Population Of Reproductive-aged Women Research Articles

A Geospatial Analysis of Abortion Access in the United States after the Reversal of Roe v Wade.

To investigate current abortion access in the United States based on geographic location and to forecast access according to the landscape of abortion care in the year after the Dobbs v Jackson Women's Health Organization decision. Addresses of abortion-providing clinics were identified using web-based directories from Planned Parenthood, the National Abortion Foundation, Abortion Finder, and Power to Decide. Using geographic coordinates and the OpenStreetMap road network, Valhalla's Isochrone application programming interface was used to calculate the areas within a 30-, 60-, and 90-minute driving distance from these clinics. The population of reproductive-aged women (15-49 years) in the tracts inside or outside the accessible areas was determined using the U.S. Census American Community Survey for 2020. Review of legislative and judicial actions for 2023 determined at-risk states. Clinic locations and laws are accurate as of June 2, 2023. The addresses of 750 abortion facilities were geocoded. Currently, 41.4% (30.8 million) of women do not have access to an abortion clinic within a 30-minute drive, and 29.3% and 23.6% do not have access within a 60-minute and 90-minute drive, respectively. When accounting for the combined population with no access, severely limited access, and at-risk of losing access, 53.5% of women do not have access within a 30-minute drive, and 45.6% and 43.0% do not have access within a 60-minute and 90-minute drive, respectively. Two of every five American women do not have access to an abortion facility within a 30-minute drive, and one in four lack access within a 90-minute drive. These proportions could significantly increase if access is restricted further with state bans proposed in 2023.

Changes in the National Prevalence of Current E-Cigarette, Cannabis, and Dual Use among Reproductive Age Women (18–44 Years Old) in the United States, 2013–2016

Background: Electronic cigarette (e-cigarette) and cannabis (marijuana) use is rapidly increasing. Objectives: To report percentage prevalence and changes over time in current (past 30 days) e-cigarette, cannabis, and dual (concurrent) use in the population of reproductive age women (18–44 years old) in the United States. Methods: Our cross-sectional analysis involved data of 11, 004 women from Waves 1 to 3 of the Population Assessment of Tobacco and Health (PATH) Study (2013–2016). We estimated weighted percentage prevalence and 95% confidence intervals (CIs) and changes between 2013 and 2016 in current e-cigarette, cannabis, and dual use at each wave overall and across race/ethnicity, age, education, cigarette smoking status, alcohol use, and perceived mental health. Changes were reported as p for trend. Results: Between 2013 and 2016, e-cigarette use increased 13.6% (p for trend <.001) [15.2% (95% CI:14.2, 16.2) in 2013–2014; 22.2% (95% CI: 20.2, 24.3) in 2014–2015; and 28.8% (95% CI: 26.3, 31.3) in 2015–2016]; cannabis use increased 6.2% (p for trend <.001) [23.6% (95% CI: 22.1, 25.1) in 2013–2014; 28.5% (95% CI: 26.0, 31.0) in 2014–2015; and 29.8% (95% CI: 27.9, 31.1) in 2015–2016]; and dual use declined 0.3% (p for trend <.001) [5.8% (95% CI: 5.2, 6.3) in 2013–2014; 4.8% (95% CI: 3.7, 5.8) in 2014–2015; and 5.5% (95% CI: 4.2, 6.7) in 2015–2016]. Increases and declines in prevalence varied across sociodemographic characteristics, cigarette smoking status, alcohol use, and perceived mental health. Conclusions: Continued monitoring can capture further changes in prevalence and patterns to inform targeted public health intervention programs.

Individual and community factors associated with unintended pregnancies among women of advanced reproductive age in Nigeria

ABSTRACT Studies have examined individual and community level factors associated with unintended pregnancies. However, existing studies tends to focus the general population of reproductive age women without isolating women of advanced reproductive age (women at the age range of 35–49 years) for specific research attention. There is need for specific attention on this group of women because pregnancies among them whether intended or unintended elevate obstetric risks for both mother and child. This study examines associated individual and community factors of unintended pregnancies among women of advanced reproductive age in Nigeria. Data were extracted from the 2018 Nigeria Demographic and Health Survey. A weighted sample of 12,509 women was analyzed. Three multilevel logistic regression models were estimated. The study revealed a 10.3% prevalence of unintended pregnancies. Individual characteristics such as maternal age, number of living children, delayed marriage, and community characteristics such as high community poverty and high community unmet contraceptive need were significantly associated with unintended pregnancies. Variations in unintended pregnancies across the communities were more attributable to individual factors. Interventions should develop specific strategies tailored toward women of advanced reproductive age.

