Postabortion contraceptive use among women in Nepal: results from a longitudinal cohort study.

Introduction: Although the Government of Nepal has developed strategies to integrate contraceptive services with abortion care to better meet the contraceptive needs of women, data indicate that significant gaps in services remain. This paper assessed post-abortion contraceptive use, trends over 36 -months, and factors influencing usage.

Methods: Data from this paper came from an ongoing cohort study of 1831 women who sought an abortion from one of the sampled 22 government-approved health facilities across Nepal.

Brief of over 300 reproductive health researchers as Amici Curiae in FDA v. Alliance for Hippocratic Medicine.

On January 30, 2024, over 300 researchers filed an amicus brief in FDA v. Alliance for Hippocratic Medicine, a United States (US) Supreme Court case that could have severely impacted access to mifepristone, one of the two drugs commonly used in medication abortion. The researchers summarize the legal challenges to the US Food and Drug Administration's (FDA's) original approval of mifepristone in 2000 and its 2016 and 2021 decisions modifying mifepristone's Risk Evaluation and Mitigation Strategy (REMS) Program and label, the responses from the FDA and drug manufacturer to the challenges, and the potential implications of the Court's decision on access to mifepristone in the US.

Amicus brief of over 300 reproductive health researchers supports mifepristone's safety and effectiveness.

On January 30, 2024, over 300 researchers filed an amicus brief in FDA v. Alliance for Hippocratic Medicine, a United States (US) Supreme Court case concerning the regulatory status of mifepristone, one of two drugs used in medication abortion. In this Comment we summarize the legal challenge, responses from the FDA and drug manufacturer to these challenges, oral arguments presented before the Court, and the implications of the Court's decision on access to mifepristone in the US.

Primary care and abortion provider perspectives on mail-order medication abortion: a qualitative study.

Background: This qualitative study aims to assess perspectives of clinicians and clinic staff on mail-order pharmacy dispensing for medication abortion.

Methods: Participants included clinicians and staff involved in implementing a mail-order dispensing model for medication abortion at eleven clinics in seven states as part of a prospective cohort study, which began in January 2020 (before the FDA removed the in-person dispensing requirement for mifepristone). From June 2021 to July 2022, we invited participants at the participating clinics, including six primary care and five abortion clinics, to complete a semi-structured video interview about their experiences.

Mail-Order Pharmacy Dispensing of Mifepristone for Medication Abortion After In-Person Screening.

Importance: Before 2021, the US Food and Drug Administration required mifepristone to be dispensed in person, limiting access to medication abortion.

Objective: To estimate the effectiveness, acceptability, and feasibility of dispensing mifepristone for medication abortion using a mail-order pharmacy.

Design, Setting, And Participants: This prospective cohort study was conducted from January 2020 to May 2022 and included 11 clinics in 7 states (5 abortion clinics and 6 primary care sites, 4 of which were new to abortion provision).

Is legal recreational cannabis associated with cannabis use during pregnancy, beliefs about safety, and perceived community stigma?

Background: Among pregnant and recently pregnant people we investigated whether legal recreational cannabis is associated with pregnancy-related cannabis use, safety beliefs, and perceived community stigma.

Methods: In 2022, we surveyed 3571 currently and recently pregnant English- or Spanish-speaking adults in 37 states. Primary outcomes included cannabis use during pregnancy and two continuous scale measures of beliefs about safety and perceived community stigma.

Support for criminalization of self-managed abortion (SMA): A national representative survey.

Objective: Since the U.S. Supreme Court eliminated the federal right to abortion, there is a heightened need to understand public opinion about the criminalization of people who attempt to end their pregnancies outside the formal healthcare setting, referred to as self-managed abortion (SMA).

Perspectives on Alternative Models of Medication Abortion Provision Among Abortion Patients in the United States.

Objective: Restrictions on the availability of medication abortion are a barrier to accessing early abortion. People seeking medication abortion may be interested in obtaining the medications through alternative models. The purpose of this study was to explore patient perspectives on obtaining abortion medications in advance of pregnancy or over the counter (OTC).

