Perspectives on options for self-sourcing medication abortion after implementation of Texas Senate Bill 8.

Objectives: To examine experiences of pregnant Texans who considered self-sourcing medication abortion following the September 2021 implementation of Texas Senate Bill 8, which prohibited abortions after detectable embryonic cardiac activity.

Study Design: This qualitative research study used in-depth telephone interviews conducted between October 2021 and August 2022 with pregnant and recently pregnant Texas residents ≥16 years of age who considered abortion. We recruited participants from two sources: flyers posted at abortion facilities in nearby states and an online survey of Texans seeking abortion care.

Abortion care preferences and trade-offs when traveling out-of-state for facility-based services: findings from a discrete choice experiment.

Background: Pregnant people living in states that banned abortion after the US Supreme Court's decision overturning Roe v Wade (Dobbs v Jackson Women's Health Organization -Dobbs decision) may evaluate multiple factors when deciding where to obtain facility-based abortion care in another state. We examine Texans' stated preferences for out-of-state facility-based abortion care and quantify the trade-offs they would make when choosing between out-of-state facilities following a 2022 abortion ban.

Methods: In August 2022, we surveyed Texans ≥ 16 years old seeking abortion at in-state facilities or who were searching online for information about accessing abortion care.

Mississippi Abortion Clients' Strategies to Pay for Abortion Care and Manage Economic Hardship.

Abortion clients who experience economic hardship face barriers paying for abortion care. Between September 2020 and June 2021, we conducted a facility-based survey with 211 abortion clients who obtained care in Mississippi, and 25 respondents completed in-depth interviews. We computed the frequency with which survey respondents used social network-based, agency-based, and individual strategies to pay for care and we employed thematic analysis to explore in-depth interviewees' decision-making and experiences with these strategies.

Barriers to Preferred Contraception Use in Mississippi.

Many Americans are not using the contraceptive method they prefer, but there has been limited study of how this may be related to health system barriers. We evaluated how such barriers to contraceptive care are related to unmet contraceptive preference in Mississippi and which contraceptive methods are preferred by those who report an unmet preference. Between September 2020 and February 2021, we used social media advertisements to recruit Mississippi residents 18-45 years of age, who were assigned female at birth, for an online survey.

Abortion Return Rates and Wait Times Before and After Texas' Executive Order Banning Abortion During COVID-19.

To assess the associations between the executive order that Texas governor Greg Abbott issued on March 22, 2020, postponing procedures deemed not immediately medically necessary, and patients' access to abortion care in Texas. We used 17 515 individual-level patient records from 13 Texas abortion facilities for matched periods in 2019 and 2020 to examine differences in return rates for abortion after completion of a state-mandated ultrasound and median wait times between ultrasound and abortion visits for those who returned. Patients were less likely to return for an abortion if they had an ultrasound while the executive order was under effect (82.

Abortion Clients' Perceptions of Alternative Medication Abortion Service Delivery Options in Mississippi.

Objectives: We assessed Mississippi abortion clients' perceptions of alternative medication abortion service delivery options that were restricted under state law but available elsewhere.

Methods: We conducted in-depth interviews with medication abortion clients between November 2020 and March 2021 at Mississippi's only abortion facility. We described alternative service delivery models: telemedicine, medications by mail, and follow-up care in their community versus returning to the facility.

Reasons for participation in abortion research in restrictive settings.

Objectives: Following the implementation of a restrictive abortion law in Texas (Senate Bill 8), we conducted in-depth interviews with pregnant people about their experiences seeking abortion care. In this analysis, we explore participants' motivations for taking part in a research study.

Study Design: Between October 2021 and August 2022, we conducted 120 in-depth interviews with Texans (aged ≥15 years) who, after considering abortion, had a facility-based abortion, self-managed their abortion, experienced miscarriage or ectopic pregnancy, or continued their pregnancy.

Travel for abortion care: implications for clinical practice.

