BACKGROUND:Although the levonorgestrel 52 mg intrauterine device is locally active and has low systemic hormone exposure, hormonal intrauterine device users sometimes report hormone-related side effects. OBJECTIVE:Evaluate hormone-related adverse event rates among all participants and compare these among those who used combined hormonal or no hormonal contraception in the month before enrollment. STUDY DESIGN:A total of 1714 women aged 16 to 45 years old received a levonorgestrel 52 mg intrauterine device in a multicenter phase 3 trial to evaluate contraceptive efficacy and safety for up to 10 years. This analysis evaluated a subset of participants who used combined hormonal or no hormonal contraception in the month prior to device placement. We assessed all nonexpulsion, nonbleeding-related events with ≥1% incidence at 180 days with a plan to include weight increase regardless of incidence; we excluded events considered nonhormonal. We computed 180-day side effect frequency rates based on the number of days a side effect was reported during the study period. We created a multivariable model for side effect incidence at 180 days based on age, race, ethnicity, body mass index at enrollment, parity, and contraception use in the month before enrollment. For those side effects with a P value <.2 on univariate comparison between combined hormonal and no hormonal contraception users, we secondarily evaluated 360-day event rates. RESULTS:Overall, 644 participants used combined hormonal contraception (primarily oral [n=499, 77.5%]) and 855 used no hormonal method before intrauterine device placement. Individual side effect rates over the first 180 days did not differ between prior combined hormonal and no hormonal contraception users except for acne (84 [13.0%] vs 73 [8.5%], respectively), P=.006, odds ratio 1.61 (95% confidence interval 1.15-2.24). However, this association was weaker after adjustment for age, race, ethnicity, obesity status, and parity (adjusted odds ratio 1.40, 95% confidence interval 0.99-1.98) At 360 days, prior combined hormonal contraception users were more likely to report acne (101 [15.7%] vs 91 [10.6%], respectively, P=.005) and orgasm/libido problems (20 [3.1%] vs 12 [1.4%], respectively, P=.03). Over the first 180 days, all side effects other than acne were reported in less than 3% of days; acne was reported an average of 13 days (7.4%) per prior combined hormonal contraception user and 9 days (5.0%) per prior nonhormonal contraception user (P<.0001). Discontinuation for evaluated side effects occurred in 83 (5.5%) participants with no difference between those who used combined hormonal (36 [5.6%]) or no hormonal contraception (47 [5.5%], P=1.0) before study entry. CONCLUSION:Using combined hormonal contraception prior to levonorgestrel 52 mg intrauterine device placement is weakly associated with reporting hormonally related side effects like acne. Only a small percentage of levonorgestrel 52 mg intrauterine device users experienced potentially hormone-related side effects during the initial 6 months of use that resulted in discontinuation.

Hemorrhage after abortion is rare, occurring in fewer than 1% of abortions, but associated morbidity may be significant. Although medication abortion is associated with more bleeding than procedural abortion, overall bleeding for the two methods is minimal and not clinically different. Hemorrhage can be caused by atony, coagulopathy, and abnormal placentation, as well as by such procedure complications as perforation, cervical laceration, and retained tissue. Evidence for practices around postabortion hemorrhage is extremely limited. The Society of Family Planning recommends preoperative identification of individuals at high risk of hemorrhage as well as development of an organized approach to treatment. Specifically, individuals with a uterine scar and complete placenta previa seeking abortion at gestations after the first trimester should be evaluated for placenta accreta spectrum. For those at high risk of hemorrhage, referral to a higher-acuity center should be considered. We propose an algorithm for treating postabortion hemorrhage as follows: (1) assessment and examination, (2) uterine massage and medical therapy, (3) resuscitative measures with laboratory evaluation and possible reaspiration or balloon tamponade, and (4) interventions such as embolization and surgery. Evidence supports the use of oxytocin as prophylaxis for bleeding with dilation and evacuation; methylergonovine prophylaxis, however, is associated with more bleeding at the time of dilation and evacuation. Future research is needed on tranexamic acid as prophylaxis and treatment and misoprostol as prophylaxis. Structural inequities contribute to bleeding risk. Acknowledging how our policies hinder or remedy health inequities is essential when developing new guidelines and approaches to clinical services.