Intimate partner violence, food insecurity and COVID-19 among newly married women in Nawalparasi district of Nepal: a longitudinal study.

This paper examines factors associated with intimate partner violence (IPV) among newly married women in Nepal, and how IPV was affected by food insecurity and COVID-19. Given evidence that food insecurity is associated with IPV and COVID-19, we explored whether increased food insecurity during COVID-19 is associated with changes in IPV. We used data from a cohort study of 200 newly married women aged 18-25 years, interviewed five times over two years at 6-month intervals (02/2018-07/2020), including after COVID-19-associated lockdowns.

Denial of legal abortion in Nepal.

Introduction: In Nepal, abortion is legal on request through 12 weeks of pregnancy and up to 28 weeks for health and other reasons. Abortion is available at public facilities at no cost and by trained private providers. Yet, over half of abortions are provided outside this legal system.

Evaluating the Effect of San Francisco's Paid Parental Leave Ordinance on Birth Outcomes.

Since 2017, San Francisco's Paid Parental Leave Ordinance (PPLO) has allowed parents who work for private-sector employers to take 6 weeks of fully paid postnatal parental leave. Previous studies have linked paid parental leave with health improvements for birthing people and babies, although evidence for birth outcomes is limited. We hypothesized that the PPLO may have improved birth outcomes via reduced stress during pregnancy due to anticipation of increased financial security and postnatal leave.

Relationship between mandatory warning signs for cannabis use during pregnancy policies and birth outcomes in the Western United States.

As U.S. states legalize recreational cannabis, some enact policies requiring Mandatory Warning Signs for cannabis during pregnancy (MWS-cannabis).

Mail-order pharmacy dispensing of mifepristone for medication abortion after in-person clinical assessment.

Objective(s): To estimate the effectiveness, acceptability, and feasibility of medication abortion with mifepristone dispensed by a mail-order pharmacy after in-person clinical assessment.

Study Design: This is an interim analysis of an ongoing prospective cohort study conducted at five sites. Clinicians assessed patients in clinic and, if they were eligible for medication abortion and ≤ 63 days' gestation, electronically sent prescriptions for mifepristone 200 mg orally and misoprostol 800 mcg buccally to a mail-order pharmacy, which shipped medications for next-day delivery.

"I'll just deal with this on my own": a qualitative exploration of experiences with self-managed abortion in the United States.

Background: A growing body of evidence indicates that some people seek options to terminate a pregnancy without medical assistance, but experiences doing so have largely been documented only among people accessing a clinic-based abortion. We aim to describe self-managed abortion (SMA) experiences of people recruited outside of clinics, including their motivations for SMA, pregnancy confirmation and decision-making processes, method choices, and clinical outcomes.

Methods: In 2017, we conducted 14 in-depth interviews with self-identified females of reproductive age who recently reported in an online survey administered to Ipsos' KnowledgePanel that, since 2000, they had attempted SMA while living in the United States.

Pre-Abortion Informed Consent Through Telemedicine vs. in Person: Differences in Patient Demographics and Visit Satisfaction.

Purpose: Utah law requires patients to have a face-to-face "informed consent" visit at least 72 hours prior to abortion. Planned Parenthood Association of Utah (PPAU) offers this visit via telemedicine as an alternative to an in-person visit, which can require burdensome travel. This novel study identifies factors associated with using telemedicine for informed consent, patients' reasons for using it, and experiences with it, compared to in-person informed consent.

Perspectives on self-managed abortion among providers in hospitals along the Texas-Mexico border.

Background: Following self-managed abortion (SMA), or a pregnancy termination attempt outside of the formal health system, some patients may seek care in an emergency department. Information about provider experiences treating these patients in hospital settings on the Texas-Mexico border is lacking.

Methods: The study team conducted semi-structured interviews with physicians, advanced practice clinicians, and nurses who had experience with patients presenting with early pregnancy complications in emergency and/or labor and delivery departments in five hospitals near the Texas-Mexico border.

Border-state abortions increased for Texas residents after House Bill 2.

