1. HPV self-collection among unhoused patients
- Implementation of Human Papillomavirus self-collection and barriers to follow-up among unhoused individuals in Texas in Obstetrics and Gynecology
Human papillomavirus (HPV) causes almost all cervical cancer, and while HPV vaccination and screening have successfully reduced cancer rates, barriers remain. Healthcare inequality profoundly affects unhoused individuals. Cervical cancer screening rates are only about 19% among unhoused individuals due to barriers like cost, transportation, and stigma. In 2024, the US Food and Drug Administration (FDA) approved primary HPV testing, including self-collection, creating an opportunity for expanded access to screening services. This study, based out of the MD Anderson Cancer Center in Texas, evaluated the feasibility of self-collected HPV testing and follow-up for unhoused people. 87 subjects were enrolled and provided samples. The authors found that self-collection was acceptable to subjects, but follow-up for abnormal results was extremely difficult: participants lacked reliable contact methods, transportation, and ability to navigate scheduling. While this study demonstrates the usefulness of self-screening in a medically underserved population, it also highlights an ongoing need for resources and support for unhoused individuals. Without improved patient navigation support, HPV self-screening would fail to be a meaningful tool for addressing health disparities among unhoused individuals.
2. Updated breast cancer screening recommendations
- Recommendations from the women’s preventive services initiative on breast cancer screening for women at average risk and patient navigation services for breast and cervical cancer screening in Obstetrics and Gynecology
The Women’s Preventive Services Initiative (WPSI) is a national coalition of healthcare organizations and other experts in reproductive healthcare that maintains up to date recommendations for preventive services for female-bodied individuals. This updated document builds on prior recommendations that females of average risk should initiate breast cancer screening between ages 40-50 and continue through age 74. The guidance now includes a specific algorithm for additional imaging and/or pathology evaluation when abnormal findings are noted. Furthermore, after reviewing extensive published literature, the WPSI also recommends creating patient navigation services for the breast cancer screening process, which have been shown to improve screening rates by addressing barriers like transportation, language, or need for reminders. Ideally, these services should be insurance-covered with minimal copays. The aim: more equitable access to breast and cervical cancer screening.
3. Clinician confidence about adolescent abortion access
- Navigating a new frontier: An exploratory study of clinicians’ confidence in their ability to help adolescents access abortion post-Dobbs in Contraception
Pregnant adolescents and young adults face numerous barriers to abortion access, which have only worsened after Dobbs v Jackson in 2022. While many of these barriers, like parental consent laws and later pregnancy recognition are well-established, less is known about how this population receives information about abortion from their health care providers. In a survey of 188 clinicians caring for adolescents, a minority reported high confidence in referring adolescents for abortion care, and this confidence was lower for clinicians living in a state with post-Dobbs restrictions. Results point to significant abortion knowledge gaps for clinicians to care for adolescents and underscore the need for provider education on adolescent abortion access.
4. Asynchronous medication abortion care
- “On my own time”: A qualitative exploration of patient experiences receiving asynchronous medication abortion care in the United States, 2022-2023 in Contraception
- Provision of abortion medications using online asynchronous telemedicine under shield laws in the US in JAMA
Medication abortion is a safe and common form of abortion care, and can be provided safely and appropriately through either traditional in-person appointments or telemedicine. Patient may have the option for either synchronous visits, where they communicate with the dispensing provider in real time over video, telephone, or chat, or asynchronous visits, where a request is evaluated by a provider at a later time before dispensing. Asynchronous provision is a relatively new model of medication abortion care, and may affect both access as well as patients’ experiences and satisfaction with abortion care.
In Aiken et al, the authors analyzed 15 months of recent usage data from Aid Access, a nonprofit asynchronous telemedicine service that utilizes shield laws to provide abortion medications to patients in all 50 states and the District of Columbia. Among more than 118,000 medication abortions, they found that 84% were to patients in restrictive states and even in non-ban states, provision was higher in counties with poverty or long distances to clinics. The authors conclude that asynchronous telemedicine abortion represents an important tool in reducing unsafe abortions and reducing access disparities in both restrictive and less restrictive US states.
Patients’ perception of and satisfaction with asynchronous telemedicine abortion care may also differ in important ways from traditional care models. Gingras et al. interviewed 18 patients who had asynchronous care. In their interviews, all respondents reported they would recommend it and use it again if needed, citing convenience, privacy, and autonomy. However, participants also highlighted the need for additional information and anticipatory guidance, and suggested the inclusion of sooner follow-up and the option of in-person support. The authors discuss that asynchronous telemedicine medication abortion can provide an important and desirable option for patients seeking abortion care, but that providers and care models must provide adequate support for patients choosing this model.
Together, these studies show asynchronous telemedicine abortion is both effective and appealing, but needs stronger patient support systems.
