搜索结果：Perspectives on sexual and reproductive health

Pregnancy rates among adolescents and young people in South Africa remain high despite the widespread availability of sexual and reproductive health information and contraception being free of charge. Knowledge gaps, misconceptions, and insufficient attention to youth voices are critical barriers to informed decision-making. Support for adolescents and young people is often negatively framed, focusing on sexual abstinence before marriage. This paper explores youth perspectives on sexual and reproductive health information and support. It also examines gaps in contraceptive knowledge, providing insights for public health programmes and interventions. Findings highlight significant gaps in contraceptive knowledge, which contribute to low uptake. The quality and nature of relationships between young people and adults also shapes the support and information provided. For adolescents and young people, trust and feeling understood impact whether adults are perceived as valuable sources of information. Suitable interventions include the creation of safe support spaces for adolescents and young people to develop sexual and reproductive health knowledge and communication skills, access accurate information, and address socioeconomic constraints.

Researchers have done limited empirical work to explore how healthcare providers are claiming conscientious objection to abortion care in Australia. Without this research, we cannot assess if existing mechanisms to regulate conscientious objection meet the needs of abortion seekers, abortion providers, and healthcare providers who conscientiously object to abortion care. We conducted semi-structured interviews with 41 interest-holders (including healthcare providers who provided or conscientiously objected to abortion care) across Australia about conscientious objection to abortion care and its regulation. We analyzed the data using framework analysis. We identified four themes describing how healthcare providers were claiming conscientious objection to abortion care. First, claims existed on a spectrum from "partial provision" to "refusal without referral." When healthcare providers refused to provide an abortion, they did not always refer the abortion seeker to a willing provider or service. Second, claims of conscientious objection could change over time. Third, the relationship between religion and conscientious objection was not necessarily direct. Finally, some healthcare providers refused to provide abortion for reasons other than conscience. The findings demonstrated that conscientious objection provisions provided a flexible mechanism for healthcare providers to opt-out of providing abortion care at different times, in different contexts, and for different reasons (including reasons other than conscience). Education and guidelines may improve healthcare providers' understandings and interpretations of conscientious objection provisions. Destigmatizing interventions may also reduce the number of healthcare providers who refuse to participate in abortion care for conscience-based and non-conscience-based reasons.

Parent-based sexual education interventions have a positive impact on adolescent sexual and reproductive health. However, despite these positive outcomes, there is a lack of comprehensive research to understand the effectiveness of these programs across different communities and demographics. We conducted a systematic search of databases from January 2013 to April 2023 and identified 51 published studies conducted globally on the effects of parent-based sexual education. We conducted meta-analyses to understand the pooled effect of interventions on parent-adolescent communication outcomes and adolescent sexual and reproductive behaviors. This review includes 51 studies. Most of the included studies (n = 36, 68.6%) were conducted in high-income countries; 17 (33.3%) involved only mothers, and 37 (72.5%) stated they were based on theoretical frameworks. The systematic review showed that interventions on sexual communication had mixed effects on parent and adolescent-related outcomes. The meta-analysis, however, showed positive effects on parent-reported sexual health communication frequency, adolescent-reported sexual health communication frequency, parental attitude, and parental self-efficacy, Cohen's d = 0.32, 0.26, 0.38, and 0.41, respectively. Parent-based sexual health education interventions positively impact various aspects of parent-adolescent sexual health communication and behavior, suggesting the effectiveness of the intervention in different social, cultural, and economic contexts. The lack of research in low- and middle-income nations and limited paternal participation highlights the need for further research.