Objectives: To assess changes in Texas-resident border-state abortions, medication abortions, and abortions ≥22 weeks from last menstrual period (LMP) before and after implementation of House Bill 2 (HB2) in November 2013 and before and after the US Supreme Court's decision regarding HB2 in June 2016.

Study Design: We conducted an interrupted time series analysis using 2012-2017 data on Texas-resident abortions in Arkansas, Louisiana, Oklahoma, and New Mexico. Data on procedure type and gestational age were available only for abortions in New Mexico.

Medication Abortion With Pharmacist Dispensing of Mifepristone.

Objective: To estimate effectiveness and acceptability of medication abortion with mifepristone dispensed by pharmacists.

Methods: We conducted a prospective cohort study at eight clinical sites and pharmacies in California and Washington State from July 2018 to March 2020. Pharmacists at participating pharmacies underwent a 1-hour training on medication abortion.

Prevalence of Self-Managed Abortion Among Women of Reproductive Age in the United States.

Importance: Increasing evidence indicates that people are attempting their own abortions outside the formal health care system. However, population-based estimates of experience with self-managed abortion (SMA) are lacking.

Objective: To estimate the prevalence of SMA attempts among the general US population.

Self-managed medication abortion outcomes: results from a prospective pilot study.

Background: To evaluate the feasibility of conducting a prospective study to measure self-managed medication abortion outcomes, and to collect preliminary data on safety and effectiveness of self-managed medication abortion, we recruited callers to accompaniment groups (volunteer networks that provide counselling through the out-of-clinic medication abortion process by trained counselors over the phone or in-person).

Methods: In 2019, we enrolled callers to three abortion accompaniment groups in three countries into a prospective study on the safety and effectiveness of self-managed medication abortion with accompaniment support. Participants completed up to five interview-administered questionnaires from baseline through 6-weeks after taking the pills.

Mifepristone-misoprostol versus misoprostol-alone regimen for medication abortion at ≥24 weeks' gestation.

Objective: To compare time from misoprostol initiation to fetal expulsion for mifepristone-misoprostol versus misoprostol-alone regimens of medication abortion performed at ≥24 weeks' gestation.

Study Design: We conducted a retrospective study of medication abortion performed at ≥24 weeks' gestation between May 2016 and January 2018 at one site, comparing outcomes of patients receiving mifepristone-misoprostol versus misoprostol alone during two periods. All patients received feticidal injection and laminaria; the mifepristone-misoprostol group also received mifepristone 200 mg orally around the time of initial laminaria.

Experiences with pain of early medical abortion: qualitative results from Nepal, South Africa, and Vietnam.

Background: Medical abortion (MA) has become an increasingly popular choice for women even where surgical abortion services are available. Pain is often cited by women as one of the worst aspects of the MA experience, yet we know little about women's experience with pain management during the process, particularly in low resource settings. The aim of this study is to better understand women's experiences of pain with MA and strategies for improving quality of care.

Characteristics of patients having telemedicine versus in-person informed consent visits before abortion in Utah.

Objective: This study aimed to evaluate demographic and service delivery differences between patients using telemedicine relative to an in-person visit to satisfy Utah's state-mandated informed consent visit, which must occur at least 72 h before the abortion.

Study Design: We conducted a retrospective cohort study with data from Planned Parenthood Association of Utah (PPAU), which included all informed consent and abortion encounters from January 1, 2015-March 31, 2018. We evaluated the following for each encounter by informed consent type (telemedicine vs in-person): demographics, distance to a PPAU facility, length of time between informed consent and abortion visits, and gestational age at time of abortion.

Women's Experiences Using Telemedicine to Attend Abortion Information Visits in Utah: A Qualitative Study.

Introduction: Utah requires abortion patients to wait at least 72 hours between attending mandatory information sessions and having an abortion. In 2015, Planned Parenthood Association of Utah began offering telemedicine as a way for patients to attend state-mandated information visits. The purpose of this study was to evaluate patients' experiences using telemedicine to attend abortion information visits.