"They were there because they were pregnant. Which is a really apolitical thing"-Medical student discussions of politics in abortion care in the United States.

OBJECTIVES: State abortion policies can vary widely. Geographic location and political climate could influence a medical student's abortion education experience. We compared how medical students training in one permissive and one restrictive state discussed politics in abortion care. STUDY DESIGN: From 2018 to 2019, we interviewed US medical students during their Obstetrics and Gynecology rotation from two Midwestern academic centers with differing state abortion policies-one in Ohio (restrictive) and one in Illinois (permissive). In-depth interviews occurred following an abortion shadowing experience and included questions about politics in abortion care. We sorted data using flexible coding, with index codes around "politics," followed by specific analytic coding. We compared codes by medical school using NVIVO software. RESULTS: We interviewed 28 students (50% in Ohio). Students in Ohio discussed specific barriers to patient care and how politics infringed upon the quality of medical care, describing abortion as stigmatized care. Students in Illinois described abortion as high-quality medical care, delivered without the infringement of restrictive laws. Students at both schools described their medical school climates as supportive to abortion, yet in Ohio, students described exposure to more diverse abortion views than Illinois students. Ohio students also described engaging in abortion advocacy work, while Illinois students felt more politically disconnected. CONCLUSIONS: Even as clinical training opportunities decline, restrictive states may hold unique advocacy opportunities. Educators should tailor abortion curricula to address state level differences, as disparities in abortion access and student learning opportunities widen. IMPLICATIONS: Students training in permissive states see abortion as routine health care, occurring without political interference. Students in restrictive states see abortion as hindered by politics and stigmatized, which may encourage advocacy. Educators should tailor curricula to address state level differences as disparities in abortion access and student learning opportunities widen.

Free, but at what cost? How US crisis pregnancy centres provide services.

In the USA, the most popular form of anti-abortion activism, crisis pregnancy centres (CPCs), provide a variety of services to prevent abortions. Moving beyond debate about misinformation and the ethics of CPCs, this study considers the services they provide and given their popularity among state legislatures, their connection to the state. Using interviews with ten CPC staff in Ohio (a state providing support to CPCs) and supplemental data from both state and CPC organisations, we find three relevant themes. First, CPC services reflect ideas about personal responsibility and Christianity held by the CPC staff. Second, we show that CPCs have assumed a variety of state duties (e.g. pregnancy testing and parenting classes), appealing to lawmakers in conservative states eager to transfer responsibility for disadvantaged residents to other entities. Finally, we consider the future direction of CPCs, highlighting tension between organisational goals (focusing on abortion prevention) and the on-the-ground experience of CPC staff (where non-pregnant clients need material aid). Drawing theoretical connections between CPC staff and social service workers sheds light on whose responsibility it is to address poverty in a post-welfare era.

Estimating Prevalence of Abortion Using List Experiments: Findings from a Survey of Women in Delaware and Maryland.

BACKGROUND: Widespread underreporting of abortion persists in survey data. The list experiment, a measurement tool designed to elicit truthful responses to sensitive questions, may alleviate underreporting. METHODS: Using The Statewide Survey of Women of Reproductive Age in Delaware and Maryland (n = 2,747), we estimate the prevalence of abortion in Maryland and Delaware using a double list experiment. RESULTS: We find 21% (95% confidence interval [CI]: 16.8%-25.3%) of respondents aged 18 to 44 ever had an abortion and we identify disparities in abortion prevalence by age, race, education, income, marital status, and insurance status. Respondents who were Black (37.0%; 95% CI: 27.1%-46.8%), had less than a college degree (24.8%; 95% CI: 18.3%-31.3%), were in a cohabiting relationship (39.0%; 95% CI: 29.1%-48.9%), were living in households with incomes less than $50,000 (28.6%; 95% CI: 19.7%-37.5%), and were currently covered by Medicaid (42.8%; 95% CI: 27.6%-58.0%) were more likely than their counterparts to have ever had an abortion. CONCLUSIONS: List experiments yield estimates of abortion substantially higher than those obtained from direct questions. Findings demonstrate external validity through consistency with estimates from administrative data sources and gold standard abortion provider survey data.

