Understanding the Impacts of the Supreme Court Case FDA v Alliance for Hippocratic Medicine.

This Viewpoint outlines the potential effects of the Supreme Court case regarding mifepristone restrictions: a decision for the FDA would allow current dispensing, while ruling against the FDA would severely curtail access to reproductive health options.

Anemia among Women of Reproductive Age: An Overview of Global Burden, Trends, Determinants, and Drivers of Progress in Low- and Middle-Income Countries.

Relatively little progress has been made in reducing anemia prevalence among women of reproductive age (WRA anemia). Interventions, policies and programs aimed at reducing WRA anemia have the potential to improve overall not only women's, but also children's health and nutrition outcomes. To our knowledge, this is the first review that aimed to compile evidence on the determinants and drivers of WRA anemia reduction in low- and middle-income countries (LMICs). We synthesized the available evidence on the determinants and drivers, including government policies and programs, of WRA anemia and their mitigation strategies across a wide range of countries and geographies, thus contributing to the complex and multifactorial etiology of anemia. We carried out a systematic review of published peer-reviewed and grey literature assessing national or subnational decline in WRA anemia prevalence and the associated drivers in LMICs. Among the 21 studies meeting our inclusion criteria, proximal determinants of healthcare utilization, especially during pregnancy and with the use of contraceptives, were strong drivers of WRA anemia reduction. Changes in other maternal characteristics, such as an increase in age at first pregnancy, BMI, birth spacing, and reduction in parity, were associated with modest improvements in anemia prevalence. Access to fortified foods, especially iron-fortified flour, was also a predictor of a decrease in WRA anemia. Of the intermediate determinants, an increase in household wealth, educational attainment and access to improved sanitation contributed significantly to WRA anemia reduction. Although several common determinants emerged at the proximal and intermediate levels, the set of anemia determinants and the strength of the association between each driver and WRA anemia reduction were unique in each setting included in this review. Further research is needed to provide targeted recommendations for each country and region where WRA anemia prevalence remains high.

Travel Time to Title X Facilities and Teenage Birth Rates in North Carolina.

OBJECTIVES: In the United States, Title X facilities are understood to be an effective starting point for improving teenagers' reproductive health outcomes, including unintended pregnancy. We investigate geographic accessibility of Title X facilities and the relationship between geographic accessibility of Title X facilities and teenage birth rates in the state of North Carolina (NC). METHODS: Vehicular travel time from each ZCTA to its nearest Title X facility was calculated using a geographic information system and summarized as the indicator of geographic accessibility. We used bivariate and multiple spatial lag regressions to evaluate the relationship between ZCTA-level teenage birth rates (n = 754) in 2016 and geographic accessibility to a Title X facility, as well as socioeconomic and demographic factors. RESULTS: Nearly 60% of teenage women lived 30 min or less from a Title X funded facility, while approximately 12% of women lived 60 min or more from the nearest facility. In the regression models, percent non-Hispanic White, percent Hispanic, percent in Poverty, percent not enrolled in school, and population density were associated with teenage birth rates; however, geographic accessibility was only associated in the bivariate model. CONCLUSIONS: Our findings show that geographic accessibility of Title X facilities is lower in NC than in other states. However, our results suggest that geographic accessibility is not related to teenage birth rates. Overall, these findings may indicate that publicly funded family planning facilities are underutilized by proximal populations or factors other than proximity act as a barrier to utilization.

[Trends of female reproductive health status in Bangladesh from 1999 to 2018].

