Background And Objectives: While workforce diversity helps mitigate health inequities, few initiatives support prospective abortion providers who are underrepresented in medicine (URiM). To address this issue, Reproductive Health Education in Family Medicine established the Resident Scholars Program for Workforce Diversity (RSPWD), a year-long program for URiM and other Black, Indigenous, People of Color (BIPOC) residents committed to sexual and reproductive health (SRH) provision. Program elements include: (a) mentorship by BIPOC family physicians; (b) virtual didactic sessions about SRH integration into primary care, advocacy, leadership, reproductive justice, and patient-centered care; (3) conference sponsorship; and (4) community-building among residents and mentors.
View Article and Find Full Text PDFThe ability to exercise autonomy in achieving reproductive health goals necessitates access to contraceptive and reproductive health information and medical care. Finding trusted, comprehensive, consistent and affordable reproductive care is particularly challenging for immigrants living in the United States, especially for those without legal immigration status and for those who prefer a language other than English. In immigrant communities, sexual and reproductive health (SRH) knowledge, contraceptive choice, and family planning are influenced by many factors including tension between traditional and adopted cultural norms, limited English proficiency, restricted health care access, and structural racism.
View Article and Find Full Text PDFThere is great variation in the experiences of Latiné/e/x/o/a, Hispanic, and/or Spanish origin (LHS) individuals in the United States, including differences in race, ancestry, colonization histories, and immigration experiences. This essay calls readers to consider the implications of the heterogeneity of lived experiences among LHS populations, including variations in country of origin, immigration histories, time in the United States, languages spoken, and colonization histories on patient care and academia. There is power in unity when advocating for community, social, and political change, especially as it pertains to equity, diversity, and inclusion (EDI; sometimes referred to as DEI) efforts in academic institutions.
View Article and Find Full Text PDFBackground: Individuals from minoritized racial and ethnic backgrounds experience pernicious and pervasive health disparities that have emerged, in part, from clinician bias.
Objective: We used a natural language processing approach to examine whether linguistic markers in electronic health record (EHR) notes differ based on the race and ethnicity of the patient. To validate this methodological approach, we also assessed the extent to which clinicians perceive linguistic markers to be indicative of bias.
Since European settlement, the United States has controlled the reproduction of communities of color through tactics ranging from forced pregnancies, sterilizations, and abortions to immigration policies and policies that separate children from their families. Lesbian, gay, bisexual, transgender, queer (or questioning), asexual, intersex, and gender diverse people (LGBTQIA+) have been persecuted for sexual behavior and gender expression, and also restricted from having children. In response, women of color and LGBTQIA+ communities have organized for Reproductive Justice (RJ) and liberation.
View Article and Find Full Text PDFObjectives: Organizations recommend providing confidential adolescent health care to reduce the consequences of high-risk health behaviors such as substance use, unhealthy eating patterns, and high-risk sexual behaviors. Family physicians are uniquely positioned to provide confidential counseling and care to this vulnerable population but must be trained to provide such care. This study describes the impact of formal and informal training on the knowledge of and comfort level in providing confidential adolescent healthcare among a sample of US Family Medicine residents.
View Article and Find Full Text PDFIn June 2022, the US Supreme Court overturned , opening the door to state-level abortion bans. By August 2023, 17 states banned abortion or instituted early gestational age bans. We performed an analysis to assess the proportion of accredited US family medicine residency programs and trainees in states with abortion restrictions.
View Article and Find Full Text PDFInstitutional ethnoracial taxation increases work stress and reduces research productivity among Mexican American and Puerto Rican faculty. Latinos are a heterogenous group, yet little is known about differences in taxation, discrimination experiences and health by race, ethnicity, and nativity. This study explores three questions: Are there differences between URM (historically underrepresented) and non-URM Latinos in: 1) demographic factors, 2) taxation experiences and 3) physical and depressive symptoms and role overload? Survey respondents included 134 Mexican American, 76 Puerto Rican, and 108 non-URM Latino faculty.
View Article and Find Full Text PDFObjectives: To explore clinician perspectives on the development, utility, and feasibility of a provider-facing point-of-care tool to assist in provision of patient-centered contraceptive care for Latina/x patients in Baltimore, MD.
Methods: We conducted 25 semi-structured qualitative interviews with a sample of clinicians who provide contraceptive care to Latina/x patients. An interview guide was developed based on prior research related to patient-centered care and extant point-of-care tools.