Objectives: To examine demographic, socioeconomic, and regional differences in contraceptive access, differences between telehealth and in-person contraception visits, and telehealth quality in the United States during the COVID-19 pandemic.Study design: We surveyed reproductive-age women about contraception visits during the COVID-19 pandemic via social media in July 2020 and January 2021. We used multivariable regression to examine relationships between age, racial/ethnic identity, educational attainment, income, insurance type, region, and COVID-19 related hardship, and ability to obtain a contraceptive appointment, telehealth vs in-person visits, and telehealth quality scores.Results: Among 2031 respondents seeking a contraception visit, 1490 (73.4%) reported any visit, of which 530 (35.6%) were telehealth. In adjusted analyses, lower odds of any visit was associated with Hispanic/ Latinx and Mixed race/Other identity (aOR 0.59 [0.37-0.94], aOR 0.36 [0.22-0.59], respectively), the South, Midwest, Northeast (aOR 0.63 [0.47-0.85], aOR 0.64 [0.46-0.90], aOR 0.52 [CI 0.36-0.75], respectively), no insurance (aOR 0.63 [0.43-0.91]), greater COVID-19 hardship (aOR 0.52 [0.31-0.87]), and earlier pandemic timing (January 2021 vs July 2020 aOR 2.14 [1.69-2.70]). Respondents from the Midwest and South had lower odds of telehealth vs in-person care (aOR 0.63 [0.44-0.88], aOR 0.54 [0.40-0.72], respectively). Hispanic/Latinx respondents and those in the Midwest had lower odds of high telehealth quality (aOR 0.37 [0.17-0.80], aOR 0.58 [0.35-0.95], respectively).Conclusions: We found inequities in contraceptive care access, less telehealth use for contraception visits in the South and Midwest, and lower telehealth quality among Hispanic/Latinx people during the COVID-19 pandemic. Future research should focus on telehealth access, quality, and patients' preferences. Implications: Historically marginalized groups have faced disproportionate barriers to contraceptive care, and telehealth for contraceptive care has not been employed equitably during the COVID-19 pandemic. Though telehealth has the potential to improve access to care, inequitable implementation could exacerbate existing disparities.& COPY; 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

We sought to determine if maternal-fetal medicine (MFM) fellows and program directors (PDs) have concordant views regarding the importance of abortion-related training during fellowship. This is a cross-sectional, web-based survey of current MFM PDs and current MFM fellows conducted in June 2022. Personalized survey links were sent to each PD and fellow utilizing emails on the Society for Maternal Fetal Medicine (SMFM) fellowship program directory and a listserv provided by SMFM. The primary outcome was self-assessed importance placed on abortion-related provision and training during fellowship, assessed with a modified Likert scale. Bivariate comparisons of sociodemographic and Likert scale data were performed using Student's t or Wilcoxon rank-sum tests, for continuous variables, and chi-squared or Fisher's exact tests, for categorical variables as appropriate. Of the 98 eligible MFM PDs and 413 eligible MFM fellows, 60 (61%) and 190 (46%), respectively, responded. PDs had a higher frequency of individuals who self-identify as male. Furthermore, PDs more frequently endorsed support for fellow participation in pro-abortion advocacy as opposed to fellows thinking that their PDs would not support them if they participated in pro-abortion advocacy (Table). PDs placed a higher importance on skills related to abortion and reproductive health – D&C, induction termination of fetuses with cardiac activity and feticidal injections – compared to fellows (Figure). There was no difference in perceived importance of D&E training in fellowship between PDs or fellows (Figure). MFM PDs placed a higher importance on most comprehensive reproductive care and abortion-related training compared to MFM fellows. These data are critical to shed light on emerging trends and needs for fellowship training at the intersection of complex family planning and MFM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