Objective: To analyze the changes of relevant indicators in reproductive health status among Bangladeshi women from 1999 to 2018 and to assess whether the 2030 Sustainable Development Goals (SDGs) can be achieved. Methods: Data were obtained from both the Bangladesh Demographic and Health as well as from the Maternal Mortality and Health Care Surveys. The trends of SDGs indicators related to reproductive health from 1999 to 2018 were analyzed and compared, and the average annual rate of change was calculated. Development index was used to assess the difficulty of achieving the SDGs. Results: The maternal mortality rate increased first and then leveled off from 2001 to 2016. From 1999 to 2018, the coverage of reproductive health care services and the proportion of women who had the right to make the decision on their own health care service, were generally increasing. Proportion of the following areas as: "contraceptive needs, women who consider that partner violence is justified, the rate of early marriage, and the rate of early childbearing etc.", were declining at various degrees. Development index of the antenatal care coverage, rate of delivery in medical facilities, percentage of live births attended by medically trained providers and the rate of postnatal care etc., were less than 1. The development indices of the maternal mortality rates were close to 1, while all the other indicators were greater than 1. Conclusions: The reproductive health-related SDGs indicators in Bangladesh appeared somehow degrees of progress from 1999 to 2018. However, for most indicators, the average annual rate of change was still lower than the expected to achieve the 2030 target which called for acceleration in the next few years.

Nursing work in assisted human reproduction: between technology and humanization.

OBJECTIVES: To analyze the social representations of nurses who work with assisted human reproduction about the operation with reproductive biotechnologies. METHODS: Qualitative approach, supported by the Theory of Social Representations, with sixteen participants. Individual, semi-structured interviews, analyzed through the Alceste software. RESULTS: Pragmatic elements related to nurses' performance from a professional, institutional, and public policy perspective in reproductive biotechnologies emerged, demonstrating the practical dimension of these representations. The characteristics of the professional to act in this area were addressed, showing the lack of information and search for scientificity; precarious perception of the organizational structure of health services; and attributions of nursing care arising from the health care practice in assisted human reproduction. FINAL CONSIDERATIONS: Social representation is anchored in the link between technology/medicalization and humanization/reception regarding reproductive biotechnologies. Working in assisted human reproduction involves a new and challenging nursing care, requiring specific and ethical knowledge.

Nursing work in assisted human reproduction: between technology and humanization / El trabajo del enfermero en reproducción humana asistida: entre la tecnología y la humanización / Trabalho do enfermeiro em reprodução humana assistida: entre tecnologia e humanização

ABSTRACT Objectives: To analyze the social representations of nurses who work with assisted human reproduction about the operation with reproductive biotechnologies. Methods: Qualitative approach, supported by the Theory of Social Representations, with sixteen participants. Individual, semi-structured interviews, analyzed through the Alceste software. Results: Pragmatic elements related to nurses' performance from a professional, institutional, and public policy perspective in reproductive biotechnologies emerged, demonstrating the practical dimension of these representations. The characteristics of the professional to act in this area were addressed, showing the lack of information and search for scientificity; precarious perception of the organizational structure of health services; and attributions of nursing care arising from the health care practice in assisted human reproduction. Final considerations: Social representation is anchored in the link between technology/medicalization and humanization/reception regarding reproductive biotechnologies. Working in assisted human reproduction involves a new and challenging nursing care, requiring specific and ethical knowledge.

RESUMEN Objetivos: Analizar las representaciones sociales del enfermero que trabaja con reproducción humana asistida acerca del trabajo con biotecnologías reproductivas. Métodos: Estudio de tipo cualitativo basándose en la Teoría de las Representaciones Sociales, realizado con 16 participantes. Las entrevistas individuales, semiestructuradas, se analizaron por medio del software Alceste. Resultados: Se desvelaron los elementos pragmáticos relacionados al desempeño del enfermero desde la perspectiva profesional, institucional y de conformación de las políticas públicas en biotecnologías reproductivas, demostrando la dimensión práctica de esas representaciones. Se abordaron las características del profesional para actuar en este campo, demostrando carencia de información y búsqueda del valor científico; la percepción precaria de la estructura organizativa de los servicios de salud; y las funciones del cuidado del enfermero provenientes de la práctica asistencial en reproducción humana asistida. Consideraciones finales: La representación social se fundamenta en el enlace entre la tecnología/medicalización y la humanización/acogida con relación a las biotecnologías reproductivas. El trabajo en reproducción humana asistida implica un nuevo y desafiante cuidado de la enfermería y le exige un conocimiento específico y de la ética.

