Study finds links between resource deprivation and reproductive autonomy

Inadequate insurance coverage and high costs of healthcare are established barriers to contraceptive access. However, we know little about the ways that broader, structural socioeconomic barriers may impact people’s ability to access their preferred contraceptive method(s)—a key dimension of reproductive autonomy.

A recent CORE publication in Contraception uses data from the statewide SHOW survey to explore connections between Wisconsinites’ socioeconomic resources, broadly defined to include housing instability and food insecurity, and their contraceptive use during the COVID-19 pandemic.

The study found that, among Wisconsin women using contraception, nearly one-third were not using their preferred method. Those who lacked socioeconomic resources, including adequate food and housing, were significantly less likely to be using their preferred contraceptive method(s) than people who had their basic financial needs covered.

The authors concluded that people with low incomes and socioeconomic struggles may have greater difficulty accessing their preferred contraceptive methods due to competing demands on their time and resources, as well as systemic barriers to care.

The article, authored by Laura Swan, Hoa Vu, Jenny Higgins, Leeann Bui, Kristen Malecki, and Tiffany Green, makes the case that full-spectrum contraceptive care and reproductive autonomy must occur in concert with community resources to reduce poverty and provide social service benefits.

Over 3.5 million more people could have access to abortion services if telemedicine for medication abortion were expanded and bans rescinded, research shows

photo of Jane Seymour

New research from CORE postdoctoral scholar Jane Seymour in the American Journal of Public Health suggests that over 3.5 million more people in the U.S., and 250,000 people in Wisconsin, could have access to abortion services if telemedicine for medication abortion bans were removed and site-to-site services were expanded. Telemedicine for medication abortion (TMAB) has been shown to be safe and effective. This study finds it also makes abortion more accessible for people living in rural areas or who live far distances from clinics currently offering abortion. However, nineteen states, including Wisconsin, currently ban telemedicine for medication abortion, despite research documenting its safety and efficacy. 

Seymour and colleagues at Boston School of Public Health, Ibis Reproductive Health, and Temple University’s College of Public Health examined how the removal of TMAB bans and expansion of site-to-site TMAB to additional Planned Parenthood health centers could affect abortion accessibility in the United States. Using epidemiologic and geographic information systems (GIS) methods, they determined the proportion of US women age 15-44 years old living within 30, 60, and 90 minutes of an abortion-providing facility, respectively. [This study relied on Census data, which only included women, not other people who use abortion services.] The researchers then considered hypothetical telemedicine for medication abortion ban removal and TMAB programming changes and their effect on abortion accessibility. 

Seymour and colleagues found that removing all TMAB bans and expanding site-to-site TMAB services to all Planned Parenthood health centers that did not offer abortions in 2018 could result in an additional 3.5 million women aged 15-44 years living within 30 min of an abortion-providing facility.  

Even with these changes, many people would lack abortion accessibility. In some states, even with the removal of TMAB bans and greater use of TMAB at clinics, more than 50% of the reproductive-aged population still would not have adequate abortion accessibility.  

As states including Wisconsin lose legal, local abortion provision, telemedicine abortion, including site-to-site TMAB, will likely take on increasing importance. Some states have enacted restrictions that effectively ban direct-to-patient TMAB, but may allow for site-to-site TMAB, including some states where abortion remains legal.  

This work demonstrates the importance of expanding site-to-site telemedicine for medication abortion services for abortion access. Removing bans on telemedicine for medication abortion is critical to ensuring a range of abortion provision options.  

Read the study in the American Journal of Public Health, and check out our fact sheet on this important research.

Contraceptives’ Effects on Sexual Experiences Play a Huge Role in Satisfaction, Study Finds

photo of two people kissing in front of golden balloons

Sexual acceptability – how birth control methods affect users’ sexual well-being – is likely an important component of contraceptive satisfaction, but hasn’t been systematically examined until now. Dissatisfaction with a contraceptive method leads many people to stop using contraception. If people want to use contraception, they should be able to find a method that works for them – and new CORE research indicates that how a method affects a user’s sexual experiences is a key factor in determining whether they will continue using this health product over time. 