BACKGROUND:The COVID-19 pandemic led to changes in the provision of pregnancy and postpartum care. The purpose of this study was to describe changes in access to prenatal and postpartum care over time, from early in the pandemic (July 2020) to mid-pandemic (January 2021) and to explore socioeconomic and COVID-19-related economic factors associated with experiencing barriers to care. METHODS:We recruited two cross sections of women and birthing people in the US in July 2020 (N = 4645) and January 2021 (N = 3343) using Facebook and Instagram Ads. RESULTS:Three out of four women in the prenatal period and four out of five women in the postpartum period reported barriers to scheduling a visit. The likelihood of not having a visit (OR = 4.44, 95% CI 2.67-7.40), being unable to schedule a visit (OR = 2.73, 95% CI 1.71-4.35), and not being offered visits (OR = 4.26, 95% CI 2.32-7.81) increased over time. Participants were more likely to report barriers attending scheduled prenatal or postpartum appointments over time (OR = 2.72, 95% CI 2.14-3.45). Women who experienced more economic impacts from COVID-19 were older, less educated, and were Black, Indigenous, or a person of color, and were more likely to have barriers to attending appointments. CONCLUSIONS:Certain subgroups are more at risk during COVID-19, and around 9 months into the pandemic, women were not only still facing barriers to care, but these had been amplified. Additional research using other data sources is needed to identify and ameliorate barriers and inequalities in access to prenatal and postpartum care that appear to have persisted throughout the pandemic.

To evaluate the importance placed by current maternal-fetal medicine (MFM) fellowship program directors (PDs) on abortion-related training during fellowship.

To evaluate the importance placed by current maternal-fetal medicine (MFM) fellows on abortion-related training in their choice to attend a fellowship in a specific location. A cross-sectional, web-based survey was conducted among all MFM fellows in June 2022. Personalized survey links were sent to each fellow utilizing a listserv provided by the Society for Maternal Fetal Medicine. The primary exposure was fellowship training in a state categorized as either "open" or "hostile" to abortion services, defined by the Center for Reproductive Rights (https://reproductiverights.org/maps/abortion-laws-by-stat/). The primary outcome was self-assessed importance placed on abortion provision and training when considering a fellowship, assessed with a modified Likert scale. Bivariate comparisons of sociodemographic and Likert scale data were performed using Student's t or Wilcoxon rank-sum tests, for continuous variables, and chi-squared or Fisher's exact tests, for categorical variables as appropriate. Of the 413 eligible MFM fellows, 190 (46%) responded. Among respondents, 98 (52%) and 92 (48%) of fellows were completing fellowship in open and hostile states, respectively. Fellows from open states had a higher frequency of self-identifying as female, to be affiliated with a complex family planning fellowship, and to participate in pro-abortion advocacy, but had a lower frequency of attending an institution affiliated with a fetal intervention center (Table). When considering the importance of abortion-related training when applying to MFM fellowship, those in open states placed a higher importance on D&Es, induction termination of fetuses with cardiac activity, and feticidal injections as part of fellowship training (Figure). The location of fellowship training in an open or hostile state is correlated with the importance of abortion-related skills MFM fellows think they should learn in fellowship. These data are critical to inform governing bodies regarding needs of trainees and potential changes in requirements for MFM fellowship.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

