Quality of care offered by health care retail markets for medication abortion self-management: Findings from states in Nigeria and India.

Dispensing of misoprostol and mifepristone by pharmacies and chemist shops for self-management of medication abortion (MA) fills a crucial gap in settings where abortion care by trained health professionals is not readily available. This promising service delivery pathway, endorsed by the World Health Organization (WHO), is hindered by concerns of poor-quality care. Simulated clients collected data on MA pill dispensing practices from 92 pharmacies and chemist shops in three Nigerian states and 127 pharmacies in an Indian state that we have anonymized.

Cognitive performance in ISS astronauts on 6-month low earth orbit missions.

Introduction: Current and future astronauts will endure prolonged exposure to spaceflight hazards and environmental stressors that could compromise cognitive functioning, yet cognitive performance in current missions to the International Space Station remains critically under-characterized. We systematically assessed cognitive performance across 10 cognitive domains in astronauts on 6-month missions to the ISS.

Methods: Twenty-five professional astronauts were administered the Cognition Battery as part of National Aeronautics and Space Administration (NASA) Human Research Program Standard Measures Cross-Cutting Project.

Close female friendships and knowledge of recommended abortion methods in Nigeria and the Democratic Republic of the Congo among a representative sample of reproductive-aged women.

Introduction: There is a high incidence of unsafe abortion among women in Nigeria and the DRC. Low knowledge of recommended abortion methods [i.e.

Measuring non-events: infertility estimation using cross-sectional, population-based data from four countries in sub-Saharan Africa.

Study Question: Does the prevalence of 12-month infertility in Burkina Faso, Côte d'Ivoire, Kenya, and Uganda differ between women trying to conceive and the broader population of women exposed to unprotected sex, and how are prevalence estimates affected by model assumptions and adjustments?

Summary Answer: Estimates of 12-month infertility among tryers ranged from 8% in Burkina Faso to 30% in Côte d'Ivoire, increasing substantially among a larger population of women exposed to unprotected intercourse.

What Is Known Already: While having a child is a fundamental human experience, the extent to which women and couples experience infertility is a neglected area of research, particularly in sub-Saharan Africa. Existing estimates of infertility in this region vary widely from 2% to 32%, however, potential impacts of variability in study populations and model assumptions have not been well-examined.

Exploring women's knowledge of abortion legality and association with source of abortion care using population-based survey data in Côte d'Ivoire and Ghana.

Background: Knowledge of the conditions under which abortion is legal is important so that people can advocate for their right to abortion care. Yet minimal research has explored the association between women's knowledge of abortion legality and the induced abortion care they receive, particularly using population-based survey data.

Methods: Using national survey data collected by Performance Monitoring for Action (PMA) in Côte d'Ivoire and Ghana, we aimed to compare the prevalence of accurate knowledge of abortion legality, factors associated with knowledge of the law, and the association between knowledge of abortion legality and the source of women's induced abortion care in these two settings.

Assessing the effect of concerns about contraceptive-induced fertility impairment on hormonal contraceptive use by parity and residence: evidence from PMA Ethiopia 2020 cross-sectional survey.

Objectives: This study aims to describe patterns of beliefs about contraceptive-induced infertility and assess their relationship with current contraceptive use, including whether these relationships vary by parity and residence.

Design: We use data from Performance Monitoring for Action Ethiopia, a nationally representative, cross-sectional survey of 7491 women, aged 15-49, to assess agreement with the statement 'If I use family planning, I may have trouble getting pregnant next time I want to.' We used multilevel hierarchical models to identify the association between agreement and use of a hormonal method of contraception among 3882 sexually active, fecund women who wish to prevent pregnancy.

Care-seeking for difficulties conceiving in sub-Saharan Africa: findings from population-based surveys in eight geographies.

Study Question: What is the nature of women's care-seeking for difficulties conceiving in sub-Saharan Africa (SSA), including the correlates of seeking biomedical infertility care at a health facility?

Summary Answer: Care-seeking for difficulties getting pregnant was low, much of which involved traditional or religious sources of care, with evidence of sociodemographic disparities in receipt of biomedical care.

What Is Known Already: Nearly all research on infertility care-seeking patterns in SSA is limited to clinic-based studies among the minority of people in these settings who obtain facility-based services. In the absence of population-based data on infertility care-seeking, we are unable to determine the demand for services and disparities in the use of more effective biomedical sources of care.

Direct and indirect estimation of adolescent sexual intercourse and contraceptive use in Rajasthan India: an application of the best friend methodology.

Background: Existing estimates of adolescent sexual and reproductive health (ASRH) behaviors may be a gross undercount given the sensitivity of this behavior in Indian culture. The objective of this study was to estimate ASRH behaviors in Rajasthan, India using direct questions and the best friend approach that seeks to reduce social desirability bias.

Methods: We used population-based data of adolescents aged 15-19 in Rajasthan collected between September and December 2022.

Infant Deaths After Texas' 2021 Ban on Abortion in Early Pregnancy.

Importance: Prior observational research has shown that infants born in states with more abortion restrictions are more likely to die during infancy. It is unclear how recent and more severe abortion bans in the US have impacted infant mortality.

Objective: To examine whether Texas Senate Bill 8 (SB8), which banned abortions after embryonic cardiac activity and did not allow exemptions for congenital anomalies, is associated with infant mortality in the state of Texas.

A qualitative exploration of reproductive coercion experiences and perceptions in four geo-culturally diverse sub-Saharan African settings.

Reproductive coercion (RC) is any intentional behavior that interferes with another's reproductive decision-making or pregnancy outcome. This study aims to qualitatively examine RC experiences and perceptions among women and men in Ethiopia, Nigeria (Kano and Anambra States), and Uganda. This is a secondary analysis utilizing qualitative data from the Women's and Girls' Empowerment in Sexual and Reproductive Health study.

