Andrea V. Jackson

Interest in and experience with IUD self-removal

OBJECTIVES In the United States, the popularity of intrauterine devices (IUDs) is low despite many positive attributes such as high effectiveness and ease of use. The requirement that a clinician remove the IUD may limit US womens interest in the method. Our objective was to describe womens experience with self-removal and its effect on attitudes toward the method. STUDY DESIGN We assessed interest in attempting and success in IUD self-removal among women seeking IUD discontinuation from five US health centers. Women were given the option of attempting self-removal of the IUD. Participants were asked to complete two surveys about their reasons for desiring IUD removal, attitudes toward IUD use and experience with self-removal and/or clinician removal. RESULTS Three hundred twenty-six racially diverse women participated (mean age, 28 years; body mass index, 27; duration of IUD use, 3 years); more than half were willing to try self-removal [95% confidence interval (CI): 45-65%], and among those who tried, one in five was successful (95% CI: 14-25%). More than half of participants (54%) reported they were more likely to recommend IUD use to a friend now that they know that it might be possible to remove ones own IUD; 6% reported they were less likely to recommend the IUD to a friend. African American women were particularly interested in the option of IUD self-removal. CONCLUSIONS Many women are interested in the concept of IUD self-removal, although relatively few women currently succeed in removing their own IUD. IMPLICATIONS Health educators, providers and advocates who inform women of this option potentially increase IUD use, reducing rates of undesired pregnancy.

Reassessing Unintended Pregnancy: Toward a Patient-centered Approach to Family Planning.

Underserved women, especially those with low incomes and from racial and ethnic minorities, experience a disproportionate share of unintended pregnancies in the United States. Although unintended pregnancy rates are general markers of womens health and status, they may not accurately capture womens experiences of these pregnancies or their social circumstances. A patient-centered approach to family planning optimizes womens reproductive preferences, is cognizant of historical harms and current disparities, and may more comprehensively address the issue of unintended pregnancy. Clinicians, researchers, and policy makers can all adopt a patient-centered approach to help underserved women regain their reproductive autonomy.

Long‐Acting Reversible Contraceptives for Incarcerated Women: Feasibility and Safety of On‐Site Provision

CONTEXT Many incarcerated women have an unmet need for contraception. Providing access to long-acting reversible contraceptive (LARC) methods--IUDs and implants--before release is one strategy to meet this need and potentially prepare them for reentry to the community, but the safety and feasibility of providing these methods in this setting have not been described. METHODS A retrospective descriptive study of all LARC insertions at the San Francisco County Jail in 2009-2014 was conducted. Data from community clinic and jail clinic databases were assessed to examine baseline characteristics of LARC initiators, complications from insertion, method continuation, and pregnancy and reincarceration rates. Correlates of method discontinuation were assessed in multivariate logistic regression analyses. RESULTS Eighty-seven LARC devices were inserted during the study period--53 IUDs and 34 implants. There were no cases of pelvic inflammatory disease or other insertion complications in IUD users and no serious complications in implant users. Median duration of known use was 11.4 months for IUDs and 12.9 months for implants. Women who discontinued a LARC method most commonly cited a desire to get pregnant (32%). Black women were more likely than whites to discontinue use (odds ratio, 4.4). CONCLUSIONS It is safe and feasible to provide LARC methods to incarcerated women. Correctional facilities should consider increasing access to all available contraceptives, including LARC methods, in a noncoercive manner as a strategy to reduce reproductive health disparities among marginalized women at high risk of unplanned pregnancies.

Racial and ethnic differences in contraception use and obstetric outcomes: A review

In the United States, racial and ethnic minority women experience higher rates of contraceptive non-use, failure, unintended pregnancy, and lower use of long-acting reversible contraception (LARC), compared to whites. Simultaneously researchers have found that unintended pregnancy is associated with poor pregnancy outcomes and pregnancy behaviors, including pre-term birth and late initiation of prenatal care, respectively. Due to the association of pregnancy intention and obstetrical outcomes, public health efforts have focused on the increase in contraception use among these populations as a way to decrease poor pregnancy outcomes. In this review, we present the current literature on unintended pregnancy and contraception use by racial and ethnic minorities in the United States and the association of pregnancy intention and obstetrical outcomes and place these associations within the social and historical context in which these patients live and make their reproductive choices.

Connecting Police Violence With Reproductive Health.

Since the police-involved deaths of Michael Brown and Freddie Gray, activists have argued for connecting police violence with reproductive justice. We argue that systematic violence, including police violence, should be evaluated in relation to reproductive health outcomes of individual patients and communities. Beyond emphasizing the relationship between violence and health outcomes, both qualitative and epidemiologic data can be used by activists and caregivers to effectively care for individuals from socially marginalized communities.

Abortion and contemporary hip-hop: a thematic analysis of lyrics from 1990–2015

OBJECTIVE To evaluate the representation of abortion in contemporary hip-hop music, gaining insight into the myriad of attitudes of abortion in the black community. STUDY DESIGN We used Genius, an online storehouse for lyrical content, to identify songs by querying the database for search terms related to family planning, including slang terms. We then cross-referenced identified songs using an online list of songs about abortion. We analyzed eligible songs using grounded theory in order to identify key themes. RESULTS Of 6577 songs available, a total of 101 songs performed by 122 individual artists met inclusion criteria. The majority of artists were Black men; five artists were Black women. Key themes were: use of abortion as braggadocio; equating abortion with sin, genocide, or murder; male pressure for women to seek abortion; and the specific association of Planned Parenthood services with abortion. CONCLUSIONS The moral and ethical themes surrounding abortion in hip-hop lyrics reveal a unique perspective within a marginalized community. The overall negative context of abortion in hip-hop lyrics needs to be reconciled with the gendered, economic, historical, political, racial and ethnic background of hip-hop and rap music in America. IMPLICATIONS This study is the first to evaluate lyrical content from contemporary popular music in relation to abortion and family planning. Examining the intersection of reproductive rights and popular culture can provide a unique insight into the limited knowledge of the perspectives of abortion in the black community.