Aberrant cervical innate immunity predicts onset of dysbiosis and sexually transmitted infections in women of reproductive age.

Sexually transmitted infections (STIs) and vaginal dysbiosis (disturbed resident microbiota presenting with abnormal Nugent score or candidiasis) have been associated with mucosal inflammation and risk of HIV-1 infection, cancer and poor reproductive outcomes. To date, the temporal relationships between aberrant cervical innate immunity and the clinical onset of microbial disturbance have not been studied in a large population of reproductive age women. We examined data from a longitudinal cohort of 934 Ugandan and Zimbabwean women contributing 3,274 HIV-negative visits who had complete laboratory, clinical and demographic data. Among those, 207 women later acquired HIV, and 584 women were intermittently diagnosed with C. trachomatis (CT), N. gonorrhoeae (NG), genital herpes (HSV-2), T. vaginalis (TV), candidiasis, and abnormal intermediate (4–6) or high (7–10) Nugent score, i.e. bacterial vaginosis (BV). Immune biomarker concentrations in cervical swabs were analyzed by generalized linear and mixed effect models adjusting for site, age, hormonal contraceptive use (HC), pregnancy, breastfeeding, genital practices, unprotected sex and overlapping infections. High likelihood ratios (1.5–4.9) denoted the values of cervical immune biomarkers to predict onset of abnormal Nugent score and candidiasis at the next visits. When controlling for covariates, higher levels of β-defensin-2 were antecedent to BV, CT and HSV-2, lower anti-inflammatory ratio IL-1RA:IL-1β–to intermediate Nugent scores and candida, lower levels of the serine protease inhibitor SLPI–to candida, lower levels of the adhesion molecule ICAM-1 –to TV, and lower levels of the oxidative stress mitigator and endothelial activation marker VEGF–to NG. Changes in innate immunity following onset of dysbiosis and infections were dependent on HC use when controlling for all other covariates. In conclusion, imminent female genital tract dysbiosis or infection can be predicted by distinct patterns of innate immunity. Future research should characterize biotic and abiotic determinants of this pre-existing innate immunity state.

Prevalence ofChlamydia trachomatisamong Childbearing Age Women in India: A Systematic Review

Background. Infection with Chlamydia trachomatis (CT) can lead to reproductive sequelae. Information on the general population of childbearing age women in India is sparse. We reviewed the literature on CT prevalence within the general population of reproductive aged women in order to improve the efforts of public health screening programs and interventions. Objective. To conduct a literature review to determine the prevalence of Chlamydia trachomatis among childbearing age women in India. Search Strategy. Ovid Medline and PubMed databases were searched for articles from January 1, 2003, through December 31, 2014. Search terms included “Chlamydia trachomatis”, “CT”, “prevalence”, “India”, and “sexually transmitted infections”. Selection Criteria. Studies on prevalence data for CT among women of childbearing age (15–45) living in India were included. Data Collection and Analysis. Articles that met the inclusion criteria were extracted by two readers and discrepancies solved through discussion. Results. Reported prevalence of active CT infection among lower risk groups ranged from 0.1% to 1.1% and in higher risk group from 2.7% to 28.5%. Conclusion. CT prevalence among women in India is comparable to other countries. Screening programs to prevent adverse outcomes among Indian women of childbearing age and their offspring are warranted.

