Blair Grant Darney

Background: Although cervical cancer is preventable, Latinas are twice as likely to receive a late diagnosis compared with non-Hispanic Whites (NHW). We currently know very little about the experiences of cervical cancer among middle- to older-age Latinas in the U.S. This study aimed to document Latina cervical cancer survivors’ journeys with an emphasis on improving the cervical cancer system of care to address inequities among a rapidly aging Latina population. Methods: We interviewed participants aged ≥ 40 years with a diagnosis of cervical cancer of three months or greater who identify as Latina. Recruitment was multi-pronged, including electronic healthcare records search, community tabling events, and snowball sampling. We conducted a qualitative study using the Database of Individual Patient Experiences (DIPEx) methodology and identified themes using grounded theory constructivist analysis. Results: A total of 20 Latinas (43 to 85 years old) participated, including 16 Spanish-language interviews. We identified three themes: formative experiences driving screening and prevention behaviors, provider communication that was suboptimal throughout the cancer continuum, and survivorship impacts including isolation and stigma with implications for the next generation. Conclusions: A central takeaway was the pervasiveness of Latinas’ feelings of shame, lack of communication, and isolation. Healthcare systems must improve culturally responsive communication, survivorship support, and screening equity for aging Latina populations. Abuelas, tias, and/or primas (grandmothers, aunts, and cousins) could play a critical role in raising awareness and increasing timely and early screening among the wider Latina population.

Research, policymakers, and advocacy groups rely on valid estimates of adolescent births to inform their work. Estimates of births among very young adolescents (10-14 years old) are especially lacking. We compared adolescent fertility rates in Mexico across the census, population-based surveys, civil registration, and birth certificates. We calculate live birth rates among very young adolescents (VYA; 10-14 and 12-14) and older adolescents (15-19) in Mexico, at national and state levels, and by year (2008-2019). We compare estimates with official reconciled data from the Mexican government. For context, we also calculate all other age-specific fertility rates (ASFRs) and total fertility rates (TFRs). Overall, all national-level data sources in the period studied show declines in TFR and ASFRs for adolescents. Official government estimates for older adolescents (15-19) declined from 78·3 to 65·1 births per 1,000 adolescents 15-19 years old between 2008 and 2019. Rates for VYAs showed a decline in hospital registration (from 3·5 to 2·8 births per 1,000 adolescents aged 12 to 14 years old), and vital statistics (from 2·6 to 1·9) compared with the census. At the state level, VYA birth rates calculated using SINAC are higher than those estimated with vital statistics; the census estimates, at only three timepoints, are variable by state. Four different publicly available data sources in Mexico produce adolescent birthrate estimates that are largely consistent with official reconciled data, validating the use of each of these data sources individually. For VYA estimates, which the government does not include in population projections, hospital registration (birth certificates) may be the best source.

Objectives: To evaluate and compare self-managed abortion (SMA) user-reported quality of care between users accessing a safe abortion hotline versus proprietary patent medicine vendors (PPMVs) that provide medicines to rural communities in Nigeria, and identify factors associated with increases in total quality scores and key indicators of abortion access and information provision. Methods: We leveraged exit surveys and 30-day follow-up data collected from users of a safe abortion hotline and PPMVs in Nigeria used to develop the Abortion Care Quality Tool (ACQTool). We used bivariate statistics to compare 17 user-reported quality indicators across six domains and eight abortion outcomes, by care source (hotline vs PPMV). We used multivariable linear regression to identify factors associated with total quality scores and multivariable logistic regression to identify factors associated with abortion affordability and preparedness for a complication, controlling for user sociodemographic characteristics. Results: Hotline users (n=182; 40.8%) scored higher than PPMV users (n=264; 59.2%) on 9 of 17 quality indicators, particularly in the decision-making and information provision domains. Mean total quality score was significantly higher for hotline users (16.53 vs 14.53; p<0.001). Hotline users were associated with an increase of 1.87 points in the total quality and higher odds (aOR=3.23; 95% CI 1.07 to 12.02) of feeling prepared if a complication occurred, but had lower odds (aOR=0.10; 95% CI 0.05 to 0.21) of indicating the abortion was affordable, adjusting for sociodemographic factors. Conclusions: This study highlights the high overall quality of abortion care from both hotlines and PPMVs but identifies key areas for improvement, such as affordability for hotline users and decision and information support for PPMV users.

Despite known hormonal influences on immune function, the impact of menstrual cycle phase on vaccine side effects and subsequent infection risk remains unexplored. We used prospectively tracked cycle data from the period tracking app, Clue, matched with an in-app vaccine survey conducted between November 2021 and February 2022. In a sample of 1,474 cycling women, we compared reported side effect and post-vaccination infection outcomes of women vaccinated in the estrogen-dominant follicular phase of their cycle, with those vaccinated in the progesterone-dominant luteal phase. Side effect presence, severity and number were analysed using binary, ordinal, and negative binomial regression models respectively. Post vaccination time to infection (over 67-372 days of follow-up) was compared between the two groups using Wilcoxon rank-sum test and a Cox proportional hazards model. Follicular-phase vaccination was associated with 35% higher odds of reporting any side effects (OR: 1.35, 95% CI: 1.05–1.66) compared to luteal-phase vaccination. The association remained significant after excluding individuals vaccinated during the bleed phase, and the perimenstrual phase, indicating that hormonal environment, rather than inflammation caused by menstruation or premenstrual symptoms, may drive the association. Median time to infection was 35 days longer for those vaccinated in the follicular phase (Follicular: 200 (140,237) Luteal 165 (107, 2107), p = 0.05), suggesting potential longer-lasting protection from the vaccine. These findings suggest that menstrual cycle phase should be considered when studying sex-based immune differences and may inform future research on vaccination timing and personalised health strategies.