"Thinking with my dad brain, not my man brain": Understanding Men's and Women's sterilization risk narratives.

The interpretation of risk influences women's reproductive decisions. Research has yet to show how men understand and interpret risk, particularly in their decision to use contraception. Contraceptive sterilization provides a case through which we compare risk narratives between men and women, as it is the only analogous birth control for both men and women. A study of risk narratives held by sterilized adults and their partners reveals how risk narratives are gendered and how they contribute to contraceptive use. Using 75 in-depth interviews with sterilized heterosexual men (n = 25), women (n = 25), and unsterilized partners (n = 17 women, n = 8 men), the present study finds that men and women report similar risk narratives grounded in (1) birth control risks to health and life plans and (2) risks to maternal health from past pregnancies and age. As expected, women's risk narratives appear to stem from their embodied experiences and their interactions with medical authorities. Rather than addressing their own embodied experiences or experiences with medicine, men's beliefs mirror women's, and are centered on the dangers of hormonal birth control and pregnancy to women. This study is novel in showing the couple dyad as a site of men's beliefs about risk, as how heterosexual couples form ideas about health and life plan risk through a mutually shared gendered lens.

Changing Educational Differentials in Female Sterilization.

CONTEXT: Female surgical sterilization is widely used in the United States. Educational differentials in sterilization are large, but poorly understood. Improved understanding of these differences is important to ensure that all women have access to the full range of contraceptive methods. METHODS: Data from the National Survey of Family Growth (1973-2015) from 8,100 women aged 40-44 were used to describe trends in sterilization and other contraceptive methods by educational attainment. Demographic standardization was employed to examine how compositional changes in marital status and age at first birth contribute to aggregate changes in sterilization prevalence. RESULTS: In 1982, women with a high school diploma and those with at least a bachelor's degree reported similar levels of sterilization use (38% and 32%, respectively), but by 2011-2015, prevalence had declined to 19% among college-educated women and had increased to 44% among those with a diploma. The trend among college graduates was largely attributable to delayed fertility; all other things being equal, if their age at first birth had not increased, the prevalence of sterilization would have declined by approximately 3% instead of 14% between 1982 and 2002. Increased use of sterilization among women with a high school diploma was only weakly related to changes in birth timing and marital status. CONCLUSIONS: Among women with a high school diploma, elements other than childbearing and marital status-such as contraceptive preferences and access-appeared to influence their contraceptive behavior. Sterilization differentials between high school and college graduates may reflect or exacerbate other socioeconomic disparities that affect women's health and well-being.

Intensive Mothers, Cautionary Tale Fathers: Adult Children's Perceptions of Parental Influence on Health.

Parents strongly influence children's health, yet how parents continue to shape the health of midlife adult children remains unknown. Moreover, while most adults are married by midlife, research has failed to identify the effects of parent-in-law relationships on midlife adult wellbeing. Using interviews with 90 individuals in 45 marriages, we investigate how midlife adults perceive the influence of parents and parents-in-law on adult child health. Findings reveal that particularly mothers and mothers-in-law positively influence child's health via support during, or in anticipation of, illness and injury. The health experiences of parents and in-laws, particularly fathers/in-law, become cautionary tales preparing adult children for future health issues. Yet, parents/in-law also have negative influence on adult children during midlife due to parents' compounding health needs. We use family systems theory to show how parents/in-laws are intertwined in ways that influence health during children's midlife that has ramifications into later life.

Does opportunistic testing bias cognitive performance in primates? Learning from drop-outs.