New Technologies: Non-Hormonal Female Contraception

Since the introduction of hormonal contraception in the 1960s, their popularity has grown exponentially and benefits a large population of reproductive aged women. Currently available options are lacking for women with comorbidities such as hypertension, migraines, lupus, liver pathology, thrombophilias, obesity, etc. Recent studies reveal promising evidence of several non-hormonal contraceptive methods that will be of tremendous benefit to women with these comorbidities. Non-hormonal contraceptive methods under investigation include Phosphodiesterase (PDE) 3/5/9 inhibitors, matrix metalloprotease (MMP) inhibitors, cyclooxygenase-2 inhibitors, prostaglandin E2 receptor antagonists, C31G spermicide, SGK/AKT, polidocanol foam, quinacrine pellets, proprotein convertase 6 inhibitors, interleukin 11 (IL-11), leukemia inhibitory factor (LIF), and Juno-Izumo binding vesicles. These methods would provide new options for female contraception particularly for those women who can’t use hormonal contraception. Keywords: Female contraception, non-hormonal.

Selection bias due to parity-conditioning in studies of time trends in fertility.

Studies of couple fertility over time have often examined study populations with broad age ranges at a cross-section of time. An increase in fertility has been observed in studies that followed episodes of fertility events either prospectively among nulliparous women or retrospectively among parous women. Fertility has a biological effect on parity. If defined at a cross-section of time, parity will also be affected by year of birth, and thus becomes a collider. Conditioning (stratifying, restricting, or adjusting) on a collider may cause selection bias in the studied association. A study with prospective follow-up was taken as the model to assess the validity of fertility studies. We demonstrate the potential for selection bias using causal graphs and nationwide birth statistics and other demographic data. We tested the existence of parity-conditioning bias in data including both parous and nulliparous women. We also used a simulation approach to assess the strength of the bias in populations with prior at-risk cycles. Finally, we evaluated the potential for selection bias due to conditioning on parity in various sampling frames. Analyses indicate that the observed increase in fertility over time can be entirely explained by selection bias due to parity-conditioning. Heterogeneity in fertility and differential success in prior at-risk cycles are the ultimate factors behind the selection bias. The potential for selection bias due to parity-conditioning varies by sampling frame. A prospective multidecade study with representative sampling of birth cohorts and follow-up from menarche to menopause would bypass the described bias.

Obese women less likely to have low serum ferritin, Nicaragua.

To examine the association between overweight and obesity and serum ferritin among women of reproductive age (15-49 years) in Nicaragua, considering the effect of α1-acid glycoprotein (AGP), a marker of inflammation. We analysed data from the 2004-05 Nicaraguan Integrated Surveillance System for Nutrition Interventions. Three logistic regression models were analysed with low serum ferritin (<15 μg/l) as the dependent variable: (i) overweight or obese status and covariates; (ii) model 1 plus AGP; and (iii) model 1 restricted to only women with normal AGP levels (≤1.0 g/l). Nicaragua. Included in this analysis were 832 non-pregnant mother/caregivers (15-49 years) surveyed in 2004-2005. In the sample, prevalence of overweight and obesity was 31.8 % and 19.2 %, respectively, and 27.6 % had low serum ferritin. In model 1, the adjusted OR of low serum ferritin was 0.74 (95 % CI 0.52, 1.05) for overweight women and 0.42 (95 % CI 0.26, 0.65) for obese women. In model 2, AGP was significantly independently associated with low serum ferritin (adjusted OR=0.56, 95 % CI 0.34, 0.92) while the adjusted OR for overweight and obesity were largely unchanged. Excluding women with elevated AGP did not appreciably affect the relationship between overweight or obesity and low serum ferritin (model 3). Overall, in this population of reproductive-age women, obese women were less likely to have low serum ferritin levels, and this was independent of inflammation as measured by AGP.

