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This study aimed to investigate the experiences of obstetrician-gynecologists (OB-GYNs) in U.S. states with restrictive and non-restrictive abortion laws to understand their perspectives on the changing political landscape and how these changes affect job satisfaction in the post-Dobbs era. We conducted semi-structured interviews with 24 OB-GYNs from states with restrictive and non-restrictive abortion laws from April-December 2024. Fourteen OB-GYNs practiced in restrictive states; nine practiced in non-restrictive states; and one practiced in both. Interviews lasted 25 min on average and were audio-recorded via Zoom. We transcribed and de-identified recordings and used Nvivo v. 14 for inductive thematic analysis. OB-GYNs from restrictive and non-restrictive states described the impact of abortion laws on their practice. Restrictive-state OB-GYNs described their inability to offer the full scope of care, fulfill patient expectations, and how circumstances in which they were hindered from following evidence-based care guidelines could lead to unsafe clinical situations. Across states, OB-GYNs conveyed frustration towards the impact of politics on reproductive health, fear of legal repercussions, and anxiety towards future restrictions. Political tensions amplified burnout for some. OB-GYNs felt that reproductive healthcare is underappreciated and underfunded. Consistently feeling limited in their ability to provide optimal care creates emotional burdens among OB-GYNs in restrictive states. Fear of legal fallout heightens risk for unsafe clinical scenarios in all states and could be addressed through institutional support and legal clarifications. OB-GYNs' growing perception that reproductive healthcare is underappreciated suggests broader dissatisfaction that requires action to ensure a sustainable workforce. OB-GYNs experience challenges fulfilling patient needs and managing changing reproductive health policies. They also experience dissatisfaction with the politicization of reproductive healthcare. Developing spaces for peer support and advocating for legal clarifications could facilitate better clinical decision-making and quality of care.

To explore how patients considering permanent contraception and their delivering obstetrician-gynecologist (OB-GYN) address partner vasectomy in contraceptive counseling. From 2021-2023, we conducted in-depth semi-structured interviews with postpartum patients desiring tubal permanent contraception and OB-GYNs at four US institutions as a part of a larger study. For this analysis, we used thematic content analysis to assess factors that shaped conversations surrounding vasectomy. We included 65 postpartum patients and 52 OB-GYNs in this analysis. Although many OB-GYNs considered vasectomy to be a part of their standard prenatal counseling, only half of patients reported counseling about vasectomy. Both patients and OB-GYNs linked lack of counseling to social and clinical factors. Some OB-GYNs either forgot or hesitated to counsel on vasectomy when the male partner was not their patient or wasn't in the exam room. Lack of vasectomy counseling thus prompted patients to seek vasectomy information on their own or opt for female permanent contraception methods. Some OB-GYNs relied on their perceptions of patients' relationship stability or partners' ability to obtain a vasectomy to guide whether they would counsel regarding vasectomy. Lastly, some patients and OB-GYNs prioritized route of delivery, surgical ease, and cancer risk reduction as reasons to obtain tubal permanent contraception versus vasectomy contraception. OB-GYNs frequently deemphasized vasectomy due to their level of comfort counseling about vasectomy and tubal PC, perceptions around male involvement in contraception, and the organization of care. Instead, vasectomy should be introduced as a viable permanent contraceptive method during standard contraceptive counseling. Our study suggests that while patients may be interested in vasectomy as an option for permanent contraception, counseling and referral pathways to vasectomy are limited. Clinicians should use a shared decision-making approach with couples, offer educational resources, and refer to vasectomy providers as appropriate.

