CORE Brief: What would happen if reproductive healthcare providers were unable to participate in the Wisconsin Medicaid program?
September 2021
The journal Contraception has published new research by UW-Madison’s Nicholas B. Schmuhl, PhD, Laurel W. Rice, MD, Cynthia K. Wautlet, MD, and Jenny A. Higgins, PhD. The article is part of a larger research project based at UW CORE, the Collaborative for Reproductive Equity. The authors’ objective was to assess abortion-related attitudes, practices, and perceptions among physicians of all specialties within a Wisconsin-based teaching hospital.
The researchers surveyed 913 physicians at UW School of Medicine and Public Health. They found that 80% of physicians surveyed reported at least some degree of support for abortion access, and 84% of physicians surveyed reported at least some degree of support for physicians who provide abortions. Physicians who perceived less support for abortion among their peers also reported less willingness to consult in abortion-related care, regardless of specialty. In their article, the authors wrote:
“Our findings have implications for abortion care access and quality in Wisconsin, as well as professional quality of life for physicians who directly and indirectly participate in abortion care. These misperceptions have tangible consequences for access and quality of abortion care, as physicians who estimated relatively lower support among peers were less willing to consult in abortion-related cases. This discrepancy was greatest among specialties commonly associated with abortion care.”
Read the study here.
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New CORE research, led by Dr. Renee D. Kramer and colleagues, sheds light on Wisconsin women’s expectations about whether they can access a range of reproductive healthcare options at a Catholic hospital—and whether those expectations are in line with their actual availability. Their latest article was published in the journal Contraception, titled “Expectations about Availability of Contraception and Abortion at a Hypothetical Catholic Hospital: Rural-Urban Disparities among Wisconsin Women.”
Catholic health systems are widespread in Wisconsin, and they can be the only health provider available for many rural residents. However, people may not know that their community hospital is Catholic owned or what healthcare services it prohibits.
Comparing the expectations of women in rural areas with the expectations of those in urban areas, Dr. Kramer and her coauthors highlighted several key findings from a survey of nearly 700 Wisconsinites:
Wisconsin has a higher-than-average rural population and the nation’s single highest proportion of Catholic hospitals. It can be challenging for patients to find out what reproductive care is offered—or not offered—at their local hospitals. “Our findings that rural women are more likely to hold inaccurate expectations about available reproductive care suggest that rural women might be particularly at risk of presenting to a Catholic healthcare system only to be turned away from care,” Kramer and the research team said. “In order for prospective patients, especially in rural areas, to meet their reproductive health needs, they need readily accessible information to help them identify providers that can provide the desired services.”
Based on their findings, the researchers recommend that hospitals should be required to make it clear what services they do and do not offer. “Ultimately,” the authors write, “given the expanding influence of Catholic healthcare systems, large-scale investment in full-spectrum reproductive service providers—especially in rural areas—is needed to ensure timely access to care.”
Check out the full study in Contraception: https://go.wisc.edu/754h0q
A new article published by CORE Researchers Laura Jacques, MD, Emma Carpenter, PhD, Taryn Valley, MA, Barbara Alvarez, MS, and Jenny Higgins, PhD, MPH was recently published in the prestigious American Journal of Obstetrics and Gynecology. The authors innovatively studied Reddit users to cast a revealing light on the barriers facing people as they choose whether to have an in-clinic abortion or a pill abortion at home. The article is titled, “Medication or surgical abortion? An exploratory study of patient decision making on a popular social media platform.” The researchers analyzed Reddit users’ posts about their abortion experiences, revealing four key themes:
Reddit, a website used by nearly a quarter of US-based young adults, with over two million user-created message boards, provides a unique source of information. Online anonymity may make the internet appealing for those seeking abortion information, and anonymity is a key feature of Reddit. The researchers approach made it possible to study people’s decision making before they ever have an abortion; most research to-date focuses on people who have already had a procedural or pill abortion.