Effects of Abortion Legalization in Nepal, 2001–2010

BackgroundAbortion was legalized in Nepal in 2002, following advocacy efforts highlighting high maternal mortality from unsafe abortion. We sought to assess whether legalization led to reductions in the most serious maternal health consequences of unsafe abortion.MethodsWe conducted retrospective medical chart review of all gynecological cases presenting at four large public referral hospitals in Nepal. For the years 2001–2010, all cases of spontaneous and induced abortion complications were identified, abstracted, and coded to classify cases of serious infection, injury, and systemic complications. We used segmented Poisson and ordinary logistic regression to test for trend and risks of serious complications for three time periods: before implementation (2001–2003), early implementation (2004–2006), and later implementation (2007–2010).Results23,493 cases of abortion complications were identified. A significant downward trend in the proportion of serious infection, injury, and systemic complications was observed for the later implementation period, along with a decline in the risk of serious complications (OR 0.7, 95% CI 0.64, 0.85). Reductions in sepsis occurred sooner, during early implementation (OR 0.6, 95% CI 0.47, 0.75).ConclusionOver the study period, health care use and the population of reproductive aged women increased. Total fertility also declined by nearly half, despite relatively low contraceptive prevalence. Greater numbers of women likely obtained abortions and sought hospital care for complications following legalization, yet we observed a significant decline in the rate of serious abortion morbidity. The liberalization of abortion policy in Nepal has benefited women’s health, and likely contributes to falling maternal mortality in the country. The steepest decline was observed after expansion of the safe abortion program to include midlevel providers, second trimester training, and medication abortion, highlighting the importance of concerted efforts to improve access. Other countries contemplating changes to abortion policy can draw on the evidence and implementation strategies observed in Nepal.

Use of Medicines Changing the Face of Abortion

Medication abortion (also commonly referred to as medical abortion) is arguably the most important advance in reproductive health technology since the discovery of oral contraceptives. This simple process, involving the use of pins rather than invasive surgical instruments, has been shown to be safe and up to 98% effective for early pregnancy termination. (1-3) In settings where abortion is legal, medication abortion has expanded the array of effective options available, thus improving the abortion experience for those who wish to avoid surgery. In settings where abortion is illegal or highly restricted, it has provided many women for the first time with a safe and discreet means for early termination of unwanted pregnancy. Further, in all settings where it is available, medication abortion has reduced women's dependence on medical systems, providing them with greater autonomy and control over their most important reproductive decisions. Administration of mifepristone, followed by a prostaglandin, is the gold standard for medication abortion. Mifepristone was initially approved in the late 1980s in China and France and has since been safely and effectively used by many millions of women worldwide. (4-7) Mifepristone diminishes the biological availability of progesterone, the hormone needed to sustain pregnancy. It is typically used in combination with misoprostol, which helps empty the uterus by inducing uterine contractions. (1) However, mifepristone is not available in many settings because of legal restrictions on the provision of abortion services. It is also unavailable in numerous settings where the population of reproductive-age women is small, since the high cost of drug registration makes entering the market unappealing to commercial entities. As a result, mifepristone is registered for pregnancy termination in only about 50 of the world's countries, the majority of which are in the developed regions of Europe. (8) Of the 20 developing countries where mifepristone is registered, two-thirds are in Asia. At present, mifepristone is registered in just five African countries (Mozambique, Zambia, Tunisia, South Africa and Ghana) and two Latin American countries (Mexico and Guyana). In many settings where mifepristone is unavailable, misoprostol is commonly used alone for early pregnancy termination. Misoprostol was originally developed in the mid-1980s for gastrointestinal indications and is licensed for such purposes in about 90 countries worldwide. (9), (10) The drug is inexpensive and stable at room temperature, making it ideal for inducing abortion in low-resource settings. The first reported widespread use of misoprostol for pregnancy termination was in Brazil in the late 1980s. (11),(12) Since then, knowledge and use of misoprostol by itself as a means of early pregnancy termination have grown throughout Latin America, as well as in other regions where abortion is legally restricted and mifepristone is unavailable. (13), (14) Although use of misoprostol alone is less effective than its use with mifepristone, misoprostol-only abortions are nevertheless a safe, acceptable and effective means of early pregnancy termination. (6), (15), (16) In still other settings, women lack access to both misoprostol and mifepristone. These include much of northern and western Africa; some parts of middle, eastern and southern Africa; and a number of countries in Asia and South America. (10) Perhaps not surprisingly, some of the world's most restrictive abortion laws and highest rates of abortion-related mortality are found in these same places. (17), (18) The acceptability of medication abortion among women seeking an abortion is high in developing countries, regardless of the setting or regimen used. (5), (6), (19) Furthermore, demand for the procedure appears to be increasing rapidly in many places. It is difficult to document specific trends in the use of medication abortion, because mifepristone is frequently unavailable and use of misoprostol is largely off-label or clandestine. …

