Communication with patients using asynchronous telehealth medication abortion services.

Objectives: Understanding patient communication with clinic providers or staff in telemedicine abortion can inform appropriate staffing.

Methodology: We describe patient-service communication when using asynchronous telemedicine abortion services from April to November 2020 (n = 504) and compare patient demographics with number of messages using Kruskal-Wallis rank sum test.

Results: About half of patients communicated with staff (56%, n = 287), median of six messages per patient (interquartile range: 3-10 messages).

Motivations to use a novel hormonal male contraceptive: Perspectives from male contraceptive clinical trial participants.

Objective: Most existing studies on men's willingness to use novel hormonal male contraceptives (HMCs) rely on survey data and focus on the hypothetical use of HMCs. The aim of this in-depth, qualitative study was to elicit the perspectives of HMC clinical trial participants - men who have actually used an HMC - to describe their motivations for using HMCs.

Study Design: In 2017-18 we conducted 30 in-depth, semi-structured interviews with a sample of men who participated in early-stage HMC clinical trials in Los Angeles or Seattle to explore their experiences with and motivations for trialing a HMC.

Person-centered abortion care scale: Validation for medication abortion in the United States.

Objective: Medication abortions now make up the majority of abortions in the US, with new service delivery models such as telehealth; however, it is unclear how this may impact patient experiences. The objective of the study is to adapt and validate a person-centered abortion care (PCAC) scale for medication abortions that was developed in a global South context (Kenya) for use in the United States.

Study Design: This study includes medication abortion patients from a hospital-based clinic who had one of two modes of service delivery: (1) telemedicine with no physical exam or ultrasound; or (2) in-person with clinic-based exams and ultrasounds.

Characterizing provider bias in contraceptive care in Tanzania and Burkina Faso: A mixed-methods study.

Provider bias based on age, marital status, and parity may be a barrier to quality contraceptive care. However, the extent to which bias leads to disparities in care quality is not well understood. In this mixed-methods study, we used four different data sources from the same facilities to assess the extent of bias and how much it affects contraceptive care.

Pregnancy and pregnancy intention after experiencing infertility: A longitudinal study of women in Malawi.

Background: Infertility is a common experience among individuals and couples. Infertility may resolve without intervention, but little is known about pregnancy intentions and incidence of pregnancy following infertility, particularly in low-resource settings.

Methods: Data come from UTHA, a longitudinal cohort study in Central Malawi, with baseline and follow up surveys conducted from 2014-2019 (N = 1,030 reproductive-aged women).

Assessing the relationship between reproductive autonomy and contraceptive use in rural Malawi.

Reproductive autonomy, or the extent to which people control matters related to their own sexual and reproductive decisions, may help explain why some people who do not intend to become pregnant nevertheless do not use contraception. Using cross-sectional survey data from 695 women aged 16 to 47 enrolled in the Umoyo Wa Thanzi (UTHA) study in Malawi in 2019, we conducted confirmatory factor analysis, descriptive analyses, and multivariable logistic regression to assess the freedom from coercion and communication subscales of the Reproductive Autonomy Scale and to examine relationships between these components of reproductive autonomy and current contraceptive use. The freedom from coercion and communication subscales were valid within this population of partnered women; results from a correlated two-factor confirmatory factor analysis model resulted in good model fit.

"I know my body and I just can't get pregnant that easily" - Women's use and non-use of the injection to manage fertility.

Approximately one-third of contraceptive users in Malawi use the Depo-Provera injection, a method that must be re-injected every three-months to prevent pregnancy and may reduce fecundity for a time after discontinuation. Little is known about women use the injection to achieve their desired family size. In 2018, we conducted 20 in-depth interviews with women who were part of a cohort study in rural Malawi.

Infertility and perceived chance of conception among men in Malawi.

Infertility is a common experience among individuals and couples worldwide, but few studies focus on men's reports of infertility or perceived chance of conceiving, particularly in high-fertility, pronatalist contexts where infertility is highly stigmatized. Using data from the fourth wave of the Umoyo wa Thanzi (UTHA) cohort study in rural Central Malawi (2017-2018), we examine the relationship between self-reported infertility, the perceived chance of conceiving within one year, and sociodemographic characteristics among men ( = 484). While 13% of men reported that they had experienced infertility, just 4% of men perceived that they were unlikely or there was no chance they would conceive with their partner within one year of having sex without contraception.

Evaluating the frequency of crisis pregnancy center visits among a population of patients seeking abortions in Los Angeles.

Objectives: Studies have illustrated crisis pregnancy centers' (CPC) disingenuous practices regarding abortion services. We evaluated the proportion of patients who visited a CPC before their abortion in Los Angeles.

Study Design: Patients attending one of two abortion clinics between July 2019 and March 2020 were recruited for a survey that examined patient characteristics and locations of care.

Measuring Nuance in Individual Contraceptive Need: A Case Study from a Cohort in Malawi.

Contraceptive counseling protocols tend to focus narrowly on pregnancy intentions, which may overlook other factors that contribute to whether an individual wants or needs contraception. In this report, we demonstrate the potential of two measures of individual contraceptive need that could be assessed as part of contraceptive counseling: (1) a composite score constructed from pregnancy intentions, sexual frequency, and perceived fecundity and (2) a direct measure of contraceptive need ("do you feel it is necessary for you to be using contraception right now?") We compare the two measures using data from Umoyo wa Thanzi, a cohort study in Central Malawi (N = 906; 2017-2018). More frequent sex, perceptions of being more fecund, and a stronger desire to avoid pregnancy were associated with directly reporting contraceptive need (p < 0.

Patient perspectives on barriers in obtaining timely abortion care in Los Angeles, California.

