Biggs M Antonia, Ralph Lauren, Ehrenreich Katherine, Kaller Shelly, Blanchard Kelly, Hauser Deb, Kapp Nathalie, Kromenaker Tammi, Moayedi Ghazaleh, Perritt Jamila, Raymond Elizabeth, White Kari, Grossman Daniel
Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, California, USA.
Ibis Reproductive Health, Cambridge, Massachusetts, USA.
Health Equity. 2025 Mar 26;9(1):189-200. doi: 10.1089/heq.2024.0128. eCollection 2025.
To explore disparities in ineligibility for medication abortion using no-test screening criteria compared with assessment with testing including ultrasound.
From June 2021 to December 2022, we surveyed patients ages ≥15 seeking abortion at nine recruitment facilities in eight U.S. states before ultrasound; clinicians assessed patients' eligibility for medication abortion with ultrasound and other testing. Using clinical guidelines and the no-test protocol criteria, we estimated (1) the proportion ineligible by no-test assessment (pregnancy duration and ectopic pregnancy risk factors as reported in patient surveys and clinician-reported assessment of other contraindications) and (2) the proportion ineligible using no-test criteria yet eligible with testing (false positives). We assessed associations between participant characteristics and ineligibility for medication abortion and reasons for ineligibility.
We approached 2,846 people, of whom 1,591 were eligible for the study. Of the 1,386 who consented and had complete clinician data, 21.1% (306/1,386) were ineligible with testing, 71.5% ( = 991/1,386) were ineligible using no-test criteria, and 51.4% ( = 713/1,386) screened false positive. In adjusted analyses, ineligibility using no-test criteria was significantly greater among people ages 15-19 (86.8% [105/121] vs. 71.5% for full sample, < 0.001) and experiencing food or housing insecurity (75.8% [525/690] vs. 67.2%[464/693], < 0.01); people ages 20-24 were more likely to screen false positive (56.1% [263/469] vs. 51.4% for full sample [713/1,386], = 0.03). Moderate/severe pelvic pain was the most common (614/1,386) patient-reported reason for ineligibility and reported significantly more by people ages 15-19, who were nulliparous, and experienced food or housing insecurity.
Screening criteria for no-test medication abortion may exclude many people who are eligible, disproportionately excluding certain population groups from getting the care they seek. More research is needed to improve screening criteria to ensure equitable access to no-test medication abortion.
探讨与包括超声检查在内的检测评估相比，使用无需检测的筛查标准进行药物流产不符合条件的差异。
2021年6月至2022年12月，我们在美国8个州的9个招募机构对年龄≥15岁寻求堕胎的患者进行了超声检查前的调查；临床医生通过超声检查和其他检测评估患者进行药物流产的资格。根据临床指南和无需检测的方案标准，我们估计了（1）无需检测评估不符合条件的比例（根据患者调查中报告的怀孕时长和异位妊娠风险因素以及临床医生报告的其他禁忌症评估）以及（2）使用无需检测标准不符合条件但通过检测符合条件的比例（假阳性）。我们评估了参与者特征与药物流产不符合条件之间的关联以及不符合条件的原因。
我们接触了2846人，其中1591人符合研究条件。在1386名同意并拥有完整临床医生数据的人中，21.1%（306/1386）通过检测不符合条件，71.5%（=991/1386）使用无需检测的标准不符合条件，51.4%（=713/1386）筛查为假阳性。在调整分析中，15至19岁的人群（86.8%[105/121]，而全样本为71.5%，P<0.001）以及经历粮食或住房不安全的人群（75.8%[525/690]，而全样本为67.2%[464/693]，P<0.01）使用无需检测标准不符合条件的比例显著更高；20至24岁的人群更有可能筛查为假阳性（56.1%[263/469]，而全样本为51.4%[713/1386]，P=0.03）。中度/重度盆腔疼痛是患者报告的最常见的不符合条件的原因（614/1386），15至19岁、未生育以及经历粮食或住房不安全的人群报告的比例显著更高。
无需检测的药物流产筛查标准可能会排除许多符合条件的人，某些人群被不成比例地排除在他们所寻求的护理之外。需要更多研究来改进筛查标准，以确保公平获得无需检测的药物流产服务。
