scholarly journals Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242015
Author(s):  
Anisa R. Assifi ◽  
Melissa Kang ◽  
Elizabeth A. Sullivan ◽  
Angela J. Dawson
Keyword(s):  
Medical Abortion ◽  
The United States ◽  
High Income ◽  
Comprehensive Care ◽  
Care Seeking ◽  
Qualitative Synthesis ◽  
Abortion Care ◽  
Legal Barriers ◽  
Abortion Procedure ◽  
Access Pathway

Limited research in high-income countries (HICs) examines adolescent abortion care-seeking pathways. This review aims to examine the pathways and experiences of adolescents when seeking abortion care, and service delivery processes in provision of such care. We undertook a systematic search of the literature to identify relevant studies in HICs (2000–2020). A directed content analysis of qualitative and quantitative studies was conducted. Findings were organised to one or more of three domains of an a priori conceptual framework: context, components of abortion care and access pathway. Thirty-five studies were included. Themes classified to the Context domain included adolescent-specific and restrictive abortion legislation, mostly focused on the United States. Components of abortion care themes included confidentiality, comprehensive care, and abortion procedure. Access pathway themes included delays to access, abortion procedure information, decision-making, clinic operation and environments, and financial and transportation barriers. This review highlights issues affecting access to abortion that are particularly salient for adolescents, including additional legal barriers and challenges receiving care due to their age. Opportunities to enhance abortion access include removing legal barriers, provision of comprehensive care, enhancing the quality of information, and harnessing innovative delivery approaches offered by medical abortion.

scholarly journals COVID-19 and reproductive justice in Great Britain and the United States: ensuring access to abortion care during a global pandemic

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Elizabeth Chloe Romanis ◽  
Jordan A Parsons ◽  
Nathan Hodson
Keyword(s):  
United States ◽  
Great Britain ◽  
Medical Abortion ◽  
The United States ◽  
Reproductive Justice ◽  
Abortion Care ◽  
Global Pandemic ◽  
The Us ◽  
The Impact ◽  
Legal Barriers

Abstract In this paper we consider the impact that the COVID-19 pandemic is having on access to abortion care in Great Britain (GB) (England, Wales, and Scotland) and the United States (US). The pandemic has exacerbated problems in access to abortion services because social distancing or lockdown measures, increasing caring responsibilities, and the need to self-isolate are making clinics much more difficult to access, and this is when clinics are able to stay open which many are not. In response we argue there is a need to facilitate telemedical early medical abortion in order to ensure access to essential healthcare for people in need of terminations. There are substantial legal barriers to the establishment of telemedical abortion services in parts of GB and parts of the US. We argue that during a pandemic any restriction on telemedicine for basic healthcare is an unjustifiable human rights violation and, in the US, is unconstitutional.

scholarly journals Medical Abortion Care During a Pandemic

2020 ◽  
Vol 7 (3) ◽  
pp. 291-292
Author(s):  
I. Cori Baill
Keyword(s):  
United States ◽  
Intensive Care ◽  
Medical Abortion ◽  
The United States ◽  
Staff Nurses ◽  
Women Nurses ◽  
Emergency Rooms ◽  
Patient Exposure ◽  
Abortion Care

In keeping with federal policy, our state’s laws do not permit medical abortion via telemedicine, not even during the coronavirus disease 2019 (COVID-19) outbreak, a decision that endangers the lives of women, clinical staff, nurses, and doctors. It also ties dedicated professionals to the clinic instead of being available to emergency rooms, bedsides, and intensive care units, knowing if their clinic doors close vulnerable women may be driven to desperate acts. Instead of 6 feet we could have been 3000 miles apart. Nearly 39% of abortions in the United States are medical abortions. Instructions, medication prescriptions, and routine follow-up can all be safely done remotely. When an examination or ultrasound are necessary, it can be accomplished with minimal staff and patient exposure. Instead, I am caught in a Kafkaesque moment in an already surreal time. Making medical abortion part of telemedicine during the COVID-19 pandemic could save the lives of women, nurses, staff, and doctors. Maybe yours, maybe even mine.

scholarly journals The microeconomics of abortion: A scoping review and analysis of the economic consequences for abortion care-seekers

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252005
Author(s):  
Ernestina Coast ◽  
Samantha R. Lattof ◽  
Yana van der Meulen Rodgers ◽  
Brittany Moore ◽  
Cheri Poss
Keyword(s):  
Scoping Review ◽  
Indirect Costs ◽  
The United States ◽  
Evidence Base ◽  
Economic Consequences ◽  
Care Seeking ◽  
Individual Level ◽  
Abortion Care ◽  
Scoping Reviews ◽  
Micro Level

