Background

Refugee women who leave their country due to persecution and violence have multiple barriers to sexual and reproductive health (SRH) services. The COVID-19 pandemic added an additional barrier to in-person reproductive health education, dialogue, and clinical care. This study aimed to assess the potential of using virtual group meetings as a forum for refugee women to learn about and discuss reproductive health concerns such as cervical cancer screening, family planning, childbirth, and postpartum care.

Method

We conducted semi-structured interviews with 36 refugee women and stakeholders to assess factors that impact refugee women's receptiveness for virtual platforms to obtain information and engage in discussions on reproductive health. Thematic analysis was conducted using the software Dedoose.

Results

Openness to engage in virtual platforms varied by refugee community, women's demographic, and life experience. The women's involvement with local refugee groups facilitated their engagement with virtual platforms. Furthermore, individuals' family structure and marital relationship, along with literacy and English proficiency, and access to and familiarity with technology impacted engagement. Virtual groups needed to mirror confidentiality and women expressed a strong preference that groups were all-women.

Conclusion

Refugee women are receptive to virtual groups on SRH when they are offered in a culturally appropriate manner that considers the living situations and access to technology after arrival to the USA. Findings from this study provide a framework to develop and tailor effective virtual or hybrid virtual-in-person programs for women in refugee communities.

Objective

We assessed the proportion of medication versus suction aspiration abortions before and after the onset of the COVID-19 pandemic in a health system that did not limit access to abortion.

Study design

We conducted an interrupted time series analysis among patients having an abortion at 10 weeks gestation or less at Planned Parenthood health centers in San Diego, Imperial, and Riverside Counties in California. Centers required in-person follow up for medication abortion throughout the pandemic. We compared the nine months prior to the pandemic (June 2019 to February 2020) to the first nine months of the pandemic (April 2020 to December 2020), with March 2020 as a washout period.

Results

There was an average monthly increase of 0.78% in the proportion of medication abortions from June 2019 to February 2020 (p = 0.01, pre-pandemic trend). Immediately following the start of the pandemic, there was an estimated increase in the proportion of medication abortions of 2.58% (p = 0.23, post-level change). However, the monthly pre-pandemic trend towards medication abortions reversed by 1.07% after the start of the pandemic (p = 0.02, post-trend change), for an average monthly decrease in the proportion of medication abortions of 0.29% from April to December 2020 (p = 0.37, pandemic trend).

Conclusions

The trend towards medication abortions that was present before the COVID-19 pandemic reversed after an initial increase in medication abortions at the start of the pandemic.

Implications

Both types of abortion should remain available during public health emergencies. Further research is needed to understand how the pandemic affected abortion methods in areas with limited access and in health centers that did not require two in-person appointments for medication abortions.

Background

Women taking teratogens may not receive teratogen and contraceptive counseling. The objective of this study is to explore the feasibility of an electronic medical record (EMR) alert and referral system to improve teratogen and contraceptive counseling.

Methods

We conducted a descriptive study in an academic outpatient setting to evaluate the feasibility of an EMR alert and referral system. Reproductive age women taking category D or X medications seen in family medicine clinics were referred by means of an EMR alert for teratogen and contraceptive counseling. A subset of these women consented to follow-up surveys assessing contraceptive usage before counseling, intended contraceptive method after counseling and satisfaction with the counseling. Participants were contacted at 1 and 3 months to assess contraceptive usage.

Results

A total of 354 women were prescribed category D or X medications by clinicians who received the EMR alert, 170 women were referred, 59 women received counseling, and 33 participants enrolled in the study. One participant did not use any contraception. Among the 32 participants using contraception, 12 (37.5%) used oral contraceptives, 11 (34.4%) used condoms, 3 (9.4%) used withdrawal, 3 (9.4%) used intrauterine devices, 2 (6.3%) used contraceptive rings, and 1 (3.1%) used the diaphragm. After counseling, one-third of participants were considering more effective contraception. Almost all participants strongly agreed or agreed that the counseling was helpful.

Conclusion

Creating an EMR alert and referral system for women prescribed category X or D medications is feasible. Counseling on teratogen exposure and contraception may improve the acceptability of more effective contraception.