Body Mass Index and Levonorgestrel Device Expulsion in Adolescents and Young Adults.

STUDY OBJECTIVE: To evaluate the relationship between body mass and levonorgestrel intrauterine device (LNG-IUD) expulsion in adolescents and young adults (AYA). DESIGN, SETTING, PARTICIPANTS & INTERVENTIONS: A retrospective chart review was conducted of nulliparous females aged 10-24 years who had a 52-milligram LNG-IUD placed between November 2017 and May 2021 by pediatric and adolescent gynecology providers at a tertiary children's hospital, including those who underwent metabolic and bariatric surgery (MBS). Primary analysis focused on 10-19 year olds as they had comparable anthropometrics (namely BMI percentile [BMIP] as defined by the Centers for Disease Control). Descriptive statistics included means, standard deviations (SD), and ranges for continuous variables counts and percentages for categorical variables. Chi-square or Fisher's exact tests were used to assess associations. Logistic regressions were fit to test the associations between BMIP, MBS, and the odds of expulsion. MAIN OUTCOME MEASURES & RESULTS: A total of 588 patients were included in the primary analysis (10-19 years). Mean age was 15.8 years (±2.0). Using BMIP, 15.5% (n = 91) of the sample was overweight and 22.3% (n = 131) were obese. Within 12 months, 33 patients (5.6%) experienced expulsion. Every one-unit increase in BMIP was associated with a 3% increase in the odds of expulsion (P = .008), and each increase in BMIP category (eg, overweight vs average/underweight) was significantly associated with increased odds of expulsion (OR = 2.77-4.28). Patients who had LNG-IUD placement during MBS (n = 43) had higher odds of expulsion (OR = 3.23; P = .024) than other patients. CONCLUSION: AYA with higher BMIP and/or who undergo MBS are at increased risk of LNG-IUD expulsion within one year of placement.

The "abortion imaginary": Shared perceptions and personal representations among everyday Americans.

Drawing upon 217 in-depth interviews and the concept of the "social imaginary," we introduce the "abortion imaginary"-a set of shared understandings regarding abortion and abortion patients. We identify four interrelated facets of the U.S. abortion imaginary pertaining to who gets an abortion and why: maternal inevitability, economic decision-making, relationship precarity, and emotional fragility. We then show how shared perceptions of abortion patients diverge into polarized opinions, revealing how those who know someone who has had an abortion differ from those who do not. Centering personal "exemplars," we integrate conceptual work on social imaginaries with contact theory to illuminate how divergent opinions coexist with shared cultural understandings.

Obstructed Hemivagina and Renal Anomalies in Patients with and without Anorectal Malformations.

STUDY OBJECTIVE: To compare the anatomic variation between patients with a diagnosis of an obstructed hemivagina with an anorectal malformation (ARM) and those without an ARM. METHODS: This was a retrospective chart review conducted at a single tertiary children's hospital. Patients with an obstructed hemivagina seen from 2004 to 2019 were included. RESULTS: We identified a total of 9 patients diagnosed with an obstructed hemivagina: 4 patients with a history of ARM and 5 patients without an ARM. Patients presented with obstructive symptoms between the ages of 11 and 20. Two-thirds of patients had a left-sided obstruction. All patients without an ARM had ipsilateral congenital anomalies of the kidney and urinary tract. Half the patients with a history of ARM had an ipsilateral renal anomaly, and the other half had a contralateral renal anomaly. CONCLUSION: Obstructed hemivagina occurs in patients with a history of ARM. However, unlike patients with isolated obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), patients with an ARM and an obstructed hemivagina can present with associated renal anomalies on either the ipsilateral or contralateral side. In our small case series, patients with a history of ARM had high septa and required more complex surgical management due to the inability to access the septum vaginally. Knowledge of renal anatomy and ureteral path is important because a hysterectomy may be needed to relieve the obstruction in patients with ARMs. A larger case series is needed to better characterize the spectrum of complex anomalies in patients with ARMs.

Caregiver goals and satisfaction for menstrual suppression in adolescent females with developmental disabilities: A prospective cohort study.

