Predictors and experiences of seeking abortion services from pharmacies in Nepal.

Abortion was legalized in Nepal in 2002; however, despite evidence of safety and quality provision of medical abortion (MA) pills by pharmacies in Nepal and elsewhere, it is still not legal for pharmacists to provide medication abortion in Nepal. However, pharmacies often do provide MA, but little is known about who seeks abortions from pharmacies and their experiences and outcomes. The purpose of this study is to understand the experiences of women seeking MA from a pharmacy, abortion complications experienced, and predictors for denial of MA. Data was collected from women seeking MA from four pharmacies in two districts of Nepal in 2021-2022. Data was collected at baseline (N = 153) and 6 weeks later (N = 138). Using descriptive results and multi-variable regression models, we explore differences between women who received and did not receive MA and predictors of denial of services. Most women requesting such pills received MA (78%), with those who were denied most commonly reporting denial due to the provider saying they were too far along. There were few socio-demographic differences between groups, with the exception of education and gestational age. Women reported receiving information on how to take pills and what to do about side effects. Just under half (45%) of women who took pills reported no adverse symptoms after taking them and only 13% sought care. Most women seeking MA from pharmacists in Nepal are receiving services, information, and having few post-abortion symptoms. This study expands the previous limited research on pharmacy provision of MA in Nepal using a unique dataset that recruits women at the time of abortion seeking and follows them over time, overcoming potential biases present in other study designs. This suggests that expansion of the law to allow pharmacy distribution would increase accessibility and reflect current practice.

Deaths among Women of Reproductive Age: an Explorative Case Study among Abortion Seekers.

In Nepal, abortion was legalized in 2002. Yet many women are denied abortion services. Women denied abortion services may either continue their pregnancies or find abortion care elsewhere. However, what is not known is the consequences on women, and their children after accessing abortion services or after being denied abortion services. This comment aims to understand the cause of death of women who sought abortion services between 2019 and 2020 and were enrolled in a longitudinal nationwide study of the consequences of legal abortion access in Nepal. Women were interviewed 6 weeks and every 6 months for 3 years after seeking abortion. During the follow-up interviews, the field research assistants were informed about the death of the clients. Once the death was reported, a trained senior research staff visited the deceased persons house and interviewed family members including husbands, maternal parents or in-laws to explore the cause of death. A total of nine deaths were reported between April 2019 and December 2022. Out of nine deceased women, four received abortions while five of them were initially denial abortion services. The majority of the deaths were due to suicide followed by tuberculosis. None of the deaths were caused by abortion or birth. Keywords: Death; Nepal; reproductive ages; womens health.

Trisiloxane Surfactants Negatively Affect Reproductive Behaviors and Enhance Viral Replication in Honey Bees.

Trisiloxane surfactants are often applied in formulated adjuvant products to blooming crops, including almonds, exposing the managed honey bees (Apis mellifera) used for pollination of these crops and persisting in colony matrices, such as bee bread. Despite this, little is known regarding the effects of trisiloxane surfactants on important aspects of colony health, such as reproduction. In the present study, we use laboratory assays to examine how exposure to field-relevant concentrations of three trisiloxane surfactants found in commonly used adjuvant formulations affect queen oviposition rates, worker interactions with the queen, and worker susceptibility to endogenous viral pathogens. Trisiloxane surfactants were administered at 5 mg/kg in pollen supplement diet for 14 days. No effects on worker behavior or physiology could be detected, but our results demonstrate that hydroxy-capped trisiloxane surfactants can negatively affect queen oviposition and methyl-capped trisiloxane surfactants cause increased replication of Deformed Wing Virus in workers, suggesting that trisiloxane surfactant use while honey bees are foraging may negatively impact colony longevity and growth. Environ Toxicol Chem 2024;43:222-233. © 2023 SETAC. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Denial of legal abortion in Nepal.