Introduction: Most family physicians do not provide abortion care, despite an apparent alignment between the defined values of family medicine and provision of abortion in primary care. This study seeks to understand how family physicians themselves perceive the relationship between their specialty's values and abortion provision.
Methods: We conducted in-depth interviews in 2019 with 56 family physicians who do not oppose abortion in the United States.
Background And Objectives: Workforce diversity in primary care is critical for improved health outcomes and mitigation of inequities. However, little is known about the racial and ethnic identities, training histories, and practice patterns of family physicians who provide abortions.
Methods: Family physicians who graduated from residency programs with routine abortion training from 2015 through 2018 completed an anonymous electronic cross-sectional survey.
Background And Objectives: Workforce diversity is associated with improved health outcomes. Currently, primary care physicians who are underrepresented in medicine (URiM) disproportionately work in underserved areas. Increasingly, URiM faculty describe experiencing imposter syndrome (IS), including a sense of not belonging in their work environment and a lack of recognition.
View Article and Find Full Text PDFObjectives: To explore: 1) provider narratives of their contraceptive counseling practices with Latina patients within the context of patient-centered care (PCC); and 2) provider perceptions about the barriers to the provision of patient-centered contraceptive counseling in general and more specifically, with Latina patients in Baltimore, MD.
Study Design: We conducted 25 semistructured qualitative interviews with physicians and nurse practitioners from four specialties who provide contraceptive care to Latinas in Baltimore, MD. We analyzed data using directed content analysis.
Over the past several years, in both clinical and academic medicine, there seems to be a growing consensus that racial/ethnic health inequities result from social, economic and political determinants of health rather than from nonexistent biological markers of race. Simply put, racism is the root cause of inequity, not race. Yet, methods of teaching and practicing medicine have not kept pace with this truth, and many learners and practitioners continue to extrapolate a biological underpinning for race.
View Article and Find Full Text PDFWomens Health Rep (New Rochelle)
January 2022
U.S. Latinas have lower rates of contraceptive use and report more negative counseling experiences compared to non-Latina white women.
View Article and Find Full Text PDFObjectives: In 2000, the United States' Food and Drug Administration (FDA) approved mifepristone for medication abortion. In this article, we explore how the Risk Evaluation and Mitigation Strategy (REMS) criteria for mifepristone specifically impede family physicians' ability to provide medication abortion in primary care settings.
Study Design: We conducted 56 qualitative interviews with a national sample of family physicians across the US who were not opposed to abortion.
US Latinos continue to experience significant health inequity, despite fluctuating healthcare policies over the past 20 years. Recent studies highlight the importance of comprehensive care and collaboration of stakeholders in reducing inequity. Few studies examine the perspectives of community-based organization leaders, health researchers, and policy experts regarding the most effective practices in the delivery of healthcare to Latino children and families.
View Article and Find Full Text PDFBackground: Poor patient-provider communication, among other reasons, is a notable barrier to contraceptive decision-making among Latinas. Patient-centered approaches to contraceptive counseling that optimize communication align with shared decision-making (SDM) -which is associated with satisfaction and continued contraceptive use among various populations.
Objective: To examine associations of patient-provider communication and importance of SDM tenets with consistent contraceptive use among a population of Latinas.
We are living in unprecedented times. While the world is grappling with COVID-19, we find the horrors of racism looming equally large as we, yet again, confront lurid deaths in the center of the news cycle of Black and brown people from police bias and brutality. Those of us who have been championing antiracism and justice work and bearing the burden of the "minority tax" have been overwhelmed by sudden asks from our well-intentioned White colleagues of how to best respond.
View Article and Find Full Text PDFReproductive autonomy is associated with educational attainment, advanced employment, and well-being. While U.S.
View Article and Find Full Text PDFObjectives: The objective of this study was to explore perceptions and experiences of immediate postpartum long-acting reversible contraception (LARC) counseling and decision-making, with a focus on reproductive autonomy. We aimed to assess the potential for reproductive coercion.
Study Design: This was a qualitative study using semi-structured interviews with Spanish and English speaking women who received an intrauterine device or contraceptive subdermal implant immediately postpartum.
Background: Contraception is important for reproductive autonomy, yet many Latinas do not use contraception consistently despite research reporting a desire to do so. Factors varying in priority and value come into play during contraceptive decision making. When measuring these, relevant survey items may vary by populations.
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