Barring specific medical reasons in the first trimester, people can select the abortion method that feels most comfortable to them. An in-clinic abortion involves a brief procedure and is often performed in outpatient clinics. A pill abortion can be accomplished in people’s own home, but in many states, including Wisconsin, patients are required to make one or more visits to a clinic to obtain medications and/or follow-up care. Some Reddit users expressed a preference for being in a health clinic setting with professional providers present, while others wanted the privacy of their own homes.
The novel use of social media as a source of information about patient decision making offers a unique opportunity for researchers to capture the thoughts and experiences of people who have not yet or may never make it to a clinic. The study presents a new source of data for researchers going forward that can inform abortion policy, information, and provision of care.
Read the full study in the American Journal of Obstetrics and Gynecology here.
Press Release: Reddit yields new information about how people make personal decisions about abortion—and how the internet shapes their decisions (6/30/2021)
FOR IMMEDIATE RELEASE: June 30, 2021
CORE: The Collaborative for Reproductive Equity
University of Wisconsin-Madison
Contact: Samantha Herndon
smherndon@wisc.edu
608-285-2364
A new article published by a team of researchers at the UW-Madison Collaborative for Reproductive Equity (CORE) innovatively studied Reddit users to cast a revealing light on the barriers facing people as they choose whether to have an in-clinic abortion or a pill abortion at home. The study, published in the prestigious American Journal of Obstetrics and Gynecology, studied Reddit users’ posts about their abortion experiences, revealing four key themes:
CORE Researchers Laura Jacques, MD, Emma Carpenter, PhD, Taryn Valley, MA, Barbara Alvarez, MS, and Jenny Higgins, PhD, MPH turned to Reddit to better understand how pregnant people who want an abortion decide what type of abortion care to choose. Reddit, a website used by nearly a quarter of US-based young adults, with over two million user-created message boards, provides a unique source of information. Online anonymity may make the internet appealing for those seeking abortion information, and anonymity is a key feature of Reddit.
Barring specific medical reasons in the first trimester, people can select the abortion method that feels most comfortable to them. An in-clinic abortion involves a brief procedure and is often performed in outpatient clinics. A pill abortion can be accomplished in people’s own home, but in many states, including Wisconsin, patients are required to make one or more visits to a clinic to obtain medications and/or follow-up care. Some Reddit users expressed a preference for being in a health clinic setting with professional providers present, while others wanted the privacy of their own homes.
The novel use of social media as a source of information about patient decision making offers a unique opportunity for researchers to capture the thoughts and experiences of people who have not yet or may never make it to a clinic. The study presents a new source of data for researchers going forward that can inform abortion policy, information, and provision of care.
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The Collaborative for Reproductive Equity (CORE) is an initiative within the School of Medicine and Public Health at the University of Wisconsin-Madison. CORE investigators conduct rigorous, interdisciplinary research focused on reproductive health, equity, and autonomy in Wisconsin, and beyond. Visit core.wisc.edu to learn more about our research.
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Researchers at the Guttmacher Institute, a leading research and policy organization committed to advancing sexual and reproductive health and rights, have been working on a multiyear state-based study, and Wisconsin is one of the states on which they are focusing. In collaboration with UW CORE and other Wisconsin research and policy partners, Guttmacher Institute investigators analyzed the effects of federal and state policy changes on publicly funded reproductive healthcare between 2017 and today. These Reproductive Health Impact Studies (RHIS) also include Arizona, New Jersey, and Iowa.
Reproductive Health Impact Study: Wisconsin Fact Sheet
By Ruth Dawson, Jennifer Frost and Megan Kavanaugh
The fact sheets include state policy background, key reproductive health indicators and details about the state’s publicly funded family planning network. Information on the impacts of COVID-19 on reproductive health care is also available. Researchers found that the COVID-19 pandemic has led to significant interruptions in patients’ ability to access family planning—particularly for those who rely on publicly funded clinics. For example, data from the study shows that 33% of patients surveyed reported having to delay, skip, or cancel visiting their doctor or clinic for sexual and reproductive healthcare as a result of the pandemic.