Background The economic consequences of abortion care and abortion policies for individuals occur directly and indirectly. We lack synthesis of the economic costs, impacts, benefit or value of abortion care at the micro-level (i.e., individuals and households). This scoping review examines the microeconomic costs, benefits and consequences of abortion care and policies. Methods and findings Searches were conducted in eight electronic databases and applied inclusion/exclusion criteria using the PRISMA extension for Scoping Reviews. For inclusion, studies must have examined at least one of the following outcomes: costs, impacts, benefits, and value of abortion care or abortion policies. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 230 included microeconomic studies, costs are the most frequently reported microeconomic outcome (n = 180), followed by impacts (n = 84), benefits (n = 39), and values (n = 26). Individual-level costs of abortion-related care have implications for the timing and type of care sought, globally. In contexts requiring multiple referrals or follow-up visits, these costs are multiplied. The ways in which people pay for abortion-related costs are diverse. The intersection between micro-level costs and delay(s) to abortion-related care is substantial. Individuals forego other costs and expenditures, or are pushed further into debt and/or poverty, in order to fund abortion-related care. The evidence base on the economic impacts of policy or law change is from high-income countries, dominated by studies from the United States. Conclusions Delays underpinned by economic factors can thwart care-seeking, affect the type of care sought, and impact the gestational age at which care is sought or reached. The evidence base includes little evidence on the micro-level costs for adolescents. Specific sub-groups of abortion care-seekers (transgendered and/or disabled people) are absent from the evidence and it is likely that they may experience higher direct and indirect costs because they may experience greater barriers to abortion care.

scholarly journals Best Practices in Specialized Amyloidosis Centers in the United States: A Survey of Cardiologists, Nurses, Patients, and Patient Advocates

2021 ◽  
Vol 15 ◽  
pp. 117954682110152
Author(s):  
Jose Nativi-Nicolau ◽  
Nitasha Sarswat ◽  
Johana Fajardo ◽  
Muriel Finkel ◽  
Younos Abdulsattar ◽  
...  
Keyword(s):  
Best Practices ◽  
Patient Care ◽  
Nurse Practitioners ◽  
Healthcare Providers ◽  
Multidisciplinary Care ◽  
The United States ◽  
Comprehensive Care ◽  
Patient Support ◽  
Patient Support Group ◽  
Patient Advocates

Background: Because transthyretin amyloid cardiomyopathy (ATTR-CM) poses unique diagnostic and therapeutic challenges, referral of patients with known or suspected disease to specialized amyloidosis centers is recommended. These centers have developed strategic practices to provide multidisciplinary comprehensive care, but their best practices have not yet been well studied as a group. Methods: A qualitative survey was conducted by telephone/email from October 2019 to February 2020 among eligible healthcare providers with experience in the management of ATTR-CM at US amyloidosis centers, patients with ATTR-CM treated at amyloidosis centers, and patient advocates from amyloidosis patient support groups. Results: Fifteen cardiologists and 9 nurse practitioners/nurses from 15 selected amyloidosis centers participated in the survey, with 16 patients and 4 patient advocates. Among participating healthcare providers, the most frequently cited center best practices were diagnostic capability, multidisciplinary care, and time spent on patient care; the greatest challenges involved coordination of patient care. Patients described the “ideal” amyloidosis program as one that provides physicians with expertise in ATTR-CM, sufficient time with patients, comprehensive patient care, and opportunities to participate in research/clinical trials. The majority of centers host patient support group meetings, and patient advocacy groups provide support for centers with physician/patient education and research. Conclusions: Amyloidosis centers offer comprehensive care based on staff expertise in ATTR-CM, a multidisciplinary approach, advanced diagnostics, and time dedicated to patient care and education. Raising awareness of amyloidosis centers’ best practices among healthcare providers can reinforce the benefits of early referral and comprehensive care for patients with ATTR-CM.

scholarly journals Pulmonary Health Effects of Indoor Volatile Organic Compounds—A Meta-Analysis

2021 ◽  
Vol 18 (4) ◽  
pp. 1578 ◽  
Author(s):  
Kyle L. Alford ◽  
Naresh Kumar
Keyword(s):  
Volatile Organic Compounds ◽  
Organic Compounds ◽  
Effect Size ◽  
Meta Analysis ◽  
The United States ◽  
High Income ◽  
Pulmonary Diseases ◽  
Health Concern ◽  
Pubmed Database ◽  
Volatile Organic

