This issue opens with a viewpoint from Mary A. Ott and colleagues–all clinicians at the Indiana University School of Medicine–in which they examine the current and potentially long‐term consequences of the U.S. public health response to the coronavirus pandemic (see article). As frontline providers, the authors offer a clinician's perspective on how the impact of pandemic‐related barriers to health care has been exacerbated by targeted policies designed to limit individuals' ability to obtain sexual and reproductive health services. They address a number of critical questions, among them: What is essential care? Which restrictions can be relaxed safely, and when? The viewpoint explores these issues through the lens of both human rights and the harm principle, and calls on providers, policymakers and advocates to ensure that underserved populations have access to needed services and that “the ethical frameworks necessary to make just and equitable decisions about balancing individual human rights and public health” are put in place.
Also in This Issue
•In the United States, family medicine residency programs routinely off er opt‐out abortion training; however, few physicians who receive this training actually provide abortion care after graduation. To identify the barriers to and enablers of postresidency abortion care provision, Aleza K. Summit and colleagues conducted phone interviews in 2017 with family medicine doctors across the country who had graduated from residencies 2‐7 years earlier (see article). Applying a social‐ecological framework to the data, the researchers found enablers and barriers on all four levels of the model–legal, institutional, social and individual. Study participants discussed how having mentors and strong staff support were enablers to providing abortion care, while state laws, institutional restrictions and stigma were cited as barriers. The authors conclude that clinical training alone is not enough to equip doctors to provide abortion care in their practices, and suggest that training clinicians on how to better integrate the procedure may be a way to increase abortion provision.
•About 15% of women experience mild or moderate depression either during pregnancy or following delivery. To explore the prevalence of and contributors to depression in early pregnancy, in 2014‐2015, Lisbet S. Lundsberg and colleagues surveyed 161 individuals seeking pregnancy testing or abortion care at four clinical sites in New Haven, Connecticut (see article). After assessment of patients for depression and level of social support during pregnancy using established screens, from one‐fifth to one‐third were classified as depressed (depending on the measure), and half reported low levels of social support. Women who said their pregnancies were unintended, poorly timed or undesired had an elevated likelihood of depression, and those who reported their pregnancy as unplanned and those who were ambivalent about the pregnancy were more likely than others to have received low social support. The researchers recommend that incorporating comprehensive depression screening into early care for all pregnant women–including those experiencing miscarriage or seeking abortion care–could help optimize early detection, referral and treatment for individuals who are at greatest risk for antenatal depression.
•As the number of Catholic hospitals in the United States continues to grow–one of every six acute‐care beds is in such a facility–their compliance with the Ethical and Religious Directives for Catholic Health Care Services is having an increased negative impact on patients' access to comprehensive reproductive health care. Erin E. Wingo et al. interviewed women aged 21‐44 who had received care at a religiously affiliated institution, and asked them about their attitudes and considerations related to receiving anticipatory counseling about miscarriage treatment and care (see article). Respondents supported the routine disclosure of hospitals' medical policies during prenatal care, and believed that such information would prepare and empower patients. Interviewees identified several important aspects of provider‐patient communication regarding miscarriage treatment: precautionary framing to reduce patient stress; sharing the hospital's rationale for their miscarriage management policy; and maintaining provider neutrality to ensure patient autonomy. The researchers believe that providers working in Catholic hospitals should offer candid information on miscarriage management policies and treatment options as part of their routine prenatal care.
•A better understanding of how young women actually use contraceptives–especially method combinations–is essential to providing high‐quality contraceptive care and reducing unintended pregnancy. In an effort to deepen such knowledge, Melissa L. Harris and colleagues examined data from Australian women aged 18‐23 who had participated in the 2012‐2013 Contraceptive Use, Pregnancy Intention and Decisions survey (see article). The vast majority reported using one or more contraceptives–most commonly short‐acting hormonal methods, barrier methods, longacting reversible contraceptives (LARCs) and withdrawal. Two‐thirds of contraceptive users relied on a single method, while a third reported two methods. Using latent class analysis, the authors identified four patterns of use: short‐acting hormonal methods (mostly the pill) supplemented with a barrier or other method (59%); low‐efficacy contraceptive combinations (21%, mostly barrier methods and withdrawal); LARCs with supplementation (15%); and no contraception (4%). The authors believe that with an improved understanding of the complexity of contraceptive choices and patterns of use, “providers will be better positioned to help young women avoid an unintended pregnancy.”