The project’s objective is to illuminate the effects of policy change from a number of different angles: Wisconsin’s Family planning landscape, clinics, clinic staff, patients, and reproductive health indicators.
Click here for the full study: RHIS Wisconsin Fact Sheet
Congratulations to Dr. Leigh Senderowicz, mixed methods reproductive health and demography researcher and Director of our CORE Lab group. Dr. Senderowicz has just published a new paper in BMJ Global Health, leading an international team of researchers from Dar es Salaam, Cambridge, Chapel Hill, Johannesburg, and Heidelberg. Senderowicz and her co-authors Erin Pearson, Kristy Hackett, Sarah Huber-Krum, Joel Msafiri Francis, Nzovu Ulenga, and Till Bärnighausen published their original research paper titled “‘I haven’t heard much about other methods’: quality of care and person-centredness in a programme to promote the postpartum intrauterine device in Tanzania” this week.
Programs promoting LARCs (long-acting reversible contraceptives) have proliferated throughout sub-Saharan Africa and South Asia. Senderowicz and her co-authors examine the impacts on patient-centered care in the new study. Focusing on five hospitals in Tanzania, they conducted twenty in-depth interviews with pregnant women seeking prenatal care. Through a contraceptive counseling quality framework, the team explored a PPIUD (postpartum IUD) intervention and its impact on quality of contraceptive counseling.
Senderowicz and the team found that providers emphasized the IUD over other contraceptive methods through biased counseling. Rather than neutral, evidence-based contraceptive counseling on a wide range of methods, women were told by providers that the PPIUD has no side effects, is broadly superior to other contraceptive methods, or were counseled on no other methods at all. Due to a shortage of trained providers, contraceptive counseling for pregnant women surveyed in the study often took place in large groups, making patient-centered care a challenge. Findings indicate that LARC-centric programs such as this PPIUD int
ervention, as currently implemented, may decrease access to person-centered contraceptive counseling and to accurate information about a broad range of contraceptive methods. The findings imply that pursuing method uptake is not the most beneficial approach for contraceptive users.
A shift away from emphasizing LARC methods to comprehensive, person-centered contraceptive counseling is critical to promote contraceptive autonomy, according to Senderowicz, Pearson, Hackett, Huber-Krum, Msafiri Francis, Ulenga, and Bärnighausen.
We encourage you to read the full article, which is open access, at this link: https://gh.bmj.com/content/6/6/e005775
CORE Research Brief: Religious Restrictions on Reproductive Care: Wisconsin Patient Perspectives Prepared by Renee Kramer, June 24, 2021
File: Religious-Restrictions-on-Reproductive-Care_June-2021.pdf
We’re excited to share a new CORE study!
Dr. Renee D. Kramer and Dr. Jenny A. Higgins of CORE, along with Dr. Marguerite E. Burns, Lori R. Freedman & Debra B. Stulberg, published a new study in the journal Contraception titled “Prevalence and experiences of Wisconsin women turned away from Catholic settings without receiving reproductive care.” The paper addresses women’s experiences of being turned away from Catholic healthcare settings without receiving care. The researchers surveyed 675 women in Wisconsin and analyzed the data.
Key findings:
• Experiences of being turned away from a Catholic healthcare setting without receiving desired contraceptive or fertility care were more common among Wisconsin women living in rural counties served by Catholic sole community hospitals compared to other rural and urban areas.
• About 1-in-12 women in Wisconsin rural counties served by Catholic sole community hospitals reported ever being turned away from a Catholic healthcare setting without receiving desired reproductive care.
• Women who were turned away by hospitals reported long delays in accessing care elsewhere, especially when seeking tubal ligation; in some cases, this led to more invasive procedures or unintended pregnancy.
As Catholic healthcare expands locally and nationally, it is important to better understand how restrictions on healthcare delivery influence patients’ lives. Read the full study here.
CORE Brief
Effects of Title X and Medicaid eligibility expansions
on reproductive outcomes
Prepared by Joanna Venator, October 3, 2018