RESUMO Objetivos: Analisar as representações sociais do enfermeiro que trabalha com reprodução humana assistida acerca da atuação com biotecnologias reprodutivas. Métodos: Abordagem qualitativa sustentada pela Teoria das Representações Sociais com dezesseis participantes. Entrevista individual, semiestruturada, analisada pelo software Alceste. Resultados: Emergiram elementos pragmáticos relacionados à atuação do enfermeiro na perspectiva profissional, institucional e de conformação das políticas públicas em biotecnologias reprodutivas, demonstrando a dimensão prática dessas representações. Abordaram-se as características do profissional para atuar nesta área, demonstrando carência de informação e busca pela cientificidade; percepção precária da estrutura organizacional dos serviços de saúde; e atribuições do cuidado do enfermeiro que advêm da prática assistencial em reprodução humana assistida. Considerações finais: A representação social ancora-se no elo entre a tecnologia/medicalização e a humanização/acolhimento em relação às biotecnologias reprodutivas. O trabalho em reprodução humana assistida envolve um novo e desafiador cuidado de enfermagem e exige conhecimento específico e ético.

Forward, Together: A Collaborative Path to Comprehensive Adolescent Sexual and Reproductive Health and Rights in Our Time.

The 1994 International Conference on Population and Development established a basis for the advancement of adolescent sexual and reproductive health and rights (ASRHR) that endures today. Twenty-five years later, our vision for the future warrants reflection based on a clear understanding of the opportunities and challenges before us. Inclusion of adolescents on global, regional, and national agendas; increased investment in ASRHR policies and programs; renewed commitments to universal health coverage; increased school enrollment; and advances in technology are all critical opportunities we can and must leverage to catalyze progress for adolescents. At the same time, a range of significant challenges remain, have newly emerged, or can be seen on the horizon, including persistent denial of adolescent sexuality; entrenched gender inequality; resistance to meaningfully engaging adolescents and young people in political and programmatic processes; weak systems, integration, and multisectoral coordination; changes in population dynamics; humanitarian and climate crises; and changes in family and community structures. To achieve as much progress toward our vision for ASRHR as possible, the global ASRHR community must take strategic and specific steps in the next 10 years within five areas for action: (1) mobilize and make full use of political and social support for ASRHR policies and programs; (2) increase and make effective use of external and domestic funding for ASRHR; (3) develop, communicate, apply, and monitor enabling and protective laws and policies for ASRHR; (4) use and improve available ASRHR data and evidence to strengthen advocacy, policies, and programs; and (5) manage the implementation of ASRHR strategies at scale with quality and equity.

Interventions integrating non-communicable disease prevention and reproductive, maternal, newborn, and child health: A systematic review.

Reproductive, maternal, newborn, and child health (RMNCH) care services could be critical entry points for preventing non-communicable diseases in women and children. In high-income countries, non-communicable diseases screening has been integrated into both the medical and public health systems. To integrate these services in low- and middle-income countries, it is necessary to closely examine its effectiveness and feasibility. In this systematic review, we evaluated the effectiveness of integrating gestational and non-gestational non-communicable diseases interventions and RMNCH care among women and children in low- and middle-income countries. This systematic review included randomized and quasi-randomized controlled trials published from 2000 to 2015. Participants included reproductive-age women, children < 5 years old, and RMNCH care providers. The included interventions comprised packaged care/services that integrated RMNCH services with non-communicable disease care. The outcomes were maternal and/or infant mortality and complications, as well as health care service coverage. We analyzed six studies from 7,949 retrieved articles. Yoga exercise (p < 0.01) and nutritional improvements (p < 0.05) were effective in reducing gestational hypertension and diabetes. Additionally, integrating cervical cancer and RMNCH services was useful for identifying potential cervical cancer cases. Interventions that integrate non-communicable disease care/screening and RMNCH care may positively impact the health of women and children in low- and middle-income countries. However, as primary evidence is scarce, further research on the effectiveness of integrating non-communicable disease prevention and RMNCH care is warranted. (Review Registration: PROSPERO International prospective register of systematic reviews (CRD42015023425).).

