Prevalence of Abortions Prior to and During the COVID-19 Pandemic in a Large Health Care System.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic presented patients with numerous barriers to accessing health care, including access to reproductive health services. The goal of this study was to assess the prevalence of abortion prior to versus during the COVID-19 pandemic within a large health care system to better understand if patients were able to access abortion care. METHODS: This was a retrospective, data-only cohort study examining the prevalence of abortion among patients aged 15 to 44 within Kaiser Permanente Northern California (KPNC) in the first 6 months of the COVID-19 stay-at-home order (April 1 to September 30, 2020) compared with a 6-month period in the year prior to the COVID-19 pandemic (April 1 to September 30, 2019). Analyses were conducted using χ2 and t tests, with a P value < .05 considered statistically significant. RESULTS: The prevalence of abortion among patients at risk of pregnancy in 2019 and 2020 was identical, at 0.04% (P = .93). Baseline characteristics were similar between the 2 periods. The prevalence of smoking among patients who had an abortion in 2019 was 11.24%, compared with 9.04% in 2020 (P = .0009). Additionally, 85.80% of patients had KPNC insurance 6 months after the abortion in 2019, compared with 89.53% in 2020 (P < .0001). DISCUSSION: The prevalence of abortion remained similar prior to and during the first 6 months of the COVID-19 pandemic within KPNC. Patients seeking abortion were less likely to smoke and were more likely to have consistent insurance 6 months after their abortion in 2020 versus 2019, potentially suggesting the COVID-19 pandemic resulted in healthier behaviors and more consistent access to health care. Despite stay-at-home orders and canceling of in-person clinic visits, abortion services remained accessible to a diverse population within a large health care system.

"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.

Protecting Access To Abortion During The COVID-19 Pandemic.

Several states attempted to deem abortions nonessential during the COVID-19 pandemic, leaving some women with difficult choices.

Effect of contraceptive choice on rapid repeat pregnancy.

OBJECTIVE: To describe the prevalence of rapid repeat pregnancy (RRP), defined as repeat pregnancy within 18 months of delivery, in a large health system and to determine the impact of contraceptive method on RRP. STUDY DESIGN: Retrospective cohort. RESULTS: The prevalence of RRP among patients who delivered in August 2014 (n=804) was 27.2%. After controlling for age and sociodemographic characteristics, women experiencing RRP were less likely to have used long-acting reversible contraception (LARC) [adjusted odds ratio (aOR) 0.45, 95% confidence interval (CI) 0.24-0.85, p=.014; RRP in 19% of implant and 18% of IUD users)] and more likely to have been prescribed a progestin-only pill (aOR 5.106, 95% CI 2.157-12.083, p<.001; RRP in 53% of users) compared to women choosing all other reversible contraceptive methods. CONCLUSIONS: Postpartum LARC decreases the odds of RRP, while a prescription for progestin-only pills is not protective.