Dropouts are a common issue in cognitive tests with non-human primates. One main reason for dropouts is that researchers often face a trade-off between obtaining a sufficiently large sample size and logistic restrictions, such as limited access to testing facilities. The commonly-used opportunistic testing approach deals with this trade-off by only testing those individuals who readily participate and complete the cognitive tasks within a given time frame. All other individuals are excluded from further testing and data analysis. However, it is unknown if this approach merely excludes subjects who are not consistently motivated to participate, or if these dropouts systematically differ in cognitive ability. If the latter holds, the selection bias resulting from opportunistic testing would systematically affect performance scores and thus comparisons between individuals and species. We assessed the potential effects of opportunistic testing on cognitive performance in common marmosets (Callithrix jacchus) and squirrel monkeys (Saimiri sciureus) with a test battery consisting of six cognitive tests: two inhibition tasks (Detour Reaching and A-not-B), one cognitive flexibility task (Reversal Learning), one quantity discrimination task, and two memory tasks. Importantly, we used a full testing approach in which subjects were given as much time as they required to complete each task. For each task, we then compared the performance of subjects who completed the task within the expected number of testing days with those subjects who needed more testing time. We found that the two groups did not differ in task performance, and therefore opportunistic testing would have been justified without risking biased results. If our findings generalise to other species, maximising sample sizes by only testing consistently motivated subjects will be a valid alternative whenever full testing is not feasible.

Healthcare Work in Marriage: How Gay, Lesbian, and Heterosexual Spouses Encourage and Coerce Medical Care.

Marriage benefits health in part because spouses promote one another's well-being, yet how spouses facilitate formal healthcare (e.g., doctor's visits, emergency care) via what we call healthcare work is unknown. Moreover, like other aspects of the marital-health link, healthcare work dynamics likely vary by gender and couple type. To explore this possibility, we use in-depth interviews with 90 midlife gay, lesbian, and heterosexual spouses to examine how spouses perform healthcare work. Our results show that in heterosexual marriage, women perform the bulk of healthcare work and typically do so in coercive ways. A minority of heterosexual men provide instrumental healthcare work for their wives. Gay and lesbian spouses appear to commonly use both coercive and supportive healthcare work strategies to effectively promote healthcare use. Our findings demonstrate the ways spouses are central to supporting and coercing one another to obtain medical care and how these patterns are gendered.

Relationships with parents and adult children's substance use.

Previous research has indicated that parents impact minor children's health behaviors and adult children's self-rated health and psychological well-being. However, little is known about the long-term consequences of the parent-child relationship for adult children's substance (i.e., smoking levels, low to moderate alcohol use) as adult children age. The present study uses growth curve analysis on longitudinal survey data (Americans' Changing Lives, N=907) to examine how multiple dimensions of the parent-child tie influence adult children's substance use. Findings show that contact with mothers in adulthood has a health-enhancing effect on sons' smoking. Fathers' support is related to a decline in alcohol use for sons and daughters, but also an increase in smoking for sons only. Our findings for strain from parents are complex, suggesting that the ways in which adult children cope and manage strain with parents may result in multiple pathways of substance use. Our study raises new questions about whether and when family ties are "good" or "bad" for health and calls for a more multifaceted view of the long-lasting parent-child tie. We spotlight the need to look at the parent-child relationship as a dynamic social tie that changes over the life course and has consequences for health in adulthood.

Chimpanzees' Bystander Reactions to Infanticide: An Evolutionary Precursor of Social Norms?

Social norms-generalized expectations about how others should behave in a given context-implicitly guide human social life. However, their existence becomes explicit when they are violated because norm violations provoke negative reactions, even from personally uninvolved bystanders. To explore the evolutionary origin of human social norms, we presented chimpanzees with videos depicting a putative norm violation: unfamiliar conspecifics engaging in infanticidal attacks on an infant chimpanzee. The chimpanzees looked far longer at infanticide scenes than at control videos showing nut cracking, hunting a colobus monkey, or displays and aggression among adult males. Furthermore, several alternative explanations for this looking pattern could be ruled out. However, infanticide scenes did not generally elicit higher arousal. We propose that chimpanzees as uninvolved bystanders may detect norm violations but may restrict emotional reactions to such situations to in-group contexts. We discuss the implications for the evolution of human morality.

Understanding the experiences of youth living with sickle cell disease: a photovoice pilot.

A Photovoice pilot was conducted with youth living with sickle cell disease (SCD), in order to further understand their lived experience and examine the acceptability, feasibility, and utility of this method in this population. SCD is an inherited genetic condition whose primary symptom is severe pain. Youth were able to reflect on their experiences with SCD using Photovoice and the adapted SHOWeD method. Parents and youth found Photovoice to be valuable for children and adolescents with SCD. Emerging themes included the impact of SCD, the importance of everyday activities and interests, and the importance of family and support.