CORE Brief: Effects of Title X and Medicaid eligibility expansions on reproductive outcomes
CORE Brief
Effects of Title X and Medicaid eligibility expansions
on reproductive outcomes
Prepared by Joanna Venator, October 3, 2018
Research
CORE Brief: Restrictive covenants and abortion access
CORE Brief
Restrictive covenants and abortion access
Prepared by Alexa DeBoth, November 2, 2018
Congratulations to Dr. Jill Denson on completing her PhD!
Please join CORE in congratulating Dr. Jill Denson, a friend of CORE and a Public Health Madison & Dane County Supervisor, who successfully defended her dissertation at the Joseph J. Zilber School of Public Health, UW-Milwaukee this week! Dr. Denson’s dissertation research used an innovative, community-based approach called Group Concept Mapping to examine African American women’s intersectional identities related to pregnancy intention, experiences accessing reproductive care, and making reproductive decisions. Congratulations, Dr. Denson!
Dissertation:
THE IMPACT OF STRUCTURAL DETERMINANTS ON PREGNANCY INTENTION AND REPRODUCTIVE DECISION MAKING AMONG AFRICAN AMERICAN WOMEN
Abstract:
BACKGROUND: Nearly half of U.S. pregnancies are unintended with African American women having the highest rates of unintended pregnancies and many of the poorest pregnancy-related health outcomes. Intersectional approaches are needed to better understand how intersecting oppressions effect pregnancy intentions in African American women’s lives. This study examined African American women’s intersectional identities related to pregnancy intention, experiences accessing reproductive care, and making reproductive decisions.
METHODS: This mixed-methods participatory study used Group Concept Mapping (GCM) along with four questionnaires (reproductive history, Adverse Childhood Experiences, Everyday Discrimination Scale, Perceived Stress Scale, and the Patient Health Questionnaire-2 item depression screen). African American women between 18-44 years were recruited and grouped into lower (n=12) and higher (n=12) income groups. Using GCM methods and software, each group engaged in the participatory data collection analysis process across three sessions. Session one included participants brainstorming factors they considered when deciding to become pregnant or not. In session two, after the group brainstorming session, participants were individually tasked with sorting statements into categories and rating from lowest to highest the importance of factors in deciding to get pregnant, preventing pregnancy and using contraceptives. The GCM software generated 102 statements, organized into 8 clusters. Multidimensional scaling analysis created maps later interpreted by participants in session 3. The researcher utilized the maps to generate go-zones and pattern matches to compare responses between groups and were stratified by stress level, trauma history, depression symptoms, and contraceptive use.
RESULTS: Three themes emerged from the Group Concept Mapping process: Inward Reflection (autonomy), Relational Reflection (sexual partners), and Outward Reflection (judged by others), which each influenced participant’s pregnancy intention and reproductive decision-making. Everyday discrimination was common. The higher income group more frequently experienced race-based and gender-based discrimination, while the lower-income group more frequently experienced class-based discrimination.
CONCLUSION: Interventions to support pregnancy intention and reproductive decision-making need to account for the intersecting oppressive identities within their design. Public health interventions are needed to address the roots of oppression in women’s reproductive lives and have a nuanced appreciation for historical and ongoing policies that can address structural determinants of health.
When it comes to contraceptive use, sexual impacts matter: CORE director Jenny Higgins and colleagues publish new study in JAMA Internal Medicine
This week CORE Director Jenny Higgins and colleagues published a new article in JAMA Internal Medicine, titled “Association Between Patients’ Perceptions of the Sexual Acceptability of Contraceptive Methods and Continued Use Over Time.”
Contraception is one of the most commonly used healthcare products in the United States, and it allows people to engage in sexual activity without experiencing unwanted pregnancies. But contraceptive research, education, and clinical care rarely consider the birth control’s sexual acceptability—that is, how contraceptives affect people’s sexual experiences, and how those effects may shape use over time.
Higgins and colleagues’ new study in JAMA Internal Medicine sheds light on this important issue–and suggests that contraceptives’ effects on people’s sex lives can have major consequences for birth control practices.
The research team included scholars from the University of Wisconsin-Madison and the University of Utah. The team conducted a study of 2,000 people who started a new contraceptive method. Research participants could switch or discontinue their method at any time, for free. They found that at one month, about half of contraceptive clients reported that their method had led to a positive impact on their sex life, less than a third reported no sexual change, and one in six reported a negative sexual impact.
The team then examined how these sexual impacts at one month helped predict people’s continued use of their contraceptive method at six months. They found that those who reported a negative impact on their sex life were upwards of three times as likely to discontinue or switch their method compared to people who reported a positive sexual impact. And this effect on contraceptive use over time was much stronger than factors that we more commonly consider: changes in vaginal bleeding, physical side effects such as headaches or bloating, and psychological side effects such as changes in mood.