BACKGROUND: Adolescents with developmental disabilities and their caregivers often seek menstrual management. Caregivers frequently serve as medical decision-makers, and little is known about caregiver goals for menstrual management and satisfaction over time. OBJECTIVE: Assess caregiver reasons for initiating menstrual management in adolescents with disabilities and satisfaction over 12 months. METHODS: Prospective cohort study of caregivers of adolescents with developmental disabilities seeking menstrual management at a pediatric and adolescent gynecology clinic. Data derive from caregiver surveys and adolescents' electronic medical records. RESULTS: Ninety-two caregiver-adolescent pairs enrolled. The mean age of adolescents was 14.4 (±2.6). The most common method started was levonorgestrel intrauterine device (LNG-IUD; 52, 56.5%), followed by oral norethindrone acetate (21, 22.8%). Caregivers cited hygiene concerns (84.8%), behavioral problems (52.2%), and heavy/excessive bleeding (48.9%) as reasons for initiating menstrual suppression. Caregivers who identified hygiene or heavy/excessive bleeding as the most important reason for management were more likely to select LNG-IUD (p = 0.009). Caregivers who cited behavioral/mood or seizure concerns as the most important reason were more likely to choose other methods (p < 0.05). At 12 months, caregiver satisfaction with all methods was high (66.2-86.9 on a 100-point scale). For every additional day of bleeding, satisfaction decreased by 3.7 points (95% CI: 2.3-5.0). CONCLUSIONS: Caregiver satisfaction with all methods is high; however, it negatively correlates with days of bleeding. Caregiver reasons for menstrual suppression influence the method chosen. Management may reflect both patient and caregiver priorities; research is needed to better understand shared decision-making models that promote reproductive autonomy in adolescents with a developmental disability.

"It Wasn't Very Public-Clinicy": Client Experiences at Faith-Based Pregnancy Centers.

Faith-based pregnancy centers strive to offer "alternatives to abortion" that supporters claim aid women and critics assert manipulate pregnant people, stigmatize abortion, and potentially delay clients from obtaining medical care. However, scholars know little about the exchanges within appointments and how clients make sense of these experiences. Drawing on ethnographic observations of client appointments in two pregnancy centers in the West and 29 in-depth interviews with clients, this article uses an intersectional framework to analyze client experiences. Clients favorably compared centers to clinical health care providers, emphasizing the unexpectedly attentive emotional care they received. These evaluations stem from clients' reproductive histories, which are shaped by gender, racism, and economic inequalities that configure their access to and interactions within the health system. Emotional care serves to create and maintain pregnancy centers' impression of legitimacy among clients.

"Gummy Bears" and "Teddy Grahams": Ultrasounds as religious biopower in Crisis Pregnancy Centers.

Scholars, activists, and medical professionals critique Crisis Pregnancy Centers (CPCs) for disseminating medical misinformation and deceptive counseling practices. Yet much of the scholarship examining CPC's counseling and medical practices relies upon discourse analyses or surreptitious approaches. I use observational data from client appointments in an evangelical CPC in the U.S. West and in-depth interviews with clients and staff to explore how guided ultrasounds construct the experience of pregnancy. I describe the "medical model of care" at this CPC and then analyze how the ultrasound becomes a socio-religious practice that shapes the social and physical experience of pregnancy. I argue this is a unique form of 'religious biopower' (Foucault 1990). Importantly, clients overwhelming describe these appointments as positive and point to how centers seemingly fill a void of care in the healthcare system. These findings reveal processes whereby faith-based, antiabortion organizations produce a 'digital quickening' through ostensibly neutral medical technologies of visualization, reinforce conservative discourses about fetal personhood and motherhood, and spread medical misinformation.

Swimming and Gendered Vulnerabilities: Evidence from the Northern and Central Philippines.

Men and women's vulnerability to disasters is different and often related, in part, to cultural norms that influence gendered behaviors and abilities. In this study we focus on gender differences in swimming abilities, which, in the case of tsunamis have resulted in far greater female mortality rates. We present results on swimming ability by gender for 940 residents of coastal rural communities in the northern and central Philippines. We also examine cross-generational transmission of swimming abilities to shed light on future vulnerability. Results reveal men are far more likely than women to swim and, importantly, parents who can swim are more likely to have children who can swim. In this way, differences in swimming ability among today's adults may perpetuate vulnerabilities within future generations.