Balancing enhanced contraceptive access with risk of reproductive injustice: A United States comparative case study.
| Title: | Balancing enhanced contraceptive access with risk of reproductive injustice: A United States comparative case study. |
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| Authors: | Moniz MH; University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, MI, United States; University of Michigan Program on Women's Healthcare Effectiveness Research (PWHER), Ann Arbor, MI, United States; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States. Electronic address: mmoniz@med.umich.edu.; Spector-Bagdady K; University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, MI, United States; University of Michigan Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI, United States.; Perritt JB; Physicians for Reproductive Health, New York, NY, United States.; Heisler M; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States; University of Michigan Department of Internal Medicine, Ann Arbor, MI, United States; University of Michigan School of Public Health, Ann Arbor, MI, United States.; Loder CM; University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, MI, United States.; Wetmore MK; University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, MI, United States.; Harris LH; University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, MI, United States; University of Michigan Department of Women's and Gender Studies, Ann Arbor, MI, United States. |
| Source: | Contraception [Contraception] 2022 Sep; Vol. 113, pp. 88-94. Date of Electronic Publication: 2022 Apr 16. |
| Publication Type: | Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: United States NLM ID: 0234361 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0518 (Electronic) Linking ISSN: 00107824 NLM ISO Abbreviation: Contraception Subsets: MEDLINE |
| Imprint Name(s): | Publication: New York : Elsevier; Original Publication: Los Altos, Calif., Geron-X. |
| MeSH Terms: | Long-Acting Reversible Contraception*; Contraception ; Contraceptive Agents ; Female ; Health Services Accessibility ; Humans ; Patient-Centered Care ; Reproduction ; United States |
| Abstract: | Objective: We aimed to examine how peripartum contraceptive care quality improvement efforts address or perpetuate reproductive health injustices.; Study Design: We conducted a comparative case study of inpatient postpartum contraceptive care implementation in 2017 to 2018, using key informant interviews at 11 United States hospitals. After our primary analysis revealed tensions between enhancing access to contraceptive care and patient-centeredness, we conducted the current inductive content analysis guided by 4 questions developed post-hoc: (1) What are healthcare workers' aspirations for contraceptive quality improvement programs? (2) What are healthcare workers' biases regarding peripartum contraceptive care delivery? (3) Do care delivery processes center patients' needs? (4) Do healthcare workers recognize and engage with structural inequities?; Results: Seventy-eight key informants (i.e., clinicians, operations staff, administrators) participated. In nine study sites, we observed evidence of interviewees both mitigating and perpetuating reproductive injustice. Many aspired to provide compassionate, patient-centered care, avoid paternalism, and foster patient autonomy. Simultaneously, interviewees demonstrated biases, including implicit subscription to an ideology of stratified reproduction, stereotyping, and "othering." Even when interviewees endorsed goals of patient-centeredness, care delivery processes sometimes prioritized healthcare systems' needs, and patients were not included on quality improvement teams. Many interviewees recognized structural inequities as driving health outcome disparities, yet relied on individual-level solutions like long-acting reversible contraception, and not structural-level interventions, to address them.; Conclusion: Alongside enthusiasm for delivering compassionate care exist biases, missed opportunities to center patients, and lack of curiosity about the appropriateness of solving structural-level problems with individual-level solutions.; Implications: Our findings call for individual and institutional self-reflection, partnership with patients and communities, and other intentional efforts to mitigate potential for harm in initiatives enhancing access to contraceptive care.; (Copyright © 2022. Published by Elsevier Inc.) |
| Grant Information: | K08 HS025465 United States HS AHRQ HHS |
| Contributed Indexing: | Keywords: Contraceptive counseling; Health disparities; Immediate postpartum LARC; Implementation science; Maternity care; Quality improvement; Reproductive justice; Shared decision-making; Stratified reproduction |
| Substance Nomenclature: | 0 (Contraceptive Agents) |
| Entry Date(s): | Date Created: 20220419 Date Completed: 20220815 Latest Revision: 20250728 |
| Update Code: | 20260130 |
| DOI: | 10.1016/j.contraception.2022.04.004 |
| PMID: | 35439531 |
| Database: | MEDLINE |
Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.