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To explore pediatricians' perspectives on supporting intimate partner violence (IPV) survivors, including (a) clinical practices and resource use, (b) ideal resources, and (c) barriers to the use of existing resources, we conducted dyadic and individual virtual interviews with pediatricians recruited through Twitter and the American Academy of Pediatrics Council, section, and chapter listservs. The interviews were approximately 60 minutes in length, audio recorded, and transcribed verbatim. We used a thematic analysis approach and hybrid deductive–inductive coding. Twenty-three pediatricians participated in 14 interviews. We identified four themes. Participants' current practices primarily focused on IPV screening and response to disclosure. They described strategies for IPV resource provision and decision-making involving child protective services. They identified multilevel barriers to addressing IPV, including barriers, such as time, identified in previous studies as well as barriers related to the COVID-19 pandemic, telehealth, the electronic health record, and disclosure-focused approaches. The participants desired provider-facing and caregiver-facing resources to strengthen the capacity to address IPV; some were unaware of currently available resources. They noted the need for continued attention to optimizing systems to enhance their capacity to support IPV survivors. Pediatricians report varying practices to address IPV and identify several surmountable barriers to supporting IPV survivors. Our study suggests that disclosure-driven clinical practices, confidentiality concerns, and lack of resources limit pediatricians' capacity to address IPV. Additional resource development and dissemination efforts are needed to improve the awareness of IPV resources currently available to pediatricians and families. [ABSTRACT FROM AUTHOR]

Background: To date, no intervention has definitively improved outcomes for families of critical illness survivors. An integrated perspective on caregivers' needs after critical illness could help identify high-priority intervention targets and improve outcomes. Objectives: To obtain diverse perspectives on the needs, barriers and facilitators, and social determinants of health associated with family caregiving across the critical illness continuum and assess the extent to which successful caregiving interventions in other populations may be adapted to the critical illness context. Methods: This qualitative content analysis of 31 semistructured interviews and 10 focus groups with family caregivers, health care providers, and health care administrators explored family caregivers' needs during post– intensive care unit (ICU) transitions and the barriers and facilitators associated with addressing them. Trained coders analyzed transcripts, identified patterns and categories among the codes, and generated themes. Results: Caregivers have 3 instrumental needs: formal and informal support, involvement in care planning, and education and training. Only caregivers described their self-care and mental health needs. Social determinants of health are the key barriers and facilitators shaping the caregivers' journey, and caregiving as a social determinant of health was a prominent theme. Conclusions: Caregivers have instrumental, self-care, and mental health needs after critical illness. Adapting hands-on and skills training interventions to the post-ICU setting, while tailoring interventions to caregivers' health-related social context, may improve caregiver outcomes. [ABSTRACT FROM AUTHOR]

We performed content analysis using a qualitative descriptive approach of 15 semistructured interviews with pregnant and postpartum women who have experienced opioid use disorder (OUD) and intimate partner violence (IPV) regarding their experiences seeking help with both issues. Participants described that their partners impacted their ability to seek OUD care; seeking help for OUD and IPV was siloed; they felt more comfortable disclosing OUD than IPV; they perceived pregnancy as a barrier and facilitator to OUD care; and they wished for integrated services. Pregnant and postpartum women experiencing OUD and IPV acknowledged these phenomena intersect and identified a need for more comprehensive services. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) has negative health impacts for pregnant people and their infants. Although inpatient postpartum units offer an opportunity to provide support and resources for IPV survivors and their families, to our knowledge, such interventions exist. The goal of this study is to explore (1) how IPV is currently discussed with postpartum people in the postpartum unit; (2) what content should be included and how an IPV intervention should be delivered; (3) how best to support survivors who disclose IPV; and (4) implementation barriers and facilitators. Materials and Methods: We used individual, semistructured interviews with postpartum people and health care providers (HCPs). Interview transcripts were coded and analyzed using an inductive-deductive thematic analysis. Results: While HCPs reported using a variety of practices to support survivors, postpartum people reported that they did not recall receiving resources or education related to IPV while in the inpatient postpartum unit. While HCPs identified a need for screening and disclosure-driven resource provision, postpartum people identified a need for universal IPV resource provision in the postpartum unit to postpartum people and their partners. Participants identified several barriers (i.e., staff capacity, education already provided in the postpartum unit, and COVID-19 pandemic) and facilitators (i.e., continuity of care, various HCPs) to supporting survivors in the postpartum unit. Conclusion: The inpatient postpartum unit is a promising setting to implement an intervention to support IPV survivors and their infants. Future research and intervention development should focus on facilitating universal education and promoting resource provision to IPV survivors. [ABSTRACT FROM AUTHOR]