Sexual health is an often-overlooked component of clinical care that has significant implications for patients' quality of life. To evaluate the practices, attitudes, and barriers faced by Israeli obstetrician-gynecologists (OB-GYNs) in addressing female sexual health, and to identify factors that influence engagement. During April-December 2024, a cross-sectional survey was conducted that assessed Israeli OB-GYNs' socio-demographics, frequency of initiating discussions, perceived training adequacy, and barriers to addressing sexual health. The primary outcomes were the frequency of initiating discussions on sexual health and the perceived adequacy of training in addressing sexual dysfunction. Among 504 participants, 19.1% routinely initiated discussions on sexual health, while 45.8% rarely did. Female compared to male OB-GYNs (P&#xa0;=&#x2009;0.002), and infertility compared to other specialists (P&#xa0;=&#x2009;0.003) were more likely to engage in these discussions. Barriers included limited clinic time (57.5%), insufficient knowledge of treatment options (48.2%), a lack of strategies for initiating discussions (27.0%), and discomfort discussing these issues (15.9%). OB-GYNs aged 60&#xa0;years and older, compared to 20-29&#xa0;years, and those who graduated in Israel, rather than abroad (P&#xa0;<&#x2009;0.001 for both), were more likely to report feeling comfortable addressing sexual health topics. OB-GYNs in central Israel and Jewish participants were more likely to feel comfortable, compared to their southern and Muslim counterparts (P&#xa0;<&#x2009;0.001 for both). Training was rated as poor or very poor by 43.2% for discussing sexual health and 60.2% for treating sexual dysfunction. Compared to their counterparts, poor training was reported by OB-GYNs under age 60&#xa0;years, with degrees from abroad, and with less experience. The respective odds ratios were 2.70 (95% CI 1.47-4.96, P&#xa0;=&#x2009;0.001), 1.799 (95% CI 1.24-2.60, P&#xa0;=&#x2009;0.002), and 1.72 (95% CI 1.04-2.82, P&#xa0;=&#x2009;0.033). Most respondents supported integrating sexual health education into medical curricula (69.5%) and OB-GYN residency programs (89.1%). Significant gaps in the training and practices of Israeli OB-GYNs underscore the need for enhanced education tailored to address cultural and demographic factors. The large, diverse sample provides valuable insights. However, the self-reported data may have introduced bias, and the cultural diversity may limit generalizability. Substantial gaps were reported in the training and practices of Israeli OB-GYNs regarding female sexual health. These findings underscore the need for enhanced education and structured training programs, tailored also to address cultural and demographic factors, to improve patient care.

Obstetrician-Gynecologist (OB-GYNs) mothers, serving dual roles as healthcare providers and patients, present an interesting demographic for studying this dynamic, particularly in China where empirical data on this subject is limited. The study aimed to determine whether OB-GYNs experience better pregnancy outcomes compared to non-physician women, hypothesizing that their medical background could lead to different health behaviors and outcomes. This was a retrospective matched cohort study conducted at the Women's Hospital, Zhejiang University School of Medicine. It included 100 OB-GYNs who gave birth between January 2012 and April 2022 and a matched control group of 200 non-medical background women. Outcomes measured were Cesarean section rates, emergency cesarean section, operative vaginal delivery, birth weight, Apgar score, and various pregnancy and childbirth complications. Statistical analysis was performed using descriptive statistics, generalized estimating equation model and Fisher's exact tests. Cesarean section rates were similar between OB-GYNs (32%) and non-physicians (36.5%). OB-GYNs had similar incidences of pregnancy complications compared with non-physicians except postpartum hemorrhage (0% in OB-GYNs vs. 5.5% in non-physicians, P&#x2009;=&#x2009;0.018). The findings indicate that OB-GYNs do not differ significantly from non-physician women in terms of Cesarean section rates and incidences of pregnancy complications except postpartum hemorrhage.

Following the Dobbs v Jackson Women's Health Organization (Dobbs) decision in June 2022, which overturned the federal right to abortion, Wisconsin physicians faced the threat of an 1849 state law widely interpreted to criminalize provision of abortion except in life-saving emergencies. Physicians and their institutions were left to interpret whether and how they could treat and/or refer certain pregnant patients. To document how the post-Dobbs legal landscape shaped Wisconsin obstetrician-gynecologists' (OB-GYNs') ability to provide health care to patients facing pregnancy-related risks and complications, with particular attention to the mediating role of health care institutions. In this qualitative study, 21 OB-GYNs were recruited between June 2022 and December 2023 from rural and urban areas with varying hospital affiliations, scopes of practice, and individual demographics to participate in semistructured, remote interviews. An 1849 abortion law that suspended abortion care in Wisconsin between June 2022 and December 2023. Physicians' perceptions of (1) how the legal landscape shaped management of pregnancy and related complications, and (2) how institutional-level factors contributed to physicians' experiences caring for pregnant patients following Dobbs. This study included 21 OB-GYNs (mean [SD] age, 43 [5.88] years; 16 [76.2%] female; 5 [23.8%] non-White and 16 [76.2%] White) who practiced obstetrics in Wisconsin. OB-GYNs described how the threat of criminalization following Dobbs was detrimental to physicians' ability to provide pregnancy care. Absence of legal clarity surrounding the 1849 law led to confusion and wide variations in institutional comfort and clinical practice, which resulted in substandard, delayed, and fragmented patient care. Overwhelmingly, the threat of criminalization after Dobbs exacerbated barriers for physicians providing comprehensive pregnancy care and patients seeking it. In this qualitative study of OB-GYNs practicing in an abortion-restrictive state, threat of criminalization in post-Dobbs Wisconsin resulted in uncertainty and confusion for OB-GYNs and worse care for pregnant patients. The absence of clear guidance and support from institutional and health care system leadership emerged as a particularly salient missed opportunity. These experiences, which contribute to a critical evidence base on the harms of abortion restrictions, are relevant to states facing similar bans that criminalize or restrict health care.

