The reproductive autonomy of persons who can give birth can be impeded through forms of interpers... more The reproductive autonomy of persons who can give birth can be impeded through forms of interpersonal violence and coercion. Moreover, macro-level factors (e.g., poverty, discrimination, community violence, legislative policies) may impede the reproductive autonomy of entire communities. This study investigates a form of violence we term perceived contraceptive pressure in Appalachia, an understudied region of the Eastern U.S., regarding reproductive health and decision-making. Through targeted Meta advertising, participants ( N = 632) residing in Appalachian zip codes completed an online survey on reproductive health. The focus of this study was to investigate the prevalence of perceived contraceptive pressure, who was at increased risk of experiencing pressure, and the source(s) of perceived pressure. Binomial regressions were conducted on three different dependent variables: perceived pressure to be sterilized, perceived pressure to use birth control, and perceived pressure not to use birth control. Approximately half of all respondents (49.5%) reported experiencing at least one type of pressure targeting contraceptive decision-making. The most prevalent source of perceived pressure to use birth control was from the healthcare provider (67.4%), and the most prevalent source of perceived pressure not to use birth control was the respondent’s partner (51.1%). Recommendations for providers serving clients in the Appalachian region include pursuing education regarding contraceptive pressure at the individual level and macro-level. In addition, Appalachian residents may benefit from educational programming on reproductive autonomy, healthy relationships, and how to navigate pressure in relationships.
International Journal of Environmental Research and Public Health
Very little is known about contraceptive behavior in Appalachia, a large geographic region in the... more Very little is known about contraceptive behavior in Appalachia, a large geographic region in the eastern United States where even basic prevalence estimates of contraceptive use/nonuse are lacking. This study characterizes contraceptive behavior among Appalachians, including contraceptive use, reasons for use, and methods used; contraceptive nonuse and reasons for nonuse; and attitudes about contraception, including acceptability. This is a secondary analysis of a subsample of survey data collected on sexual and reproductive health attitudes, behaviors, and needs among reproductive-age women (18–49 years) living in the Appalachian region (n = 332). Results identify rates of contraceptive use (66.6%) and nonuse (33.1%) among Appalachian residents. Methods used most frequently included those that did not require prescription (i.e., external condoms and natural family planning methods) though many reported the use of intrauterine devices (IUDs). Among nonusers, fear of side effects fr...
Abstract Background Opioid use among reproductive-age women has greatly increased, resulting in h... more Abstract Background Opioid use among reproductive-age women has greatly increased, resulting in high rates of opioid-exposed pregnancies, which are associated with negative outcomes, such as neonatal abstinence syndrome. Prevention of unintended pregnancy among opioid users is a critical pathway to reducing opioid-exposed pregnancies; however, little is known about pregnancy intention in this group. This article estimates the prevalence of unintended pregnancy among opioid-using women, thereby supporting efforts to develop interventions to reduce unintended pregnancy. Methods A systematic literature search was conducted in PubMed, Web of Science, PsycINFO, and CINAHL, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses framework. Reference lists of articles were searched. Eligibility criteria included reported unintended pregnancy rates within a population of opioid-using women of reproductive age. The search was completed in July 2018 and updated in October 2019. Results We identified 115 citations, screened 64 titles/abstracts, reviewed 31 full-text articles, and included 12 articles for this review. Rates of unintended pregnancy in opioid users were estimated in two ways, across the lifetime and for a current pregnancy, depending on study samples. Rates for both groups were high, with rates among currently pregnant opioid-using women (85%) compared with 45% among the general population. Conclusions and Implications Unintended pregnancy rates in opioid-using women were strikingly high, indicating a critical need for intervention. Routine inclusion of pregnancy planning in opioid treatment care is indicated. Education regarding contraception and opioid treatment services is essential for nurses in these settings. Family planning and opioid treatment efforts can be optimized by care coordination, with focus on nurse training for screening and patient education.
