Elizabeth A. Mosley

Objectives: High-quality contraceptive counseling has been associated with increased contraceptive method satisfaction. We aimed to assess this relationship in the postpartum period and to investigate practical aspects of counseling underlying this association. Study Design: We used data from 219 pregnant individuals aged 21–44 years contemplating tubal sterilization who were recruited to a randomized trial assessing the efficacy of the MyDecision/MiDecisión decision aid. Three months postpartum, participants rated their satisfaction with their chosen contraceptive method and their perception of contraceptive counseling encounter quality on Likert scales. Counseling quality domains included provider demonstration of respect, explanation of methods, pressure toward a method, and response to questions, as well as subjective counseling satisfaction. We used logistic regression analyses to assess the relationship between optimal counseling (both overall and in each domain) and optimal contraceptive method satisfaction, adjusting for randomization arm and demographic covariates significant in bivariate analysis. Results: Participants had a mean (SD) age of 30 (5) years; 42% identified as non-Hispanic White, 25% as non-Hispanic Black, and 26% as Hispanic. Approximately one-third of participants (37%) had a tubal sterilization by study follow-up; 11% reported using no method of contraception. Many participants reported optimal contraceptive counseling (61%) and optimal method satisfaction (65%). Optimal counseling was associated with higher odds of optimal method satisfaction (aOR 1.88, 95% CI 1.03–3.46, p = 0.04). This relationship was sustained across all individual counseling quality domains. Conclusions: Patient-perceived provider demonstration of respect, discussion of contraceptive pros and cons, avoidance of pressure, and answering questions were associated with postpartum contraceptive method satisfaction.

Background: The Dobbs v. Jackson Supreme Court decision overturned Roe v. Wade and federal abortion protections, resulting in nearly half of U.S. states banning or significantly restricting abortion. Qualitative data are needed to understand how abortion restrictions influence pregnancy perceptions and experiences. Objectives: This study describes pregnancy perceptions and experiences before and after Dobbs , across states with abortion restrictions and protections, and across individual-level differences in income and age. Design and Methods: We conducted in-depth interviews with people during pregnancy ( n = 31, 28 pre- Dobbs ) and a subset of those individuals again during the postpregnancy period ( n = 14, all post- Dobbs ) from October 2021 to August 2023. All interviews were recorded, transcribed, concept mapped, and coded using MAXQDA 2022. We also conducted across-group comparisons by state abortion policy, income, and age. Results: Before Dobbs , participants described how abortion accessibility was already compromised in some states. After abortion was banned in restrictive states, participants described feeling dehumanized, criminalized, that their reproductive autonomy was constrained, and that pregnancy carried real risks to their lives. In protective states, participants were grateful they had abortion access but lacked awareness and knowledge about abortion access in other states. Participants explained that Dobbs and abortion restrictions are harming perinatal wellbeing, even for wanted pregnancies. Group comparisons demonstrated that lower income and younger people described greater impacts related to abortion availability. Conclusion: Post- Dobbs abortion restrictions are negatively impacting the mental and physical well-being of pregnant people, even those with wanted pregnancies. Dobbs could exacerbate existing health inequities for younger and lower-income people.

Sexual and reproductive health (SRH) research, programming, policy, and services have long relied on the narrow paradigm of “pregnancy intendedness and planning,” including its “unintended pregnancy” measure. This framework is limited and problematic, overlooking diverse perspectives on pregnancy, structural factors, and non‐parenting outcomes such as abortion and adoption. In response, we developed the Self‐Assessed Pregnancy Acceptability (SAPA) framework and measure as a person‐centered alternative. The SAPA framework was developed by centering the lived experiences of pregnant people in Texas, Tennessee, Pennsylvania, and California through baseline interviews shortly after pregnancy confirmation (N = 31) and follow‐up post‐pregnancy interviews (N = 14). Development was also informed by a diverse Expert Panel (N = 19) including reproductive justice leaders, reproductive measurement experts, and lived experience experts. Using cognitive interviews (N = 13), we refined an 11‐item measure of SAPA that is currently being validated in a nationwide sample of nearly 600 people in early pregnancy. Following validation, SAPA could be integrated into national and state‐level epidemiological surveillance surveys such as the National Survey of Family Growth and the Pregnancy Risk Assessment Monitoring System. This novel framework and measure offer an alternative to unintended pregnancy and contribute to an ecosystem of person‐centered, rigorously developed measures of SRH equity.

Pregnancy ambivalence is increasingly recognized and studied in sexual and reproductive health research, yet its associations with adverse outcomes remain unclear. The purpose of this paper was to explore different measures of ambivalence and whether any were associated with poor pregnancy, birth, social or mental health outcomes. A cross‐sectional survey was conducted with 1941 individuals assigned female at birth, ages 18–45, who had been pregnant in the past 2 years. Ambivalence measures included the London Measure of Unplanned Pregnancy (LMUP) and additional questions exploring mixed feelings, uncertainty, incongruent feelings, and fatalistic beliefs about pregnancy planning. No associations were observed between ambivalence and birth/neonatal outcomes, though ambivalence measures were linked to delayed prenatal care, exposure to harmful behaviors during pregnancy, and increased odds of depression, anxiety, and intimate partner violence. Mental health assessments and intimate partner violence screening could improve care delivery and outcomes more than screening for pregnancy ambivalence. The LMUP, which captures multiple dimensions of ambivalence as well as addresses the deficiencies with traditional measures of behavior, may be the strongest measure to use when needing to comprehensively measure pregnancy ambivalence.

The Food and Drug Administration proposed “patient medication information” inserts for all medications, including the abortion drug Mifepristone. It is unclear how abortion attitudes or state policies affect how people evaluate such communications. Participants ( n = 311) were randomized to view variants of the Mifepristone insert. Linear regression was used to assess abortion attitudes’ and policies’ relationships with comprehension and perceived evidence strength, safety, and effectiveness. Interaction terms were constructed to assess moderation of those relationships. Abortion policies were unrelated to comprehension, perceived evidence strength, or perceived effectiveness, but abortion bans at or before 6 weeks were associated with lower perceived safety. Attitudes were not associated with comprehension, but participants with positive attitudes rated the evidence as stronger and the drug as safer. Abortion attitudes moderated the effect of randomized group on perceived safety. The informational inserts communicate well across abortion policy environments (except perceived safety where abortion is banned at or before 6 weeks), yet negative abortion attitudes affected perceptions of evidence strength and drug safety.

Background: Maternal morbidity and mortality in the United States—and disparities therein—are significant and growing public health crises. Doulas (nonclinical perinatal support professionals) could be part of the solution, but there are significant barriers to health care in rural areas. Methods: This study examines the facilitators and barriers rural communities face in accessing doulas and ideas for expanding doula work in rural communities. As part of a larger-mixed methods, community-engaged project on full-spectrum doula care in Georgia, this study surveyed and interviewed doulas in Georgia from June 2022 to January 2023. We conducted descriptive statistics and thematically analyzed the transcripts using memoing, coding, and group discussion. Results: We surveyed and interviewed 22 doulas, 17 of whom serve rural clients including 7 who reported over 20% of their clientele are rural. Our main findings included (1) significant perinatal and social service gaps in rural areas, (2) rural poverty that impedes perinatal options, including doula access, (3) long distances between doulas, rural clients, and health care, and (4) childbirth education disparities, resulting in knowledge gaps that doulas could fill. Discussion: These results are relevant to national maternal health equity efforts in rural communities and can inform policies, programs, and future research including Medicaid reimbursement, doula training, and community-engaged research with doulas.