Abortion Reporting in the United States: An Assessment of Three National Fertility Surveys.

Despite its frequency, abortion remains a highly sensitive, stigmatized, and difficult-to-measure behavior. We present estimates of abortion underreporting for three of the most commonly used national fertility surveys in the United States: the National Survey of Family Growth, the National Longitudinal Survey of Youth 1997, and the National Longitudinal Study of Adolescent to Adult Health. Numbers of abortions reported in each survey were compared with external abortion counts obtained from a census of all U.S. abortion providers, with adjustments for comparable respondent ages and periods of each data source. We examined the influence of survey design factors, including survey mode, sampling frame, and length of recall, on abortion underreporting. We used Monte Carlo simulations to estimate potential measurement biases in relationships between abortion and other variables. Underreporting of abortion in the United States compromises the ability to study abortion-and, consequently, almost any pregnancy-related experience-using national fertility surveys.

Sexual activity, contraceptive use and sexual violence among Asian high school students in the United States.

OBJECTIVE: To compare the prevalence of sexual behaviors and experiences between Asian high school students in the U.S. and students of other race/ethnicities. STUDY DESIGN: We pooled the 2013, 2015 and 2017 rounds of the Youth Risk Behavior Survey (N = 42,854). Logistic regression was used to identify differences between racial/ethnic groups and by sex. RESULTS: Compared to their peers, a smaller proportion of Asian students reported engaging in sexual behaviors or using contraception, including prescription methods, at last sex. Asian students also reported fewer experiences of forced sexual intercourse compared to their peers. CONCLUSIONS: These findings demonstrate distinct patterns in Asian students' sexual health behaviors compared to their peers. Future research should examine determinants of these differences. IMPLICATIONS: Filling a gap in the literature, these data can inform education and health practices that support the sexual and reproductive health needs of Asian and all adolescents in the country.

Data Opportunities for Studying the Sexual and Reproductive Health of Immigrants in the United States.

This paper aims to identify, review, and evaluate publicly available national- and local-level data sources that collect information on the sexual and reproductive health (SRH) of immigrants in the United States. We review public-use sources from the last 30 years that include information on immigration, SRH, health service utilization, and race/ethnicity. For each source, we evaluated the strengths and challenges of the study design and content as they relate to studying immigrant SRH. We identified and reviewed 22 national and seven local sources. At the national level, the National Longitudinal Study of Adolescent to Adult Health and the National Survey of Family Growth contained the most information; at the local level, the New York City Community Health Survey was the most robust. These sources present opportunities to advance research, improve public health surveillance, and inform policies and programs related to the SRH of this rapidly growing and often underserved population.

Immigrant Women's Access to Sexual and Reproductive Health Coverage and Care in the United States.

Issue: Immigrant women of reproductive age in the U.S. face significant challenges obtaining comprehensive and affordable health insurance coverage and care--including sexual and reproductive health services--compared with U.S.-born women, because of myriad policy and systemic factors. Goals: Synthesize recent evidence on immigrant women's access to sexual and reproductive health coverage and care and provide recommendations for policymaking and research. Methods: A rapid literature review to identify and summarize evidence from peer-reviewed and select grey literature published since 2011 on health insurance coverage and sexual and reproductive health care services use among immigrant women in the U.S. Where available, evidence is compared to U.S.-born women. Findings and Conclusions: Immigrant women are less likely to have coverage and use sexual and reproductive health services than U.S.-born women, which may increase their risk of negative outcomes. Federal and state policymakers could take actions to advance immigrant women's sexual and reproductive health, including expanding eligibility for coverage and shoring up the nation's health care safety net. Further research is needed to understand the needs, use of services, and outcomes of immigrant women, as well as the factors that contribute to differences between immigrant and U.S.-born women, and among groups of immigrant women.

Estimating abortion provision and abortion referrals among United States obstetrician-gynecologists in private practice.

OBJECTIVE: The objective was to examine the provision of abortion by obstetrician-gynecologists in private practice in the United States (U.S.) and their willingness to provide referrals for abortion services. STUDY DESIGN: We conducted a cross-sectional national survey of 1961 U.S. obstetrician-gynecologists to estimate the frequency with which abortions and referrals for abortion care were provided in private practice settings. Key measures included whether respondents had provided any abortions in 2013 or 2014, type of abortions provided and willingness to provide abortion referrals. Facility location by region was the only measured correlate of abortion provision. RESULTS: We received a total of 988 surveys for a response rate of 65%. Sixty-seven (7%) obstetrician-gynecologists reported providing at least one abortion in 2013 or 2014, though this result ranged from 4% (n=23) to 13% (n=44) of obstetrician-gynecologists depending on survey response type. Among physicians practicing in the Northeast and West, 14% and 10%, respectively (n=24 in each region) were abortion providers compared to 4% (n=9) and 3% (n=10) of physicians in the Midwest and South, respectively. Twenty-three (42%) providers indicated only performing surgical abortions, 14 (25%) indicated only medication abortions, and 18 (33%) reported providing both. Among respondents who did not provide abortions, just over half (n=415, 54%) indicated that they referred patients to a facility or practice where they could obtain an abortion, but 271 (35%) said they would not provide a referral. CONCLUSIONS: Only a small proportion of all obstetrician-gynecologists in private practice settings provide abortions. Among nonproviders, a substantial minority do not offer abortion referrals. IMPLICATIONS: Particularly in geographic areas with few abortion providers, continued efforts are needed to equip medical professionals with information and training to make direct referrals.

Reasons why women have induced abortions: a synthesis of findings from 14 countries.