INTRODUCTION: In Nepal, abortion is legal on request through 12 weeks of pregnancy and up to 28 weeks for health and other reasons. Abortion is available at public facilities at no cost and by trained private providers. Yet, over half of abortions are provided outside this legal system. We sought to investigate the extent to which patients are denied an abortion at clinics legally able to provide services and factors associated with presenting late for care, being denied, and receiving an abortion after being denied. METHODS: We used data from a prospective longitudinal study with 1835 women aged 15-45. Between April 2019 and December 2020, we recruited 1,835 women seeking abortions at 22 sites across Nepal, including those seeking care at any gestational age (n = 537) and then only those seeking care at or after 10 weeks of gestation or do not know their gestational age (n = 1,298). We conducted interviewer-led surveys with these women at the time they were seeking abortion service (n = 1,835), at six weeks after abortion-seeking (n = 1523) and six-month intervals for three years. Using descriptive and multivariable logistic regression models, we examined factors associated with presenting for abortion before versus after 10 weeks gestation, with receiving versus being denied an abortion, and with continuing the pregnancy after being denied care. We also described reasons for the denial of care and how and where participants sought abortion care subsequent to being denied. Mixed-effects models was used to accounting clustering effect at the facility level. RESULTS: Among those recruited when eligibility included seeking abortion at any gestational age, four in ten women sought abortion care beyond 10 weeks or did not know their gestation and just over one in ten was denied care. Of the full sample, 73% were at or beyond 10 weeks gestation, 44% were denied care, and 60% of those denied continued to seek care after denial. Nearly three-quarters of those denied care were legally eligible for abortion, based on their gestation and pre-existing conditions. Women with lower socioeconomic status, including those who were younger, less educated, and less wealthy, were more likely to present later for abortion, more likely to be turned away, and more likely to continue the pregnancy after denial of care. CONCLUSION: Denial of legal abortion care in Nepal is common, particularly among those with fewer resources. The majority of those denied in the sample should have been able to obtain care according to Nepal's abortion law. Abortion denial could have significant potential implications for the health and well-being of women and their families in Nepal.

Examination of Hivetop Incubator Efficacy for Emerging Osmia lignaria (Hymenoptera: Megachilidae) and the Impact on Apis mellifera (Hymenoptera: Apidae) Colonies.

Osmia lignaria Say is used in combination with Apis mellifera L. to pollinate U.S. orchard crops. The deployment of O. lignaria requires artificial warming to synchronize adult bee emergence with crop bloom. However, current methods for emerging bees are time consuming and inefficient; the Hivetop Incubator (HTI) invention creates a space atop an A. mellifera hive whose heat flows through the screened bottom of the HTI to incubate cocooned O. lignaria adults therein. In response to HTI heat, O. lignaria adults chew out of cocoons, find an exit hole, and fly away to nest in provided nesting sites and, thereby, pollinate a crop. Objectives for studies performed in Utah and Washington were to: 1) determine whether HTIs inhibit A. mellifera thermoregulation or colony growth, 2) compare O. lignaria emergence duration from an HTI with and without hive heat, and 3) assess whether O. lignaria females leave HTIs located at the orchard edge to nest throughout the orchard. We found no significant differences between the internal temperatures of A. mellifera colonies with and without HTIs and no impact on A. mellifera food storage or brood production. Osmia lignaria in hive-heated HTIs emerged 3× faster than bees in unheated HTIs. Heated HTIs were significantly cooler than hive temperatures but significantly warmer than HTIs atop empty hive boxes. Osmia lignaria nest distribution was not correlated to the location of HTIs at the orchard edge. Overall, HTIs were effective for timely, on-site emergence of O. lignaria for orchard pollination without negatively impacting A. mellifera colonies.

Novel Microsatellite Markers for Osmia lignaria (Hymenoptera: Megachilidae): A North American Pollinator of Agricultural Crops and Wildland Plants.

Comprehensive decisions on the management of commercially produced bees, depend largely on associated knowledge of genetic diversity. In this study, we present novel microsatellite markers to support the breeding, management, and conservation of the blue orchard bee, Osmia lignaria Say (Hymenoptera: Megachilidae). Native to North America, O. lignaria has been trapped from wildlands and propagated on-crop and used to pollinate certain fruit, nut, and berry crops. Harnessing the O. lignaria genome assembly, we identified 59,632 candidate microsatellite loci in silico, of which 22 were tested using molecular techniques. Of the 22 loci, 12 loci were in Hardy-Weinberg equilibrium (HWE), demonstrated no linkage disequilibrium (LD), and achieved low genotyping error in two Intermountain North American wild populations in Idaho and Utah, USA. We found no difference in population genetic diversity between the two populations, but there was evidence for low but significant population differentiation. Also, to determine if these markers amplify in other Osmia, we assessed 23 species across the clades apicata, bicornis, emarginata, and ribifloris. Nine loci amplified in three species/subspecies of apicata, 22 loci amplified in 11 species/subspecies of bicornis, 11 loci amplified in seven species/subspecies of emarginata, and 22 loci amplified in two species/subspecies of ribifloris. Further testing is necessary to determine the capacity of these microsatellite loci to characterize genetic diversity and structure under the assumption of HWE and LD for species beyond O. lignaria. These markers will inform the conservation and commercial use of trapped and managed O. lignaria and other Osmia species for both agricultural and nonagricultural systems.