Purpose: Thecurrent manuscript explores barriers to care for pregnant and post-partum women experiencing co-occurring intimate partner violence and opioid use disorder through the lens of providers who work with this unique population. Methods: We conducted a qualitative study consisting of 49 semi-structured, open-ended interviews with service providers working across contexts (e.g., IPV, prenatal care, substance use, addiction medicine, law enforcement, criminal justice, welfare services, etc.). Results: Participants reported three main types of barriers which can impact outcomes and reduce care for pregnant and post-partum women with co-occurring IPV and OUD (Co-IPV/OUD). 1) Barriers that make it difficult for pregnant or post-partum women to seek, receive, and successfully engage in care for both IPV and OUD. Barriers that providers encounter in trying to care for and/or treat pregnant and post-partum women with Co-IPV/OUD. Lastly, barriers which present a challenge to providing comprehensive, coordinated care for pregnant or post-partum women with Co-IPV/OUD. Conclusion: We conclude that finding ways to improve coordinated or integrated care for IPV and OUD is vital to outcomes for this population, and initiatives which support providers' ability to work across different service contexts are needed. [ABSTRACT FROM AUTHOR]

Introduction: Research exploring the mistreatment of birthing people in the United States is emerging rapidly within the context of increasingly poor maternal health outcomes that include unacceptable racial disparities. Previous research has explored overlap between psychological birth trauma and mistreatment using patient descriptions of birth experiences, but no previous studies have explored these issues from the perspectives of clinicians. The aim of this study was to explore whether maternity care providers' descriptions of patient birth trauma overlap with categories of mistreatment from a globally accepted typology. Methods: Content analysis was performed on a qualitative data set of 28 semi-structured interviews about patient birth trauma, completed in 2018–2019 with U.S. maternity care clinicians, including obstetricians, family physicians, midwives and labor/delivery nurses. The interviews were part of a larger study exploring maternity clinician perspectives and experiences of patient birth trauma. For this analysis Krippendorff's method of categoric distinction was used, with categories from a globally recognized typology of maternity patient mistreatment. Results: Clinicians' descriptions of their experiences with patient birth trauma mapped onto all seven mistreatment categories, although no interview questions specifically asked about mistreatment. In more than 30 hours of interviews, transcribed to more than 800 pages, the word mistreatment appears only once, suggesting that some healthcare providers may use the phrase "birth trauma" as a euphemism to describe mistreatment. Eighteen of 28 interviews included at least one description that fit into a mistreatment category. "Failure to meet professional standards of care" was the category with the most mapped clinician statements, followed by "Stigma and discrimination" and "Poor rapport between women and providers." Conclusions: This study contributes new insight into maternity clinicians' conceptualization of patient trauma and how their descriptions of birth trauma overlap with mistreatment. Clinicians implicitly connected mistreatment with some patient experiences of birth trauma, even when they were not specifically asked about mistreatment. Findings point to a need for further research into mistreatment, including routinized "everyday care" that may include mistreatment, particularly for marginalized and historically excluded birthing people. Future research also must explore the potential role of mistreatment in poor and inequitable U.S. birth outcomes. Plain language summary: Many people giving birth in the United States experience poor health outcomes, and there is a wide racial disparity, with people of color more likely to experience poor outcomes. In recent research, birthing people reported that they were mistreated during their labor and delivery, including being shouted at, scolded, or threatened. Mistreatment accounts were more frequent among women of color. Previous research has looked at patient reports about their birth experiences to explore whether their descriptions of psychological trauma include overlap with mistreatment, but no other studies have looked at descriptions of birth trauma from the perspectives of medical clinicians. The objective of this study was to explore whether maternity care providers' descriptions of patient birth trauma overlap with categories of mistreatment from a globally accepted list. This study analyzed the content of 28 semi-structured interviews about patient birth trauma, completed in 2018–2019 with obstetricians, family physicians, midwives and labor/delivery nurses. In the interviews, participant descriptions of patient birth trauma fit into all seven mistreatment categories. Participant descriptions included examples of patients receiving medical procedures or treatments without first giving consent, nurses avoiding the rooms of patients who do not speak English, and other forms of mistreatment. Participants were not asked specifically about mistreatment, but they described birth trauma by giving examples of mistreatment, which suggests that some healthcare providers may use the phrase "birth trauma" when talking about "mistreatment." This study shows a need for further research into mistreatment, including routine "everyday care" that may include mistreatment. [ABSTRACT FROM AUTHOR]