BACKGROUNDAt the start of the COVID-19 pandemic, telehealth practices for pregnancy-related care were rapidly implemented. Telehealth for pregnancy-related care is likely to continue after the pandemic. In order for health systems and clinicians to provide person-centered pregnancy-related care via telehealth, it is critical to understand patients’ telehealth experiences and their preferences regarding the use of telehealth moving forward.OBJECTIVEThis study aimed to describe perceived quality of prenatal and postpartum telehealth visits during COVID-19 and to examine the association between telehealth quality during the pandemic and future telehealth preferences.STUDY DESIGNWe used data from of an online sample of US women aged 18 to 45 years seeking reproductive health care during COVID-19. Two cross-sections of survey data were collected in July 2020 and January 2021. This analysis included those who sought prenatal (n=1496) or postpartum (n=482) care during the pandemic. Among those who had a prenatal or postpartum telehealth visit, we used multivariable logistic regression to examine the association between a measure of perceived telehealth quality and openness to future telehealth visits, adjusting for sociodemographic characteristics.RESULTSA total of 57.5% of prenatal and 52.9% of postpartum respondents had a telehealth appointment. Respondents agreed with most statements about the quality of their telehealth appointments, with ≥80% reporting that they were convenient, easy, safe, and provided good information. Lower-ranked quality items were related to visits feeling personal and the patient feeling cared for. A total of 35.2% of prenatal (n=816) and 43.3% of postpartum (n=231) respondents expressed openness to telehealth visits in the future. Prenatal and postpartum respondents reporting higher telehealth quality had increased odds of being open to telehealth in the future (prenatal: adjusted odds ratio, 1.2; 95% confidence interval, 1.2–1.3; postpartum: adjusted odds ratio, 1.2; 95% confidence interval, 1.1–1.3).CONCLUSIONPrenatal and postpartum respondents with better telehealth experiences were more likely to express openness to telehealth in the future, although most preferred future in-person visits. As pregnancy-related telehealth continues, it is important to offer appointment options that match patient preferences, especially populations that face barriers in access to care, and to explore ways to personalize care and support positive patient–provider relationships.

Background Patient agency in contraceptive decision-making is an essential component of reproductive autonomy. Objective We aimed to develop a psychometrically robust measure of patient contraceptive agency in the clinic visit, as a measure does not yet exist. Design For scale development, we generated and field tested 54 questionnaire items, grounded in qualitative research. We used item response theory–based methods to select and evaluate scale items for psychometric performance. We iteratively examined model fit, dimensionality, internal consistency, internal structure validity, and differential item functioning to arrive at a final scale. Participants A racially/ethnically diverse sample of 338 individuals, aged 15–34 years, receiving contraceptive care across nine California clinics in 2019–2020. Main Measures Contraceptive Agency Scale (CAS) of patient agency in preventive care. Key Results Participants were 20.5 mean years, with 36% identifying as Latinx, 26% White, 20% Black, 10% Asian/Native Hawaiian/Pacific Islander. Scale items covered the domains of freedom from coercion, non-judgmental care, and active decision-making, and loaded on to a single factor, with a Cronbach’s α of 0.80. Item responses fit a unidimensional partial credit item response model (weighted mean square statistic within 0.75-1.33 for each item), met criteria for internal structure validity, and showed no meaningful differential item functioning. Most participants expressed high agency in their contraceptive visit (mean score 9.6 out of 14). One-fifth, however, experienced low agency or coercion, with the provider wanting them to use a specific method or to make decisions for them. Agency scores were lowest among Asian/Native Hawaiian/Pacific Islander participants (adjusted coefficient: -1.5 [-2.9, -0.1] vs. White) and among those whose mothers had less than a high school education (adjusted coefficient; -2.1 [-3.3, -0.8] vs. college degree or more). Conclusions The Contraceptive Agency Scale can be used in research and clinical care to reinforce non-coercive service provision as a standard of care.