“Our study shows that people’s sexual experiences of their contraceptive method seem to matter a lot in whether people like their method and use it over time. It’s important that we pay more attention to sexual acceptability in our contraceptive research, clinical care, and education,” said Dr. Higgins. For example, both clinicians and educators could emphasize that patients’ sexual experiences of their methods are important and encourage them to find a method that works for them, sexually and otherwise. “It’s also great news that contraception seems to have a positive sexual impact on so many people’s sex lives,” Dr. Higgins said. “And I urge those people who think their method is a sexual detractor to keep trying other methods—they deserve to find one that they like!”
Read the open-access research letter in JAMA Internal Medicine.
JAMA Press Release
Press Release for JAMA Internal Medicine Publication, April 2021
FOR IMMEDIATE RELEASE: April 27, 2021
Samantha Herndon
CORE: Collaborative for Reproductive Equity
University of Wisconsin-Madison
smherndon@wisc.edu
When It Comes to Contraceptive Use, Sexual Impacts Matter: UW-Madison CORE Director Jenny Higgins and Colleagues Publish New Study in JAMA Internal Medicine
This week at University of Wisconsin-Madison, Professor and CORE Director Jenny Higgins and colleagues published a new article in JAMA Internal Medicine, a major peer-reviewed journal put out by the American Medical Association. The paper is titled “Association Between Patients’ Perceptions of the Sexual Acceptability of Contraceptive Methods and Continued Use Over Time.”
Contraception, which is one of the most commonly used healthcare products in the United States, is a sexual product and not just a public health good: it allows people to engage in sexual activity without experiencing unwanted pregnancies. But contraceptive research, education, and clinical care rarely consider the birth control’s sexual acceptability—that is, how contraceptives affect people’s sexual experiences, and how those effects may shape use over time.
Higgins and colleagues’ new study in JAMA Internal Medicine sheds light on this important issue–and suggests that contraceptives’ effects on people’s sex lives can have major consequences for birth control practices.
Led by CORE Director Jenny Higgins, a research team from the University of Wisconsin-Madison and the University of Utah conducted a study of 2,000 people who started a new contraceptive method and could switch or discontinue their method at any time for free. They found that at one month, about half of contraceptive clients reported that their method had led to a positive impact on their sex life (26% said it “improved my sex life a lot,” 27% “improved my sex life a little), 30% reported no sexual change, and one in six reported a negative sexual impact (2% said it “has made my sex life a lot worse,” 14% “has made my sex life a little worse”).
The team then examined how these sexual impacts at one month helped predict people’s continued use of their contraceptive method at six months. They found that those who reported a negative impact on their sex life were upwards of three times as likely to discontinue or switch their method compared to people who reported a positive sexual impact. And this effect on contraceptive use over time was much stronger than factors that we more commonly consider: changes in vaginal bleeding, physical side effects such as headaches or bloating, and psychological side effects such as changes in mood.
“Our study shows that people’s sexual experiences of their contraceptive method seem to matter a lot in whether people like their method and use it over time,” said Higgins, the study’s lead author. “It’s important that we pay more attention to sexual acceptability in our contraceptive research, clinical care, and education.” For example, both clinicians and educators could emphasize that patients’ sexual experiences of their methods are important and encourage them to find a method that works for them, sexually and otherwise. “It’s also great news that contraception seems to have a positive sexual impact on so many people’s sex lives,” Higgins said. “And I urge those people who think their method is a sexual detractor to keep trying other methods—they deserve to find one that they like!”
CORE, the Collaborative for Reproductive Equity, is a research center within the Department of Obstetrics and Gynecology at the University of Wisconsin’s flagship Madison campus. CORE investigators conduct and translate rigorous, interdisciplinary research to inform policies and programs so that all people in Wisconsin have access to the full range of high-quality, evidence-based reproductive health information and services.
Dr. Tiffany L. Green and colleagues publish new article in Obstetrics & Gynecology
In a article in Obstetrics & Gynecology, also known as the Green Journal, authors Tiffany L. Green, PhD, Jasmine Y. Zapata, MD, Heidi W. Brown, MD, MAS, and Nao Hagiwara, PhD address the limitations of existing implicit bias interventions as a strategy for achieving maternal health equity. Entitled “Rethinking Bias to Achieve Maternal Health Equity: Changing Organizations, Not Just Individuals,” the article focuses on how institutionally sanctioned racial stereotyping harms Black maternal health and marginalizes a key group in the fight for health equity—Black physicians. Finally, Green and colleagues provide strategies to address racial bias in perinatal health care and structural barriers impeding Black physicians’ success, addressing the importance of physician training and the physician pipeline to increasing equity and maternal health outcomes.
Read the full article here.
Valley and Alvarez’s new research on medication abortion policy appears in Scholars Strategy Network
MD/PhD Candidate and CORE Researcher Taryn Valley and CORE alumna Barbara Alvarez have a new piece out this week in Scholars Strategy Network titled “How Medication Abortion Legislation in Wisconsin Impedes Access to Safe Care.” Our map of Wisconsin above, designed by Department of Obstetrics and Gynecology media specialist Rob Garza, shows the location of Wisconsin clinics that provide abortion care as of 2021.