Relatively few studies have considered the impact of the COVID-19 pandemic on intimate partner violence (IPV) advocates or the agencies where they work. In this study, based on United States IPV advocates' experiences working with survivors during the COVID-19 pandemic, we conducted interviews to explore: 1) personal challenges and resilience working as IPV advocates during the COVID-19 pandemic; 2) how agencies adapted to the pandemic to support IPV survivors and advocates; and 3) specific needs and challenges of culturally-specific agencies. We conducted semi-structured interviews with 53 IPV advocates from June to November 2020. Participants were included if they worked directly with survivors, identified as an IPV advocate, worked at a US-based agency, and spoke and understood English. We created a sampling matrix to ensure adequate representation from IPV advocates serving survivors from communities which have been marginalized. Interviews were conducted through a virtual platform by a trained member of the research team. We used an inductive thematic analysis approach, with weekly coding meetings to resolve discrepancies in coding. Five themes emerged from the data: 1) IPV advocates described how working as an IPV advocate during the COVID-19 pandemic impacted them personally; 2) agencies developed new methods of addressing IPV advocates' needs; 3) agencies developed new solutions to address pandemic-related client needs; 4) transitioning advocacy work to virtual formats created challenges but also opportunities and; 5) pandemic limitations and impacts compounded pre-pandemic challenges for culturally specific agencies. IPV advocates are frontline workers who have played essential roles in adjusting services to meet survivor needs during the COVID-19 pandemic while simultaneously coping with pandemic impacts on themselves and their agencies. Developing inter-agency collaborations and promoting advocates' safety and wellbeing during future public health crises will help support IPV survivors. [ABSTRACT FROM AUTHOR]

Title X is a federally funded family planning initiative that provides low-cost and confidential reproductive health services to its clients. In recent years, Title X has been the subject of debate as its core tenants have been revised by the current administration. Though advocates have fought against these changes, the voices of survivors on intimate partner violence are absent from this conversation. This study was designed to elicit the opinions and experiences on survivors of intimate partner violence on reproductive decision-making, their access to care, and their opinions about political efforts to restrict this access. Twenty-six semi-structured interviews were conducted with women who were seeking services for intimate partner violence. These interviews were audio-recorded, transcribed, and coded. Codes were then organized into themes. Participants endorsed the need for confidential services due to experiences of coercion from their partners and the fear of retaliation against them. Participants largely supported accessible contraception but reported the need for contraception to be reliable. Participants addressed pregnancy and its many complexities and advocated for nondirective options-counseling. Overall, participants spoke about their challenges with reproductive health care and their opinions on how best to service survivors of intimate partner violence. This study asserts the need for advocates for survivors to advocate for the preservation of Title X and establishes the need for future studies on the prevalence of intimate partner violence in Title X clinics. [ABSTRACT FROM AUTHOR]

