What Women Want: A Qualitative Study of Contraception in Jail.

OBJECTIVES: We undertook this study to understand women's perceptions of receiving contraception at Rikers Island Jail. METHODS: We conducted semi-structured in-depth interviews in 2011 to 2012 with 32 women incarcerated at Rikers Island Jail. We analyzed the data using standard qualitative techniques. RESULTS: Almost all participants believed that contraception should be provided at the jail. However, many said they would hesitate to use these services themselves. Reservations were caused in part by women's negative views of health care services at the jail. Fears about the safety of birth control, difficulties associated with follow-up in the community, and desire for pregnancy were other factors that influenced interest in accepting contraception. CONCLUSIONS: Contraception at the jail must be provided by trusted medical providers delivering high quality care with the goal of allowing women to control their own fertility; this would ensure that women could access birth control and cease using birth control when desired.

A review of primary care training programs in correctional health for physicians.

BACKGROUND: Despite the health consequences of incarceration, there are no national standards for teaching physicians about correctional health. The purpose of this study was to survey existing correctional health training programs for primary care physicians. SUMMARY: Programs were identified through literature and Web search, snowballing, and professional meetings. Programs were contacted and asked to complete a survey. Correctional health programs exist in a variety of disciplines. We identified 22 in primary care. Programs seek to improve public health, reduce stigma, and recruit physicians to correctional health. Curricula covered specific health problems as well as the impact of incarceration on families and communities. Relationships between the academic center and the correctional facilities were varied. Barriers include issues of security, time, financial resources, and stigma. Programs evaluate their learners, as well as educational and clinical outcomes. CONCLUSIONS: A variety of correctional health programs currently exist. A national model curriculum could strengthen teaching in correctional health.

The contraceptive needs and pregnancy desires of women after incarceration: A qualitative study.

OBJECTIVE: Prior qualitative research with women incarcerated at Rikers Island Jail asked women to anticipate their future contraceptive needs and pregnancy desires upon re-entering the community. We conduct this follow-up study to understand better the actual contraceptive needs and pregnancy desires experienced by women after incarceration. STUDY DESIGN: We conducted semi-structured in-depth interviews in New York City in 2014 with 10 women incarcerated within the past three years. We coded transcripts using an iterative process, identified emerging themes, and stopped recruitment after reaching thematic saturation. RESULTS: Most participants desired to wait to become pregnant until they had stable housing, income, and employment. A few faced systemic barriers to obtaining contraception, including the process of re-applying for insurance and obtaining medical appointments. For many, incarceration disrupted their use of contraception, insurance status, and relationship with trusted medical providers. Most women lacked trust in the new health professionals they encountered after incarceration. CONCLUSIONS: Incarceration disrupted medical care in general, and contraceptive care in particular. Assistance should be provided to re-apply for insurance, make appointments, and support women to see trusted health professionals. IMPLICATIONS: Incarceration further disenfranchises an already marginalized community through disrupting access to medical care and constrains women's reproductive autonomy long after return to the community.

The accuracy of using last menstrual period to determine gestational age for first trimester medication abortion: a systematic review.

OBJECTIVE: We sought to evaluate the accuracy of assessing gestational age (GA) prior to first trimester medication abortion using last menstrual period (LMP) compared to ultrasound (U/S). STUDY DESIGN: We searched Medline, Embase and Cochrane databases through October 2013 for peer-reviewed articles comparing LMP to U/S for GA dating in abortion care. Two teams of investigators independently evaluated data using standard abstraction forms. The US Preventive Services Task Force and Quality Assessment of Diagnostic Accuracy Studies guidelines were used to assess quality. RESULTS: Of 318 articles identified, 5 met inclusion criteria. Three studies reported that 2.5-11.8% of women were eligible for medication abortion by LMP and ineligible by U/S. The number of women who underestimated GA using LMP compared to U/S ranged from 1.8 to 14.8%, with lower rates found when the sample was limited to a GA <63 days. Most women (90.5-99.1%) knew their LMP, 70.8-90.5% with certainty. CONCLUSION: Our results support that LMP can be used to assess GA prior to medication abortion at GA <63 days. Further research looking at patient outcomes and identifying women eligible for medication abortion by LMP but ineligible by U/S is needed to confirm the safety and effectiveness of providing medication abortion using LMP alone to determine GA.