Estimating the proportion of Medicaid-eligible pregnant women in Louisiana who do not get abortions when Medicaid does not cover abortion.

BackgroundTo estimate the proportion of pregnant women in Louisiana who do not obtain abortions because Medicaid does not cover abortion.MethodsTwo hundred sixty nine women presenting at first prenatal visits in Southern Louisiana, 2015-2017, completed self-administered iPad surveys and structured interviews. Women reporting having considered abortion were asked whether Medicaid not paying for abortion was a reason they had not had an abortion. Using study data and published estimates of births, abortions, and Medicaid-covered births in Louisiana, we projected the proportion of Medicaid births that would instead be abortions if Medicaid covered abortion in Louisiana.Results28% considered abortion. Among women with Medicaid, 7.2% [95% CI 4.1-12.3] reported Medicaid not paying as a reason they did not have an abortion. Existing estimates suggest 10% of Louisiana pregnancies end in abortion. If Medicaid covered abortion, this would increase to 14% [95% CI 12, 16]. 29% [95% CI 19, 41] of Medicaid eligible pregnant women who would have an abortion with Medicaid coverage, instead give birth.ConclusionsFor a substantial proportion of pregnant women in Louisiana, the lack of Medicaid funding remains an insurmountable barrier to obtaining an abortion. Forty years after the Hyde Amendment was passed, lack of Medicaid funding for abortion continues to have substantial impacts on women's ability to obtain abortions

Rare coding variants in PLCG2, ABI3, and TREM2 implicate microglial-mediated innate immunity in Alzheimer's disease

We identified rare coding variants associated with Alzheimer’s disease (AD) in a 3-stage case-control study of 85,133 subjects. In stage 1, 34,174 samples were genotyped using a whole-exome microarray. In stage 2, we tested associated variants (P<1×10-4) in 35,962 independent samples using de novo genotyping and imputed genotypes. In stage 3, an additional 14,997 samples were used to test the most significant stage 2 associations (P<5×10-8) using imputed genotypes. We observed 3 novel genome-wide significant (GWS) AD associated non-synonymous variants; a protective variant in PLCG2 (rs72824905/p.P522R, P=5.38×10-10, OR=0.68, MAFcases=0.0059, MAFcontrols=0.0093), a risk variant in ABI3 (rs616338/p.S209F, P=4.56×10-10, OR=1.43, MAFcases=0.011, MAFcontrols=0.008), and a novel GWS variant in TREM2 (rs143332484/p.R62H, P=1.55×10-14, OR=1.67, MAFcases=0.0143, MAFcontrols=0.0089), a known AD susceptibility gene. These protein-coding changes are in genes highly expressed in microglia and highlight an immune-related protein-protein interaction network enriched for previously identified AD risk genes. These genetic findings provide additional evidence that the microglia-mediated innate immune response contributes directly to AD development

A qualitative exploration of women's experiences discovering pregnancies in the emergency department.

ObjectivesThe few studies examining pregnancy testing in emergency departments (EDs) address pregnancy-related physical risks. Here, we examine experiences of people who discover pregnancies in EDs.MethodsBetween 2015 and 2017, as part of a larger study, we conducted interviews with 29 women in Southern Louisiana (n = 13) and Baltimore, MD (n = 16), who reported discussing their pregnancy during an ED visit. We analyzed these interviews for content and themes.ResultsRespondents reported diagnosis of pregnancy as a routine and straightforward component of care received in EDs. They reported receiving diagnostic studies and therapeutic interventions to rule out and treat complications of pregnancy and care for what brought them to the ED to begin with, such as treatments for nausea and vomiting; education about physical symptoms and nutrition-related needs during pregnancy; and referrals to prenatal care. However, we find evidence of unmet needs related to patient-centered communication, such as providing emotional care to women discovering pregnancies in EDs and lack of support for transitions to abortion care.ConclusionsWhile diagnosis of pregnancy in the ED may be routine for ED clinicians, it is not necessarily routine or straightforward for people receiving the diagnosis. ED clinicians should not assume that all people who discover their pregnancies in the ED want to continue their pregnancy. People who discover pregnancies in EDs may benefit from patient-centered communication and support for the range of transitions to care people might need in addition to the routinely provided diagnostic and therapeutic interventions.ImplicationsED clinicians may need additional training and support to ensure that they can meet the range of needs of people who discover their pregnancies in the ED

Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative Study.

