Talen en spiralen: kennis en besluitvorming in anticonceptieconsultaties met een taalbarrière

Misconception and contraception: knowledge and decision-making in contraceptive consultations with a language barrier Just like in general medical consultations, different domains of knowledge come together and are negotiated in contraceptive consultations, followed by decision-making on the contraceptive method. Research shows that a language barrier can hamper knowledge negotiation and decision-making in medical consultations. Our paper contributes to those findings by focussing on contraceptive counselling as a specific and underexplored consultation type. We gathered our data in a Belgian abortion clinic, where contraception is discussed during the consultations, and where an important part of the consultations are characterised by a language barrier. We adopt a Bourdieusian view on language as capital, and use a linguistic ethnographic and interactional sociolinguistic approach, complemented with analytical tools from conversation analysis on epistemics and deontics. The analysis of data fragments, ranging from a limited to a double language barrier, shows that this barrier is connected in various ways with how, and how much, knowledge is negotiated. Incomplete renditions, interruptions, epistemic and deontic claims from non-professional interpreters, along with a lack of shared contextualisation, impede clients to gather information and therefore influence decision-making. We conclude that a language barrier involves a potential risk for knowledge negotiation and decision-making in contraceptive consultations. More attention from healthcare professionals to language barriers could empower women in their sexual and reproductive health choices.

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

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.

Dirty Work and Intimacy: Creating an Abortion Worker

Abortion work has changed in the decades since Roe v. Wade, and concerns over efficiency and cost reduction have resulted in increased specialization and compartmentalization of duties among health workers. This study examines the current state of surgical abortion at a clinic in southern California. Drawing on 18 months of ethnographic fieldwork at an abortion clinic, I use theories of dirty work and intimate work to examine how abortion work is organized and allocated among staff. I find that work in the clinic is best understood as existing on two intersecting spectrums of intimacy and dirtiness. Whereas existing research on abortion workers has primarily focused on doctors and nurses, this study includes medical assistants and compares experiences across different occupations. I conclude that frequency, intensity, and purpose of intimate work and dirty work coalesce to create distinct types of abortion workers.

Miles and days until medical abortion via TelAbortion versus clinic in Oregon and Washington, USA

BackgroundMedical abortion provided via telemedicine is becoming more widely available, potentially decreasing travel time for in-person abortion evaluation.MethodsWe conducted a retrospective chart review of all outpatient medical abortions from October 2016 through December 2019 at our academic medical centre in Portland, Oregon, USA. Using mifepristone administration logs, we identified patients who underwent abortion via direct-to-patient telemedicine or in clinic. Both groups had pre-abortion ultrasound examination. We extracted patient characteristics and geographic data to compare travel distance to clinic, ultrasound facility, and nearest advertised abortion clinic. We compared time from first contact until mifepristone ingestion and gestational age at mifepristone ingestion.ResultsMedian distance from mailing address to clinic for 80 telemedicine and 124 clinic medical abortions was 95 (range 4–377) and 12 (range 0–184) miles (p<0.01). Distance travelled to ultrasound facility was shorter for telemedicine patients (median 7 miles, range 0–150 vs 12 miles, range 0–184; p<0.01) excluding outliers >200 miles. Distance to nearest advertised abortion clinic was equal between groups (median 7 miles, p=0.4). Time to mifepristone administration (ingestion) was longer (11 vs 6 days; p<0.01) and median gestational age was higher (49 vs 44 days; p=0.01) for telemedicine.ConclusionsTelemedicine increases the reach of abortion providers and provides care to more geographically distant patients. Patients chose telemedicine abortion even when they had an equidistant option, suggesting that patients value telemedicine for reasons other than geographic convenience. This telemedicine delivery model that included ultrasound testing prior to abortion resulted in up to a 5-day delay in abortion initiation, which was not clinically significant.

Get PrEPPT (pre-exposure prophylaxis and pregnancy termination): an exploration of the values, attitudes and preferences regarding HIV and PrEP among women seeking abortion

IntroductionPre-exposure prophylaxis (PrEP) for the prevention of HIV transmission is under utilised by women in the US. Women seeking abortion have a higher HIV prevalence than women who continue prenatal care and could benefit from HIV risk assessment and PrEP counselling. We assessed the knowledge, attitudes, and preferences of women seeking abortion care regarding their HIV risk and knowledge of PrEP, and identified individual and system barriers to PrEP access.MethodsWe performed a cross sectional descriptive study of English speaking women at a freestanding abortion clinic through an anonymous survey. Participants with indications for PrEP care included those who performed sex work, experienced a recent sexually transmitted infection, or had multiple sexual partners and inconsistent condom use. We performed descriptive statistics on response data; Wilcoxon tests were used to compare continuous variables across groups.Results64 (32.3%) participants had indications for PrEP, but only 31 (16.1%) had previous knowledge of PrEP. After the concept was explained, attitudes towards PrEP were generally positive, and 54 participants (27.8%) would consider starting PrEP in the next 6 months. Participants were most interested in receiving PrEP care from their primary care provider rather than from an abortion clinic.ConclusionsAmong women seeking abortion, women vulnerable to HIV infection outnumbered those with PrEP knowledge by 2 to 1. Prior knowledge of PrEP as an HIV prevention method was low, but women found PrEP acceptable. While women reported preferring to receive PrEP from a primary care provider, the abortion clinic visit may also represent an important time for HIV education and risk screening.