Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
基本信息
- 批准号:10557980
- 负责人:
- 金额:$ 21.43万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2020
- 资助国家:美国
- 起止时间:2020-05-05 至 2024-01-31
- 项目状态:已结题
- 来源:
- 关键词:Administrative SupplementAffectAreaAttitudeBeliefBioethicsClinicClinicalCoercionCollaborationsComplexConsentContraceptive AgentsContraceptive methodsDataData SetDecision MakingDeltastabDemographic FactorsEnsureEnvironmentEquilibriumEthical AnalysisEthicsExclusionFaceGeneral PopulationGoalsGuidelinesHealthHealth InsuranceHealthcare SystemsHospitalsImprisonmentIndividualInformed ConsentInfrastructureInstitutionIntakeInterviewInvestigationJusticeKnowledgeLawsLinkLogisticsMedicalMedical RecordsMethodsMinorityModelingNorth CarolinaOutcomeParentsPatientsPersonal SatisfactionPersonsPoliciesPopulationPositioning AttributePostpartum PeriodPregnant WomenPrenatal carePreventive carePreventive healthcarePrisonsProceduresProviderPublic HealthRecommendationRegretsResearchRiskSafetySterilizationStructureSystemTestingUnited StatesUnited States National Institutes of Healthabstractingbasebuilt environmentclinical caredisparity reductionevidence baseexperiencehealth disparityhealth disparity populationshealth equityhealth inequalitiesimprovedinfant morbidity/mortalityinsightinterestlensmaternal morbiditymaternal riskmindfulnessparent grantpatient orientedpolicy recommendationpostpartum contraceptionpostpartum outcomepreferencepregnantprospectivereproductivesocial culturesocial stigmasocioeconomicssoundunintended pregnancy
项目摘要
ABSTRACT
Pregnant or postpartum people experiencing incarceration (PPEI) represent a critical U3 population that is
understudied due to barriers within carceral institutions, underrepresented due to the exclusion of
institutionalized individuals from research, and underreported because they comprise a minority within
incarcerated people. PPEI have higher than average representation of NIH-designated health disparities, and
disparities in the fulfillment of desired postpartum sterilization are particularly complex for PPEI because of the
unique multilevel barriers that influence health outcomes. Tragically, many PPEI have been sterilized without
consent. Thus, policies and laws are in place to limit access of PPEI to sterilization given the challenges
involved in obtaining true informed consent, potential of coercion, and risk of regret after incarceration.
However, others with well-formulated, long-standing desires to obtain postpartum sterilization have
encountered barriers over several domains, including harsh built environments, punitive sociocultural
environments, and health care systems. Therefore, nuanced consideration is required to balance these
protections with the unintended consequence of disparities. Investigation of factors that influence postpartum
sterilization desire and fulfillment in PPEI represents a critical knowledge gap. In this Administrative
Supplement, we seek to extend efforts from our parent R01 (1R01HD098127H) to meet an overall objective
of better understanding the goals, experiences, and health outcomes of PPEI desiring postpartum sterilization
and their delivering medical team. This objective is directly related to Strategic Goal 1.3 of the ORWH and
directly responsive to the NOSI’s specific areas of research interest in terms of assessing structural
determinants of health, utilizing preventive health care and exploring the intersectional stigma impacting this
U3 population through a multidimensional research framework. Leveraging our extensive expertise in bioethics
and observational analysis and long-term collaboration with the North Carolina state prison system, we have
the infrastructure to rapidly meet our objective. Consistently, our Aims are to 1) Longitudinally assess the
contraceptive goals of PPEI by retrospectively abstracting medical record data from pregnant women who
were incarcerated from 2016-2021 (n=850) to understand postpartum sterilization decision-making and
compare with the general population via a similar dataset created through the parent grant. 2) Identify the
attitudes, beliefs, and practices of PPEI and their obstetricians regarding postpartum sterilization by
performing and analyzing semi-structured interviews of PPEI requesting postpartum sterilization and their
delivering obstetrician (n=15 dyads); 3) Develop clinical guidance for ethical postpartum sterilization for
PPEI by performing robust ethical analysis from a patient-centered and health-equity lens. Our results will
provide a critical framework for long overdue, evidence-based policy recommendations to improve clinical care,
advance public health, and mitigate disparities among PPEI.