Intimate relationships after receiving versus being denied an abortion: A 5-year prospective study in the United States.

CONTEXT: When an individual seeking an abortion cannot obtain one, carrying that pregnancy to term may affect both her relationship with the man involved in the pregnancy and her prospects for new intimate relationships. We aimed to assess the impact of receiving versus being denied a wanted abortion on women's intimate relationships, up to 5 years after seeking an abortion in the United States. METHODS: Using mixed-effects regression models, we compared relationship outcomes among women who presented for abortion care just under facilities' gestational age limits ("Near-limit abortion patients," n = 452) with those who presented just over, were denied an abortion ("Turnaways," n = 146) at 30 US facilities. RESULTS: At 1 week post-abortion seeking, the predicted probability of being in a relationship with the man involved in the pregnancy was 58%, gradually declining to 27% at 5 years with no significant differences between those who received and those who were denied an abortion. However, from 2 to 5 years post-abortion seeking, participants who were denied an abortion had double the odds (aOR = 2.01, 95% CI: 1.09-3.69) of being in a poor intimate relationship, with a predicted probability of being in a poor relationship of 14% among those denied an abortion compared with 9% among those who received one (p < 0.05). CONCLUSIONS: Carrying an unwanted pregnancy to term does not increase the chance of being in an intimate relationship with the man involved in the pregnancy but may have negative implications for the quality of future relationships up to 5 years post-abortion seeking.

Comparison of Pregnancy Preferences Preceding vs Year 1 of the COVID-19 Pandemic.

Importance: Understanding how the COVID-19 pandemic affected people's desire to avoid pregnancy is essential for interpreting the pandemic's associations with access to reproductive health care and reproductive autonomy. Early research is largely cross-sectional and relies on people's own evaluations of how their desires changed. Objective: To investigate longitudinal changes in pregnancy desires during the year before and the first year of the COVID-19 pandemic. Design, Setting, and Participants: In this cohort study, participants reported their pregnancy preferences at baseline and quarterly for up to 18 months between March 2019 and March 2021. An interrupted time series analysis with mixed-effects segmented linear regression was used to examine population-averaged time trends. People were recruited from 7 primary and reproductive health care facilities in Arizona, New Mexico, and Texas. Participants were sexually active, pregnancy-capable people aged 15 to 34 years who were not pregnant or sterilized. Data analysis was performed from September 2021 to January 2022. Exposures: Continuous time, with knots at the onset of the first (July 1, 2020, summer surge) and second (November 1, 2020, fall surge) COVID-19 cases surges in the Southwest. Main Outcomes and Measures: Preferences around potential pregnancy in the next 3 months, measured using the validated Desire to Avoid Pregnancy (DAP) scale (range, 0-4, with 4 indicating a higher desire to avoid pregnancy). Results: The 627 participants in the analytical sample had a mean (SD) age of 24.9 (4.9) years; 320 (51.0%) identified as Latinx and 180 (28.7%) as White. Over the year before the first case surge in the US Southwest in summer 2020, population-averaged DAP scores decreased steadily over time (-0.06 point per quarter; 95% CI, -0.07 to -0.04 point per quarter; P < .001). During the summer 2020 surge, DAP scores stopped declining (0.05 point per quarter; 95% CI, -0.03 to 0.13 point per quarter; change in slope, P < .001). During the fall 2020 surge, however, DAP scores declined again at -0.11 point per quarter (95% CI, -0.26 to 0.04 point per quarter; change in slope, P = .10). Participants aged 15 to 24 years and those who were nulliparous and primiparous experienced greater declines in DAP score before the summer surge, and greater reversals of decline between summer and fall 2020, than did those who were aged 25 to 34 years and multiparous. Conclusions and Relevance: These findings suggest that the COVID-19 pandemic onset was associated with the stalling of a prior trend toward greater desire for pregnancy over time, particularly for people earlier in their reproductive lives.

