Misconceptions about the legality of reproductive healthcare could prevent or delay people from accessing needed services. We evaluated knowledge about the legality of abortion and 11 other reproductive health practices in Ohio. We analyzed data from a population-representative survey of adult, reproductive-age women in Ohio (September 2022-August 2023; N = 2421) collected after the US Supreme Court's June 2022 Dobbs decision allowing states to restrict abortion. We used log binomial regression to identify participant factors related to lacking knowledge of legality and compared knowledge in 2022-2023 to a pre-Dobbs wave (October 2018-June 2019; N = 2516) to evaluate whether misconceptions increased over time. Abortion was legal in Ohio until 22 weeks of gestation during both survey periods; however, during a brief (< 3 months) intervening period, legal abortion was restricted after approximately 6 weeks. Post-Dobbs, substantial percentages reported believing that abortion was illegal (40.5%) or not knowing (28.7%). Many did not know the legality of other practices such as using assisted reproductive technology (17.3%), traveling out of state to obtain an abortion (44.3%), or obtaining medical care during or after miscarriage (21.3%) or for ectopic pregnancy (27.7%). The prevalence of believing that abortion was illegal was higher post-Dobbs (40.5%) compared to pre-Dobbs (10.1%; p < 0.001). Overall, 69.2% of adult, reproductive-age women in Ohio in 2022-2023 did not know that abortion was legal in the state. Even in a state with legally protected abortion rights, women might be unaware of their legal right to healthcare, which could introduce delays in seeking or foregoing care.

Over the last decade at the University Hospital of Nancy in Lorraine, France, we have observed an increasing number of people under 35 years old who receive consultation for gender incongruence, from an average of 7 new patients per year in 2002-2013 to an average of 27 per year in 2014-2017. We conducted a mixed-methods study, including a retrospective quantitative analysis of medical records of youths who sought care for gender incongruence from 2004 to 2020, and a qualitative analysis of in-depth interviews with 11 patients identified through the medical records. The study included 235 participants (135 assigned female at birth, 100 assigned male at birth). Transgender men were younger than transgender women: mean age 20 (1.6, standard deviation, [SD]) years vs. 22.7 (4.3 SD) years; p = 0.01 at first referral. We observed no difference in age at the initiation of gender-affirming hormonal treatments. More than half of our participants chronologically situated their first questioning about their gender identity in the prepubertal period. Their life experiences revealed a lack of transgender representation in society, discomfort with the treatments offered, difficulties in becoming aware of and disclosing their gender identity, and the importance of peer/community support. The present study provides insights into the growing population of transgender and gender nonconforming people receiving care in the University Hospital of Nancy which has coincided with the evolution of the national legal framework. Our results identify several priorities for transgender youth who are receiving gender-affirming care. Further research outside hospital networks appears warranted.

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.

The limited literature on family planning among Asian populations in the United States suggests that this group underutilizes contraception. We examined factors associated with contraceptive use, particularly among South Asians. We used cross-sectional data from the 2013, 2014, and 2016 New York City Community Health Surveys and included women and men aged 18-44 years who engaged in sexual activity with a member of a different sex in the last year and did not intend to get pregnant, were not/partner was not pregnant, and could/partner could get pregnant (N = 7101). We conducted bivariate and multivariate logistic regressions with backward elimination to estimate the association between sociodemographic, behavioral, and health care-related factors with the use of any contraceptive at the last sexual encounter. The primary analysis included race as a key independent variable and the secondary analysis was restricted only to South Asians (n = 189). Two thirds of South Asians (67%) used a contraceptive at last sexual encounter. After full adjustment, compared to South Asians, other Asians showed a higher likelihood of using contraception (aOR 1.54; 95% CI: 1.05, 2.26). In the secondary analysis of South Asians, those who were married/living together (aOR 0.19; 95% CI: 0.08, 0.45) or divorced/separated/widowed (aOR 0.14; 95% CI: 0.03, 0.68) showed a lower likelihood of using any contraception compared to those who were never married. Researchers need to conduct additional research to better understand contraceptive behavior among South Asians and identify if/what optimal interventions will increase access and help meet and support their reproductive goals and autonomy.

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 = 1.02 [1.01-1.04], p = 0.002). We observed only two interactions between FSFI and BMI (p = 0.015) and education (p < 0.001). When considering educational subgroups, FSFI level was mainly associated with quality of life among those with a moderate educational level (OR = 1.07 [1.04-1.10], p < 0.001) and when considering BMI subgroups, FSFI level was mainly associated with quality of life among those with a moderate BMI (OR = 1.05 [1.02-1.08], p = 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 = 9.1, p < 0.001). This study underscores the importance of professionals who treat patients with endometriosis addressing sexual dysfunction to ensure their quality of life.

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 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.

Given the history of coercion in the provision of sterilization, it is important that patients who desire permanent contraception receive patient-centered care that respects their preferences. Recent literature examiningthe provision of postpartum permanent contraception has not explored whether patients who desire permanent contraception feel supported by their clinical teams. We interviewed patients from four medical centers around the United States with a documented desire for postpartum permanent contraception. We audio-recorded, transcribed, and analyzed interviews using rapid qualitative methods and thematic content analysis. Of the 81 patients interviewed, most (n = 64) felt supported by their clinician throughout their prenatal care and delivery hospitalization. Seventeen patients shared stories of feeling unsupported. Patients recalled feeling dismissed when they initiated conversations about permanent contraception. Additionally, they felt they had received incomplete counseling on permanent contraception and felt discouraged from getting the procedure during prenatal care encounters. During delivery hospitalization, patients discussed not being informed about barriers to permanent contraception as they surfaced, facing lack of prioritization of the procedure by clinicians, recognizing communications errors among the clinical team, and feeling pressured to undergo or not undergo permanent contraception. Most patients felt supported by their clinicians throughout permanent contraception decision-making and provision. Patients who did not feel supported reported a spectrum of experiences ranging from rushed appointments, perceived clinician bias in counseling, and communications barriers to the provision of permanent contraception after delivery. Patient-centered care that prioritizes patient experiences, values, and desires is necessary to ensure that all people can achieve their reproductive goals.

Consensual sexual choking has become prevalent among young United States (US) adults. In sex between women and men, women are overwhelmingly the ones choked, perhaps reproducing traditional heteronormative power dynamics. No research has examined the relationship between being choked during consensual sex and the use of external condoms and other contraceptives. We administered a cross-sectional campus-representative survey to 4989 undergraduate students at a large public Midwestern US university. Half of respondents (n = 1803) had ever been choked during sex. Having been choked was associated with a significantly lower likelihood of event-level condom use (OR = 0.32 [0.19, 0.54] for >5 times lifetime choking among men and OR = 0.35 [0.27, 0.45] for >5 times lifetime choking among women compared to those with no choking experiences) and in the past 6 months (OR = 0.42 [0.24, 0.72] for >5 times lifetime choking among men and OR = 0.59 [0.43, 0.81] for >5 times lifetime choking among women compared to those with no choking experiences). Also, having ever been choked was associated with a significantly greater likelihood of having used an implant/intra-uterine device in the past 6 months (OR = 1.85 [1.28, 2.68] for >5 times lifetime choking compared to those with no choking experiences). Recognition that sexual choking is prevalent among young people has only recently emerged and educational programs are lacking. Study findings could be used to engage people in discussions about choking in relation to gender, power, and reproductive health agency.