Valley and Alvarez’s research, building on previous work on the subject by a variety of scholars, finds that medication abortion is safe and can be provided via telehealth and by advanced practice practitioners like Nurse Pracitioners and Physician Associates, in addition to physicians.
Current abortion regulations in the US vary widely by state. Valley and Alvarez studied Act 217, a Wisconsin regulation requiring that the same physician conduct an initial appointment and then, at least 24 hours later, physically provide patients with the medicines for a medication abortion. Medication abortions can be administered orally, and do not require any medical procedures.
The study found that Act 217’s medically unnecessary restrictions create significant barriers for patients seeking abortions, as well as unnecessary challenges for doctors who provide abortion care.
Next Steps for Wisconsin
Valley and Alvarez write, “Abortion is legal and guaranteed under the U.S. Constitution, but people who can get pregnant in Wisconsin face a complicated web of restrictions, including the many barriers erected by Act 217. While the increasingly politicized U.S. Supreme Court has forbidden telehealth use for medication abortion, globally, the World Health Organization asserts misoprostol – the second of the two-medication regimen – is an essential medication that is safe to use at home. Wisconsin’s restrictions go against both domestic constitutional protections and global consensus about safety and best practices. The providers as well as the involved researchers call on the legislature and judiciary of Wisconsin to repeal Act 217 in order to provide the legal right to an abortion, including medication abortion, in Wisconsin.”
Read the full research brief at the Scholars Strategy Network website. Congratulations to Taryn and Barbara on the publication!
The Need For Accurate Contraceptive Awareness And Advocacy Among Health Care Providers
In a new article for Health Affairs titled “The Need For Accurate Contraceptive Awareness And Advocacy Among Health Care Providers,” CORE Researchers Jenny Higgins, Lindsay M. Cannon, Laurel W. Rice and David K. Turok investigate how health care professionals understand and define pregnancy, the mechanisms of contraception, and the differences between contraception and abortifacients. Broad misunderstandings of these terms contribute to health policies that limit access to the full range of FDA-approved contraceptive methods.
The team writes, “According to the American College of Obstetricians and Gynecologists (ACOG), pregnancy is defined as “the period of time from implantation to delivery,” which begins when a fertilized egg is implanted into the uterine wall. This definition is consistent across all major US medical organizations and US governmental agencies. Abortion has a precise meaning in the medical and scientific community as a termination of pregnancy. As such, an abortifacient, or drug that causes an abortion, works after a fertilized egg has implanted into the uterine lining.
In contrast, a method of contraception must prevent pregnancy by preventing the fertilization of an egg or by preventing the implantation of a fertilized egg. Thus, to be considered a contraceptive product, a method must prevent pregnancy before a pregnancy is established through the process of implantation. Thus, contraceptive methods including but not limited to pills, patches, rings, IUDs, injections, implants, sterilization, emergency contraception, and barrier methods, all prevent pregnancy prior to implantation; none disrupt an existing pregnancy.
There are two methods of contraception that tend to be especially misunderstood: IUDs and pill-based emergency contraception.”
To read the full article and see survey data from healthcare providers, go to healthaffairs.org.
The authors express gratitude to the University of Wisconsin Survey Center for their invaluable methodological expertise and survey administration. They also thank the supporters and staff of UW CORE. Finally, they are grateful to Freya Riedlin at the Center for Reproductive Rights for helping identify political appointees’ statements about contraception.
CORE Research Highlight: An Analysis of Abortion Clinic Closures, Births, and Abortions in Wisconsin
Between 2010 and 2017, Wisconsin passed three laws regulating abortion providers. Two of five abortion clinics closed in Wisconsin, increasing the distance to the nearest clinic to 55 miles on average and to over 100 miles in the most affected counties. CORE Researchers Joanna Venator and Jason Fletcher examined the impact on clinics, birth rates, and abortion rates in this paper published in the Journal of Policy Analysis and Management. The study is titled “Undue Burden Beyond Texas: An Analysis of Abortion Clinic Closures, Births, And Abortions in Wisconsin.”
The brief below highlights their findings:
CORE investigators found that the clinic closures in Wisconsin led to similar if not greater barriers to abortion access than seen in studies of other states. The greatest impacts occurred in counties close to one of the clinics that closed, reducing access to services for those in rural Wisconsin.
https://doi.org/10.1002/pam.22263
New CORE research on the impact of medication abortion care restrictions in Wisconsin
CORE investigators have published a brief summarizing interviews with Wisconsin healthcare professionals about their experience providing medication abortion care services and how current Wisconsin policies affect their patients and their work. Investigators found overwhelming evidence that reproductive healthcare professionals believe current medication abortion restrictions in Wisconsin undermine both patient care and provider capacity. You can read the brief here.