In the final issue of 2020, Perspectives offers six research articles that examine topics ranging from abortion access and care to the link between parent connectedness and sexual health among transgender and gender‐diverse youth. However, the issue kicks off with a triad of commentaries that examine several critical areas of maternal health and equity: the importance of addressing the COVID‐related, structural and institutional barriers that impede Black women's access to community‐based doulas; the dearth of research to guide the development of effective and culturally appropriate mobile health applications to promote Black women's sexual and reproductive health; and, finally, the disturbing and widespread practice of forcibly separating incarcerated women from their newborns for nonmedical reasons immediately after delivery. These three issues—lack of access to community‐based doulas, the need for tailored mobile health technologies and infant removal following birth—call for immediate attention from public health researchers and policymakers, and focused efforts to address them can help mitigate some of the maternal and infant health disparities and unjust infant removal policies currently affecting populations of color in the United States.
•While the COVID‐19 pandemic has had profound and widely reported effects on the U.S. health care system, its impact on abortion clinics has not been well documented. In a unique rapid‐response project, Sarah C.M. Roberts, Rosalyn Schroeder and Carole Joffe surveyed representatives of 103 independent abortion clinics in the spring of 2020 to explore how the facilities were being affected by—and were navigating—the pandemic and associated restrictions. More than a quarter of clinics had had to cancel or postpone medication or procedural abortions, and more than half had canceled or postponed gynecologic or other nonabortion services. Some facilities—including a third of those in the South—had had to close temporarily. Respondents also described a variety of other disruptions, ranging from the emotional toll on staff to increased expenses and declining revenue. In future crises of this sort, the authors write, public health efforts should consider taking steps “to ensure the sustainability of independent abortion clinics and the well‐being of their workforce.”
•A major contributor to the growing distance women must travel to reach an abortion provider has been the enactment of state‐level abortion restrictions, which have led to facility closures and, in turn, reduced access to abortion. To clarify the interplay between abortion access and the abortion rate, Benjamin P. Brown and colleagues conducted two analyses—a series of linear regression models and an instrumental variable analysis—using linked data on provider locations and county‐level abortion data from 18 states over the period 2000–2014. In both analyses, the greater the distance between the center of a county and the nearest abortion provider, the lower the county's abortion rate. The researchers conclude that policies resulting in facility closures have the potential to harm patients who are unable to access safe and legal abortion care because of the increased travel distances required.
•U.S. teaching hospitals play a crucial role in abortion care, both as providers of such care and as training grounds for physicians who wish to provide abortions. However, abortion provision in these facilities may be hindered by staff who are not committed to providing such care. To examine the nature and prevalence of interprofessional opposition, Ariana H. Bennett et al. conducted a nationwide survey of residency and site directors at 169 obstetrics‐gynecology training programs, as well as in‐depth interviews with 18 program directors, in 2014–2017. Among respondents who reported that they or their colleagues had wanted or needed to provide abortions in the previous year, seven in 10 faced opposition from hospital staff—most commonly nurses and anesthesiologists. The authors recommend that interventions prioritize patient care and address the hospital restrictions and staff opposition that commonly interfere with the provision of abortion services.
•Although community health centers (CHCs) provide a growing share of contraceptive services, little is known about how clinicians in these centers counsel patients about contraceptive methods, including IUDs. To explore this topic, M. Antonia Biggs and colleagues interviewed 20 clinicians from San Francisco Bay Area CHCs regarding their IUD counseling with young people. While some providers viewed counseling as an opportunity to empower their patients to make contraceptive decisions without pressure, they also described a tension between guiding young people toward higher‐efficacy methods and respecting their choices. Many clinicians tried to dissuade women from removals within a year of placement, or downplayed the side effects they experienced—practices that could be considered coercive. According to the authors, “more training is needed to ensure that providers employ patient‐centered counseling approaches, including honoring patient requests for removals.”
•Engaging in unprotected sex and having many partners are often termed “risky behaviors,” but little is known about whether adolescents who engage in risky nonsexual behaviors—from not wearing a seat belt to using narcotics—differ from their peers in their use of contraceptives. To examine this issue among female adolescents, Mónica L. Caudillo and colleagues performed latent class analyses, separately by race and ethnicity, using data from the 2011–2015 National Youth Risk Behavior Surveys. Compared with their less risk‐prone peers, White youth in the “high substance use and violence” group were less likely to use condoms (alone or with prescription contraceptives) rather than no method, and more likely to use withdrawal or no method than condoms alone. However, they also favored prescription methods over condoms, suggesting that they had taken steps to mitigate risk. Few associations were seen among Black and Hispanic adolescents, perhaps indicating that external factors, rather than risk‐taking tendencies, were key determinants of their contraceptive use.
•Although parent connectedness has been shown to play an important role in adolescents’ sexual and reproductive health, it has not been examined in a population‐based sample of transgender and gender‐diverse youth—a group that may be at elevated risk for negative sexual health outcomes. To address this gap in the literature, Camille Brown and colleagues performed a secondary analysis of data from nearly 2,200 ninth‐ and 11th‐grade participants of the 2016 Minnesota Student Survey. Employing multivariate logistic regression models to examine parent connectedness and eight sexual health indicators, the researchers found results similar to those among general adolescent populations: Higher levels of connectedness were associated with not having had sex, fewer risky sexual behaviors and more health‐promoting behaviors, regardless of sex assigned at birth. The authors call for the development of tools that can help health care and community service providers better assist transgender and gender‐diverse youth.