Purpose Of Review: Traveling long distances to obtain abortion care due to restrictions and scarce availability is associated with significant obstacles. We review clinical strategies that can facilitate abortion access and outline considerations to ensure person-centered and equitable care.

Recent Findings: Establishing a patient's gestational duration prior to travel may be beneficial to ensure they are eligible for their desired abortion method at the preferred facility or to determine if a multiday procedure is required.

Self-diagnosing the end of pregnancy after medication abortion.

This qualitative study conducted between November 2020 and March 2021 in the US state of Mississippi examines the experiences of 25 people who obtained medication abortion at the state's only abortion facility. We conducted in-depth interviews with participants after their abortions until concept saturation was reached, and then analysed the content using inductive and deductive analysis. We assessed how people use embodied knowledge about their individual physical experiences such as pregnancy symptoms, a missed period, bleeding, and visual examinations of pregnancy tissue to identify the beginning and end of pregnancy.

Abortion Access and Medically Complex Pregnancies Before and After Texas Senate Bill 8.

Objective: To evaluate how Texas health care professionals who care for patients experiencing medically complex pregnancies navigate abortion restrictions.

Methods: We conducted qualitative in-depth interviews with health care professionals across Texas who cared for patients with life-limiting fetal diagnoses or who had existing or developed health conditions that adversely affected pregnancy. We conducted the first round of interviews March-June 2021 and the second round of interviews January-May 2022 after the implementation of Texas Senate Bill 8 (SB8), which prohibited most abortions after detection of embryonic cardiac activity.

Interest in advance provision of abortion pills: a national survey of potential users in the USA.

Objective: To assess interest in clinician-administered advance provision of abortion pills among potential users in the USA.

Methods: Using social media advertisements, we recruited people living in the USA who were aged 18-45 years and assigned female at birth, who were not pregnant or planning pregnancy, for an online survey on reproductive health experiences and attitudes. We explored interest in advance provision of abortion pills, participant characteristics, including demographics and pregnancy history, contraceptive use, abortion knowledge and comfort, and healthcare system distrust.

Abortion-client religious identity and self-judgment in a setting with antiabortion protestors in Mississippi.

Objective: To assess abortion patients' self-judgment in a setting with antiabortion protestors.

Study Design: We analyzed data from a survey of 196 Mississippi abortion clients who interacted with antiabortion protestors, using ANOVA to compare feelings of self-judgment (measured on a 0-to-4 Likert-based scale) by religious identity. We assessed support for a law limiting protestor activity using a Χ test.

Publicly Funded Family Planning Organizations' Response to the COVID-19 Pandemic in Texas.

Introduction: After the onset of the COVID-19 pandemic, the use of family planning services decreased, but there are limited data on how safety net providers were affected.

Methods: Between November 2020 and March 2021, we conducted in-depth interviews with administrators at health departments, federally qualified health centers, and specialized family planning organizations across Texas about pandemic-related changes in family planning services. We analyzed interview transcripts using an inductive thematic approach.

Service delivery at Title X sites in Texas during the COVID-19 pandemic.

Context: The important role of Title X sites in supporting publicly funded reproductive healthcare was elevated during the COVID-19 pandemic, as many people experienced economic uncertainty and changed their fertility preferences. In this study, we assessed changes in service delivery during the first year of the COVID-19 pandemic at Title X-supported sites in Texas, a large state with a high uninsured rate and a diverse Title X network.

Methods: Using surveys of Title X-funded organizations in Texas from April and November 2020, we examined the percentage of organizations reporting service modifications.

Association of Texas' 2021 Ban on Abortion in Early Pregnancy With the Number of Facility-Based Abortions in Texas and Surrounding States.

Importance: Texas' 2021 ban on abortion in early pregnancy may demonstrate how patterns of abortion might change following the US Supreme Court's June 2022 decision overturning Roe v Wade.

Objective: To assess changes in the number of abortions and changes in the percentage of out-of-state abortions among Texas residents performed at 12 or more weeks of gestation in the first 6 months following implementation of Texas Senate Bill 8 (SB 8), which prohibited abortions after detection of embryonic cardiac activity.