The United States (US) federal Title X program provides funding for affordable and accessible family planning and sexual health services through competitive grant funding across US jurisdictions. In 2022, non-profit clinic network Converge: Partners in Access became the sole Title X grantee in the state of Mississippi. Converge developed a strategic evaluation plan to ensure efficient utilization and high-quality provision of care by eligible state residents. The study purpose is to determine the implementation climate of the Title X clinic network, including service utilization, quality improvement opportunities and challenges, and potential patients' awareness of and experience with receiving Title X-funded services. The study utilized in-depth, semi-structured phone and in-person interviews conducted between January 2023 and May 2023 with clinic staff, administrators, providers, and potential patients to assess implementation climate, challenges in healthcare provision, and opportunities to improve Title X utilization by eligible state residents. Researchers conducted 22 interviews with clinic staff and health care providers and 16 with potential patients. Clinic-based participants indicated the use of evidence-based practices in their respective settings-a key component of the Title X program. However, challenges to implementation were identified including understaffing, high staff turnover, difficulties with reporting and documentation, competing priorities for patients, and differences in capacity based on clinic characteristics. Potential patients identified the need for person-centered approaches to care and increased awareness and availability of Title X services in their communities. Results from this study can inform strategies to improve service utilization by potential patients and the quality of care for Title X funded networked clinics in Mississippi. Improving the delivery of care and service utilization can ultimately better meet the reproductive and sexual health needs of patients served through the Title X funded system.

Healthcare providers play a vital role in promoting comprehensive, sex-positive sexual health care. In the United States (US), patient-provider communication frameworks for sexual health predominantly rely on collecting the sexual health history. The most notable framework, the US Centers for Disease Control and Prevention's 5 Ps framework, emphasizes how an individual's current and past behaviors can predict a client's susceptibility to poor sexual health outcomes. However, this behavior centric approach has the capacity to introduce bias, stigma, and shame, potentially hindering effective communication and preventative care. The National Coalition for Sexual Health's 6 Ps framework introduced "Plus" to include sexual satisfaction as an integral part of sexual health communication. Building on these existing frameworks, we developed an expanded model designed to reorient providers toward a paradigm that fosters more inclusive and affirming sexual health discussions, improves patient-provider communication and connection, and acknowledges the broader social and structural determinants that shape sexual well-being and vulnerability to human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). We propose an expanded 8 Ps sexual health history that introduces "Proximity," which refers to the influence of one's living and sexual environment, and "Perspectives," highlighting how personal beliefs fundamentally shape behaviors. Fortifying the sexual health discussions between providers and patients with non-behavioral context, such as geographical determinants of health and understanding of sexual health in general, that increase vulnerability to HIV and other STIs can begin to address the limitations in the prior frameworks.

Experiences of gender-based discrimination against transgender and nonbinary people and racial discrimination against people of color in sexual healthcare settings serve as significant barriers to care. However, the sexual healthcare experiences of transgender young adults of color (TNYAC), who face intersecting forms of discrimination, are poorly understood. We conducted a qualitative analysis of semi-structured interviews (n = 20) with TNYAC ages 20-30 years, residing across the United States. Interviews, conducted via Zoom from September 2021 to January 2022, focused on recent sexual healthcare experiences and potential discrimination based on gender or race. Researchers double-coded and, guided by intersectionality theory, analyzed transcripts using thematic analysis. Among 20 interviewees with diverse racial/ethnic identities (Black, Latine, Asian-American and Pacific Islander, and multiracial), we identified several themes. Participants described how interpersonal and systemic interactions related to their gender and race determined their sexual healthcare experiences, specifically experiences of gender discrimination, racial stereotyping, and racial segregation. Importantly, participants noted ways their sexual healthcare experiences were shaped by intersecting systems of both racial and gender oppression. Lastly, participants developed identity-affirming protective strategies to navigate discrimination, such as independent information seeking or choosing providers with shared gender and/or racial identities. The use of protective strategies in response to racial and gender discrimination in sexual healthcare highlights both the resilience of TNYAC and the need for equitable and inclusive healthcare services. Healthcare providers and practices can implement interventions like cultural humility training and co-located services to improve care for those who experience multiple forms of oppression.