Objectives: Although California is a state with supportive abortion policies, recent evidence suggests people may still encounter barriers to obtaining timely abortion care. To provide an in-depth understanding of these barriers and augment existing literature focusing on restrictive and hostile states, we sought to understand the patient perspectives of barriers to timely abortion care in Los Angeles, California.

Study Design: We recruited participants from two, high-volume urban clinical sites and conducted semi-structured interviews with 17 individuals who visited three or more clinics and/or encountered more than 2 weeks between seeking and obtaining their abortion.

Measuring impact of storyline engagement on health knowledge, attitudes, and norms: A digital evaluation of an online health-focused serial drama in West Africa.

Background: "Cest la Vie!" (CLV) is a serial drama that entertains, educates, and promotes positive health behaviors and social change for West African audiences. The purpose of this study was to evaluate if watching the CLV Season 2 series online had an impact on people's health knowledge, attitudes, and norms, focusing on populations in francophone West Africa.

Methods: Between July 2019 and October 2019, viewers of CLV and non-viewers were recruited from Facebook and YouTube.

Vasectomy Knowledge and Interest Among U.S. Men Who Do Not Intend to Have More Children.

Vasectomy is used less often than female sterilization, and many men who do not want more children may lack accurate information about vasectomy. Between May and June 2018, we used a nationally representative online panel to survey U.S.

Infertility, Perceived Certainty of Pregnancy, and Contraceptive Use in Malawi.

Infertility and unintended pregnancy are dual burdens in Malawi, where 41% of pregnancies are unintended and approximately 20% of people report infertility. Although preventing unintended pregnancy has been a focus in public health, infertility has rarely been explored as a factor that may be associated with contraceptive use. Using cross-sectional survey data (2017-2018; N = 749), we report on the prevalence of and sociodemographic characteristics associated with infertility and certainty of becoming pregnant among women in Malawi.

An application of Systematic Anomalous Case Analysis to improve models predicting contraceptive use in the Philippines.

Amidst persistently high unintended pregnancy rates and lags in contraceptive use, novel methodological approaches may prove useful in investigating sexual and reproductive health outcomes in the Philippines. Systematic Anomalous Case Analysis (SACA) - a mixed-methods technique - was employed to examine predictors of women's lifetime contraceptive use. First, multivariable, longitudinal Poisson regression models predicted fertility and sexual debut using the 1998-2009 Cebu Longitudinal Health and Nutrition Surveys (CLHNS), then regression outliers and normative cases were used to identify 48 participants for in-depth interviews (2013-2014) for further examination.

Nomadic Tibetan women's reproductive health: findings from cross-sectional surveys with a hard-to-reach population.

Background: Western China has undergone substantial sociodemographic change, yet little is known about the health status of ethnic minority populations living in these areas.

Methods: We report findings from two cross-sectional surveys conducted with female Tibetan nomads living in rural areas of Western China/Eastern Tibet. We present results of descriptive analyses of data collected from reproductive-aged females who attended community health fairs in 2014 (n = 193) and 2016 (n = 298).

Desire to avoid pregnancy and contraceptive use among female methadone patients in Los Angeles.

Objective: Opioid use disorder (OUD) is increasing among U.S. women.

Women's Reproductive Rights Policies and Adverse Birth Outcomes: A State-Level Analysis to Assess the Role of Race and Nativity Status.

Introduction: Reproductive rights policies can potentially support or inhibit individuals' abilities to attain the highest standard of reproductive and sexual health; however, research is limited on how broader social policies may differentially impact women of color and immigrants in the U.S. This study examines the associations among state-level reproductive rights policies, race, and nativity status with preterm birth and low birth weight in the U.

A mixed methods study exploring methadone treatment disclosure and perceptions of reproductive health care among women ages 18-44 years, Los Angeles, CA.

Introduction: Opioid use disorder (OUD) and methadone treatment are increasing among women ages 18-44 years old, a population with unique healthcare needs. Despite this increase, there is little research on the healthcare experiences of women with OUD, particularly experiences with reproductive healthcare.

Methods: We designed a sequential, mixed-methods study in three Los Angeles methadone clinics.

Challenges for Adult Undocumented Immigrants in Accessing Primary Care: A Qualitative Study of Health Care Workers in Los Angeles County.

Amid increasingly restrictive federal immigration and health care policies in the United States, access to health care for undocumented immigrants is highly dependent on the extent to which local and state policies and programs address the needs of this population. In Los Angeles County (LA County), home to the nation's largest undocumented immigrant population, supportive policies are in place, yet little is known about how undocumented immigrants navigate available services. To gain insight into how federal, state, and local policies overlay and contribute to the experience of health care seeking among undocumented immigrants in LA County, we interviewed 19 key informant health care workers involved in the delivery of health care services, using a purposive snowball sampling approach.

Development and Validation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults.

Purpose: We developed and validated a measure that assesses the latent construct of sexual and reproductive empowerment among adolescents and young adults. A specific measure for this group is critical because of their unique life stage and circumstances, which often includes frequent changes in sexual partners and involvement from parents in decision-making.

Methods: After formative qualitative research, a review of the literature, and cognitive interviews, we developed 95 items representing nine dimensions of sexual and reproductive empowerment.

Using Systematic Anomalous Case Analysis to Examine Sexual and Reproductive Health Outcomes in the Philippines.

The Philippines is characterized by sustained economic growth and political stability, yet sexual and reproductive health indicators have stalled or even worsened in recent decades. We employed an innovative, mixed-methods approach-Systematic Anomalous Case Analysis-to gain insights into these worsening trends by examining sexual and reproductive decision-making among a cohort of young adults in Metro Cebu, Philippines. We first analyzed longitudinal data (1998-2009) to predict reproductive outcomes (i.