Design, Setting, And Participants: Retrospective study of a sample of 50 Texas and out-of-state abortion facilities using an interrupted time series analysis to assess changes in the number of abortions, and Poisson regression to assess changes in abortions at 12 or more weeks of gestation.

Update on medication abortion follow-up options: many sizes to fit all.

Purpose Of Review: To assess the efficacy, benefits, and limitations of available and emerging follow-up options for medication abortion.

Recent Findings: Medication abortion follow-up does not have to be a 'one size fits all' protocol. From most to least invasive, follow-up options include facility-based ultrasound, laboratory-based repeat serum beta-human chorionic gonadotropin (hCG) testing, urine hCG testing (high sensitivity, low sensitivity, and multilevel pregnancy tests), self-assessment with symptom evaluation, and no intervention.

Lactogenesis and breastfeeding after immediate vs delayed birth-hospitalization insertion of etonogestrel contraceptive implant: a noninferiority trial.

Background: Initiating a progestin-based contraceptive before the drop in progesterone required to start lactogenesis stage II could theoretically affect lactation. Previous studies have shown that initiating progestin-based contraception in the postnatal period before birth-hospitalization discharge has no detrimental effects on breastfeeding initiation or continuation compared with outpatient interval initiation. However, there are currently no breastfeeding data on the impact of initiating the etonogestrel contraceptive implant in the early postnatal period immediately in the delivery room.

Use of a contraceptive decision support tool in the abortion care setting.

Objective: To evaluate the use of a contraceptive decision support tool in the abortion care setting.

Study Design: In 2019, Mississippi residents aged 18 to 45 used a tablet-based decision support tool at the consultation visit and completed a survey about their satisfaction with the tool.

Results: Among the 325 participants, the majority found the tool "very helpful" for method decision-making (86%) and considered the amount of information provided to be "just right" (95%).

Leveraging the Client-Provider Interaction to Address Contraceptive Discontinuation: A Scoping Review of the Evidence That Links Them.

Despite considerable investment and effort, unmet need for contraception remains an obstacle to improved family planning outcomes. One influencing factor is the frequency of contraceptive discontinuation among users who desire to prevent pregnancy, often due to method-related concerns and side effects. Contraceptive users have the right to be supported during counseling to voluntarily choose methods that align with their individual needs and preferences.

Transcutaneous Electrical Nerve Stimulation for Pain Management of Aspiration Abortion up to 83 Days of Gestation: A Randomized Controlled Trial.

Objective: To evaluate high-frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) as an inexpensive, noninvasive pain management approach for first-trimester aspiration abortion.

Methods: We conducted a noninferiority, single-blind, randomized controlled trial of patients seeking aspiration abortion at up to 83 days of gestation. Participants received TENS (placed posteriorly, T10-L1 and S2-S4) or intravenous (IV) sedation (fentanyl, midazolam).

A Comparison of Paracervical Block Volumes Before Osmotic Dilator Placement: A Randomized Controlled Trial.

Objective: To evaluate whether a 12-mL paracervical block is noninferior to a 20-mL block in reducing pain with osmotic dilator insertion.

Methods: In this single-blinded noninferiority trial, we randomized individuals undergoing insertion of osmotic dilators before second-trimester abortion to receive either a 12-mL or 20-mL 1% lidocaine paracervical block. The primary outcome was pain immediately after insertion of osmotic dilators.

Comparison of two home pregnancy tests for self-confirmation of medication abortion status: A randomized trial.

Objectives: To evaluate individuals' ability to perform and comprehend low-sensitivity and multilevel urine pregnancy tests during medication abortion follow-up.

Study Design: We conducted a pilot study of individuals using mifepristone and misoprostol for medication abortion through 63-days gestation. We randomly assigned participants to use a 1000 mIU/mL low-sensitivity pregnancy test or a five-level multilevel pregnancy test.