Population estimates of the prevalence of intimate partner violence (IPV) victimization and perpetration are limited for sexual minorities in mid-adulthood. We examined IPV prevalence estimates, and associations between sexual orientation and self-reported physical and sexual IPV experiences among 10,812 respondents ages 33-43 years who were in a current relationship and participated in Wave V of the National Longitudinal Study of Adolescent to Adult Health, a population-based US study. We conducted sex-stratified logistic regressions to model associations between sexual orientation and IPV, adjusted for age, race/ethnicity, highest educational attainment, and household income as percent of federal poverty level. Ninety one percent of men and 80% of women self-identified as heterosexual. Prevalence ratios indicated greater victimization and perpetration among male and female sexual minorities compared to heterosexuals. In adjusted regression models, sexual minority men had higher odds of physical perpetration (AOR = 1.8) than heterosexuals. Among women, sexual minorities had higher odds of physical and sexual victimization (AORs = 1.8 and 1.8, respectively) than heterosexual females, and higher odds of physical perpetration (AOR = 1.9). Even into mid-adulthood, sexually minoritized groups have a disproportionate likelihood of experiencing both IPV perpetration and victimization compared to heterosexual peers. More work is needed to understand and address sources of these disparities.

Access to sexual and reproductive health care has been a critical issue affecting public health outcomes, particularly for the youth population. This project identified common barriers to accessing sexual and reproductive health care for youth in rural areas and applied multiple educational and clinical interventions that helped enhance access to care. We designed a three-year-long program at Finger Lakes Community Health (FLCH) in rural upstate New York that involved youth, their parents or caregivers, educators, and medical professionals to improve youth access to care. Using results from a survey with 1155 youth participants to determine the barriers to care, we designed the program to overcome the fear of seeking help, basic facts ignorance, transportation issues, parental opposition, and financial issues. We implemented multiple interventions, including providing adequate education and school services, ensuring privacy and confidentiality, changing work hours, establishing phone and online services, facilitating transportation, and reducing cost barriers. The results were dramatic. Sexual and reproductive health visits to FLCH from youth in the region increased significantly from 280 in 2017 to 1100 in 2019. Even during the COVID-19 pandemic, when the number of visits slightly decreased, visits were still better than before 2018. In 2023, the number of reproductive health visits was 990, which is 3.5 times the visits in 2017. This study emphasizes the substantial role that tailored interventions can play in enhancing reproductive health access for youth in rural areas, significantly promoting healthcare equity and service utilization. These interventions reduce healthcare use inequities and foster potential improved public health outcomes. While our study did not directly measure clinical outcomes, the substantial increase in utilization represents an important step toward achieving them and underscores the need for further research to evaluate resulting health outcomes.

Current understanding of reproductive health content in medical school curricula is limited. This study explores abortion education offerings of osteopathic medical students (OMS) in the United States (US). After successfully completing their training, OMS receive a doctorate in osteopathic medicine (DO) rather than a Doctor of Medicine (MD). An increasing number of students are receiving DO medical education. We developed and distributed a 19-item survey to OMS through social media and research offices at all US osteopathic medical schools. We used descriptive statistics and logistic regression models to analyze the data. Our survey resulted in 256 responses from 37 institutions (43% preclinical, n&#x2009;=&#x2009;108; 57% clinical, n&#x2009;=&#x2009;143). Approximately 72.1% of respondents (n&#x2009;=&#x2009;137) were attending medical school in a state with limitations on abortion access. Over half (52.4%, n&#x2009;=&#x2009;108) of respondents indicated their school was delivering abortion and/or contraception curriculum, with fewer schools having optional training (20%, n&#x2009;=&#x2009;42) or no educational offerings (27%, n&#x2009;=&#x2009;56). Of schools offering abortion education, the most frequent content included "both abortion and contraception education" (79.2%, n&#x2009;=&#x2009;80); fewer reported "contraception education only" (17.8%, n&#x2009;=&#x2009;18) or "abortion education only" (3%, n&#x2009;=&#x2009;3) content. Half of respondents with optional abortion education participated, while 40.5% (n&#x2009;=&#x2009;17) opted out. The most frequently reported time dedicated to abortion education was <&#x2009;59&#x2009;min (39.9%, n&#x2009;=&#x2009;75). Clinical students were significantly more satisfied (p&#x2009;=&#x2009;0.0458) with the time allotted to abortion content and perceived ability (p&#x2009;=&#x2009;0.0256) to provide patient education on abortion. Clinical students reported significantly increased satisfaction with abortion education received during their training as compared to preclinical students. Despite the majority supporting abortion education, most OMS received less than 1&#x2009;h of dedicated instruction highlighting expansion opportunities.