Renee D. Kramer, Jenny A. Higgins, and colleagues at the University of Utah examined contraceptive satisfaction among contraceptive users who were starting a new method. They wanted to find out if sexual acceptability measures could be used to predict contraceptive satisfaction after three months of use. Their study was recently published by the American Journal of Obstetrics & Gynecology, also known as “the Gray Journal.”

Among about 2,000 users, over half were completely satisfied with their contraceptive method after 3 months. Patients who said their contraceptive method improved their sex life were upwards of 8x as likely to be satisfied with their method.

Contraceptive care providers may wish to underscore that sexual experiences of birth control methods matter and encourage patients to find a contraceptive method that works for them sexually.

Read the full study, “A prospective analysis of the relationship between sexual acceptability and contraceptive satisfaction over time” in The American Journal of Obstetrics & Gynecology

CORE Review Finds Close Association Between Economic and Sexual Wellbeing

cover image from The Journal of Sex Research

A new analysis led by CORE Director Jenny A. Higgins, Madison Lands, Mfonobong Ufot, and Sara McClelland reviewed 47 studies from over 22 countries, and found nearly universal associations between socioeconomic constraints and poorer sexual wellbeing.

Public health organizations such as the American Public Health Association and the World Health Organization emphasize that sexual health involves positive and pleasurable sexual experiences, not only the prevention of negative sexual outcomes. However, surprisingly little research has paid specific attention to sexual pleasure and its relationship with poverty. To address this gap, CORE researchers systematically drew from nearly studies to document relationships between socioeconomic conditions (such as financial stressors, income, and education level) with indicators of sexual wellbeing (such as sexual satisfaction, functioning, and orgasm).

The authors proposed a variety of pathways through which socioeconomic conditions may shape sexual wellbeing and flourishing. Such pathways include, but aren’t limited to:

  • financial-associated stress, which can undermine positive aspects of sexuality;
  • the psychosocial effects of having comparatively less social and political clout, which can undermine all aspects of health, including sexual health;
  • expectations for enjoyable sexual experiences, which can be undermined by poverty; 
  • inadequate housing and access to private space, which can also erode pleasurable sexual experiences.

The authors argue that true “erotic equity” can only come about after sweeping changes to educational and employment opportunities as well as access to health and social services. 

While these changes will take time, sexual health as a human right depends on them. Sexual pleasure and positive sexual experiences are a critical part of reproductive autonomy and reproductive justice.

In 94% of studies the authors reviewed, poorer socioeconomic conditions were significantly associated with poorer sexual wellbeing and flourishing. People with comparatively low levels of income reported much lower levels of sexual satisfaction compared to those living on higher incomes. The relationship between socioeconomic conditions and sexual flourishing were consistent across geographic location and gender.

The authors identified many limitations with the existing research on this topic, including narrow and one-dimensional approaches to poverty – a very complex concept and experience. The articles included in the review were primarily focused on cisgender women, and studies from the United States and Europe contained overwhelmingly white samples. Future research in this area must attend to both gender and racial diversity.

Without broader structural improvements to socioeconomic opportunities for all, poverty will continue to undermine sexual wellbeing, which is a fundamental human right.

Read the open-access article in The Journal of Sex Research here.

Sexual Health and Flourishing Negatively Impacted by Economic Constraints

photo of two people kissing in front of a blue sky. photo by Shingi Rice

New research by CORE investigators documents that poverty and other financial constraints undermine people’s ability to have positive sexual experiences.

All major public health organizations in the United States underscore that sexual health involves both the absence of negative outcomes (such as unwanted pregnancies and STIs), and the presence of sexual flourishing, including a pleasurable and satisfying sex life.

CORE researchers examined how these positive aspects of sexual health may be affected by by socioconomic conditions. Their research brief, just published online in Perspectives on Sexual and Reproductive Health, shares findings from a study of over 2,500 people of reproductive age seeking family planning services. The project was a collaboration between researchers at the University of Wisconsin-Madison’s Collaborative for Reproductive Equity (UW CORE) and the University of Utah, using data from the HER Salt Lake Initiative. 