Understanding the distribution of obstetrician-gynecologists (ob-gyns) is crucial to combatting inequities in care access throughout the United States. In this cross-sectional study, we used data from the Health Resources & Services Administration to characterize counties with and without ob-gyns. Of the 3,143 U.S. counties analyzed, 1,473 (46.9%) did not have a single ob-gyn. Counties without ob-gyns were more likely to be nonmetropolitan (57.5% vs 44.6%, P <.01), have a lower median household income ($52,989 vs $59,470, P <.01), and have a greater proportion of White residents (87.6% vs 79.0%, P <.01). Notably, only 103 (7.0%) counties without an ob-gyn had any midwives. Inequities in maternity care provision remain a significant issue in the United States, creating a need for creative policy solutions to improve access.

Obstetricians and gynecologists (OB-GYNs) provide essential health care to women across their lifespan. Yet nearly half of US counties have no OB-GYNs, with nonmetropolitan communities disproportionately affected. Targeted Regulation of Abortion Providers (TRAP) laws, spurred by the 1992 US Supreme Court decision in Planned Parenthood v. Casey, impose regulatory burdens on abortion providers and may have influenced whether and where OB-GYNs choose to practice, which has not yet been comprehensively studied. Using a staggered difference-in-differences design and county-level data, we found that TRAP laws were associated with an average reduction of 4.67&#xa0;percent in the density of OB-GYNs per 100,000 women ages 15-44 during the period 1993-2021, between Casey and the Dobbs v. Jackson Women's Health Organization decision in 2022. TRAP laws affected both general and fellowship-trained OB-GYNs, as well as counties without abortion facilities. Concerningly, TRAP laws led to lower physician density in nonmetropolitan counties-a difference that persisted for a decade. As OB-GYN shortages are projected to worsen and TRAP laws are still in effect in twenty-four states, policy makers should consider the long-run effects of TRAP laws on women's access to health care and their potential to exacerbate geographic disparities in access to care.

Multiple sclerosis (MS) is often diagnosed in people of reproductive age. However, family planning counselling is not always integrated within MS care. Decisions on family planning can be further complicated by potential side effects associated with several disease-modifying therapies. While neurologists may lack training in contraceptive use and family planning counselling, obstetricians and gynaecologists (OB-GYNs) and other health care professionals involved in reproductive life planning (RHCPs) may lack detailed knowledge and experience around the use of contemporary MS treatments. Through a modified Delphi consensus programme, a multidisciplinary steering committee of 13 international experts developed practical clinical recommendations on contraceptive use and family planning for people with MS (PwMS). This article offers insights to help OB-GYNs and RHCPs implement these recommendations, focusing on contraceptive decision-making and MS medications. The perspectives discussed emphasise providing education on MS to OB-GYNs and other RHCPs, enabling informed counselling for PwMS and their partners regarding contraception and family planning. Close collaboration among the multidisciplinary team, including neurologists, is crucial in providing reproductive care for PwMS. The detailed perspectives provided aim to enable OB-GYNs and other RHCPs to provide informed counselling for PwMS and their partners regarding contraception and family planning. Multiple sclerosis (MS) onset often coincides with reproductive age, but family planning counselling is not standard in MS care. The detailed perspectives provided here aim to enable health care professionals involved in reproductive life planning to provide informed counselling for people with MS and their partners.