Journal of Health Care for the Poor and Underserved, 2021
BACKGROUND In 2015, Tennessee enacted a law requiring a 48-hour wait and two clinic visits to obt... more BACKGROUND In 2015, Tennessee enacted a law requiring a 48-hour wait and two clinic visits to obtain an abortion. METHODS Using data from a Tennessee clinic in 2016, we explore whether abortion seekers from the most economically disadvantaged ZIP codes and those who lived farther from the clinic were less likely to return for the abortion procedure at the second visit. RESULTS Rates of non-return were 44%-91% higher among residents of neighborhoods in which ≥25% of the population was below federal poverty level, ≥25% of the female population was below federal poverty level, and median annual household income was <$35,000. Mean clinic distance was also consistently greater among those who did not return. CONCLUSIONS Residents of the most economically disadvantaged ZIP codes may be disproportionately burdened by Tennessee's waiting period law, rendering them less able to return for the abortion procedure than residents of less economically disadvantaged ZIP codes. Furthermore, greater clinic distance may also impede access under this law.
This article describes a secondary data analysis of a health data set representing the experience... more This article describes a secondary data analysis of a health data set representing the experiences of abortion fund service recipients (ASRs) who received financial assistance to help pay for unaffordable abortion costs. The authors analyzed 3,216 ASR cases from 2001 to 2015. Demographic characteristics, service utilization rates, and the personal hardships reported by the sample were assessed. The personal hardships of the Florida ASRs were compared with the hardships reported by ASRs who received assistance from a national fund. Results indicate that Florida ASRs are primarily people of color who are single, in their mid-20s, already parenting children, and receiving assistance in the second trimester of pregnancy. ASRs in this current study are experiencing multiple personal hardships while trying to access an abortion, including economic hardships (such as lack of insurance coverage and unemployment) and trauma (including rape and partner violence). When compared with the ASRs at the national level, these state-level ASRs reported higher rates of unemployment, partner violence, and rape, which suggests that the Florida ASRs face some more dire circumstances compared with ASRs at the national level. Repeal of policy that restricts public funding of abortion in Florida is recommended to improve access to abortion.
The purpose of the study was to examine the association between women’s experience of two types (... more The purpose of the study was to examine the association between women’s experience of two types (sexual and physical) of intimate partner violence (IPV) and number of previous abortions among a national sample of 4,586 abortion patients between the ages of 13 and above 38 years in the United States. Using data from the nationally representative Abortion Patients Survey 2008, χ2 tests were conducted to examine the bivariate associations between all independent and dependent variables. Prevalence ratios were calculated to determine the association between IPV, physical and sexual, and number of abortions, controlling for whether the coconceiving partner knew about the pregnancy and the abortion, and demographic factors including age, education, income, poverty rate, race, and type of union. Results indicate that approximately 51% of the sample of women seeking abortion services had never gotten an abortion before. Reports of IPV were low among this sample—5.6% reported physical violence and 2.4% reported sexual violence, while 82.3% of the coconceiving partners knew about the abortion, and 87.1% knew about the pregnancy. Prevalence ratios revealed that physical violence was positively associated with number of abortions (PR = 1.31, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), but sexual violence was negatively associated with number of abortions (PR = 0.74, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05) when all control variables were accounted for. Findings suggesting that physical and sexual violence are differentially associated with a history of multiple abortions were unexpected and suggest the need for additional research in this area. Implications for practice, policy, and directions for future research are discussed.
Introduction: African immigrants are a vulnerable population who are seldom seen in the literatur... more Introduction: African immigrants are a vulnerable population who are seldom seen in the literature, however, the scant research available reports that they experience increased challenges when making family planning decisions. A robust understanding of their specific family planning practices is imperative to providing appropriate, culturally congruent care. Considering this disparity, a scoping review was conducted to synthesize empirical knowledge and identify gaps in the literature around family planning in African immigrant populations in the United States. Methods: Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) framework, EMBASE, Global Health Database, PsycINFO, CINAHL, and PubMed were searched for literature regarding family planning topics such as decision-making and health care access among African immigrant women in the United States in June 2020. Results: The small number of retrieved studies for the literature review clearly hig...