The Court is ignoring science.

A recently leaked draft opinion indicated that the US Supreme Court is prepared to overturn Roe v. Wade as early as next month in the matter of Dobbs v. Jackson Women's Health Organization. In doing so, the Justices won't just be disregarding decades of precedent. They'll also be disregarding ample evidence of abortion's positive impact on patients' health and well-being.

Predictors of prior unsuccessful pharmacy abortion attempts among women presenting for abortion in government certified clinics in Nepal.

OBJECTIVE: Although abortion in Nepal is broadly legal and free of charge, many women seek abortion care outside the legal system, including from pharmacies. We evaluated the prevalence of, and factors associated with, prior unsuccessful abortion attempts among women presenting to 14 randomly-selected government approved abortion health facilities across Nepal. METHODS: Eligible participants were recruited in 2019 by trained research staff from certified abortion facilities. Participants (n = 1160) completed research staff-administered baseline surveys. We used multivariable mixed-effects logistic regression models to evaluate factors associated with having attempted pharmacy abortion prior to coming to the health facility. RESULTS: Almost one in seven (14%) women had tried to end their pregnancy before presenting to a participating clinic, often (9%) using medication obtained from a pharmacy. Women who lived farther from the clinic (aOR 1.28 per log hours travel time, 95% CI 1.10-1.49) and who reported financial difficulty in accessing the clinic (19% vs. 10%, aOR 2.10, 95% CI 1.20-3.70) had increased odds of having tried to access abortion through a pharmacy. CONCLUSION: Integrating pharmacies into the legal network of abortion providers may improve access to safe care, particularly for rural women with financial and practical travel limitations.

Home pregnancy test use and timing of pregnancy confirmation among people seeking health care.

OBJECTIVES: Understanding the timing of pregnancy suspicion and confirmation, including the role of home pregnancy tests, can facilitate earlier entry into pregnancy-related care and identify individuals likely to be impacted by gestation-based abortion restrictions. STUDY DESIGN: We use data from 259 pregnant individuals participating in a cross-sectional survey at 8 primary and reproductive health care clinics in 6 U.S. states (2016-2017). We use regression models to identify differences in utilization of HPTs, barriers to use, and to compare gestational duration at pregnancy confirmation. RESULTS: Three-quarters (74%) of respondents took a home pregnancy test as the first step in confirming pregnancy; this figure was lower among adolescents versus young adults (65 vs 81%, p = 0.01). Two-thirds (64%) reported delays in home testing, higher among adolescents (85%). People taking a test at home confirmed pregnancy 10 days earlier than those first testing at a clinic (41.3 vs 51.8 days gestation, p = 0.02). Those that did not test at home cited concerns about test accuracy (42%) and difficulties accessing one (26%). While overall 21% confirmed pregnancy at ≥7 weeks gestation, and 35% at ≥6 weeks, confirmation at ≥7 weeks was higher among adolescents versus young adults (47 vs 13%, p = 0.001), Latina versus white women (28 vs 11%, p = 0.02), food insecure versus secure women (28 vs 17%, p = 0.06), and people with unplanned versus planned/mistimed pregnancies (25 vs 13%, p = 0.07). CONCLUSIONS: Home pregnancy testing is common and associated with earlier pregnancy confirmation. Still, barriers to at-home testing are evident, particularly among adolescents. Efforts to expand access to home pregnancy tests and increase knowledge about their accuracy may be impactful in increasing utilization. IMPLICATIONS: While at home pregnancy testing is common and facilitates earlier confirmation of pregnancy, one in 5 confirm pregnancy at 7 weeks gestation or later (and one in 3 do so at 6 weeks or later). Gestational bans in the first trimester will disproportionately prevent young people, people of color, and those living with food insecurity from being able to access abortion.

Effects of Provision Type and Pesticide Exposure on the Larval Development of Osmia lignaria (Hymenoptera: Megachilidae).