Researchers collected information on people’s financial resources (for example, whether they had trouble paying for basic needs in the past month) as well as indicators of sexual flourishing (for example, sexual satisfaction and orgasm).

Nearly universally, those who reported experiencing more financial constraints also reported fewer signs of sexual flourishing. Results from this analysis suggest that economics are strongly associated with sexual wellbeing, with indications that financial scarcity may reduce sexual satisfaction, orgasm, and overall functioning. These results remind us that structural constraints affect sexual bodies.

A reproductive justice framework indicates that all people must have access to the social conditions needed for healthy and autonomous reproductive and sexual lives. 

To address inequities in sexual health, public health leaders and policymakers must continue to support economic reform and poverty reduction.

Read the open-access article here:

Study Finds Over Half of Physicians Who Are Willing to Refer for Abortion Care Don’t Know How to Do So

A new study by CORE researchers shows that physicians want to refer patients for abortion services, but many lack the knowledge on how to do so. Published in in Social Science and Medicine – Population Health, the paper shares findings from a survey of over 800 physicians across specialties at the University of Wisconsin School of Medicine and Public Health, the state’s largest and only public medical school.

Elizabeth Anderson, Sarah K. Cowan, Jenny A. Higgins of CORE, Nicholas B. Schmuhl, and Cynthie K. Wautlet teamed up to learn more about how referral knowledge may serve as a barrier to abortion access.

Their survey results indicate that the overwhelming majority (over 80%) of physicians were willing to consult on abortion-related patient cases. However, only half (53%) of physicians who were willing to refer a patient for abortion care knew how to do so. Physicians who had not received abortion-related information in medical school, as well as more junior physicians, were especially lacking in abortion referral knowledge.

These findings illustrate another obstacle for those seeking abortion: healthcare providers who are “willing but unable” to direct patients to abortion services if needed.

Clear and robust referral systems could aid physicians in helping their patients get the reproductive healthcare they need.

Read the open-access article here, titled “Willing but unable: Physicians’ referral knowledge as barriers to abortion care.”





CORE’s Survey of Doctors Highlights Widespread Support for Abortion Access

graph showing physician support for abortion access. 78% support access, according to a core survey. Bar chart format in yellow, coral, red, marigold, and gray.

Bar chart in coral, marigold, gray, yellow, and pink. Shows that 78% of physicians surveyed support unrestricted access to abortion care.

Our recent series of studies here at UW CORE, Collaborative for Reproductive Equity, document overwhelming support of abortion services among faculty physicians at the UW School of Medicine and Public Health. More than three-quarters of doctors surveyed expressed support for abortion access, and more than nine in ten expressed concern about abortion restrictions. We are sharing these findings in the research brief “Physician Support of Unrestricted Abortion Services in Wisconsin.”

The new research is part of a larger project that assessed abortion-related attitudes, practices, and perceptions among physicians of all specialties within a Wisconsin-based teaching hospital. The researchers surveyed 913 physicians who represent more than 20 medical specialties. The survey results showed:

  • More than three-quarters of physicians surveyed reported at least some degree of support for unrestricted access to abortion (78% said they support unrestricted abortion access somewhat or a lot).
  • 99% were at least a little concerned about legislation interfering in the doctor-patient relationship, and nearly half (48%) were extremely concerned.
  • Most doctors expressed at least some level of concern that abortion laws will make it difficult for physicians to offer timely and appropriate care (93%) and for patients to receive the care they need (91%).
  • Nine in ten doctors (90%) surveyed indicated that women’s health in Wisconsin would get worse if Roe v. Wade is overturned.

These findings underscore substantial physician concern that Wisconsin abortion restrictions can negatively affect patient care, the patient–provider relationship, and patients’ health.

CORE’s research suggests that Wisconsin’s abortion restrictions, which include (but are not limited to) a mandatory 24-hour waiting period, multiple clinically unnecessary constraints on medication abortion services, and the criminalization of abortion if Roe v. Wade is overturned, are not in line with physician’s professional perspectives. While doctors’ personal beliefs vary, the majority of doctors surveyed report that current abortion restrictions worsen patient care and that women’s health will decline further if abortion becomes illegal in our state.

Read the full research brief here.