The Association Between Multiple Abortions Within 1 Year and Previous Postabortal Desired Contraception at an Urban, Public Hospital.

Objectives: To determine the proportion of women undergoing multiple abortions within 1 year at an urban, public hospital and the association with desired contraception after the index abortion. Materials and Methods: We conducted a retrospective analysis of all women undergoing abortion up to 13 weeks and 6 days gestation at Stroger Hospital from June 1, 2012 to May 31, 2014. We examined the proportion of women with additional abortions up to 1 year after the index abortion and contraception desired at the index abortion. We also collected data about Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) infection in surgical abortion patients, to assess suitability for intrauterine device insertion immediately postabortion. Results: Of the 5,104 women with an abortion in the study period, 720 (14.1%) had at least one additional abortion within 1 year. Among women with multiple abortions, 153 (21.3%) selected Tier 1 contraception, 359 (49.8%) Tier 2, 103 (14.3%) Tier 3, and 105 (14.6%) were undecided or desired no method. The contraception desired at the index abortion did not differ significantly between women with and without subsequent abortions (p = 0.107). CT/GC coinfection and CT infection alone were associated with having multiple abortions over the 1-year period (p = 0.020 and p = 0.006). Conclusions: Among women presenting for abortion at an urban, public hospital, desired contraception did not differ significantly between women with multiple abortions versus one abortion within 1 year, but prevalence of CT/GC did. Women at high risk for multiple abortions may benefit from immediate postabortion IUD insertion to avoid unintended pregnancy, provided risk of infection is carefully evaluated.

Benefits and challenges of linking green infrastructure and highway planning in the United States.

Landscape-level green infrastructure creates a network of natural and semi-natural areas that protects and enhances ecosystem services, regenerative capacities, and ecological dynamism over long timeframes. It can also enhance quality of life and certain economic activity. Highways create a network for moving goods and services efficiently, enabling commerce, and improving mobility. A fundamentally profound conflict exists between transportation planning and green infrastructure planning because they both seek to create connected, functioning networks across the same landscapes and regions, but transportation networks, especially in the form of highways, fragment and disconnect green infrastructure networks. A key opportunity has emerged in the United States during the last ten years with the promotion of measures to link transportation and environmental concerns. In this article we examined the potential benefits and challenges of linking landscape-level green infrastructure planning and implementation with integrated transportation planning and highway project development in the United States policy context. This was done by establishing a conceptual model that identified logical flow lines from planning to implementation as well as the potential interconnectors between green infrastructure and highway infrastructure. We analyzed the relationship of these activities through literature review, policy analysis, and a case study of a suburban Maryland, USA landscape. We found that regionally developed and adopted green infrastructure plans can be instrumental in creating more responsive regional transportation plans and streamlining the project environmental review process while enabling better outcomes by enabling more targeted mitigation. In order for benefits to occur, however, landscape-scale green infrastructure assessments and plans must be in place before integrated transportation planning and highway project development occurs. It is in the transportation community's interests to actively facilitate green infrastructure planning because it creates a more predictable environmental review context. On the other hand, for landscape-level green infrastructure, transportation planning and development is much more established and better funded and can provide a means of supporting green infrastructure planning and implementation, thereby enhancing conservation of ecological function.