一项在美国寻求医疗机构服务的人群中考察自行人工流产意向的横断面研究。
A cross-sectional study examining consideration of self-managed abortion among people seeking facility-based care in the United States.
机构信息
Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612, USA.
出版信息
Reprod Health. 2022 Aug 12;19(1):176. doi: 10.1186/s12978-022-01486-8.
INTRODUCTION
With increasing restrictions on abortion across the United States, we sought to understand whether people seeking abortion would consider ending their pregnancy on their own if unable to access a facility-based abortion.
METHODS
From January to June 2019, we surveyed patients seeking abortion at 4 facilities in 3 US states. We explored consideration of self-managed abortion (SMA) using responses to the question: "Would you consider ending this pregnancy on your own if you are unable to obtain care at a health care facility?" We used multivariable Poisson regression to assess associations between individual sociodemographic, pregnancy and care-seeking characteristics and prevalence of considering SMA. In bivariate Poisson models, we also explored whether consideration of SMA differed by specific obstacles to abortion care.
RESULTS
One-third (34%) of 741 participants indicated they would definitely or probably consider ending the pregnancy on their own if unable to obtain care at a facility. Consideration of SMA was higher among those who reported no health insurance (adjusted prevalence ratio [aPR] = 1.66; 95% Confidence Interval [CI] 1.12-2.44), described the pregnancy as unintended (aPR = 1.53; 95% CI 1.08-2.16), were seeking abortion due to concerns about their own physical or mental health (aPR = 1.50, 95% CI 1.02, 2.20), or experienced obstacles that delayed their abortion care seeking (aPR = 2.26, 95% CI 1.49, 3.40). Compared to those who would not consider SMA, participants who would consider SMA expressed higher difficulty finding an abortion facility (35 vs. 27%, p = 0.019), figuring out how to get to the clinic (29 vs 21%, p = 0.021) and needing multiple clinic visits (23 vs 17%, p = 0.044).
CONCLUSIONS
One in three people seeking facility-based abortion would consider SMA if unable to obtain abortion care at a facility. As abortion access becomes increasingly restricted in the US, SMA may become more common. Future research should continue to monitor people's consideration and use of SMA and ensure that they have access to safe and effective methods.
简介
随着美国对堕胎的限制越来越多，我们试图了解如果无法在医疗机构进行堕胎，寻求堕胎的人是否会考虑自行终止妊娠。
方法
2019 年 1 月至 6 月，我们对美国 3 个州的 4 家医疗机构的堕胎患者进行了调查。我们通过回答以下问题来探讨自行管理堕胎（SMA）的考虑因素：“如果您无法在医疗机构获得护理，您是否会考虑自行终止妊娠？”我们使用多变量泊松回归来评估个体社会人口统计学、妊娠和寻求护理特征与考虑 SMA 的流行率之间的关联。在双变量泊松模型中，我们还探讨了 SMA 的考虑是否因堕胎护理的具体障碍而有所不同。
结果
741 名参与者中有三分之一（34%）表示，如果无法在医疗机构获得护理，他们肯定或可能会考虑自行终止妊娠。在未投保（调整后流行率比 [aPR] = 1.66；95%置信区间 [CI] 1.12-2.44）、妊娠为非意愿（aPR = 1.53；95% CI 1.08-2.16）、因自身身心健康问题而寻求堕胎（aPR = 1.50；95% CI 1.02-2.20）或经历过延迟堕胎护理寻求的障碍（aPR = 2.26；95% CI 1.49-3.40）的参与者中，考虑 SMA 的比例更高。与不会考虑 SMA 的参与者相比，考虑 SMA 的参与者表示寻找堕胎机构的难度更大（35% vs. 27%，p=0.019）、了解如何前往诊所的难度更大（29% vs. 21%，p=0.021），并且需要多次诊所就诊（23% vs. 17%，p=0.044）。
结论
在美国，寻求设施堕胎的人中，有三分之一如果无法在医疗机构获得堕胎护理，可能会考虑 SMA。随着美国堕胎机会的日益受限，SMA 的使用可能会变得更加普遍。未来的研究应继续监测人们对 SMA 的考虑和使用情况，并确保他们能够获得安全有效的方法。
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