Although pregnant people are a WHO priority population for hepatitis C (HCV) elimination, there is limited guidance on HCV treatment in pregnancy. Emerging data suggests direct acting antiviral (DAA) therapy is safe and effective. We performed a multinational survey among gastro-hepatologists (GI-Hep), infectious disease (ID) specialists, obstetricians-gynaecologists (ob-gyns), and general practitioners (GP) to evaluate current perspectives on HCV treatment in pregnancy. A 39-item survey was designed by experts at The Global Liver Council, the American College of Obstetricians and Gynaecologists, and the Coalition for Global Hepatitis Elimination and distributed electronically. Survey responses were compared across medical specialties and regions. A total of 651 participants from all WHO regions representing 58 countries completed the survey: GI-Hep: 46%, GP-ID: 36%, ob-gyns: 18%. Only 25% would consider treating HCV during pregnancy, with significant differences by specialty. Main reasons for not considering DAAs in pregnancy were insufficient safety data (27%) and no clear guidelines for HCV treatment (32%). The highest acceptance of DAA use in pregnancy was in North America (45% vs. <&#x2009;20% in other regions (p&#x2009;<&#x2009;0.01)). Predictors of a greater willingness to treat HCV in pregnancy were having &#x2265;&#x2009;10% of practice population with injection drug use (aOR: 2.31; 95% CI: 1.49-3.60; p&#x2009;=&#x2009;0.0002). GI-Hep specialty was associated with a lower willingness (aOR: 0.47; 95% CI: 0.28-0.78; p&#x2009;=&#x2009;0.004). Despite relatively high levels of HCV knowledge, few participants have experience with HCV treatment in pregnancy or would consider such treatment. Further availability of safety evidence and the inclusion of specific recommendations in guidelines could increase uptake of DAAs for pregnant individuals. Addressing hepatitis C (HCV) in pregnant individuals is a World Health Organization priority goal towards HCV elimination in the year 2030 and emerging data suggest that direct acting antivirals (DAAs) are potentially safe and effective in pregnancy. We performed the first multinational survey of multidisciplinary providers evaluating current provider practices in managing HCV in pregnant individuals and identified significant variability in provider practices regarding HCV screening in pregnancy and hesitancy in considering HCV treatment of pregnant people. Per survey conclusions, there is an urgent need for clear global guidelines for HCV treatment in pregnancy and increased DAA safety data in order to incorporate pregnant individuals into global HCV elimination efforts.

To evaluate whether artificial intelligence (AI)-based software was associated with enhanced identification of eight second-trimester fetal ultrasound findings suspicious for congenital heart defects (CHDs) among obstetrician-gynecologists (ob-gyns) and maternal-fetal medicine specialists. A dataset of 200 fetal ultrasound examinations from 11 centers, including 100 with at least one suspicious finding, was retrospectively constituted (singleton pregnancy, 18-24 weeks of gestation, patients aged 18 years or older). Only examinations containing two-dimensional grayscale cines with interpretable four-chamber, left ventricular outflow tract, and right ventricular outflow tract standard views were included. Seven ob-gyns and seven maternal-fetal medicine specialists reviewed each examination in randomized order both with and without AI assistance and assessed the presence or absence of each finding suspicious for CHD with confidence scores. Outcomes included readers' performance in identifying the presence of any finding and each finding at the examination level, as measured by the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. In addition, reading time and confidence were evaluated. The detection of any suspicious finding significantly improved for AI-aided compared with unaided readers with a significantly higher AUROC (0.974 [95% CI, 0.957-0.990] vs 0.825 [95% CI, 0.741-0.908], P =.002), sensitivity (0.935 [95% CI, 0.892-0.978] vs 0.782 [95% CI, 0.686-0.878]), and specificity (0.970 [95% CI, 0.949-0.991] vs 0.759 [95% CI, 0.630-0.887]). AI assistance also resulted in a significant decrease in clinician interpretation time and increase in clinician confidence score (226 seconds [95% CI, 218-234] vs 274 seconds [95% CI, 265-283], P <.001; 4.63 [95% CI, 4.60-4.66] vs 3.90 [95% CI, 3.85-3.95], P <.001, respectively). The use of AI-based software to assist clinicians was associated with enhanced identification of findings suspicious for CHD on prenatal ultrasonography.

To assess the knowledge and practices of Israeli healthcare providers in managing genital herpes and evaluate the performance of large language models (LLMs) in addressing key clinical questions. An anonymous survey comprising 24 questions assessing genital herpes management and guideline familiarity was distributed to healthcare providers (obstetricians and gynecologists (OB-GYNs), dermatologists, infectious disease specialists, and family doctors). Further, four LLM tools were tested on the main questions. Overall, 122 physicians participated, with OB-GYNs showing the highest familiarity with guidelines; however, only 22.9% of respondents were fully familiar with local guidelines. Significant knowledge gaps in transmission risks and preventive treatments were identified. LLM tools demonstrated strong performance, often surpassing physicians in accuracy, but exhibited limitations in interpreting certain guideline aspects. Israeli healthcare providers show critical knowledge gaps, underscoring the need for enhanced education and guidelines. Further, LLMs show promise as supplementary tools for improving guideline adherence.