BACKGROUND:Little research documents the self-identified reproductive health priorities and health care experiences of lesbian, gay, bisexual, transgender, queer (LGBTQ)-identified individuals who may be in need of services. METHODS:We conducted in-depth interviews with a diverse sample of 39 female-assigned-at-birth individuals (ages 18-44) who also identified as lesbian, bisexual, queer, and/or genderqueer, or transmasculine. Interviews were primarily conducted in person in the Bay Area of California, and Baltimore, Maryland, with 11 conducted remotely with participants in other U.S. LOCATIONS:We asked participants about their current reproductive health care needs, topics they felt researchers should pursue, and past reproductive health care experiences. Data were analyzed using a framework method, incorporating deductive and inductive thematic analysis techniques. RESULTS:Reproductive health care needs among participants varied widely and included treatment of polycystic ovary syndrome and irregular menses, gender-affirming hysterectomies, and fertility assistance. Many faced challenges getting their needs met. Themes related to these challenges cross-cutting across identity groups included primary focus on fertility, provider lack of LGBTQ health competency relevant to reproductive health priorities and treatment, and discriminatory comments and treatment. Across themes and identity groups, participants highlighted that sexual activity and reproduction were central topics in reproductive health care settings. These topics facilitated identity disclosures to providers, but also enhanced vulnerability to discrimination. CONCLUSIONS:Reproductive health priorities of LGBTQ individuals include needs similar to cisgender and heterosexual groups (e.g., abortion, contraception, PCOS) as well as unique needs (e.g., gender affirming hysterectomies, inclusive safer sex guidance) and challenges in pursuing care. Future reproductive health research should pursue health care concerns prioritized by LGBTQ populations

Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative Study.

BACKGROUND:Little research documents the self-identified reproductive health priorities and health care experiences of lesbian, gay, bisexual, transgender, queer (LGBTQ)-identified individuals who may be in need of services. METHODS:We conducted in-depth interviews with a diverse sample of 39 female-assigned-at-birth individuals (ages 18-44) who also identified as lesbian, bisexual, queer, and/or genderqueer, or transmasculine. Interviews were primarily conducted in person in the Bay Area of California, and Baltimore, Maryland, with 11 conducted remotely with participants in other U.S. LOCATIONS:We asked participants about their current reproductive health care needs, topics they felt researchers should pursue, and past reproductive health care experiences. Data were analyzed using a framework method, incorporating deductive and inductive thematic analysis techniques. RESULTS:Reproductive health care needs among participants varied widely and included treatment of polycystic ovary syndrome and irregular menses, gender-affirming hysterectomies, and fertility assistance. Many faced challenges getting their needs met. Themes related to these challenges cross-cutting across identity groups included primary focus on fertility, provider lack of LGBTQ health competency relevant to reproductive health priorities and treatment, and discriminatory comments and treatment. Across themes and identity groups, participants highlighted that sexual activity and reproduction were central topics in reproductive health care settings. These topics facilitated identity disclosures to providers, but also enhanced vulnerability to discrimination. CONCLUSIONS:Reproductive health priorities of LGBTQ individuals include needs similar to cisgender and heterosexual groups (e.g., abortion, contraception, PCOS) as well as unique needs (e.g., gender affirming hysterectomies, inclusive safer sex guidance) and challenges in pursuing care. Future reproductive health research should pursue health care concerns prioritized by LGBTQ populations

Abortion terminology preferences: a cross-sectional survey of people accessing abortion care

Abstract Background Abortion stigma likely affects the terminology abortion patients, providers and the public use or avoid using to refer to abortion care. Knowing the terminology people seeking abortion prefer could help inform the language used in clinical interactions and improve patients’ experiences with abortion care. However, research in the U.S. has not examined patients’ preferences in this area or whether terminology preferences vary by participant characteristics, in the way that experiences of stigma vary across different contexts and communities. This study aims to describe preferred terminology among people presenting for abortion care and to explore the pregnancy-related characteristics associated with these preferences. Methods We surveyed abortion patients about their experiences accessing abortion care, including preferred terms for the procedure. Respondents could mark more than one term, suggest their own term, or indicate no preference. We recruited people ages 15–45 seeking abortion from four U.S. abortion facilities located in three states (California, Illinois, and New Mexico) from January to June 2019. We used descriptive statistics and multivariable multinomial logistic regression to explore associations between respondents’ pregnancy-related characteristics and their preferred terminology. Results Among the 1092 people approached, 784 (77%) initiated the survey and 697 responded to the terminology preference question. Most participants (57%, n = 400) preferred only one term. Among those participants, “abortion” (43%) was most preferred, followed by “ending a pregnancy” (29%), and “pregnancy termination” (24%). In adjusted multivariable models, participants who worried “very much” that other people might find out about the abortion (29%) were significantly more likely than those who were “not at all” worried (13%) to prefer “ending a pregnancy” over having no preference for a term (adjusted relative risk ratio: 2.68, 95% Confidence Interval: 1.46–4.92). Conclusions People seeking abortion have varied preferences for how they want to refer to their abortions, in particular if they anticipate abortion stigma. Findings can be useful for clinicians and researchers so that they can be responsive to people’s preferences during clinical interactions and in the design and conduct of abortion research

Abortion terminology preferences: a cross-sectional survey of people accessing abortion care.