Integrating Reproductive Health Services Into Intimate Partner and Sexual Violence Victim Service Programs.

This study assessed the feasibility of integrating reproductive health services into intimate partner violence/sexual violence (IPV/SV) programs. After a training for victim service agencies on integration of health services, we conducted semistructured interviews with IPV/SV program leadership. Leadership reported advocates were more likely to recognize the need to refer clients to health services, and revealed challenges operationalizing partnerships with health care centers. Training to integrate basic health assessment into victim services may be one way to address women's urgent health needs. Formal partnership agreements, protocols to facilitate referrals, and opportunities to cross-train are needed to nurture these cross-sector collaborations.

Gender differences in Australian general practice trainees performing procedures related to women's reproductive health: A cross-sectional analysis

BACKGROUND AND OBJECTIVES: Gender differences may exist in the performance of women's reproductive procedures. The aim of this study was to investigate the prevalence and association of general practice registrars' performance of women's procedures with trainees' gender, rurality of practice and in-consultation seeking of information or assistance. METHOD: This was a cross-sectional analysis of a cohort study of registrars' consultations in 2010­17. Registrars recorded 60 consecutive consultations during each six-month training term. The outcome was performance of a procedure related to women's reproductve health. RESULTS: Of 24,333 procedures performed in 332,700 encounters, 15,634 were on female patients and 6025 of those included procedures relating to women's reproductive health; 5002 were Pap smears (20.6%). Only 235 (4.7%) Pap smears were performed by male trainees. Performing women's procedures was significantly associated with trainees' gender, with an adjusted odds ratio of 4.80 (95% confidence interval: 4.10, 5.61). DISCUSSION: Our findings suggest that a gender difference exists in general practice trainees' frequency of performing women's procedures. Male trainees require more opportunities and support from their preceptors, clinical settings and training programs to perform these procedures.

Looking back and moving forward: can we accelerate progress on adolescent pregnancy in the Americas?

Adolescent fertility rates in Latin America and the Caribbean (LAC) remain unacceptably high, especially compared to the region's declining total fertility rates. The Region has experienced the slowest progress of all regions in the world, and shows major differences between countries and between subgroups in countries. In 2013, LAC was also noted as the only region with a rising trend in pregnancies in adolescents younger than 15 years. In response to the lack of progress in the LAC region, PAHO/WHO, UNFPA and UNICEF held a technical consultation with global, regional and country-level stakeholders to take stock of the situation and agree on strategic approaches and priority actions to accelerate progress. The meeting concluded that there is no single portrait of an adolescent mother in LAC and that context and determinants of adolescent pregnancy vary across and within countries. However, lack of knowledge about their sexual and reproductive health and rights, poor access to and inadequate use of contraceptives resulting from restrictive laws and policies, weak programs, social and cultural norms, limited education and income, sexual violence and abuse, and unequal gender relations were identified as key factors contributing to adolescent pregnancy in LAC. The meeting participants highlighted the following seven priority actions to accelerate progress: 1. Make adolescent pregnancy, its drivers and impact, and the most affected groups more visible with disaggregated data, qualitative reports, and stories. 2. Design interventions targeting the most vulnerable groups, ensuring the approaches are adapted to their realities and address their specific challenges. 3. Engage and empower youth to contribute to the design, implementation and monitoring of strategic interventions. 4. Abandon ineffective interventions and invest resources in applying proven ones. 5. Strengthen inter-sectoral collaboration to effectively address the drivers of adolescent pregnancy in LAC. 6. Move from boutique projects to large-scale and sustainable programs. 7. Create an enabling environment for gender equality and adolescent sexual and reproductive health and rights.