Precision in obstetrician-gynecologist (ob-gyn) workforce planning requires comprehensive projections of supply and demand. Using the Health Workforce Simulation Model from the Health Resources & Services Administration and publicly available datasets, we assessed the adequacy of the number of ob-gyns across all U.S. states to forecast changes from 2025 to 2035. In 2025, the national supply met 93.4% of the demand, with significant geographic disparities. By 2035, all but six states are projected to experience inadequate supplies of ob-gyns, with a particularly severe shortfall in nonmetropolitan areas. Mitigation strategies include expanding the ob-gyn pipeline, retaining the existing workforce, integrating advanced-practice clinicians using technology to extend reach, and optimizing care-delivery models.

Since the US Supreme Court's Dobbs v. Jackson decision, 17 states have imposed near-total abortion bans. These bans may negatively impact health and well-being of obstetrician-gynaecologists (OB-GYNs), due to high levels of work-related stress that the laws have created for them. The goal of the present study is to evaluate the impacts of post-Dobbs v. Jackson state abortion bans on occupational health and well-being of OB-GYNs. The Study of OB-GYNs in Post-Roe America is a qualitative study of 54 OB-GYNs practising in 13 of the 14 states with near-total abortion bans as of March 2023. Using volunteer sampling methods, participants were recruited for semistructured qualitative interviews via videoconference from March to August 2023. Thematic analysis of interview transcripts identified six major domains of health and well-being impacts of state abortion bans on OB-GYNs: anxiety and depression, burden of negative emotions, burn-out, coping-related health behaviours, sleep disruption and personal relationships. State abortion bans following the 2022 Dobbs decision may impact the health and well-being not only of pregnant patients but also of their providers. These provider health impacts include mental health and burn-out but also extend to physical health outcomes and the work-life interface.

Local anesthetics (LAs) are commonly used in obstetrics and gynecology (OB-GYN); however, inappropriate administration can cause local anesthetic systemic toxicity (LAST), a life-threatening condition. For safe medical practice, healthcare providers should carefully follow the guidelines for administering LAs for early identification and proper management of LAST when it occurs. This nationwide study used a 36-item self-administered questionnaire administered to healthcare professionals in OB-GYN and anesthesiology. The survey assessed the knowledge, attitudes, and practices of commonly used LA agents, their appropriate dosage, and awareness of LAST's management. A study of 391 Saudi healthcare professionals, between OB-GYN (51.2%) and anesthesiology (48.8%), reported greater engagement in anesthetic training and usage among anesthesiologists (88% trained, 58.1% daily use) than among OB-GYNs (38.5% trained, 30.5% daily use). OB-GYNs most commonly performed perineal tear repairs (88.5%), whereas anesthesiologists mainly performed paracervical blocks (89.5%). Lidocaine was the preferred local anesthetic for OB-GYNs at 93.5%, with anesthesiologists also favoring lidocaine but showing a higher use of bupivacaine (75.4%). Furthermore, the knowledge, attitudes, and practices scores of OB-GYN participants were significantly lower scores in all parameters compared to the anesthesiology participants (P < 0.001). Healthcare professionals in OB-GYN lack adequate knowledge of the safe and effective use of LA agents. Their knowledge must be increased through education to ensure safe practices.

State-level abortion bans enacted after Dobbs v. Jackson may have a deleterious impact on the health of women and may increase maternal morbidity and mortality. In obstetrics-gynecology, strong patient-physician relationships, which are built via patient-centered care strategies, are associated with better pregnancy-related outcomes. Abortion bans may limit physicians' ability to utilize these strategies by restricting care that can legally be provided. Further, all members of the care team, including social workers, may face legal and professional consequences for engaging in options counseling, altering how providers engage with patients. This study assessed OB-GYNs' perceptions of how patient relationships have been impacted by Dobbs, using semi-structured interviews with 54 OB-GYNs from 13 US abortion-restrictive states. Four themes emerged: mistrust and fear of legal consequences; governmental intrusion into the patient-physician relationship; patients assigning blame; and strategies for strengthening relationships post-Dobbs. These findings indicate that abortion bans may have a substantial impact on patient-physician relationships. Knowledge of this dynamic provides context for social workers related to identifying gaps in patients' education about care options and intervention targets.