Qualitative research on batterer intervention programs (BIPs) has primarily consisted of interview-based studies of clients and facilitators. To date, no research has utilized observational data to understand how BIPs "work," or the processes occurring in BIPs that promote prosocial behavioral change. Forty-four observations of BIP group sessions were conducted. Two key processes were found: "facilitator processes" (e.g., managing group dynamics and engaging clients in learning) and "client processes" (e.g., mutual aid, help-seeking, and support). More observational research on BIPs is needed to uncover the full range of processes occurring during BIPs and that can link group processes to client outcomes. [ABSTRACT FROM AUTHOR]

Objective: Describe the experiences and perspectives among pregnant people with chronic HCV infection receiving ledipasvir/sofosbuvir (LDV/SOF) therapy during pregnancy. Methods: We conducted semi-structured, in-depth interviews within an open-label, phase 1 study of LDV/SOF therapy among pregnant people with chronic HCV infection. Participants took 12 weeks of LDV/SOF and were interviewed at enrollment and again at the end of treatment. We transcribed the interviews verbatim and coded them with NVivo software for subsequent inductive thematic analysis. Results: Nine pregnant people completed the study, leading to 18 interview transcripts. All participants identified as women. Eight women acquired HCV through injection drug use, and 1 through perinatal transmission. We identified 3 themes. (1) Treatment for HCV during pregnancy with LDV/SOF was tolerable and convenient. (2) Women described that taking investigational LDV/SOF increased their self-esteem and sense of well-being due to possible cure from HCV, and they felt that the experience of working hard to achieve cure may potentially prevent return to drug abuse in the future. (3) Women appreciated researchers and providers that gave non-judgmental care and communicated honestly, and preferred person-centered care that acknowledges women's individual needs. Conclusions: Women stated that cure from HCV would be "life-changing," and described antepartum treatment for HCV with LDV/SOF as tolerable and desired, when provided by non-judgmental providers. Antepartum treatment was found to be acceptable by study participants and should be further evaluated to combat the increasing HCV epidemic among young persons, including pregnant people. [ABSTRACT FROM AUTHOR]

Intimate partner violence is common among people with opioid use disorder (OUD), but little research has focussed on identifying barriers survivors with OUD face when trying to leave an abusive relationship. Semi-structured interviews were conducted with 40 postpartum women with OUD. Interview questions were designed to identify barriers to help-seeking and facilitators and supports that have helped survivors make positive changes. Qualitative data were coded and analyzed, using a phenomenological approach to develop emerging themes. Most participants were white, 24–29 years old, single, unemployed, Medicaid insured, and used medications for OUD. All participants (n = 40, 100%) shared that a current or past partner physically, sexually, emotionally, or verbally abused them. Participants identified multiple barriers to help-seeking including abusive partner control of money and resources, fear of retaliatory violence, and concerns related to police and child welfare. Participants also described supports that helped them make positive changes, including being treated with care and support from domestic violence shelters and treatment programs. Finally, survivors offered suggestions for ways providers can better meet survivors' needs. Clinicians and policymakers should prioritize overcoming multiple barriers to service access and engagement faced by survivors and their children. [ABSTRACT FROM AUTHOR]

Batterer intervention programs (BIPs) constitute the primary treatment for perpetrators of intimate partner violence (IPV). Systematic evaluations of BIPs, however, have yielded modest results in terms of these programs' ability to reduce perpetration. Descriptive studies, which can provide information on the contexts and process associated with BIPs, can provide insights into the underlying mechanisms that might promote change among BIP clients, and as such are important to improving efficacy measures for BIPs. To date, however, limited research exists on what challenges BIPs encounter in working with clients, and how those challenges present barriers to behavioral change among perpetrators at the intervention level. As part of a 2-year ethnographic study, we conducted 36 individual semistructured interviews with professionals working with BIPs. We identified six themes related to challenges to promoting behavioral change among men who perpetrate violence: (a) social acceptance of IPV, (b) hypermasculine attitudes, (c) emotional problems, (d) childhood exposure to violence, (e) co-morbid mental health issues, and (f) denial, minimization, and blame. Our results have implications for thinking about some of the contextual factors that may impede BIPs ability to produce desired outcomes and for identifying areas in which programs can be tailored to improve the overall client experience. Our results also point to the need for a more coordinated community response to IPV, and in particular to helping provide resources that support BIPs sustained, safe, and as effective as possible work. [ABSTRACT FROM AUTHOR]