Identifying youth-friendly service practices associated with adolescents' use of reproductive healthcare services in post-conflict Burundi: a cross-sectional study.

BACKGROUND: Very little is known about reproductive health service (RHS) availability and adolescents' use of these services in post-conflict settings. Such information is crucial for targeted community interventions that aim to improve quality delivery of RHS and outcomes in post-conflict settings. The objectives of this study therefore was to examine the density of RHS availability; assess spatial patterns of RHC facilities; and identify youth-friendly practices associated with adolescents' use of services in post-conflict Burundi. METHODS: A cross-sectional survey was conducted from a full census of all facilities (n = 892) and provider interviews in Burundi. Surveyed facilities included all public, private, religious and community association owned-centers and hospitals. At each facility efforts were made to interview the officer-in-charge and a group of his/her staff. We applied both geospatial and non-spatial analyses, to examine the density of RHS availability and density, and to explore the association between youth-friendly practices and adolescents' use of RHS in post-conflict Burundi. RESULTS: High spatial patterning of distances of RHC facilities was observed, with facilities clustered predominantly in districts exhibiting persistent violence. But, use of services remained undeterred. We further found a stronger association between use of RHS and facility and programming characteristics. Community outreach, designated check-in/exam rooms, educational materials (posters, print, and pictures) in waiting rooms, privacy and confidentiality were significantly associated with adolescents' use of RHS across all facility types. Cost was associated with use only at religious facilities and youth involvement at private facilities. No significant association was found between provider characteristics and use of RHS at any facility. CONCLUSIONS: Our findings indicate the need to improve youth-friendly service practices in the provision of RHS to adolescents in Burundi and suggest that current approaches to provider training may not be adequate for improving these vital practices. Our mixed methods approach and results are generalizable to other countries and post-conflict settings. In post-conflict settings, the methods can be used to identify service availability and spatial patterns of RHC facilities to plan for targeted service interventions, to increase demand and uptake of services by youth and young adults.

Screening and management practices for renal disease in the HIV-positive patient population of an inner metropolitan sexual health service.

Renal disease is an important and commonly encountered co-morbidity in HIV infection. Despite this, few data are available concerning renal disease in this patient group. A retrospective review was conducted of all HIV-positive patients of an inner metropolitan sexual health service who attended from 1 August 2013 to 31 July 2014 for HIV management. One hundred eighty-eight HIV-positive patients attended the clinic during the study period. The majority were male (96%), Caucasian (70%) and 30-39 years of age (37%). There was a high prevalence of renal risk factors in the population, including potentially nephrotoxic antiretroviral therapy (61%), smoking (38%), hypertension (12%), dyslipidemia (11%) and hepatitis C co-infection (7%). In the previous year, measurements of estimated glomerular filtration rate were performed in all patients, but measurements of lipid profiles, urinary protein and serum phosphate were performed within the last year in only 48%, 33% and 30% of patients, respectively. These are the first comprehensive data regarding renal disease, associated risk factors and screening and management practices in the HIV-positive patient population of a specialized sexual health service in Australia. This patient population demonstrates a particularly high prevalence of risk factors for renal disease. Despite this, screening investigations were not performed as recommended. This represents a potential area to improve patient care.

Do efforts to standardize, assess and improve the quality of health service provision to adolescents by government-run health services in low and middle income countries, lead to improvements in service-quality and service-utilization by adolescents?