摘要
怀孕或产后的人经历监禁(PPEI)代表了一个关键的U3人口,
由于监狱机构内部的障碍,研究不足,
制度化的个人从研究,并低估,因为他们构成了少数人在
被监禁的人。PPEI在NIH指定的健康差异中的代表性高于平均水平,
实现所需产后绝育的差异对于PPEI来说特别复杂,因为
影响健康结果的独特多层次障碍。不幸的是,许多PPEI已经灭菌,
同意.因此,鉴于面临的挑战,制定了政策和法律,限制PPEI接受绝育手术
涉及获得真正的知情同意,胁迫的可能性,以及监禁后后悔的风险。
然而,其他具有良好配方的、长期渴望获得产后绝育的人,
在几个领域遇到了障碍,包括恶劣的建筑环境,惩罚性的社会文化
环境和卫生保健系统。因此,需要进行细致的考虑,以平衡这些因素。
保护,但却产生了意想不到的不平等后果。产后影响因素调查
PPEI中的灭菌愿望和实现代表了关键的知识差距。本行政
补充,我们寻求从我们的母公司R 01(1 R 01 HD 098127 H)扩展努力,以满足总体目标
更好地了解PPEI的目标,经验和健康结果,希望产后绝育
以及他们的医疗团队这一目标与ORWH的战略目标1.3直接相关,
直接响应NOSI在评估结构方面的研究兴趣的具体领域
健康的决定因素,利用预防性保健,并探讨影响这一点的交叉污名
U3人口通过多维研究框架。利用我们在生物伦理学方面的广泛专业知识
和观察分析以及与北卡罗来纳州监狱系统的长期合作,
快速实现我们的目标。因此,我们的目标是:1)纵向评估
PPEI的避孕目标,通过回顾性提取的病历资料,从孕妇,
从2016年至2021年被监禁(n=850),以了解产后绝育决策,
通过父母补助金创建的类似数据集与普通人群进行比较。2)识别
PPEI及其产科医生对产后绝育的态度、信念和做法,
进行和分析PPEI要求产后绝育的半结构化访谈,
分娩产科医生(n=15对); 3)制定符合伦理的产后绝育临床指南,
PPEI通过从以患者为中心和健康公平透镜进行强大的伦理分析。我们的结果将
提供一个重要的框架,为长期拖延,以证据为基础的政策建议,以改善临床护理,
促进公共卫生,减少PPEI之间的差距。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Kavita Shah Arora其他文献
Improving Rates of Post-Essure Hysterosalpingography in an Urban Population Using Electronic Tracking Reminders
- DOI:
10.1016/j.jmig.2016.10.019 - 发表时间:
2017-02-01 - 期刊:
- 影响因子:
- 作者:
Yu-Han Virginia Hu;Kavita Shah Arora - 通讯作者:
Kavita Shah Arora
Correction to: Changes in Rates of Inpatient Postpartum Long‑Acting Reversible Contraception and Sterilization in the USA, 2012–2016
- DOI:
10.1007/s10995-021-03202-7 - 发表时间:
2021-08-25 - 期刊:
- 影响因子:1.700
- 作者:
David Sheyn;Kavita Shah Arora - 通讯作者:
Kavita Shah Arora
Uncertainty in Postpartum Permanent Contraception Decision-Making: Physician and Patient Perspectives
- DOI:
10.1016/j.whi.2024.06.005 - 发表时间:
2024-11-01 - 期刊:
- 影响因子:
- 作者:
Brooke W. Bullington;Madeline Thornton;Madison Lyleroehr;Kristen A. Berg;Kari White;Margaret Boozer;Tania Serna;Emily S. Miller;Jennifer L. Bailit;Kavita Shah Arora - 通讯作者:
Kavita Shah Arora
Consistency of antenatal contraceptive plan and postpartum fulfillment in patients with opioid use disorder
- DOI:
10.1007/s00737-023-01388-z - 发表时间:
2023-11-03 - 期刊:
- 影响因子:2.700
- 作者:
Tani Malhotra;Kathryn Thomas;David Ngendahimana;Kelly S Gibson;Kavita Shah Arora - 通讯作者:
Kavita Shah Arora
Transfer of embryos affected by monogenic conditions: an Ethics Committee Opinion
单基因疾病影响的胚胎移植:伦理委员会的意见
- DOI:
10.1016/j.fertnstert.2025.02.001 - 发表时间:
2025-05-01 - 期刊:
- 影响因子:7.000
- 作者:
Sigal Klipstein;Sina Abhari;Deborah Anderson;Aishwarya Arjunan;Kavita Shah Arora;Tolulope Bakare;Zeki Beyhan;Katherine Cameron;Susan Crockin;Ruth Farrell;Catherine Hammack-Aviran;Mandy Katz-Jaffe;Jennifer Kawwass;Louise King;Edward Martinez;Joshua Morris;Torie Comeaux Plowden;Robert Rebar;Chevis N. Shannon;Hugh Taylor;Julianne Zweifel - 通讯作者:
Julianne Zweifel
Kavita Shah Arora的其他文献
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{{ truncateString('Kavita Shah Arora', 18)}}的其他基金
Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
- 批准号:
10792263 - 财政年份:2023
- 资助金额:
$ 21.43万 - 项目类别:
Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
- 批准号:
10159298 - 财政年份:2020
- 资助金额:
$ 21.43万 - 项目类别:
Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
- 批准号:
10557170 - 财政年份:2020
- 资助金额:
$ 21.43万 - 项目类别:
Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
- 批准号:
10360685 - 财政年份:2020
- 资助金额:
$ 21.43万 - 项目类别:
Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
- 批准号:
10455329 - 财政年份:2020
- 资助金额:
$ 21.43万 - 项目类别:
Multi-level factors affecting postpartum sterilization
影响产后绝育的多层次因素
- 批准号:
9883068 - 财政年份:2020
- 资助金额:
$ 21.43万 - 项目类别:
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