Seventy-six adult male perpetrators of intimate partner violence enrolled in a batterer intervention program (BIP) were interviewed on their perspectives of the intra-BIP group peer interactions. A majority of participants endorsed positives aspects of working with peers in the group context. Only one negative aspect arose, namely, other group members who disrupted the BIP process in some way. More importantly, a minority of participants expressed indifference toward the group process. This study has implications for training of BIP facilitators and for future research on BIPs that helps to tailor the approaches these groups use to maximize client engagement. [ABSTRACT FROM AUTHOR]

As part of a two-year ethnographic study of batterer intervention programs (BIPs) we interviewed 76 male perpetrators of intimate partner violence (IPV) on their perspectives regarding BIP facilitators. Participants endorsed a number of characteristics of facilitators that helped to reduce their resistance to the group process and assisted in engaging them in the learning process, including facilitators who were invested in the program and its mission, and displayed a non-judgmental demeanor. At the same time, they also endorsed facilitators who were honest with them and challenged them on their behavior, and who exhibited a high degree of experience in IPV. Additionally, participants endorsed the need to have a female facilitator as part of the group to further promote engagement and learning. This study has implications for thinking about what components of BIP facilitation might be important for reducing some of the resistance that may lead to client attrition, and how BIPs can better engage clients in prosocial behavioral changes. [ABSTRACT FROM AUTHOR]

Batterers intervention programs (BIPs) constitute a primary intervention for perpetrators of intimate partner violence (IPV). There is little understanding as to what operational, or program-level, challenges BIPs face that can impede their effectiveness and adherence to state standards. As part of a 2-year ethnographic study, we conducted 36 individual semistructured interviews with professionals working with BIPs and identified five themes related to program-level challenges for BIPs: (a) information barriers, (b) safety issues, (c) facilitator retention and training, (d) the need for monitoring, and (e) funding constraints. We conclude that continued work needs to be done at both the state and local level, and in coordination with community judicial, mental health, human services, and other agencies to help provide resources that support BIPs in sustained, safe, and as effective as possible work. [ABSTRACT FROM AUTHOR]

Objective: Although developmental milestones have been observed to alter eating disorder (ED) symptom burden, it remains unknown how the transition to university affects symptomatology. To address this gap, we designed a qualitative study to elucidate how students with an ED perceive their general university experience and to describe how the university environment shapes their ED. Method: Undergraduate students who self‐reported an ED were recruited through fliers, an undergraduate advocacy organization, and local treatment centers. We conducted audio‐recorded semi‐structured individual interviews. Two investigators separately coded verbatim transcripts using an editing approach, and final themes emerged from the pattern of descriptors. Results: Fifteen undergraduate students participated. Participants endorsed a variety of ED symptoms and sought various levels of treatment. Most participants transitioned to university with an already‐established diagnosis. Participants described that ED symptoms tended to worsen in university for a variety of reasons including (a) minimization of ED severity, (b) loss of external accountability, (c) use of ED symptoms as a coping mechanism, and (d) glorification of ED behaviors in campus diet culture. Subsequently, the ED disrupted the university experience by (e) hindering participants' ability to focus on academic responsibilities and (f) leading to social isolation on campus. Discussion: We identified challenges unique to the university experience that can be addressed by ED treatment teams in order to provide anticipatory guidance and patient‐centered care. Study limitations include lack of formal diagnostic ED assessment by research team and sampling of students from one university. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) accounts for up to 50% of all calls to police. In an effort to standardize arrest criteria, mandatory arrest laws were established. It is unclear whether subsequent increased rates of female arrest are due to greater recognition of female IPV perpetrators or of women acting in self-defense. This study aims to understand the context and consequences of IPV-related arrest from perspectives of women arrested in a single metropolitan area. Semi-structured qualitative interviews were conducted with women arrested and court-ordered to attend IPV education groups at a women’s shelter in the Northeast United States. Interviews addressed circumstances surrounding arrest, experience with past violence, and reasoning regarding use of partner violence. Two researchers independently coded transcripts and met to iteratively refine the code and review transcripts for themes. Eighteen women were interviewed. Major themes that emerged were as follows: (a) Women’s use of violence occurred within the context of their own victimization; (b) the arrest included a complex interplay between subject, partner, and police; (c) women perceived police arrest decisions to be based on a limited understanding of context; and (d) women experienced both positive and negative consequences of arrest. Many relationships did not fall under the traditional victim/perpetrator construct. Rather, women’s use of violence evolved, influenced by prior experiences with violence. More appropriate methods must be developed for making arrest decisions, guiding justice system responses, and developing interventions for couples experiencing IPV. Recognition that women’s use of partner violence often represented either a retaliatory or self-defensive gesture within the context of prior victimization suggests that victims’ interventions should not only focus on empowerment but also provide skills and strategies to avoid temptation to adopt aggression as a primary method of self-protection. [ABSTRACT FROM PUBLISHER]