The relationship between self-reported and biologic measures of stress in low-income, reproductive age women

The relationship between self-reported and biologic measures of stress in low-income, reproductive age women

Effects of competition among fertility centers on pregnancy and high-order multiple gestation rates

To measure the effect of competition among fertility centers on pregnancy and high-order multiple (HOM) gestation rates after IVF. Retrospective cohort study. Four hundred eight fertility clinics registered with the Society for Assisted Reproductive Technology as providing IVF services in 2000. Competition was defined as number of clinics in a geographically defined area. Demand for services was based on the population of reproductive-aged women. Three hundred eighty-one fertility clinics reporting clinical outcomes. Pregnancy rates, HOM gestation rates, population of reproductive-aged women, and number of competing clinics were calculated for each clinic from Society for Assisted Reproductive Technology and census data. The clinic HOM gestation rate (percentage of pregnancies that were HOM) and age-adjusted pregnancy rate. The number of clinics in an area of competition ranged from 1 to 22. The HOM gestation rate per clinic ranged from 0% to 50%. As demand increased, competition increased. As competition increased, the number of HOM pregnancies per clinic decreased. In areas of low competition (1 to 2 clinics) the clinic HOM gestation rate was 8.43%, in areas of intermediate competition (3-7 clinics) 8.39%, and in areas of high competition (8-22 clinics) 8.24%. In areas with intermediate demand, high levels of competition resulted in fewer HOM pregnancies than intermediate competition (relative risk 0.56, 95% confidence interval 0.36-0.89) or low levels of competition (RR 0.57, 95% confidence interval 0.35-0.94). Age-adjusted pregnancy rates did not differ by level of competition. According to these data, the risk of HOM gestation decreases with increasing competition among clinics; however, pregnancy rates are unaffected.

Influence of Pregnancy-Related Diagnoses on Sick-Leave Data in Women Aged 16–44

Absence from work because of sickness often is used as an outcome measure in clinical and public health studies, reflecting morbidity and its social consequences, Whether the effects of sick leave differ in pregnant women, compared with the entire population of reproductive-age women, is not clear. The present study examined the contribution of pregnant women to the level of sickness absence in 24,481 Swedish women. Another goal was to determine to what extent sick-listed pregnant women could be identified by diagnoses on sickness certificates. The cross-sectional study enrolled sick leave-insured women aged 16 to 44 years living in Linkoping, Sweden (population 117,000), in 1985-1986. Two population-based research registers were used: one of sickness absence for the entire population and one of pregnant women in the same population and year. Pregnant women accounted for 5% of the study population and 20% of those having at least one sick leave lasting longer than 7 days. They had a significantly higher cumulative incidence of sick leave than all women. Their sick leave episodes also lasted longer than in the general population of women (45 vs. 10 days). More than 90% of all physicians' diagnoses in pregnant women were related to pregnancy (53%) or to back pain (40%). Only 46% of sick-listed pregnant women were identified from diagnoses on the sickness certificates. At any given time, pregnant women are only a fraction of all women of childbearing age, but they nevertheless make a significant contribution to registered sick leave. For this reason, the incidence of pregnancy in different groups or at different ages should be considered when analyzing data on sick leave in studies of women's work-related health.

The association of sexual abuse with pelvic pain complaints in a primary care population

OBJECTIVE: Our purpose was to determine the prevalence of sexual abuse during childhood and adulthood and its association with pelvic and other pain complaints in a population of reproductive-aged women. STUDY DESIGN: A 10-page questionnaire was administered to 581 nonpregnant women aged 18 to 45 years examined in primary care offices. RESULTS: The reported incidences of childhood and adult sexual abuse were 26% and 28%. In regression analyses, with the exception of irritable bowel syndrome, women with only a history of childhood sexual abuse and no abuse later in life are not more likely than nonabused women to report pain syndromes. By contrast, with the exception of dysmenorrhea, all pain complaints studied were more common in women reporting abuse both as children and as adults. CONCLUSIONS: Sexual abuse that occurs during childhood and again as an adult is strongly associated with pelvic pain complaints.(Am J Obstet Gynecol 1997;177:12)