 316 pharmacists included in the analysis who worked at community pharmacies across California (mean [SD] age, 40.9 [12.0] years; 169 of 285 [59.3%] cisgender women; and 159 of 272 [58.5%] non-Hispanic Asian individuals), most (193 of 280 [68.9%]) indicated willingness to prescribe medication abortion to pharmacy clients if allowed by law. However, less than half were confident in their knowledge of medication abortion (139 of 288 [48.3%]) or their ability to prescribe it (115 of 285 [40.4%]). Pharmacists who indicated that providing access to hormonal birth control as a prescribing provider was important (263 of 289 [91.0%]) and were confident in their ability to prescribe it (207 of 290 [71.4%]) were 3.96 (95% CI, 1.80-8.73) times and 2.44 (95% CI, 1.56-3.82) times more likely to be willing to prescribe medication abortion and to express confidence in doing so, respectively. Although most pharmacists held favorable attitudes toward hormonal birth control, less than half (144 of 308 [46.8%]) worked in a pharmacy that provided prescriptions for hormonal birth control, and 149 who did not reported barriers such as lack of knowledge or training (65 [43.6%]), insufficient staff or time to add new services (58 [38.9%]), and lack of coverage for services (50 [33.6%]). The findings of this cross-sectional survey study of California pharmacists suggest that most pharmacists were willing to prescribe medication abortion. However, future efforts to expand pharmacists' scope of practice should include training to increase knowledge and confidence in prescribing medication abortion. Pharmacy-level barriers to hormonal birth control prescription, such as insurance coverage for pharmacist effort, should also be addressed, as they may serve as barriers to medication abortion access.

The maze of interpretation: abortion laws and legal indeterminacy in Indian courts

ABSTRACT This article outlines the structural barriers to abortions in India, exacerbated by the COVID-19 pandemic and ensuing lockdowns. It discusses the limits to access inherent within India’s abortion law, strict state-imposed pandemic management measures, the unequal public healthcare system, and resultant systemic coercion of pregnant persons to approach courts to seek abortions. It reviews abortion-related cases to argue that the judiciary’s neglect of its responsibilities during the pandemic has been mirrored in its lack of willingness to realize the reproductive rights of pregnant persons requiring abortions during and after the pandemic. Cases are examined using the legal indeterminacy framework to understand how abortion laws overlook pregnant persons’ autonomy. These laws have relied on stereotypes, betraying the underlying paternalistic and protectionist rationale of the judiciary. The judiciary has assumed the role of ultimate arbiter in determining what constitutes a “good” or “bad” abortion and who is deemed deserving of abortion access.

Abortion Training in Family Medicine Residency Programs: A National Survey of Program Directors 5 Months After the Dobbs Decision.

Routine abortion training during family medicine (FM) residency leads to higher rates of postresidency provision; increased availability of abortion care in the FM setting could greatly improve access. Especially in the post-Dobbs context, understanding the landscape of abortion training in US family medicine residency programs (FMRPs) is critical. We invited all directors of US FMRPs accredited by the Accreditation Council for Graduate Medical Education to complete a larger omnibus online survey that included questions on abortion training. We compiled descriptive statistics and conducted χ2 tests and multivariate regression analyses to detect associations with abortion training. The response rate was 42% (N=286). Nineteen percent of programs had routine medication abortion (MAB) training and 10% had routine aspiration training. In addition, 58% of programs offered elective MAB training and 52% offered elective aspiration training. In multivariate regression, the presence of abortion training was associated with a program having 31 or more residents, being in a state with protected abortion access, not having a Catholic affiliation, and having a program director who believed abortion training should be routine in FMRPs. While more than half of responding FMRPs reported some abortion training, much of it was elective, and 40% of programs lacked abortion training completely. Although abortion training is severely limited or prohibited in states with abortion bans, more training opportunities in the states where abortion is possible could increase access to abortion within primary care.

Lessons Learned from Argentina's Struggles for Legal Abortion

This essay argues that abortion, as a practice and a political cause, challenges traditional and hegemonic health frameworks and contributes to the development of a feminist approach to health. The essay focuses on experiences and activism for legal abortion in contemporary Argentina, drawing some examples from other contexts. First, it argues that abortion reveals the extent to which health and sickness are entangled with symbolic and localized processes, including marked stigma, which influence the lived experience of health care. The essay analyzes how feminist activism in Argentina gradually changed these processes. Second, it contends that abortion as a health practice contributes to the deconstruction of traditional dichotomies between prevention and intervention and health and sickness, as well as to modifying hierarchical decision-making mechanisms. In the Argentine case, ensuring abortion access in public health institutions, with the help of activist professionals, allowed for the broadening of biomedical frameworks and a move toward more holistic approaches. Third, the essay analyzes how increasing access to medication abortion challenged monopolistic and exclusionary processes in the production and institutionalization of legitimate knowledge about health.

Deaths among Women of Reproductive Age: an Explorative Case Study among Abortion Seekers.