Background: African-American (AA) women have higher rates of obesity and obesity-related diseases but are less likely than other women to undergo bariatric surgery or have success with conventional weight loss methods.Objective: To explore obese AA women's perceptions regarding barriers to weight loss and bariatric surgery.Design: Focus groups to stimulate interactive dialogue about beliefs and attitudes concerning weight management. PARTICIPANTS AND APPROACH: We partnered with a community organization to recruit women who were AA, were > or = 18 years old, and had a body mass index (BMI) of > or = 30 kg/m2. We audiotaped the 90-minute focus groups and used content analysis for generating and coding recurring themes.Results: In our sample of 41 participants, the mean age was 48.8 years and mean BMI was 36.3. Most participants were unmarried, had some postsecondary education, and reported good or fair health. About 85% knew someone who had undergone bariatric surgery. Qualitative analysis of 6 focus group sessions revealed that the most common barriers to weight loss were lack of time and access to resources; issues regarding self-control and extrinsic control; and identification with a larger body size. Common barriers to bariatric surgery were fears and concerns about treatment effects and perceptions that surgery was too extreme or was a method of last resort.Conclusions: Only through the elimination of barriers can AA women receive the care needed to eliminate excess weight and prevent obesity-related morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background Sexual assault (SA) affects about 40% of women in the United States and has many mental and physical health sequelae. Physicians often do not address SA with patients, although SA survivors describe a desire to talk to physicians to obtain additional help. Little information exists on how providers perceive their roles regarding caring for women SA survivors and what barriers they face in providing this care. Methods We performed a qualitative study using semistructured one-on-one interviews with 16 faculty physicians from five specialties: obstetrics and gynecology ( n = 4), internal medicine ( n = 4), family medicine ( n = 1), emergency medicine ( n = 3), and psychiatry ( n = 4). Interviews were conducted between July 2011 and July 2012, transcribed verbatim, and coded using a constant comparative approach. Once a final coding scheme was applied to all transcripts, we identified patterns and themes related to perceived roles and barriers to caring for SA survivors. Results Physicians described two main categories of roles: clinical tasks (e.g., testing and treating for sexually transmitted infections, managing associated mental health sequelae) and interpersonal roles (e.g., providing support, acting as patient advocate). Physician barriers fell into three main categories: 1) internal barriers (e.g., discomfort with the topic of SA), 2) physician–patient communication, and 3) system obstacles (e.g., competing priorities for time). Conclusions Although physicians describe key roles in caring for SA survivors, several barriers hinder their ability to fulfill these roles. Training interventions are needed to reduce the barriers that would ultimately improve clinical care for SA survivors. [ABSTRACT FROM AUTHOR]