BackgroundAbortion stigma likely affects the terminology abortion patients, providers and the public use or avoid using to refer to abortion care. Knowing the terminology people seeking abortion prefer could help inform the language used in clinical interactions and improve patients' experiences with abortion care. However, research in the U.S. has not examined patients' preferences in this area or whether terminology preferences vary by participant characteristics, in the way that experiences of stigma vary across different contexts and communities. This study aims to describe preferred terminology among people presenting for abortion care and to explore the pregnancy-related characteristics associated with these preferences.MethodsWe surveyed abortion patients about their experiences accessing abortion care, including preferred terms for the procedure. Respondents could mark more than one term, suggest their own term, or indicate no preference. We recruited people ages 15-45 seeking abortion from four U.S. abortion facilities located in three states (California, Illinois, and New Mexico) from January to June 2019. We used descriptive statistics and multivariable multinomial logistic regression&nbsp;to explore associations between respondents' pregnancy-related characteristics and their preferred terminology.ResultsAmong the 1092 people approached, 784 (77%) initiated the survey and 697 responded to the terminology preference question. Most participants (57%, n = 400) preferred only one term. Among those participants, "abortion" (43%) was most preferred, followed by "ending a pregnancy" (29%), and "pregnancy termination" (24%). In adjusted multivariable models, participants who worried "very much" that&nbsp;other people might find out about the abortion (29%) were significantly more likely than those who were "not at all" worried (13%) to prefer "ending a pregnancy" over having no preference for a term (adjusted relative risk ratio: 2.68, 95% Confidence Interval: 1.46-4.92).ConclusionsPeople seeking abortion have varied preferences for how they want to refer to their abortions, in particular if they anticipate abortion stigma. Findings can be useful for clinicians and researchers so that they can be responsive to people's preferences during clinical interactions and in the design and conduct of abortion research

Approaches, barriers, and facilitators to abortion-related work in U.S. health departments: perspectives of maternal and child heath&nbsp;and family planning professionals.

BackgroundPublic health agencies in the United States have engaged in abortion-related activities for nearly 50&nbsp;years. Prior research indicates that, while most state health departments engage in some abortion-related work, their efforts reflect what is required by law rather than the breadth of core public health activities. In contrast, local health departments appear to engage in abortion-related activities less often but, when they do, initiate a broader range of activities.MethodsThis study aimed to: 1) describe the abortion-related activities undertaken by maternal and child health (MCH) and family planning professionals in state and local health departments; 2) understand how health departments approach their programmatic work on abortion, and 3) examine the facilitators and barriers to whether and how abortion work is implemented. Between November 2017 and June 2018, we conducted key informant interviews with 29 professionals working in 22 state and local health departments across the U.S. Interview data were thematically coded and analyzed using an iterative approach.ResultsMCH and family planning professionals described a range of abortion-related activities undertaken within their health departments. We identified three approaches to this work: those mandated strictly by law or policy; those initiated when mandated by law but informed by public health principles (e.g., scientific accuracy, expert engagement, lack of bias, promoting access to care) in implementation; and those initiated by professionals within the department to meet identified needs. More state health departments engaged in activities when mandated, and more local health departments initiated activities based on identified needs. Key barriers and facilitators included political climate, funding opportunities and restrictions, and departmental leadership.ConclusionsAlthough state health departments are tasked with implementing legally-required abortion-related activities, some agencies bring public health principles to their mandated work. Efforts are needed to engage public health professionals in developing and implementing best practices around engaging in abortion-related activities

Improving Reproductive Health Communication Between Providers and Women Affected by Homelessness and Substance Use in San Francisco: Results from a Community-Informed Workshop.

OBJECTIVES: Many cisgender women affected by homelessness and substance use desire pregnancy and parenthood. Provider discomfort with patient-centered counseling about reproductive choices and supporting reproductive decisions of these women poses barriers to reproductive healthcare access. METHODS: We used participatory research methods to develop a half-day workshop for San Francisco-based medical and social service providers to improve reproductive counseling of women experiencing homelessness and/or who use substances. Guided by a stakeholder group comprising cisgender women with lived experience and providers, goals of the workshop included increasing provider empathy, advancing patient-centered reproductive health communication, and eliminating extraneous questions in care settings that perpetuate stigma. We used pre/post surveys to evaluate acceptability and effects of the workshop on participants attitudes and confidence in providing reproductive health counseling. We repeated surveys one month post-event to investigate lasting effects. RESULTS: Forty-two San Francisco-based medical and social service providers participated in the workshop. Compared to pre-test, post-test scores indicated reduced biases about: childbearing among unhoused women (p &lt; 0.01), parenting intentions of pregnant women using substances (p = 0.03), and women not using contraception while using substances (p &lt; 0.01). Participants also expressed increased confidence in how and when to discuss reproductive aspirations (p &lt; 0.01) with clients. At one month, 90% of respondents reported the workshop was somewhat or very beneficial to their work, and 65% reported increased awareness of personal biases when working with this patient population. CONCLUSIONS FOR PRACTICE: A half-day workshop increased provider empathy and improved provider confidence in reproductive health counseling of women affected by homelessness and substance use