We conducted a cross-sectional, blinded expert evaluation of AI-generated answers to 22 frequently asked pregnancy questions to characterize content quality and potential clinical utility. Five obstetricians (not involved in rating) compiled the questions; ChatGPT produced responses using a minimal prompt with a fresh session per item. Forty board-certified OB/GYNs rated each answer on 5-point Likert scales for accuracy, comprehensiveness, safety, and understandability; two deliberately incorrect attention-check items were embedded and excluded. We obtained 879/880 expected rating blocks (<0.1% missing). Domain means clustered tightly (accuracy 3.95&#xa0;&#xb1;&#xa0;0.20, safety 3.94&#xa0;&#xb1;&#xa0;0.16, understandability 3.94&#xa0;&#xb1;&#xa0;0.19, comprehensiveness 3.91&#xa0;&#xb1;&#xa0;0.17), with no overall domain difference (Friedman &#x3c7;2(3)&#xa0;=&#xa0;3.13, p&#xa0;=&#xa0;0.372). Question-level means ranged 3.71-4.31, highest for routine daily-life topics (air travel, sexual activity, sleep position, exercise) and lowest for context-dependent items (e.g., (non-stress test) NST 3.71; heartburn 3.72; edema 3.79; vaginal bleeding 3.81). Pre-specified subgroups showed a small but significant difference (Kruskal-Wallis p&#xa0;=&#xa0;0.033): daily life scored higher than follow-up/testing/procedures (adjusted p&#xa0;<&#xa0;0.05), whereas daily life vs symptoms and symptoms vs follow-up were not significant. In domain&#xa0;&#xd7;&#xa0;subgroup analyses, only understandability differed (p&#xa0;=&#xa0;0.020), with daily life&#xa0;>&#xa0;symptoms (adjusted p&#xa0;=&#xa0;0.043); safety's global difference did not yield significant pairwise contrasts. Overall inter-rater reliability was moderate, supporting consistent expert evaluation while underscoring increased variability in symptom-based assessments. Experts rated the AI-generated answers as moderate-to-high overall; however, inter-rater reliability was only moderate and varied markedly by question type (highest for daily life questions and very low for symptom-related questions) indicating heterogeneous clinician judgments and supporting cautious interpretation of these findings.

Recent changes to United States medical practice following the U.S. Supreme Court's decision in Dobbs v Jackson Woman's Health Organization have led to new forms of medical uncertainty arising from the interpretation and implementation of state law. Post-Dobbs legal restrictions are particularly challenging because they entail multiple forms of uncertainty that intensify when combined, with risks to pregnant patients and to the clinicians who care for them. In this article, we identify and describe three distinct types of uncertainty that obstetrician-gynecologists (OB-GYNs) in states with abortion bans encounter when caring for patients with an obstetric complication known as preterm prelabor (or premature) rupture of membranes (PPROM, i.e., 'water breaking'). PPROM represents a paradigmatic case in which prognostic, legal, and existential uncertainty coalesce, leading to stress and discomfort for both patients and the clinicians caring for them. Focusing on OB-GYNs, we describe each of these forms of medical uncertainty in turn, and then elaborate a case study to show how they operate in tandem over time. In doing so, we add to a growing body of literature highlighting the relationship between structural conditions shaping medicine and uncertainty in practice. Whereas evidence-based medicine is organized around the logic of reducing uncertainty, we find that doing so is far more difficult when the uncertainty arises from politics as opposed to clinical factors.

Cisgender women account for approximately 20% of new HIV diagnoses in the U.S., yet of those indicated for pre-exposure prophylaxis (PrEP) uptake is only 10%. Cisgender women are amenable to PrEP; however, clinicians encounter individual and interpersonal barriers to prescriptions. This research examines clinicians' decision-making processes regarding PrEP provision for cisgender women. Semi-structured individual interviews were conducted with clinicians working with cisgender women in the U.S. to explore their decision-making processes for PrEP prescription and were presented with a vignette of a hypothetical patient. Clinicians were asked how they would assess their eligibility for PrEP and their clinical recommendations. Eighteen clinicians were interviewed. The majority reported at least some familiarity with PrEP. The majority were practicing clinicians trained as OB/GYNs, followed by Primary Care/Family/Internal Medicine. Clinicians frequently report their PrEP recommendations rely on the patient's overall risk and ability to use condoms. Clinicians' decision-making processes often follow a linear pathway through (1) the assessment of HIV risk, (2) STI testing, (3) condom counseling, and (4) PrEP counseling and provision. Despite medical guidelines recommending PrEP to all sexually active patients, clinicians rely on condoms as the primary prevention method and continue to assess the utility of PrEP through a risk-focused lens.