The purpose of this article was to examine the average distance traveled to access an abortion pr... more The purpose of this article was to examine the average distance traveled to access an abortion procedure, rates of return for the procedure, and whether or not those living in rural zip codes were less likely to return for the abortion compared with residents in urban zip codes, in the context of a 48-hour in-person mandatory waiting period in Tennessee. Findings indicated that over 12 percent of patients who attended the in-person counseling session did not return for the procedure. Moreover, abortion patients in this study traveled an average of 50.53 miles to access abortion care, which is notably higher than the estimated national average of 11.00 miles. Rural residents were significantly more likely than urban residents to have to travel farther to access abortion services. However, neither geographic location nor distance traveled were predictive of returning to the clinic for the second appointment to obtain the abortion, suggesting that patients who did return were able to overcome any geographic disparities. Given the policy mandate that requires a minimum of two in-person clinic visits to obtain the abortion, patients who are traveling farther must still use more resources for two trips, which is a burden to them that is not experienced by more urban residents who are located in closer proximity to abortion providers. The article concludes with a discussion of the implications of the findings for social work practice and policy.
This article examines the concept of being "easy" as a quality that female caregivers a... more This article examines the concept of being "easy" as a quality that female caregivers aspire to as they envision their potential care in later life. It draws on data from a qualitative study exploring the significance of caregiving to adult daughters' perspectives and plans for their own aging. Caregivers' experiences differ based upon their perception of how easy or difficult it was to care for their loved one. The former exemplifies a positive way to approach aging and the receiving of care. Being easy describes an attitude that these caregivers desired for their own later life.
The effect of intimate partner violence (IPV) on women's lives includes negative reproductive... more The effect of intimate partner violence (IPV) on women's lives includes negative reproductive health outcomes by way of compromised control over their bodies. This effect is contextual, which leads to contradictory implications for practitioners involved in sexual and reproductive health. The current article adds to the literature by providing an examination of the association between partner violence and contraceptive use in a nationally representative sample of married women in Bangladesh, where some 24 percent of national samples of women report IPV. The study is a secondary data analysis of the Bangladesh Demographic and Health Survey 2007 with a sample of 4,467 women aged 15-49 years. Significant main effects were observed for partner violence: The probability of using contraceptives was 9 percent higher for women who reported partner violence compared with women who did not. Additionally, women were more likely to use contraceptives when they had children under the age of five and were employed. Policy and practice implications for social work are discussed. Key Practitioner Message: • To understand how intimate partner violence may increase the odds of contraceptive use as a way of "help seeking"; • To understand the implications of contraceptive use in a Muslim majority population; • To provide policy suggestions for bundling services for intimate partner violence with reproductive health services. Language: en
The reproductive autonomy of persons who can give birth can be impeded through forms of interpers... more The reproductive autonomy of persons who can give birth can be impeded through forms of interpersonal violence and coercion. Moreover, macro-level factors (e.g., poverty, discrimination, community violence, legislative policies) may impede the reproductive autonomy of entire communities. This study investigates a form of violence we term perceived contraceptive pressure in Appalachia, an understudied region of the Eastern U.S., regarding reproductive health and decision-making. Through targeted Meta advertising, participants ( N = 632) residing in Appalachian zip codes completed an online survey on reproductive health. The focus of this study was to investigate the prevalence of perceived contraceptive pressure, who was at increased risk of experiencing pressure, and the source(s) of perceived pressure. Binomial regressions were conducted on three different dependent variables: perceived pressure to be sterilized, perceived pressure to use birth control, and perceived pressure not to use birth control. Approximately half of all respondents (49.5%) reported experiencing at least one type of pressure targeting contraceptive decision-making. The most prevalent source of perceived pressure to use birth control was from the healthcare provider (67.4%), and the most prevalent source of perceived pressure not to use birth control was the respondent’s partner (51.1%). Recommendations for providers serving clients in the Appalachian region include pursuing education regarding contraceptive pressure at the individual level and macro-level. In addition, Appalachian residents may benefit from educational programming on reproductive autonomy, healthy relationships, and how to navigate pressure in relationships.
International Journal of Environmental Research and Public Health
Very little is known about contraceptive behavior in Appalachia, a large geographic region in the... more Very little is known about contraceptive behavior in Appalachia, a large geographic region in the eastern United States where even basic prevalence estimates of contraceptive use/nonuse are lacking. This study characterizes contraceptive behavior among Appalachians, including contraceptive use, reasons for use, and methods used; contraceptive nonuse and reasons for nonuse; and attitudes about contraception, including acceptability. This is a secondary analysis of a subsample of survey data collected on sexual and reproductive health attitudes, behaviors, and needs among reproductive-age women (18–49 years) living in the Appalachian region (n = 332). Results identify rates of contraceptive use (66.6%) and nonuse (33.1%) among Appalachian residents. Methods used most frequently included those that did not require prescription (i.e., external condoms and natural family planning methods) though many reported the use of intrauterine devices (IUDs). Among nonusers, fear of side effects fr...