5. In-clinic option for deep implant removals
- Patient cost savings with introduction of office-based ultrasonography for removal of deep or nonpalpable contraceptive implants: A case series in European Journal of Obstetrics and Gynecology and Reproductive Biology
Contraceptive implants such as Nexplanon provide safe, reversible, and highly effective birth control, and can typically be safely placed and removed after a short training by a variety of physicians and advanced practice providers. Removal, however, can be significantly more complex if an implant is not palpable at the time of removal. In this case series of 12 patients with non-palpable or deep contraceptive implants, the authors attempted same-day ultrasound localization of the implants and removal if identified. 11 of 12 patients had successful ultrasound-guided removal in the clinic, and one was referred for fluoroscopy-guided removal with Interventional Radiology (IR). In their cost analyses, the authors determined that same-day ultrasound guided removal instead of immediate IR referral represented a savings of approximately $2200 in out-of-pocket costs to the patient. The authors conclude that a skilled provider and appropriate ultrasound technology can provide patients with safe and convenient deep implant removal while also providing significant healthcare cost savings.
6. Younger patients and permanent contraception
- Experience of nulliparous patients aged <30 years seeking permanent female contraception: A qualitative study in Contraception
Contraceptive implants such as Nexplanon provide safe, reversible, and highly effective birth control, and can typically be safely placed and removed after a short training by a variety of physicians and advanced practice providers. Removal, however, can be significantly more complex if an implant is not palpable at the time of removal. In this case series of 12 patients with non-palpable or deep contraceptive implants, the authors attempted same-day ultrasound localization of the implants and removal if identified. 11 of 12 patients had successful ultrasound-guided removal in the clinic, and one was referred for fluoroscopy-guided removal with Interventional Radiology (IR). In their cost analyses, the authors determined that same-day ultrasound guided removal instead of immediate IR referral represented a savings of approximately $2200 in out-of-pocket costs to the patient. The authors conclude that a skilled provider and appropriate ultrasound technology can provide patients with safe and convenient deep implant removal while also providing significant healthcare cost savings.
7. Telehealth and medication abortion pre- and post Dobbs
- Demand for medication abortion through telehealth before and after the Dobbs v. Jackson Supreme Court decision in states where abortion is legal in Women’s Health Issues
Modern medication abortion has been increasing in popularity since the FDA approval of mifepristone in 2000 and now makes up the majority of abortions in the US. Telehealth provision has expanded access across the United States. Despite the implementation of total or near total abortion bans in many US states after Dobbs, patients in all states continued to pursue telemedicine medication abortion. In this cross-sectional study of more than 6000 patients in abortion-protective states, the authors found an overall increase in daily demand of 74% for telehealth abortion after the Dobbs decision, with an even larger increase (88%) in those states with fewer abortion protections. Patients highlighted the privacy and comfort of telemedicine medication abortion, as well as increased concern about legal issues after the Dobbs decision. The authors discuss that the Dobbs decision had a complex impact on abortion care patterns in the US, even in currently abortion-protective states, and stress the need for continued investment in telehealth infrastructure.
8. Birth control decision-making during and after pregnancy
- Fluidity in contraceptive decision-making throughout pregnancy and the postpartum period among patients at an urban county hospital in Ohio in Contraception
Limited evidence suggests that patients’ preferences for postpartum contraception will shift multiple times during pregnancy and postpartum as priorities and needs evolve. This prospective study followed 123 patients during pregnancy and postpartum, administering surveys at five different time points, from the first trimester until the postpartum visit. Surveys assessed patients’ contraceptive history, priorities, experiences with counseling, and methods that they were considering. While a minority of patients completed all five surveys, the authors were still able to determine that the study participants experienced numerous shifts in their priorities and preferences, most notably between delivery and their postpartum visit. Furthermore, contraceptive priorities did not always align with participants’ chosen methods (for example, patients desiring methods with high efficacy who ultimately decided not to use contraception), highlighting the complexity and nuance of this decision. Overall, this study suggests that pregnant individuals may benefit from contraceptive counseling at multiple time points, allowing them to ask questions and modify their plans throughout pregnancy. Understanding these nuances may be helpful for providers who care for pregnant people.
9. Contraceptive experiences and disability
- Differences in contraceptive method discontinuation and contraceptive method preferences by disability status in Women’s Health Issues
Disabled individuals have historically faced reproductive discrimination, including forced sterilization. Furthermore, healthcare providers may make ableist assumptions about disabled people, imagining that they are not sexually active or do not have specific preferences about contraception and childbearing. The authors of this study performed an analysis of survey data to assess the differences in contraceptive experiences between disabled and non-disabled people. Almost 20% of reproductive-aged females identified as disabled in the study sample, and most were sexually active. Disabled respondents were more dissatisfied with methods than non-disabled peers, and reported unmet contraceptive needs. Results point to ongoing inequities in reproductive healthcare and highlight the need for provider education to counter ableist assumptions and ensure equitable contraceptive access.