When people start getting real: The Group Living Skills Survey for extreme work environments.

Introduction: Group living skills (GLS), that is, being tidy and considerate of others, are an important skillset for teams who live and work together. However, this construct does not have a validated measure to enable an understanding of how group living skills influence team dynamics over time. We developed and validated a short measure of group living skills for teams living in extreme work environments.

"Maybe if we weren't in the pandemic, I would have reconsidered": Experiences of abortion care-seeking during the COVID-19 pandemic in Maryland.

Objective: To understand the COVID-19 pandemic's impact on abortion care-seeking in Maryland, a state with Medicaid coverage for abortion, high service availability, and laws supporting abortion rights.

Methods: We conducted semi-structured telephone interviews with 15 women who had an abortion between January 2021 and March 2022 at a hospital-based clinic in a mid-sized Maryland city. We purposively recruited participants with varied pandemic financial impacts.

Abortion information-seeking experiences among women who obtained abortions in Kinshasa, DRC: Results from a qualitative study.

Little is known about the process of seeking information related to abortion care options among women in the Democratic Republic of Congo (DRC). Understanding how women obtain information can help identify opportunities for intervention to increase awareness and use of safe pregnancy termination options. Using qualitative data collected from women in Kinshasa, DRC who reported having an abortion in the last 10 years, this study aims to determine how women navigate obtaining information about their options for abortion and the role of their social network in their information-seeking processes.

Reproductive autonomy and the experience of later-than-desired pregnancy: results from a cross-sectional survey of reproductive-aged women in Uganda.

Background: The focus of reproductive autonomy research has historically been on the experience of unintended pregnancy and use of contraceptive methods. However, this has led to the neglect of a different group of women who suffer from constraints on their reproductive autonomy-women who experience pregnancies later than they desire or who are unable to become pregnant. This study examines the extent of later-than-desired pregnancy among women and evaluates the sociodemographic and reproductive factors associated with this experience in Uganda.

Postabortion care service availability, readiness, and access in Burkina Faso: results from linked female-facility cross-sectional data.

Background: Little is known about postabortion care (PAC) services in Burkina Faso, despite PAC's importance as an essential and life-saving component of emergency obstetric care. This study aims to evaluate PAC service availability, readiness, and accessibility in Burkina Faso.

Methods: Data for this study come from the Performance Monitoring for Action (PMA) Burkina Faso project and the Harmonized Health Facility Assessment (HHFA) conducted by the Institut de Recherche en Sciences de la Santé and the Ministry of Health.

Postabortion care availability, readiness, and accessibility in Niger in 2022: results from linked facility-female cross-sectional data.

Background: Postabortion care (PAC), which is an essential element of emergency obstetric care, is underresearched in Niger. The study aims to assess the availability, readiness, and accessibility of facility-based PAC services in Niger.

Methods: This study uses female and facility data from Performance Monitoring for Action Niger.

Abortion incidence and safety in Niger in 2021: Findings from a nationally representative cross-sectional survey of reproductive-aged women using direct and indirect measurement approaches.

Niger is a country in which legal restrictions and a dearth of research has long limited our understanding of the extent and safety of induced abortion. The current study is the first national study of induced abortion in Niger. It uses direct (self-report) and indirect (best friend method) to provide nationally representative estimates of induced abortion incidence and safety and evaluates the performance of the indirect measurement approach.

Self-reported abortion experiences in Ethiopia and Uganda, new evidence from cross-sectional community-based surveys.

Unsafe abortion is a major contributor to maternal morbidity and mortality. To gain insight into the ways in which abortion restrictions and stigma may shape reproductive health outcomes, we present self-reported data on abortions in Ethiopia and Uganda and compare these findings across the two varying legal contexts. W investigate differences in sociodemographic characteristics by whether or not a woman self-reported an abortion, and we describe the characteristics of women's most recent self-reported abortion.

Impact of new abortion restrictions on people in prison: Estimated number of incarcerated people without abortion access and distance to abortion providers.

Objectives: This study aimed to estimate the annual number of incarcerated pregnant people in state and federal prisons needing an abortion.

Study Design: We used 2021 Bureau of Justice Statistics data and prior studies' findings to estimate the number of pregnant incarcerated people, then calculated state-specific abortion ratios to determine the number potentially needing an abortion.

Results: Of 638 pregnant people incarcerated in prisons annually, 110 would be expected to need an abortion, including 55 in states where abortion is currently banned or restricted.

Separating Procedure-related Fears From Future Fertility Concerns Among a Cohort Seeking Abortion Information Online.

Introduction: The general public and abortion patients in the United States have misinformation about the risks of infertility associated with abortion, which may influence abortion care-seeking.

Methods: The Google Ads Abortion Access Study was a national study of people considering abortion and searching online for information. Participants completed baseline and follow-up surveys, providing free text responses to questions about barriers and facilitators to abortion.

The Relationship Between Contraceptive Method Use and Return of Fecundity Among Women Attempting Pregnancy in Low- and Middle-Income Countries.

One of the most common barriers to using effective family planning methods is the belief that hormonal contraceptives and contraceptive devices have adverse effects on future fertility. Recent evidence from high-income settings suggests that some hormonal contraceptive methods are associated with delays in return of fecundity, yet it is unclear if these findings generalize to low- and middle-income populations, especially in regions where the injectable is widely used and pressure to bear children is significant. Using reproductive calendar data pooled across 47 Demographic and Health Surveys, we find that the unadjusted 12-month probability of pregnancy for women attempting pregnancy after discontinuing traditional methods, condoms, the pill, and the IUD ranged from 86% to 91%.