Evidence suggests that symptoms of endometriosis related to sexual dysfunction can disrupt intimate and sexual partnerships. The goal of this study was to understand the association between quality of life and sexual functioning and all its components among women with endometriosis. We developed an anonymous online survey, which received responses from 1586 French women with endometriosis. We performed multivariable logistic regression to highlight the association between the Female Sexual Functioning Index (FSFI) and its dimensions with quality of life. Interaction analyses allowed subgroup investigation. Adjusted covariables were age, body mass index (BMI), tobacco, education, children, number of symptoms and menopause. We performed logworth analyses to assess the order of the strength relationships between all the components of FSFI. We found that FSFI was mainly associated with quality of life (OR&#x2009;=&#x2009;1.02 [1.01-1.04], p&#x2009;=&#x2009;0.002). We observed only two interactions between FSFI and BMI (p&#x2009;=&#x2009;0.015) and education (p&#x2009;<&#x2009;0.001). When considering educational subgroups, FSFI level was mainly associated with quality of life among those with a moderate educational level (OR&#x2009;=&#x2009;1.07 [1.04-1.10], p&#x2009;<&#x2009;0.001) and when considering BMI subgroups, FSFI level was mainly associated with quality of life among those with a moderate BMI (OR&#x2009;=&#x2009;1.05 [1.02-1.08], p&#x2009;=&#x2009;0.002). We did not observe an association between sexual functioning and quality of life among obese and low educational level women. Dyspareunia appeared to be the main component of sexual dysfunction among women with endometriosis (FDR logworth&#x2009;=&#x2009;9.1, p&#x2009;<&#x2009;0.001). This study underscores the importance of professionals who treat patients with endometriosis addressing sexual dysfunction to ensure their quality of life.

Emotional touchpoints are moments during perinatal care that evoke an emotional response in a woman. There is a lack of knowledge regarding the centrality of how touchpoints and emotions are framed in the real-life experiences of childbearing women. To explore how birth-related emotional touchpoints interact and how the emotions in the context of these healthcare experiences interact. We performed a systematic mixed studies review to capture childbearing women's prospective and retrospective reports of birth expectations and experiences. We conducted a literature search in CINAHL (EBSCO), Medline (EBSCO), PubMed, Web of Science, and Ovid, followed by hand searching and forward and backward citation searching from the included articles. We performed a quality appraisal using the Critical Appraisal Skills Program. We used Epistemic Network Analysis to model and visualize the connections and structure of the emotional touchpoints and the emotions. We included 28 articles, showing overall moderate quality. We constructed two models, one of emotional touchpoints and one of emotions. The emotional touchpoints model showed a strong connection between Coping and the Process of Labor & Birth and between the Process of Labor & Birth and Beliefs (belief systems) about Labor & Birth. The primary emotions model showed strong connections between Joy and Fear, between Fear and Sadness and between Sadness and Joy. This paper illustrates how the multidimensionality of birth-related emotional touchpoints and the positive and negative emotions prospectively and retrospectively reported by pregnant and postpartum women were distilled-informing the conversation between care providers and childbearing women.