Background: Access to desired contraceptive care is a critical component of reproductive autonomy. Telemedicine (TM), or the remote provision of clinical services via technology, in community-based health centers has the potential to expand access to family planning services, potentially enhancing both reproductive autonomy and equity. However, little is known about which patient populations use TM for contraceptive services in the US “ safety net” (community-based health centers), if there are inequities in access to TM care, or patient preferences for TM contraceptive care. Also unknown are potential unintended consequences may result from using TM versus face-to-face visits for contraceptive care. Methods: This paper describes the protocol for a 5-year, multilevel, mixed-methods study examining the use of TM for contraceptive services across a large network of over 2400 US community-based health centers serving millions of patients. Quantitative analyses will use electronic health record data from the ADVANCE network to identify differences in the use of TM for contraceptive services and quantify inequities or unintended consequences of such use for individuals and the health system. Quantitative outcomes include the use of TM versus face-to-face visits for any contraceptive care, contraceptive method switching, no-show and cancellation rates, and access to long-acting reversible contraception (LARC). Quantitative analyses will include variables at the patient, clinic, and contextual (census tract of patient address and state of clinic location) levels. The qualitative investigation will focus on experiences with TM and factors that may impact access to contraceptive services through TM versus in-person care, providing a comprehensive understanding of both statistical trends and underlying contextual dynamics. Discussion: Our study will provide real-world evidence about use of TM for contraceptive services in the US “safety net”. Our results will help us understand the potential for TM to expand access to contraceptive care and any unintended consequences. Our findings will have broad implications for reducing disparities in contraceptive care access and can inform best practices for TM delivery, as well as policy decisions about payer reimbursements for different TM strategies for contraceptive services.

Background: The inadequate handling of obstetrical complications may be attributed to the suboptimal quality of prenatal care (PC) and a lack of trust in healthcare provider (HP) among pregnant women. Objective: This study explores the perceptions of satisfaction among women without social security regarding the PC provided by public health services, and compares the dimensions of satisfaction between those who received group prenatal care (GPC) and those who received individual prenatal care (IPC), as well as to identify the dimensions of satisfaction most valued by women to support the inclusion of said dimensions in primary health guidelines. Design: We performed a qualitative analysis to explore women’s satisfaction perception regarding PC. Satisfaction was explored using the following dimensions: women-HP relationship, educational support, opportunity of PC, emotional support and perception of clinical procedures. Setting: The study was conducted between 2015 and 2018 across eight primary health facilities, from which four implemented IPC and four implemented GPC. Semi-structured interviews were applied: 28 for women with IPC and 18 for women with GPC. The sample size was defined by theoretical saturation. Content analysis was performed using a combination of deductive–inductive process into dimensions and attributes. To analyse the relationship among dimensions and attributes, we performed onto semiotic networks. ATLAS.ti was used to analyse the information. Participants: Women without social security who received PC care in public health facilities. Results: Women who received GPC reported higher satisfaction than those who received IPC. In GPC, the most valued dimensions were (1) women-HP relationship, particularly the continuity of care delivered by the same HP and (2) the trust in that same provider. According to semiotic networks, these dimensions showed interconnections with each other, but also connected with attributes of other dimensions. Therefore, they have the potential to enhance trust, communication, the effectiveness of educational activities and emotional support. Conclusion: A holistic approach to GPC is essential for ensuring a positive prenatal experience. However, a hybrid model that incorporates elements of both IPC can further enhance overall satisfaction among women. Consistency in care, particularly by providing services in public health facilities with the same HP, should be a fundamental strategy in PC, as it can significantly improve women’s satisfaction.

This qualitative study explored provider perspectives on self-managed abortion (SMA) in India, their roles, and how they share information about pathways to both clinician- and self-managed abortion care. We conducted 33 semi-structured interviews with a range of providers (medical, community health, and pharmacy) in three states in India: Jharkhand, Bihar, and Tamil Nadu. Using thematic analysis, we examined provider perspectives on SMA, their involvement in abortion care, and how they contribute to information-sharing around access pathways. We categorised findings by provider type, direction of care pathways, abortion modality (clinician-managed vs. SMA), and the kind of care delivered. Our findings showed most providers described abortion as conditionally acceptable and primarily encouraged clinician-managed care. Concerns about SMA safety and potential liability often led them to discourage SMA. Nonetheless, participants acknowledged three areas where providers played a role in SMA: providing information, dispensing medication, and providing support (i.e., managing pain). Pharmacy workers and local providers shared information with abortion seekers on pathways to access SMA care. Some community health workers directed clients to pharmacies, but more often only provided SMA information and support. Despite provider concerns, support for and pathways to SMA exist in India. Understanding the dynamics of provider perspectives and roles can inform improvements to comprehensive reproductive health policies and programmes in order to promote person-centred abortion care - including SMA - and address provider concerns. Synergies are needed between the formal health sector and SMA support networks to advance person experiences and reinforce quality abortion care as a human right.