Traveling for rights: Abortion trends in New Mexico after passage of restrictive Texas legislation.

OBJECTIVES: To determine the proportion of abortions provided to patients from Texas in New Mexico before and after the 2013 enactment of Texas House Bill 2 (HB2), an omnibus bill of abortion restrictions, and to compare the gestational ages at which Texans presented for abortion in New Mexico before and after HB2. STUDY DESIGN: We conducted a chart review of Texas and New Mexico patients obtaining an abortion in New Mexico abortion clinics before HB 2 was signed and implemented (time period 1: January 1, 2012 to December 31, 2012) and after HB 2 went into effect (time period 2: May 1, 2014 to April 30, 2015). We used random sampling of corresponding 7-day periods (by week number during the one-year sample) to obtain data until we reached the desired sample of at least 300 patients. We compared proportions of individuals from Texas obtaining abortions and the gestational age at which they presented in the two time periods. RESULTS: We abstracted data from 350 and 300 Texas and New Mexico patients, respectively. The proportion of procedures provided to women from Texas increased from 10 (3%) pre-HB2 to 43 (14%) post-HB2 (p < 0.0001). The proportion of procedures in Texas patients at 13 to ≤24 weeks increased from 1 of 29 (3%) pre-HB2 to 10 of 38 (26%) post-HB2 (p = 0.012). CONCLUSION: The proportion of Texans scheduling abortions in New Mexico within the first 24 weeks of gestation increased after passage of HB2. Restrictive legislation may force more people to travel across state lines to obtain abortion care. IMPLICATIONS: Patients residing in Texas and seeking abortion care in Texas experienced barriers to abortion care, likely related to restrictions imposed by HB2.

Satisfaction with Sex Education in New Mexico High Schools: A Survey of College Students.

OBJECTIVE: To evaluate the perceived quality of and satisfaction with sex education among University of New Mexico (UNM) college students. STUDY DESIGN: Survey methods utilized with 18-21- year-old UNM freshmen and sophomores who graduated from a New Mexico high school. The survey included questions about type of sex education, satisfaction with sex education (on a 5-point Likert scale), and impact on sexual decision-making and was emailed to participants. RESULTS: A total of 9,866 surveys were emailed; 2,441 were returned (response rate = 24.7%); 415 did not attend high school in New Mexico, leaving 2,024 surveys in the analytic sample. Comprehensive sex education received higher ratings than abstinence-only or no sex education (3.29 ± 0.03 vs. 2.53 ± 0.07 vs. 1.87 ± 0.08, respectively, p<0.0001). More students receiving comprehensive sex education than abstinence-only education reported improved ability to make decisions about sexual initiation (66.6% vs. 54.0%; p = 0.0005), pregnancy prevention (92.7% vs. 72.9%; p < 0.0001), sexually transmitted, infection prevention (92.5% vs. 70.4%; p < 0.0001), and avoidance of unwanted sex (77.6% vs. 65.8%; p = 0.0003). CONCLUSION: New Mexico college students were more satisfied with comprehensive sex education in high school. New Mexico should consider establishing a state requirement for comprehensive sex education.

Postpartum contraceptive choices among ethnically diverse women in New Mexico.

OBJECTIVE: The objective of the study was to determine if postpartum contraceptive choices by primiparous women differ by ethnicity. STUDY DESIGN: Retrospective nested cohort study analyzing women's characteristics and contraceptive choice. RESULTS: Of 652 participants, 312 (47.8%) were Hispanic, 287 (44.0%) were non-Hispanic white, and 53 (8.1%) were American Indian (AI). In multivariate analysis, depot medroxyprogesterone acetate (DMPA) and intrauterine device (IUD)/implant choice was related to AI [DMPA: odds ratio (OR) 15.28, confidence interval (CI) 4.49-52.04; IUD/implant: OR 0.46, CI 0.22-0.92] and Hispanic (DMPA: OR 3.44, CI 1.12-10.58) ethnicity. CONCLUSION: DMPA use was higher among Hispanic and AI women and IUD/implant use lower in AI women compared to non-Hispanic white women.

Misoprostol for intrauterine device insertion in nulliparous women: a randomized controlled trial.

OBJECTIVE: To examine the effects of preprocedure misoprostol on intrauterine device (IUD) placement in nulliparous women. STUDY DESIGN: In this randomized controlled double-blind trial at the University of New Mexico reproductive health clinic, nulliparous women requesting an IUD were randomized to 400 mcg of buccal misoprostol or placebo 2-8 hours before insertion. Primary outcomes included pain on a 10-cm visual analog scale and women's perception of the value of delaying insertion for an effective medication. Provider ease of insertion and need for adjunctive insertion measures were also assessed, on a visual analog scale. Participants indicated maximum pain after IUD insertion, pain level they would tolerate to avoid delay in IUD insertion, and preference for IUD insertion without delay if an effective medication was available. RESULTS: Of 85 women enrolled, 3 were ineligible; 42 were randomized to misoprostol and 40 to placebo. There were no differences between groups in worst insertion pain, (5.8 ± 2.0 vs 5.9 ± 2.0, P = .94), provider ease of insertion (2.2 ± 2.2 vs 2.5 ± 2.2; P = .54) or adjunctive measures (14% vs 25%; P = .27). The groups were willing to tolerate the same mean pain (4.9 ± 2.5 vs 5.7 ± 2.4, P = .18) to avoid waiting for medication. The majority of women (85%) preferred to wait for an effective medication. CONCLUSION: Misoprostol for nulliparous women did not decrease pain or improve the ease of insertion of an IUD. Most women were willing to wait for a medication that decreases pain, indicating a need to pursue alternatives for pain control with IUD insertion.

Exploring factors in the decision to choose sterilization vs alternatives in rural El Salvador.

CONTEXT: To explore the factors that influence rural Salvadoran women to undergo tubal sterilization versus opting for alternative methods of family planning. EVIDENCE ACQUISITION: A moderator fluent in English and Spanish conducted eleven 90-minute focus groups consisting of 5-10 women each. Eligible women in the municipality of San Pedro Perulapan, El Salvador, were identified and recruited by local health workers. Participant demographics and information about family planning decisions were collected through detailed notes and tape-recorded sessions. The tapes were transcribed verbatim, and all data were analyzed using grounded theory procedures to identify common themes. EVIDENCE SYNTHESIS: Eighty women aged 24-45 years who had previously been sterilized participated in the study. Three major themes influenced a woman's decision to undergo sterilization instead of opting for alternative forms of family planning: (1) availability: tubal sterilization is readily available, (2) fears about side effects of other methods: these women associated negative side effects with other forms of family planning, (3) effectiveness: the women in these focus groups thought sterilization was more effective than other forms of family planning. CONCLUSIONS: This study shows that there is a lack of information, and misinformation, about other effective methods of contraception, especially the intrauterine device and oral contraceptives. Reproductive health education projects, especially those providing services in locations similar to rural El Salvador, should focus on providing accurate information about all forms of contraception, including tubal sterilization.