Volatile organic compounds (VOCs) are commonly found in consumer products, including furniture, sealants and paints. Thus, indoor VOCs have become a public health concern, especially in high-income countries (HICs), where people spend most of their time indoors, and indoor and outdoor air exchange is minimal due to a lack of ventilation. VOCs produce high levels of reaction with the airway epithelium and mucosa membrane and is linked with pulmonary diseases. This paper takes a stock of the literature to assess the strength of association (measured by effect size) between VOCs and pulmonary diseases with the focus on asthma and its related symptoms by conducting a meta-analysis. The literature was searched using the PubMed database. A total of 49 studies that measured VOCs or VOC types and pulmonary health outcomes were included in the analysis. The results of these studies were tabulated, and standard effect size of each study was computed. Most studies were conducted in high-income countries, including France (n = 7), Japan (n = 7) and the United States (n = 6). Our analysis suggests that VOCs have a medium-sized effect on pulmonary diseases, including the onset of asthma (effect size (or Cohen’s d) ~0.37; 95% confidence interval (CI) = 0.25–0.49; n = 23) and wheezing (effective size ~0.26; 95% CI = 0.10–0.42; n = 10). The effect size also varied by country, age and disease type. Multiple stakeholders must be engaged in strategies to mitigate and manage VOC exposure and its associated pulmonary disease burden.

scholarly journals A scoping review of female drowning: an underexplored issue in five high-income countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kym Roberts ◽  
Ogilvie Thom ◽  
Susan Devine ◽  
Peter A. Leggat ◽  
Amy E. Peden ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
United Kingdom ◽  
New Zealand ◽  
Clinical Outcomes ◽  
Scoping Review ◽  
The United States ◽  
Clinical Treatment ◽  
High Income ◽  
Public Health Issue

Abstract Background Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. Methods A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines. Results The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females). Conclusion Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.

scholarly journals Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States

2021 ◽  
pp. bmjsrh-2020-200966
Author(s):  
Heidi Moseson ◽  
Laura Fix ◽  
Caitlin Gerdts ◽  
Sachiko Ragosta ◽  
Jen Hastings ◽  
...  
Keyword(s):  
United States ◽  
Clinical Supervision ◽  
Online Survey ◽  
Clinical Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Physical Trauma ◽  
Abortion Care ◽  
And Gender

BackgroundTransgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision.MethodsIn 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings.ResultsOf 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost.ConclusionsThese data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.

Selecting an Abortion Clinic: The Role of Social Myths and Risk Perception in Seeking Abortion Care

2021 ◽  
pp. 002214652110444
Author(s):  
Orlaith Heymann ◽  
Tamika Odum ◽  
Alison H. Norris ◽  
Danielle Bessett
Keyword(s):  
Health Care ◽  
Risk Perception ◽  
Health Care Facilities ◽  
Previous Experience ◽  
Care Seeking ◽  
Abortion Care ◽  
Care Facilities ◽  
Abortion Clinic

Recent shifts in the abortion provision landscape have generated increased concern about how people find abortion care as regulations make abortion less accessible and clinics close. Few studies examine the reasons that people select particular facilities in such constrained contexts. Drawing from interviews with 41 Ohio residents, we find that people’s clinic selections are influenced by the risks they associate with abortion care. Participants’ strategies for selecting an abortion clinic included: drawing on previous experience with clinics, consulting others online, discerning reputation through name recognition and clinic type, and considering location, especially perceptions about place (privacy, legality, safety). We argue that social myths inform the risks people anticipate when seeking health care facilities, shaping care seeking in ways that are both abortion-specific and more general. These findings can also inform research in other health care contexts where patients increasingly find their options constrained by rising costs, consolidation, and facility closure.

“Painful, yet Beautiful, Moments”: Pathways Through Infant Feeding and Dynamic Conceptions of Breastfeeding Success

2021 ◽  
pp. 104973232110321
Author(s):  
Mackenzie D. M. Whipps ◽  
Hirokazu Yoshikawa ◽  
Jill R. Demirci ◽  
Jennifer Hill
Keyword(s):  
United States ◽  
Infant Feeding ◽  
The United States ◽  
High Income ◽  
First Year ◽  
Cultural Narratives ◽  
Structured Interviews ◽  
Written Narratives ◽  
Intensive Mothering ◽  
First Time

What is breastfeeding “success”? In this article, we challenge the traditional biomedical definition, instead centering visions of success described by breastfeeding mothers themselves. Using semi-structured interviews, quantitative surveys, and written narratives of 38 first-time mothers in the United States, we describe five common pathways through the first-year postpartum, a taxonomic distinction far more complex than a success–failure dichotomy: sustained breastfeeding, exclusive pumping, combination feeding, rapid weaning, and grinding back to exclusivity. We also explore the myriad ways in which mothers define and experience breastfeeding success, and in the process uncover the ways that cultural narratives—especially intensive mothering—color those experiences. Finally, we discuss how these experiences are shaped by infant feeding pathway. In doing so, we discover nuance that has gone unexplored in the breastfeeding literature. These findings have implications for supporting, promoting, and protecting breastfeeding in the United States and other high-income countries.

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