BACKGROUND: Researchers and implementers working in adolescent health, and adolescents themselves question whether government-run health services in conservative and resource-constrained settings can be made adolescent friendly. This paper aims to find out what selected low and middle income country (LMIC) governments have set out to do to improve the quality of health service provision to adolescents; whether their efforts led to measurable improvements in quality and to increased health service-utilization by adolescents. METHODS: We gathered normative guidance and reports from eight LMICs in Asia, Africa, Central and Eastern Europe and the Western Pacific. We analysed national quality standards for adolescent friendly health services, findings from the assessments of the quality of health service provision, and findings on the utilization of health services. RESULTS: Governments of LMICs have set out to improve the accessibility, acceptability, equity, appropriateness and effectiveness of health service provision to adolescents by defining standards and actions to achieve them. Their actions have led to measurable improvements in quality and to increases in health service utilisation by adolescents. CONCLUSIONS: With support, government-run health facilities in LMICs can improve the quality of health services and their utilization by adolescents.

Family Planning and Preconception Health Among Men in Their Mid-30s: Developing Indicators and Describing Need.

The Centers for Disease Control and Prevention and Healthy People 2020 call for improvements in meeting men's reproductive health needs but little is known about the proportion of men in need. This study describes men aged 35 to 39 in need of family planning and preconception care, demographic correlates of these needs, and contraception use among men in need of family planning. Using data from Wave 4 (2008-2010) of the National Survey of Adolescent Males, men were classified in need of family planning and preconception care if they reported sex with a female in the last year and believed that they and their partner were fecund; the former included men who were neither intentionally pregnant nor intending future children and the latter included men intending future children. Men were classified as being in need of both if they reported multiple sex partners in the past year. About 40% of men aged 35 to 39 were in need of family planning and about 33% in need of preconception care with 12% in need of both. Current partner's age, current union type, and sexually transmitted infection health risk differentiated men in need of family planning and preconception care (all ps < .01) and participants' race/ethnicity further differentiated men in need of preconception care (p < .01). More than half of men in need of family planning reported none of the time current partner hormonal use (55%) or condom use (52%) during the past year. This study identified that many men in their mid-30s are in need of family planning or preconception care.

The relationship between social, policy and physical venue features and social cohesion on condom use for pregnancy prevention among sex workers: a safer indoor work environment scale.

BACKGROUND: This study aims to report on a newly developed Safer Indoor Work Environmental Scale that characterises the social, policy and physical features of indoor venues and social cohesion; and using this scale, longitudinally evaluate the association between these features on sex workers' (SWs') condom use for pregnancy prevention. METHODS: Drawing on a prospective open cohort of female SWs working in indoor venues, a newly developed Safer Indoor Work Environment Scale was used to build six multivariable models with generalised estimating equations (GEE), to determine the independent effects of social, policy and physical venue-based features and social cohesion on condom use. RESULTS: Of 588 indoor SWs, 63.6% used condoms for pregnancy prevention in the last month. In multivariable GEE analysis, the following venue-based features were significantly correlated with barrier contraceptive use for pregnancy prevention: managerial practices and venue safety policies (adjusted OR (AOR)=1.09; 95% CI 1.01 to 1.17), access to sexual and reproductive health services/supplies (AOR=1.10; 95% CI 1.00 to 1.20), access to drug harm reduction (AOR=1.13; 95% CI 1.01 to 1.28) and social cohesion among workers (AOR=1.05; 95% CI 1.03 to 1.07). Access to security features was marginally associated with condom use (AOR=1.13; 95% CI 0.99 to 1.29). CONCLUSIONS: The findings of the current study highlight how work environment and social cohesion among SWs are related to improved condom use. Given global calls for the decriminalisation of sex work, and potential legislative reforms in Canada, this study points to the critical need for new institutional arrangements (eg, legal and regulatory frameworks; labour standards) to support safer sex workplaces.

Towards ending preventable maternal deaths by 2035.