Social media platforms have rapidly become key sources of contraceptive health information, shaping the beliefs and behaviors of individuals of reproductive age. Yet, it has become increasingly difficult to distinguish accurate content from misleading information, potentially leading to higher unintended pregnancy rates. Given the limited insights into the quality and reliability of contraceptive information on TikTok, this cross-sectional study aimed to systematically evaluate popular TikTok content on contraception created by various users to identify and analyze misinformation. Between August and September 2023, we analyzed 100 videos from the top five hashtags related to contraception methods (#birthcontrol, #contraception, #thepill, #naturalbirthcontrol, and #cycletracking) to assess the characteristics of the health information presented and their quality, using the DISCERN tool. The TikTok videos collectively received 4.85 billion views. Only 10% were created by medical professionals. Overall, the content showed poor reliability and quality, indicating a prominent presence of contraceptive health misinformation. Furthermore, there was a concerning trend favoring natural contraceptive methods over hormonal options, often without appropriate risk disclosures, accompanied by a growing distrust in health professionals. The rise of contraceptive misinformation on social media is re-shaping patient-provider relationships and impacting contraceptive beliefs. TikTok offers an excellent public health opportunity to disseminate accurate contraceptive information accessible to all individuals, regardless of their background or resources. To address the observed distrust in health professionals, it is essential to improve contraceptive care quality and promote shared decision-making, which would likely increase satisfaction with contraceptive choices and mitigate negative narratives online.

Women experiencing homelessness have higher rates of unintended pregnancies than stably housed women. Given that some of this may be attributed to nonuse or inconsistent use of contraception, we explored the behavioral cognitions for contraceptive use among women experiencing homelessness. The Information-Motivation-Behavioral Skills (IMB) model can examine health behavior cognitions, while acknowledging the macro-level context. Therefore, this study explored the IMB characteristics related to contraception use among women experiencing homelessness. We conducted interviews (n&#x2009;=&#x2009;19) among pregnancy-capable women 18-45&#x2009;years old experiencing homelessness. We recruited women between 2019 and 2020 in North Texas. Interviews were thematically analyzed based on the IMB framework. The mean age of women in the study sample was 33.4&#x2009;years (SD&#x2009;=&#x2009;7.6). In the information construct, most women were aware of different contraceptive methods; however, many desired to learn more about the side effects. For motivation, most women had a positive attitude toward their current contraception, but their motivation to use a type of contraceptive method depended on side effects and comfort with the method. Additionally, their trusted social connections influenced their contraception decisions. When examining behavioral skills, uncertainty of being able to obtain contraception was a barrier, especially with macro-level context related to lack of adequate insurance coverage and transportation. Improving knowledge about side effects of contraceptive methods, addressing misconceptions, and increasing accessibility to contraceptive methods by providing transportation and financial assistance while maintaining reproductive autonomy may be effective strategies to improve equitable access to contraception and reduce unintended pregnancies among this population.

Sexual health is crucial for well-being, yet research often overlooks middle-aged and older adults, as well as those with disabilities. This study explores the sexual health of disabled middle-aged and older adults in Britain. We aim to explain sexual behaviors and outcomes among disabled adults aged 45-74 in Britain. We conducted a secondary quantitative analysis using data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a British population-representative survey. The study did not focus on a specific type of disability but rather included people who consider themselves to have a long-standing illness that limits their activity. The analysis incorporated variables on sexual behaviors and outcomes: bivariate analyses and multiple logistic regressions stratified by sex compared behaviors and outcomes by disability status. Of 7082 participants included, 1906 were classified as being with limiting disability status. Adjusting for sociodemographic differences, compared to nondisabled individuals, those with limiting disability status adults were less likely to engage in sex in the last 4&#x2009;weeks (aOR: 0.60, CI: 0.51-0.71) or be in a steady relationship (aOR: 0.69, CI: 0.59-0.80) and were more likely to report poorer sexual health outcomes, including having experienced coerced sex attempts (aOR:1.83, CI:1.48-2.27), had coerced sex (aOR: 1.64, CI:1.33-2.01), had their sex life affected by health in the last year (aOR: 5.08, CI:4.27-6.05), and sought help for their sex lives (aOR:1.73, CI:1.38-2.17). Middle-aged and older disabled adults in Britain are less likely to be sexually active, yet more likely to experience negative sexual health outcomes. The increased health-seeking behaviors and their vulnerability highlight the necessity for tailored sexual health services, extending into middle age and older adulthood.