Abstract Background Opioid use among reproductive-age women has greatly increased, resulting in h... more Abstract Background Opioid use among reproductive-age women has greatly increased, resulting in high rates of opioid-exposed pregnancies, which are associated with negative outcomes, such as neonatal abstinence syndrome. Prevention of unintended pregnancy among opioid users is a critical pathway to reducing opioid-exposed pregnancies; however, little is known about pregnancy intention in this group. This article estimates the prevalence of unintended pregnancy among opioid-using women, thereby supporting efforts to develop interventions to reduce unintended pregnancy. Methods A systematic literature search was conducted in PubMed, Web of Science, PsycINFO, and CINAHL, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses framework. Reference lists of articles were searched. Eligibility criteria included reported unintended pregnancy rates within a population of opioid-using women of reproductive age. The search was completed in July 2018 and updated in October 2019. Results We identified 115 citations, screened 64 titles/abstracts, reviewed 31 full-text articles, and included 12 articles for this review. Rates of unintended pregnancy in opioid users were estimated in two ways, across the lifetime and for a current pregnancy, depending on study samples. Rates for both groups were high, with rates among currently pregnant opioid-using women (85%) compared with 45% among the general population. Conclusions and Implications Unintended pregnancy rates in opioid-using women were strikingly high, indicating a critical need for intervention. Routine inclusion of pregnancy planning in opioid treatment care is indicated. Education regarding contraception and opioid treatment services is essential for nurses in these settings. Family planning and opioid treatment efforts can be optimized by care coordination, with focus on nurse training for screening and patient education.
Journal of Health Care for the Poor and Underserved, 2021
BACKGROUND In 2015, Tennessee enacted a law requiring a 48-hour wait and two clinic visits to obt... more BACKGROUND In 2015, Tennessee enacted a law requiring a 48-hour wait and two clinic visits to obtain an abortion. METHODS Using data from a Tennessee clinic in 2016, we explore whether abortion seekers from the most economically disadvantaged ZIP codes and those who lived farther from the clinic were less likely to return for the abortion procedure at the second visit. RESULTS Rates of non-return were 44%-91% higher among residents of neighborhoods in which ≥25% of the population was below federal poverty level, ≥25% of the female population was below federal poverty level, and median annual household income was <$35,000. Mean clinic distance was also consistently greater among those who did not return. CONCLUSIONS Residents of the most economically disadvantaged ZIP codes may be disproportionately burdened by Tennessee's waiting period law, rendering them less able to return for the abortion procedure than residents of less economically disadvantaged ZIP codes. Furthermore, greater clinic distance may also impede access under this law.
This article describes a secondary data analysis of a health data set representing the experience... more This article describes a secondary data analysis of a health data set representing the experiences of abortion fund service recipients (ASRs) who received financial assistance to help pay for unaffordable abortion costs. The authors analyzed 3,216 ASR cases from 2001 to 2015. Demographic characteristics, service utilization rates, and the personal hardships reported by the sample were assessed. The personal hardships of the Florida ASRs were compared with the hardships reported by ASRs who received assistance from a national fund. Results indicate that Florida ASRs are primarily people of color who are single, in their mid-20s, already parenting children, and receiving assistance in the second trimester of pregnancy. ASRs in this current study are experiencing multiple personal hardships while trying to access an abortion, including economic hardships (such as lack of insurance coverage and unemployment) and trauma (including rape and partner violence). When compared with the ASRs at the national level, these state-level ASRs reported higher rates of unemployment, partner violence, and rape, which suggests that the Florida ASRs face some more dire circumstances compared with ASRs at the national level. Repeal of policy that restricts public funding of abortion in Florida is recommended to improve access to abortion.