Postpartum contraception counseling and method use vary widely among patients who had a preterm birth. We performed this study to explore what issues and concerns individuals with preterm infants requiring intensive care describe as influencing their postpartum contraceptive choices. We conducted a qualitative study using semi-structured interviews with participants who gave birth to a singleton preterm infant admitted to the neonatal intensive care unit (NICU). We explored pregnancy, childbirth, postpartum care, and NICU experiences, as well as future reproductive plans and postpartum contraceptive choices. Two coders used a constant–comparative approach to code transcripts and identify themes. We interviewed 26 participants: 4 (15%) gave birth at less than 26, 6 (23%) at 26 to 27 6/7, 8 (31%) at 28 to 31 6/7, and 8 (31%) at 32 to 36 6/7 weeks of gestation. We identified three main themes related to future pregnancy plans and contraception choice. First, participants frequently described their preterm birth and their infants' NICU hospitalization as traumatic experiences that affected plans for future pregnancies. The loss of control in predicting or preventing a future preterm birth and uncertainty about their premature child's future medical needs resulted in participants wanting to avoid going through the same experience with another child. Second, participants chose contraception based on previous personal experiences, desired method features, and advice from others. Last, having a preterm birth did not result in any ambivalence among those who desired permanent contraception. Preterm birth influences future pregnancy plans. When discussing reproductive goals with patients, clinicians should be aware of potential trauma associated with a premature birth, assess for whether patients want to discuss contraception, and center the conversation around individual needs if patients do desire contraceptive counseling. [ABSTRACT FROM AUTHOR]

Objective: To explore initial pregnancy intentions and postmiscarriage family planning needs and counseling preferences of women experiencing spontaneous abortion.Methods: We conducted semistructured qualitative interviews with women who recently experienced spontaneous abortion to explore their feelings about conception, pregnancy, and miscarriage; their future family planning goals; and contraceptive counseling preferences. Two trained coders utilized an inductive, iterative approach to code transcripts and identify themes using Atlas.ti software to organize the analysis.Results: We interviewed 26 women reporting varied intentions in their recent pregnancies: 54% were trying to conceive, 27% were not trying but not preventing, and 19% were attempting to avoid pregnancy. Participants reported a range of feelings about the pregnancy diagnoses and eventual miscarriages with some relatively unemotional ("a little disappointed…suffering for two months for nothing") and others feeling devastated by their pregnancy losses ("in shock," "for it to be taken away was crushing"). Varying character and intensity of emotional reactions were seen across the range of initial pregnancy intentions. Some participants had consistent childbearing plans before and after miscarriage, whereas others experienced their pregnancies and losses as clarifying events leading to changed goals moving forward ("it was a wake-up call"). Although family planning needs were inconsistently addressed after spontaneous abortion, women were generally receptive to the idea of contraceptive counseling, though they had different preferences regarding timing, ranging from immediately to weeks later.Conclusion: Women's reproductive goals after spontaneous abortion cannot be inferred based on initial pregnancy intention or emotional reactions to pregnancy loss. Health care providers should offer family planning counseling to all women after spontaneous abortion, remaining responsive to individual patient needs. [ABSTRACT FROM AUTHOR]

Background Marijuana is the most commonly used illicit substance in pregnancy. Little is known about how pregnant women who use marijuana obtain and understand information about perinatal marijuana use. We conducted a qualitative study among pregnant women who had used marijuana to understand their information-seeking patterns and perceptions of usefulness of available information about perinatal marijuana use. Study Design We conducted semistructured interviews with 26 pregnant women who were receiving prenatal care and who either disclosed marijuana use or had urine samples testing positive for marijuana. Interviews assessed women's sources of information about risks of perinatal marijuana use and perceptions regarding the usefulness of such information. Interview data were coded independently by two coders who iteratively refined the codes and reviewed transcripts for themes. Results Commonly reported sources of information about perinatal marijuana use included Internet searching and anecdotal experiences or advice from family or friends. Few women reported receiving helpful information from a health care provider or social worker. Women perceived a lack of evidence about harms of perinatal marijuana use, and reported being dissatisfied with the quality of information. Most women said they desired information about the effects of perinatal marijuana use on infant health. Conclusions Women who used marijuana before or during pregnancy did not find available information about perinatal marijuana use to be useful, and sought more information pertaining to infant health and well-being. Efforts to reduce perinatal marijuana use should focus on addressing this need in both clinical and public health settings. [ABSTRACT FROM AUTHOR]