When positioned as part of a cluster of related social and political attitudes, abortion attitudes are characterized as somewhat fixed from a young age. The extent to which abortion attitudes are malleable, and can be shaped by experience, is under-researched in the United Kingdom (UK). To address this gap, we conducted semi-structured interviews with individuals with (N&#x2009;=&#x2009;12) and without (N&#x2009;=&#x2009;16) abortion experience living in the United Kingdom, consisting of England, Scotland, Wales or Northern Ireland. Inductive thematic analysis was used to address the research question: How does experience and/or contact with abortion shape attitudes towards abortion? The theme From Abstract Idea to Reality illustrates participants' understanding of how abortion attitudes are developed by contact with real, lived experiences of abortion-someone's own and/or their friends' or acquaintances' abortions. Participants were clear that proximity to abortion helped them, and others, to see abortion as tangible, personal, and sensory ("reality") as opposed to intangible, imagined, and conceptual ("abstract"). Subthemes capture our participants' understanding of abortion as a reality as opposed to something imagined; abortion is a complex issue and abortion experiences are varied (Complexity of Abortion), attitudes towards abortion are largely stable (Consistency of Attitudes), and abortion, and the people who seek abortion in the United Kingdom, is still stigmatized (Persistent Stigma). Our themes and discussion provide direction for future scholarship considering contact as a stigma reduction strategy, highlighting some potential benefits but also urging caution in oversimplifying a complicated social issue.

Sexual and reproductive health (SRH) is a critical component of overall well-being, yet individuals with substance use disorder (SUD) often face significant barriers to accessing SRH services-and vice versa. SRH settings offer important opportunities to identify and address SUD needs through screening and referral, whereas SUD treatment settings can serve as key access points for SRH care. The Link Study was developed as a cross-training intervention to strengthen collaboration and care coordination between SRH and SUD providers. We designed a curriculum covering core elements of SRH and SUD care, emphasizing person-centered practices, trauma-informed approaches, and evidence-based screening and referral tools. Thirty-five providers from three SRH and SUD site pairs participated. Evaluation included pre- and post-training knowledge surveys, site-level screening and referral data, and provider focus groups. We used confidence intervals to assess changes in quantitative outcomes and conducted thematic analysis of qualitative data. Providers demonstrated consistent increases in self-reported knowledge across key domains. Two of the three SRH and SUD sites showed statistically significant improvements in screening practices. Although referral rates did not change significantly, sites reported meaningful updates to workflows, tools, and policies to support integration. All sites sustained cross-sector provider relationships for at least 6&#x2009;months post-training. The Link Study showed promising gains in provider knowledge, improvements in screening practices, and lasting collaboration across SRH and SUD service sectors. Findings highlight the potential of cross-disciplinary training and technical assistance to build integrated care pathways and strengthen community-based health systems.