The purpose of the study was to examine the association between women’s experience of two types (... more The purpose of the study was to examine the association between women’s experience of two types (sexual and physical) of intimate partner violence (IPV) and number of previous abortions among a national sample of 4,586 abortion patients between the ages of 13 and above 38 years in the United States. Using data from the nationally representative Abortion Patients Survey 2008, χ2 tests were conducted to examine the bivariate associations between all independent and dependent variables. Prevalence ratios were calculated to determine the association between IPV, physical and sexual, and number of abortions, controlling for whether the coconceiving partner knew about the pregnancy and the abortion, and demographic factors including age, education, income, poverty rate, race, and type of union. Results indicate that approximately 51% of the sample of women seeking abortion services had never gotten an abortion before. Reports of IPV were low among this sample—5.6% reported physical violence and 2.4% reported sexual violence, while 82.3% of the coconceiving partners knew about the abortion, and 87.1% knew about the pregnancy. Prevalence ratios revealed that physical violence was positively associated with number of abortions (PR = 1.31, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), but sexual violence was negatively associated with number of abortions (PR = 0.74, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05) when all control variables were accounted for. Findings suggesting that physical and sexual violence are differentially associated with a history of multiple abortions were unexpected and suggest the need for additional research in this area. Implications for practice, policy, and directions for future research are discussed.
Introduction: African immigrants are a vulnerable population who are seldom seen in the literatur... more Introduction: African immigrants are a vulnerable population who are seldom seen in the literature, however, the scant research available reports that they experience increased challenges when making family planning decisions. A robust understanding of their specific family planning practices is imperative to providing appropriate, culturally congruent care. Considering this disparity, a scoping review was conducted to synthesize empirical knowledge and identify gaps in the literature around family planning in African immigrant populations in the United States. Methods: Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) framework, EMBASE, Global Health Database, PsycINFO, CINAHL, and PubMed were searched for literature regarding family planning topics such as decision-making and health care access among African immigrant women in the United States in June 2020. Results: The small number of retrieved studies for the literature review clearly hig...
The purpose of this article was to examine the average distance traveled to access an abortion pr... more The purpose of this article was to examine the average distance traveled to access an abortion procedure, rates of return for the procedure, and whether or not those living in rural zip codes were less likely to return for the abortion compared with residents in urban zip codes, in the context of a 48-hour in-person mandatory waiting period in Tennessee. Findings indicated that over 12 percent of patients who attended the in-person counseling session did not return for the procedure. Moreover, abortion patients in this study traveled an average of 50.53 miles to access abortion care, which is notably higher than the estimated national average of 11.00 miles. Rural residents were significantly more likely than urban residents to have to travel farther to access abortion services. However, neither geographic location nor distance traveled were predictive of returning to the clinic for the second appointment to obtain the abortion, suggesting that patients who did return were able to overcome any geographic disparities. Given the policy mandate that requires a minimum of two in-person clinic visits to obtain the abortion, patients who are traveling farther must still use more resources for two trips, which is a burden to them that is not experienced by more urban residents who are located in closer proximity to abortion providers. The article concludes with a discussion of the implications of the findings for social work practice and policy.
This article examines the concept of being "easy" as a quality that female caregivers a... more This article examines the concept of being "easy" as a quality that female caregivers aspire to as they envision their potential care in later life. It draws on data from a qualitative study exploring the significance of caregiving to adult daughters' perspectives and plans for their own aging. Caregivers' experiences differ based upon their perception of how easy or difficult it was to care for their loved one. The former exemplifies a positive way to approach aging and the receiving of care. Being easy describes an attitude that these caregivers desired for their own later life.
The effect of intimate partner violence (IPV) on women's lives includes negative reproductive... more The effect of intimate partner violence (IPV) on women's lives includes negative reproductive health outcomes by way of compromised control over their bodies. This effect is contextual, which leads to contradictory implications for practitioners involved in sexual and reproductive health. The current article adds to the literature by providing an examination of the association between partner violence and contraceptive use in a nationally representative sample of married women in Bangladesh, where some 24 percent of national samples of women report IPV. The study is a secondary data analysis of the Bangladesh Demographic and Health Survey 2007 with a sample of 4,467 women aged 15-49 years. Significant main effects were observed for partner violence: The probability of using contraceptives was 9 percent higher for women who reported partner violence compared with women who did not. Additionally, women were more likely to use contraceptives when they had children under the age of five and were employed. Policy and practice implications for social work are discussed. Key Practitioner Message: • To understand how intimate partner violence may increase the odds of contraceptive use as a way of "help seeking"; • To understand the implications of contraceptive use in a Muslim majority population; • To provide policy suggestions for bundling services for intimate partner violence with reproductive health services. Language: en
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