Wild and managed bee populations are in decline, and one of many environmental causes is the impact of pesticides on developing bees. For solitary bees, delayed larval development could lead to asynchronous adult emergence, unhealthy and inefficient adult pollinators, and decreased brood production and survival. We examined a methodology for testing Osmia lignaria Say (Hymenoptera: Megachilidae) larval responses to pesticide exposure using a laboratory bioassay. We created two provision types: a homogenized blend of O. lignaria provisions from an apple orchard and homogenized almond pollen pellets collected by honey bees plus sugar water. Pesticides were administered to the provisions to compare toxic effects. We recorded larval developmental durations for second-fifth instar and for fifth instar to cocoon initiation for larvae fed provisions treated with water (control) or doses of three pesticides and a representative spray-tank mixture (acetamiprid, boscalid/pyraclostrobin, dimethoate, and acetamiprid plus boscalid/pyraclostrobin). All larvae survived to cocoon initiation when only water was added to provisions. Impacts of pesticide treatments significantly differed between the apple and almond homogenates. The greatest treatment effects occurred when the homogenized almond provision was mixed with acetamiprid alone and when combined with boscalid/pyraclostrobin. Optimizing bioassays through the use of appropriate larval food for exposing solitary bee larvae to agrochemicals is crucial for assessing risks for pollinators.

Genetic and Usurpation Data Support High Incidence of Bumble Bee Nest Invasion by Socially Parasitic Bumble Bee, Bombus insularis.

Cuckoo bumble bees (Psithyrus) (Lepeletier, 1832) (Hymenoptera: Apidae) are a unique lineage of bees that depend exclusively on a host bumble bee species to provide nesting material, nutritional resources, and labor to rear offspring. In this study, we document usurpation incidence and population genetic data of Bombus insularis (Smith, 1861) (Hymenoptera: Apidae), a bumble bee species in the Psithyrus subgenus, on field-deployed B. huntii colonies in northern Utah, United States. Within 12 d of deploying B. huntii Greene, 1860 (Hymenoptera: Apidae) colonies at two field sites, 13 of the 16 colonies contained at least one established B. insularis female. Although our results demonstrate that field-deployed bumble bee colonies are highly susceptible to B. insularis usurpation, applying a fabricated excluder to prevent the inquiline from invading a colony was 100% effective. Sibship analysis using microsatellite genotype data of 59 B. insularis females estimates that they originated from at least 49 unique colonies. Furthermore, sibship analysis found siblings distributed between the field sites that were 7.04 km apart. Our result suggests that B. insularis females have the capacity to disperse across the landscape in search of host colonies at distances of at least 3.52 km and up to 7.04 km. Our study underscores the detrimental impact B. insularis usurpation has on the host bumble bee colony. As B. insularis significantly impacts the success of bumble bee colonies, we briefly discuss how the utilization of excluders may be useful for commercial bumble bee colonies that are used to pollinate open field crops.

Timing of pregnancy discovery among women seeking abortion.

OBJECTIVE: Little is known about the incidence and causes of delay in recognition of pregnancy. Delay in pregnancy recognition is associated with later presentation for abortion and exacerbates the burdens in accessing care. Using Turnaway study data, this study assessed the prevalence of later pregnancy recognition among a sample of people who obtained or were denied a wanted abortion. STUDY DESIGN: The Turnaway Study included telephone interviews of 956 women who sought an abortion in the first trimester or just over or under the gestational limit of one of 30 abortion facilities across the United States and in-depth interviews with 31 who completed 5 years of surveys. We describe women's experiences discovering pregnancy and conducted multivariate analyses assessing factors associated with later pregnancy discovery (after 13 weeks since last menstrual period [LMP]). RESULTS: Most women seeking second trimester abortions recognized their pregnancy more than 8 weeks after their LMP; more than 1 in 5 recognized pregnancy after 20 weeks. In interviews, women explained that recognition was delayed because of a lack of pregnancy symptoms or concurrence of other conditions with symptoms similar to pregnancy. According to multivariate analyses, women who had never given birth (adjusted odds ratio [aOR] = 1.71; 95% confidence interval [CI]: 1.24, 2.35) and those who used hormonal contraceptives in the month of conception (aOR = 1.83; 95% CI: 1.35, 2.47) were more likely to discover pregnancy after 13 weeks. CONCLUSION: Laws imposing gestational limits will make abortion unavailable to people who discover pregnancy after the limit. Such bans are likely to disproportionately affect people using contraceptive methods to prevent pregnancy and those who have never given birth. IMPLICATIONS: Some pregnant people have few pregnancy symptoms and/or have conditions with symptoms similar to pregnancy, such as irregular periods or chronic pain. Gestational limits to abortion are likely to disproportionately affect people who recognize pregnancy later in pregnancy, particularly those without prior pregnancy experiences and who are using contraception.