In Nepal, abortion was legalized in 2002. Yet many women are denied abortion services. Women denied abortion services may either continue their pregnancies or find abortion care elsewhere. However, what is not known is the consequences on women, and their children after accessing abortion services or after being denied abortion services. This comment aims to understand the cause of death of women who sought abortion services between 2019 and 2020 and were enrolled in a longitudinal nationwide study of the consequences of legal abortion access in Nepal. Women were interviewed 6 weeks and every 6 months for 3 years after seeking abortion. During the follow-up interviews, the field research assistants were informed about the death of the clients. Once the death was reported, a trained senior research staff visited the deceased persons house and interviewed family members including husbands, maternal parents or in-laws to explore the cause of death. A total of nine deaths were reported between April 2019 and December 2022. Out of nine deceased women, four received abortions while five of them were initially denial abortion services. The majority of the deaths were due to suicide followed by tuberculosis. None of the deaths were caused by abortion or birth. Keywords: Death; Nepal; reproductive ages; womens health.

Female-Specific Health Care of Military Female-Designated Service Members and Veterans: A Systematic Overview of Reviews.

Since the War in Afghanistan began in 2001, service members have faced significant health effects related to service during war, with female-designated service members facing unique challenges. Numerous high-quality review articles have been published on the health and care of female-designated service members and veterans. Given the increasing volume of literature, we completed an overview of reviews on the health and health care of female-designated military populations. Our objective was to conduct an overview of reviews on the obstetrics and gynecologic health and health care of female-designated military populations since 2000 to understand female-specific health consequences of military service during war and make clinical recommendations. On May 10, 2022, a medical librarian performed a comprehensive search across five databases (Ovid Medline, Embase, CINAHL, PsycINFO, Ovid All EBM Reviews, and Web of Science) for all relevant reviews published from 2000 to May 10, 2022. Results were limited to English language. After the removal of duplicates, 2,438 records were reviewed, and 69 studies were included in the final review. The search strategy and methods were registered with PROSPERO and are reported according to the Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. Two independent reviewers conducted title and abstract screening and subsequent full text review using Covidence Systematic Review Software. Reviews addressing female-specific and obstetrics and gynecologic health of female-designated service members or veterans, utilizing a clear and systematic methodology, were eligible for inclusion. Quality assessment was conducted by teams of two reviewers. A total of 69 studies were included in the final review. Themes included mental health and impact of sexual assault on service members or veterans, veteran health care, issues of menstruation, pregnancy, and urogenital concerns. Areas with few reviews included occupational risks of military service and impact on obstetric outcomes, eating disorders, and menopause. There were insufficient or no reviews on the impact of military service on fertility, access to abortion care, reproductive health outcomes of lesbian, bisexual and transgender service members, surgical treatment of gynecologic conditions, and screening and treatment for breast, gynecologic, and non-pelvic organ cancers. Female-designated military populations serving during periods of war face unique health challenges that should be considered in screening practices and the delivery of trauma informed care. Further research and reviews are needed for female-specific oncology, fertility, abortion access, and sexual and non-binary and expansive gender identities to better capture female-designated service member and veteran health during wartime and beyond.

The association between postpartum depressive symptoms and contraception

BackgroundPostpartum depression affects 10-20% of birthing people and is associated with changes in healthcare utilization. Little is known about the association between postpartum depressive symptoms and choice to use contraception, however both un- or under-treated depression and short interpregnancy intervals pose significant perinatal health risks. ObjectiveTo evaluate whether postpartum depressive symptoms are associated with changes in decisions to use any method of contraception. Study DesignThis retrospective cohort study included birthing people who delivered between 2017-2022 and were referred to a collaborative care program for mental health care. Through this program, birthing people with mental health conditions have access to specialized perinatal mental health care and prospective symptoms monitoring via a patient registry. Postpartum depressive symptoms are assessed via the Patient Health Questionnaire-9 (PHQ-9) and scores were stratified by severity according to clinical cutoffs. Contraceptive method choice was determined by documentation in the electronic health record and dichotomized as “none” if the participant declined all forms of contraception both at delivery and at the postpartum visit. Bivariable and multivariable analyses were performed. ResultsOf the 1871 participants that met inclusion criteria, 160 (8.5%) had postpartum PHQ-9 scores > 14, representing moderately severe or worse depressive symptoms and 43 (2.3%) had severe (PHQ-9 > 19) depressive symptoms. Compared to birthing people with PHQ-9 ≤ 14, those with higher PHQ-9 scores were more likely to have medical comorbidities, have a higher body mass index, to self-identify as Black, Native Hawaiian or Pacific Islander, or Hispanic/Latina, have a preterm delivery, and less likely to be married or nulliparous. There were no differences in any other sociodemographic or clinical characteristics. The choice to use any contraceptive method decreased with increasing depressive symptoms in bivariable and multivariable analyses, reaching statistical significance in birthing people with severe depressive symptoms (aOR 2.92, 95% CI 1.46-5.84). ConclusionSevere perinatal depressive symptoms are associated with a declination of any form of postpartum contraception. This finding becomes increasingly relevant as abortion access continues to be threatened across the US, compounding the potential impact of opting not to use contraception.