As access to abortion services becomes increasingly restricted in the United States, it is likely that growing numbers of women will attempt to end unwanted pregnancies without medical assistance—that is, to "self‐manage" abortions at home. There is evidence that U.S. women attempt to self‐manage abortion through a variety of approaches, including the use of vitamins, botanicals and other substances. But little is known about one particular strategy: obtaining abortion medication online. In this issue of Perspectives on Sexual and Reproductive Health, Abigail R.A. Aiken and colleagues report on the motivations and experiences of 32 individuals they interviewed who had tried this strategy (page 157). Predictably, they found that some study participants had gone this route because they had encountered barriers to clinic access. Others, however, simply desired the convenience, privacy or comfort of undergoing the abortion in their own home. Irrespective of their motivation, participants described inadequacies of online sources, reporting that the information provided was "minimal or inconsistent," and made them question the sites’ legitimacy. Given their lack of confidence in the online sources, some participants had considered using methods of questionable effectiveness or safety to terminate their pregnancies. The findings, Aiken and coauthors write, highlight the need for "coordinated dissemination of information about abortion medications and efforts to reduce barriers to access."
Also in This Issue
•Gestational age at the time of abortion is closely linked to women's access to services and to the outcome of the procedure; identifying correlates of variations in this measure, therefore, is important in ensuring that all women have access to care when they need it. Potential correlates studied in the past have included women's state of residence, but not the county in which they live. Jenny O'Donnell and colleagues (page 165) posit that county is also important, given that it is "the smallest geographic unit with policy implications and is the unit that often helps explain reproductive health care access." Indeed, in analyses of 2012 data from three Appalachian states, they find that county‐level characteristics accounted for 8% of the variation in gestational age at abortion. Further examination of this relationship, they write, "may be critical to capturing underlying dynamics around disparities in access to care."
•University students typically are in emerging adulthood, a period that often is characterized by risky sexual and contraceptive practices. Do their risks increase when they travel internationally, when factors like disrupted routines, perceived anonymity and different cultural norms may affect behavior? Summer L. Martins and colleagues explored this question in a 2016–2017 survey of students at one U.S. university, and they report their findings in this issue (page 173). Comparisons between female students who had recently traveled internationally and those who planned to do so soon revealed an elevated risk of new sexual partnerships, but not of contraceptive lapse, during international travel. Most participants had a source of regular sexual and reproductive health care, and nearly half of travelers had seen a health care provider in preparation for their trip. Therefore, the authors conclude, if the findings are supported by further study, "they may suggest a potential role for health care providers in the pretravel period."
•Community college students, as a group, are generally overlooked in sexual and reproductive health research, although available data suggest that they have an elevated risk of unintended pregnancy. Available data also suggest that these students are highly motivated to achieve their educational objectives. Marta A. Cabral and colleagues conducted in‐depth interviews with a sample of California community college students, to explore how well prepared they were to prevent pregnancy and how they thought a pregnancy would affect their educational goals (page 181). Participants expressed strong desires to avoid pregnancy, yet many reported having unprotected intercourse with partners of the opposite sex. Their knowledge of their pregnancy risk and of features of contraceptive methods was limited. While students thought that a pregnancy would make it more challenging to reach their educational goals, they did not think it would prevent them from doing so. The authors suggest that community colleges may be "important venues" for supporting contraceptive education and services for young people.
•To reduce the risk of unintended pregnancy following a birth or of short interpregnancy intervals, women should receive an effective contraceptive immediately after delivery or at the first postpartum visit. Yet, in a 2014–2016 prospective study of a cohort of low‐income women in Texas (page 189), Kate Coleman‐Minahan and colleagues found that many of those who desired a reversible contraceptive method and discussed it with a provider at their first postpartum visit did not receive it that day. Cost was an obstacle for many women, but so were factors at the clinic level (e.g., the method was unavailable) or the provider level (e.g., counseling was inadequate). Most women who did not get their desired method at the first visit were not using it three months after delivering, and the majority of those using a different method were using a less effective one. The authors recommend avenues for further research that could help pave the way toward improved access.
•In 2000, Perspectives published an evaluation showing limited effect of a sex education program in New York City that relied on a small‐group format aimed at enabling youth to explore their thoughts and feelings about sexuality with both trusted adults and peers. As part of our celebration of the journal's 50th year, we asked Lisa Lieberman, the lead author of the evaluation, to reflect on lessons learned from the project, her views on sex education in the United States today and what goals are yet to be achieved. The interview appeared on our anniversary blog (https://www.guttmacher.org/perspectives50) and is reproduced in this issue (page 199).