Association of Travel Distance to Nearest Abortion Facility With Rates of Abortion.

Importance: Travel distance to abortion services varies widely in the US. Some evidence shows travel distance affects use of abortion care, but there is no national analysis of how abortion rate changes with travel distance. Objective: To examine the association between travel distance to the nearest abortion care facility and the abortion rate and to model the effect of reduced travel distance. Design, Setting, and Participants: This cross-sectional geographic analysis used 2015 data on abortions by county of residence from 1948 counties in 27 states. Abortion rates were modeled using a spatial Poisson model adjusted for age, race/ethnicity, marital status, educational attainment, household poverty, nativity, and state abortion policies. Abortion rates for 3107 counties in the 48 contiguous states that were home to 62.5 million female residents of reproductive age (15-44 years) and changes under travel distance scenarios, including integration into primary care (<30 miles) and availability of telemedicine care (<5 miles), were estimated. Data were collected from April 2018 to October 2019 and analyzed from December 2019 to July 2020. Exposures: Median travel distance by car to the nearest abortion facility. Main Outcomes and Measures: US county abortion rate per 1000 female residents of reproductive age. Results: Among the 1948 counties included in the analysis, greater travel distances were associated with lower abortion rates in a dose-response manner. Compared with a median travel distance of less than 5 miles (median rate, 21.1 [range, 1.2-63.6] per 1000 female residents of reproductive age), distances of 5 to 15 miles (median rate, 12.2 [range, 0.5-23.4] per 1000 female residents of reproductive age; adjusted coefficient, -0.05 [95% CI, -0.07 to -0.03]) and 120 miles or more (median rate, 3.9 [range, 0-12.9] per 1000 female residents of reproductive age; coefficient, -0.73 [95% CI, -0.80 to -0.65]) were associated with lower rates. In a model of 3107 counties with 62.5 million female residents of reproductive age, 696 760 abortions were estimated (mean rate, 11.1 [range, 1.0-45.5] per 1000 female residents of reproductive age). If abortion were integrated into primary care, an additional 18 190 abortions (mean rate, 11.4 [range, 1.1-45.5] per 1000 female residents of reproductive age) were estimated. If telemedicine were widely available, an additional 70 920 abortions were estimated (mean rate, 12.3 [range, 1.4-45.5] per 1000 female residents of reproductive age). Conclusions and Relevance: These findings suggest that greater travel distances to abortion services are associated with lower abortion rates. The results indicate which geographic areas have insufficient access to abortion care. Modeling suggests that integrating abortion into primary care or making medication abortion care available by telemedicine may decrease unmet need.

The impact of the COVID-19 pandemic on economic security and pregnancy intentions among people at risk of pregnancy.

OBJECTIVE: To understand how the COVID-19 pandemic affected women of reproductive age, specifically their economic conditions, desire for pregnancy, and access to contraceptive services during the pandemic. STUDY DESIGNS: A total of 554 women respondents age 18 to 49 and reside in the United States were recruited using social media between May 16, 2020 and June 16, 2020. Logistic regression models assessed predictors of reporting pandemic-related changes in economic conditions, desire for pregnancy, and contraceptive access. RESULTS: Compared to White/Caucasian respondents, Hispanics/Latinx and Black/African Americans have 4 times the odds of experiencing inability to afford food, transportation, and/or housing (p < 0.01) during the pandemic; Hispanics/Latinx have twice the odds of experiencing food insecurity (p < 0.05). Inability to afford food, transportation, and/or housing was associated with drop in desire to be pregnant (p < 0.01). Despite the 25% of participants who reported a drop in desire for pregnancy, 1 in 6 reported difficulty accessing contraceptives, particularly those who experienced reduced income (p < 0.01). CONCLUSIONS: In our sample, the pandemic unevenly affected people from different socioeconomic groups. Many simultaneously experienced reduced income, difficulties in accessing contraception, and a greater desire to avoid a pregnancy. This combination of factors increases the chance that people will experience unintended pregnancies. IMPLICATIONS: The pandemic caused economic hardship and an increased desire to postpone or prevent pregnancy at the same time that it created new barriers to contraceptive services. This pattern may lead to a potential net effect of an increase in unintended pregnancy, particularly among people who had difficulty affording food, transportation, and/or housing during the pandemic.