Intravaginal rings (IVRs) are marketed or in development for contraception and other indications. We sought to develop and validate the IVR Acceptability Scale (IVR-AS) as a multidimensional, standardized tool for assessing IVR acceptability among end-users in the United States. Scale items reflect specific aspects of IVR acceptability for women and male partners. Response options range from 1 (not-at-all acceptable) to 5 (highly acceptable). We evaluated the IVR-AS within a randomized, crossover clinical trial of three nonmedicated silicone IVRs of differing external diameters (46, 56, 66&#x2009;mm) in heterosexual couples who used each for ~30&#x2009;days, then completed a self-administered survey. We conducted exploratory factor analysis and multivariable regression to assess convergent validity. Follow-up in-depth interviews with all participants explored scale salience. Twenty-four couples participated (mean age 27). The final 19-item women's scale (Cronbach's alpha&#x2009;=&#x2009;0.93) included six subdimensions: ease of use; experience and sensation; effect on sexual desire/engagement, and effect on vaginal sex (all alphas&#x2009;>&#x2009;0.78). The final eight-item men's scale comprised two subdimensions: effect on sexual desire/engagement and effect on vaginal sex (all alphas >&#x2009;0.89). For both sexes, higher overall/subdimension scores were consistently associated with favorable assessments of the ring, for example, ease of insertion/removal; adherence (most p&#x2009;<&#x2009;0.001). The 46/56&#x2009;mm IVRs had higher overall and subdimension scores than the 66&#x2009;mm IVR (most p&#x2009;<&#x2009;0.001). Qualitative reports reinforced the salience of scale subdimensions and item content. The IVR-AS captures multiple dimensions of IVR acceptability among women and their partners. The scales demonstrated excellent reliability and convergent validity. Further validation is warranted in future studies. Clinical Trials.gov: NCT05128136. https://clinicaltrials.gov/study/NCT05128136?intr=non-medicated%20silicone%20ring&rank=2.

China's one-child policy was implemented in 1980 primarily through mandatory intrauterine devices, tubal surgery, or abortion for "unauthorized pregnancies." While it was replaced in 2015, it affected millions of persons and its effects on reproductive decision making are not well known. We designed, validated, and performed a cross-sectional survey of reproductive age Chinese-born or first-generation women of Chinese descent to describe the policy's impact on reproductive decision-making. Descriptive statistics and multivariate logistic regression were used to identify self-reported policy impact on contraceptive utilization and childbearing choices, and demographic associations. Between June 1 and October 31, 2021, 1098 people accessed the survey, and 838 were eligible. A total of 588 responded to questions pertaining to the primary outcome, yielding a response rate of 70.2%. Approximately 42% of participants lived under the policy and were affected by it in some way. 17.3% of participants stated their contraceptive utilization was affected and 23.3% stated their childbearing choices were affected. Those with low acculturation scores (OR&#x2009;=&#x2009;2.27, 95% CI 1.35-3.85, p&#x2009;=&#x2009;0.002) and those living in the United States for <&#x2009;21&#x2009;years (OR&#x2009;=&#x2009;2.25, 95% CI 1.09-4.67, p&#x2009;<&#x2009;0.01) were more likely to report their contraceptive plans were affected. 72.8% of participants self-reported high reproductive autonomy, whereas acculturation was mixed. Although the one-child policy has had a large effect on people of the Chinese diaspora, its impact on reproductive decision-making may decrease with the duration of time in the United States and increasing acculturation.

We sought to understand the relationship between Kentucky medical students' personal beliefs and values about the state's restrictive abortion climate and their considerations for residency training and/or post-residency practice in Kentucky. We surveyed medical school students enrolled in two medical schools in Kentucky about their personal beliefs and values regarding the state's abortion climate and whether they were considering residency training and/or staying post-residency in Kentucky. We used descriptive statistics to examine differences in responses, stratified by consideration for residency training and staying. We further examined these relationships among the subset of students who were considering a residency in obstetrics and gynecology (OBGYN). The survey response rate was 17.9%. Overall, 77.8% (n&#x2009;=&#x2009;210) of respondents indicated that the current anti-abortion climate in Kentucky did not align with their personal beliefs and values. Among all medical students, 51.1% (n&#x2009;=&#x2009;138) indicated they were considering staying in Kentucky post-residency, including 29% of those considering an OBGYN residency. Among those considering an OBGYN residency (n&#x2009;=&#x2009;74), 51.4% (n&#x2009;=&#x2009;38) reported that they were considering staying in Kentucky for residency, compared with 48.6% (n&#x2009;=&#x2009;69) of those who were not considering an OBGYN residency. While most responding medical students reported their personal beliefs and values do not align with the state's anti-abortion climate, the majority are considering staying in Kentucky for residency and post-residency practice, regardless of their interest in an OBGYN residency. This suggests that opinions about the anti-abortion climate may not factor prominently in students' decisions about residency training and practice location.