OBJECTIVE: Many reasons inform women's reproductive decision-making. This paper aims to present the reasons women give for obtaining induced abortions in 14 countries. STUDY DESIGN: We examined nationally representative data from 14 countries collected in official statistics, population-based surveys, and facility-based surveys of abortion patients. In each country, we calculated the percentage distribution of women who have abortions by main reason given for the abortion. We examined these reasons across countries and within countries by women's sociodemographic characteristics (age, marital status, educational attainment, and residence). Where data are available, we also studied the multiple reasons women give for having an abortion. RESULTS: In most countries, the most frequently cited reasons for having an abortion were socioeconomic concerns or limiting childbearing. With some exceptions, little variation existed in the reasons given by women's sociodemographic characteristics. Data from three countries where multiple reasons could be reported in the survey showed that women often have more than one reason for having an abortion. CONCLUSION: This study shows that women have abortions for a variety of reasons, and provides a broad picture of the circumstances that inform women's decisions to have abortions. IMPLICATIONS: Future research should examine in greater depth the personal, social, economic, and health factors that inform a woman's decision to have an abortion as these reasons may shed light on the potential consequences that unintended births can have on women's lives.

Incidence of emergency department visits and complications after abortion.

OBJECTIVE: To conduct a retrospective observational cohort study to estimate the abortion complication rate, including those diagnosed or treated at emergency departments (EDs). METHODS: Using 2009-2010 abortion data among women covered by the fee-for-service California Medicaid program and all subsequent health care for 6 weeks after having an abortion, we analyzed reasons for ED visits and estimated the abortion-related complication rate and the adjusted relative risk. Complications were defined as receiving an abortion-related diagnosis or treatment at any source of care within 6 weeks after an abortion. Major complications were defined as requiring hospital admission, surgery, or blood transfusion. RESULTS: A total of 54,911 abortions among 50,273 fee-for-service Medi-Cal beneficiaries were identified. Among all abortions, 1 of 16 (6.4%, n=3,531) was followed by an ED visit within 6 weeks but only 1 of 115 (0.87%, n=478) resulted in an ED visit for an abortion-related complication. Approximately 1 of 5,491 (0.03%, n=15) involved ambulance transfers to EDs on the day of the abortion. The major complication rate was 0.23% (n=126, 1/436): 0.31% (n=35) for medication abortion, 0.16% (n=57) for first-trimester aspiration abortion, and 0.41% (n=34) for second-trimester or later procedures. The total abortion-related complication rate including all sources of care including EDs and the original abortion facility was 2.1% (n=1,156): 5.2% (n=588) for medication abortion, 1.3% (n=438) for first-trimester aspiration abortion, and 1.5% (n=130) for second-trimester or later procedures. CONCLUSION: Abortion complication rates are comparable to previously published rates even when ED visits are included and there is no loss to follow-up. LEVEL OF EVIDENCE: II.

Women know best--findings from a thematic analysis of 5,214 surveys of abortion care experience.

OBJECTIVE: Patient experience is an essential component of quality care. Few studies have comprehensively evaluated patient experiences of abortion care. The objectives of this study were to describe women's experiences of abortion care in their own words, and to determine themes across patient experiences. STUDY DESIGN: Data for this thematic analysis, a qualitative method that allows for the identification, analysis, and report of patterns or themes within data, come from a larger study of safety and quality of aspiration abortion care across 22 clinical sites. Participants completed an abortion experience survey including fixed choice questions and an open-ended question: "Is there anything you would like to tell us about your experience?" The data were then categorized by responses to another survey question: "Overall, was your experience about, better, or worse than you expected?" RESULTS: A total of 5,214 responses were analyzed. Women reported positive abortion care experiences with the majority of women rating their experience as better than expected (n = 3,600). Two major themes that emerged from the data include clinic- and patient-level factors that impact how patients rate their experiences. Analysis of the responses categorized in the worse than expected group (n = 136) found that women primarily faulted clinic-level factors for their negative experiences, such as pain control and management, and wait time for appointments and in clinic. CONCLUSION: This analysis highlights specific areas of abortion care that influence patients' experience. The few women who were disappointed by care in the clinic tended to fault readily modifiable clinical factors, and provided suggested areas of improvement to enhance positive experiences related to their abortion care.

Google it: obtaining information about local STD/HIV testing services online.

BACKGROUND: Although the Internet is one of the most commonly accessed resources for health information, finding information on local sexual health services, such as sexually transmitted disease (STD) testing, can be challenging. Recognizing that most quests for online health information begin with search engines, the purpose of this exploratory study was to examine the extent to which online information about local STD/HIV testing services can be found using Google. METHODS: Queries on STD and HIV testing services were executed in Google for 6 geographically unique locations across the United States. The first 3 websites that resulted from each query were coded for the following characteristics: (1) relevancy to the search topic, (2) domain and purpose, (3) rank in Google results, and (4) content. RESULTS: Websites hosted at .com (57.3%), .org (25.7%), and .gov (10.5%) domains were retrieved most frequently. Roughly half of all websites (n = 376) provided information relevant to the query, and about three-quarters (77.0%) of all queries yielded at least 1 relevant website within the first 3 results. Searches for larger cities were more likely to yield relevant results compared with smaller cities (odds ratio [OR] = 10.0, 95% confidence interval [CI] = 5.6, 17.9). On comparison with .com domains, .gov (OR = 2.9, 95% CI = 1.4, 5.6) and .org domains (OR = 2.9, 95% CI = 1.7, 4.8) were more likely to provide information of the location to get tested. DISCUSSION: Ease of online access to information about sexual health services varies by search topic and locale. Sexual health service providers must optimize their website placement so as to reach a greater proportion of the sexually active population who use web search engines.