Maternal mortality has been reduced by half from 1990 to 2010, yet a woman in sub-Saharan Africa has a lifetime risk of maternal death of 1 in 39 compared with around 1 in 10,000 in industrialized countries. Annual rates of reduction of maternal mortality of over 10% have been achieved in several countries. Highly cost-effective interventions exist and are being scaled up, such as family planning, emergency obstetric and newborn care, quality service delivery, midwifery, maternal death surveillance and response, and girls' education; however, coverage still remains low. Maternal mortality reduction is now high on the global agenda. We examined scenarios of reduction of maternal mortality by 2035. Ending preventable maternal deaths could be achieved in nearly all countries by 2035 with challenging yet realistic efforts: (1) massive scaling-up and skilling up of human resources for family planning and maternal health; (2) reaching every village in every district and every urban slum toward universal health coverage; (3) enhanced financing; (4) knowledge for action: enhanced monitoring, accountability, evaluation, and R&D.

Trends in office-based care for reproductive-aged women according to physician specialty: a ten-year study.

BACKGROUND: The anticipated increase in access to health care has prompted an interest in where women go for their office-based care. The objectives of this study were to examine which types of office site are chosen by reproductive-aged women for their health care and to compare the reasons for their visits among these sites. METHODS: This descriptive study involved an analysis of national data from the Medical Expenditure Panel Survey between 2002 and 2011. We restricted the analysis to a nationally representative group of women between 19 and 39 years old (n=45,133). Interviews with patients were used to identify the patient's demographics, type of physician seen, and main reason for each self-reported office visit (n=208,814). RESULTS: One in four women did not go to a physician's office each year. Nearly all who sought some sort of office-based care went to family physicians, ob-gyns, or a combination. For the women who did go to a physician's office, going only to a family physician's office was most common (42.6%). In contrast, 28.6% of these women visited only an ob-gyn office, and an additional 21.5% went to offices of a family physician or general internist as well as an ob-gyn physician. Visits only to offices of ob-gyns were highest among women who were married and healthy. Compared with family physicians or internists, the percentages of office visits to an ob-gyn were more likely for pregnancy (57.0% vs. 2.8%), about the same for a general check-up (23.6% vs. 29.2%), and less for diagnosis or treatment (13.7% vs. 55.5%). Those who went to ob-gyn offices were most apt to return for several visits per year. CONCLUSION: Almost all health care sought by women aged 19 to 39 in a year is to ob-gyns or family physicians, and significant sharing of care exists across these provider groups. While most visits to family physicians were for diagnosis or treatment, the majority of visits to ob-gyn were for pregnancy-related care.

Addressing reproductive health disparities as a healthcare management priority: pursuing equity in the era of the Affordable Care Act.

PURPOSE OF REVIEW: To summarize the newest available evidence on maternal and reproductive health disparities, and to describe elements of the Affordable Care Act most likely to impact these disparities. RECENT FINDINGS: Significant racial and ethnic disparities in maternal and reproductive health outcomes have persisted in recent years, contributing to poor outcomes and increasing costs. Pregnancy-related mortality ratios are up to three times higher in Black women compared with non-Hispanic White women, with the risk of severe maternal morbidity also significantly higher in Black and Hispanic women. Unintended pregnancy is twice as likely in minority women. Insurance status, socioeconomic status, and broader social determinants of health are implicated in these disparities. Coverage changes associated with the Affordable Care Act may provide some opportunities to reach communities most at risk. Delivery innovation, payment reform, and further public financing of key services are examples of further management approaches that can be used to address reproductive health disparities. SUMMARY: The Affordable Care Act offers important opportunities to address persistent reproductive health disparities, but significant gaps remain. Efforts must be made to reduce the negative outcomes and high financial and human costs associated with disparities in reproductive health.

Reproductive health care delivery.

Most patients in the United States with reproductive health disorders are not covered by their health insurance for these problems. Health insurance plans consider reproductive care as a lifestyle choice not as a disease. If coverage is provided it is, most often, directed to female factor infertility and advanced reproductive techniques, ignoring male factor reproductive disorders. This article reviews the history of reproductive health care delivery and its present state, and considers its possible future direction.