ObjectiveThis article aims to determine the prevalence of caregiving among faculty at a large academic health sciences institution, to examine the effect of gender and other demographic and professional covariates on caregiving status, and to explore caregiver-generated policy recommendations.MethodA cross-sectional, mixed-methods survey was collected from June through August 2018. Participants were faculty within one of the institution's health professional schools (dentistry, medicine, nursing, or pharmacy) receiving at least 50% salary from the institution. In addition to demographic information, we collected academic series and rank, and assessed association between covariates on caregiving status using logistic regression. We analyzed open-ended responses using thematic analysis to identify themes in caregiver barriers and policy suggestions.ResultsAmong 657 eligible respondents, 11.4% were informal caregivers. Women were more likely to be caregivers than men (aOR 2.53, 95% CI: 1.40, 4.78), as were older faculty. Caregivers identified unsupportive climate or unrealistic work expectations, concern about career advancement, insufficient information about policies, and concern about colleague burden as barriers to support. Suggestions for workplace support included improved leave policies, increased flexibility, caregiver resource support, improved clarity and dissemination of policy information, and financial support.ConclusionsWomen faculty are more likely to be informal caregivers, exacerbating disparities within academic medicine for promotion and retention among women faculty. Institutions might include caregiving status in annual burnout surveys to guide the development of structural support and policies for extension of family leave beyond childbearing (or catastrophic leave), flexibility in work hours, and subsidized eldercare services.

The levonorgestrel 52-mg intrauterine device (IUD) is approved for contraception for 8 years. We evaluated outcomes for 339 phase 3 study participants aged 16–35 years at enrollment who used the IUD for more than 8 years. At study closure, 83 and 77 participants reached 9 and 10 years, respectively. No pregnancies occurred during years 9 and 10. Expulsion occurred in one (0.3%) participant, a partial expulsion during year 10. No perforations, pelvic infections, or IUD-related serious adverse events were noted. Absence of bleeding or spotting was reported by 33 (39.8%) and 28 (36.4%) participants at years 9 and 10, respectively. The levonorgestrel 52-mg IUD demonstrates continued efficacy and safety in a small population of users during years 9 and 10 of use. FUNDING SOURCE: Medicines360. The Sponsor, Medicines360, designed the study and oversaw its conduct, including funding the trial and providing all study product free of charge to participants. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT00995150.

OBJECTIVE:People seeking abortion care in the Western United States face unique challenges. We conducted a qualitative study among people who traveled to California from out of state to receive abortion services, with the aim of characterizing the interplay of motivators, costs, and facilitators to accessing abortion in this region.METHODS:We recruited English-speaking people residing outside of California who accessed care at an urban abortion clinic in San Francisco between October 2017 and May 2018. Interested participants completed a brief demographic survey and in depth semi-structured telephone interview. We relied on grounded theory methods to perform thematic analysis and stopped recruitment upon reaching thematic saturation.RESULTS:We conducted 18 in-depth interviews. People mostly had to travel to California for abortion due to local clinic gestational age limits, medical necessity, and to reduce cost. Participants also lamented that travel necessitated unwanted disclosure of their abortion, however this disclosure enabled them to get the logistical support needed for travel. People mostly relied on their networks of family and friends to facilitate these logistics.CONCLUSIONS:This study highlights the interplay of motivators, costs, and facilitators people who travel to California from nearby states face when seeking abortion services.IMPLICATIONS:We position the concept of 'unwanted disclosure' as both an emotional cost and an operator that often served to enable people to get the support (logistical, financial, professional) they needed to actualize their abortion in California. These people may benefit from additional financial and social support services in order to actualize their abortion.

Objectives: Vaccination for COVID-19 is an effective method of preventing complications; however, studies suggest that public attitudes toward the vaccine are heterogeneous. The objective of our study was to identify predictors for low likelihood of COVID-19 vaccination among women in the United States and determine whether reasons for low intention were modified by race, ethnicity, or other characteristics to better understand the factors that shape attitudes toward the COVID-19 vaccine and help inform multilevel interventions. Methods: In January 2021, we used social media to recruit a cross-section of reproductive-aged women in the United States (N = 5269). Our primary outcome was self-reported low vaccination likelihood (responses of unlikely or very unlikely on a 5-item scale). Our secondary outcome was concerns influencing vaccination decision that participants selected from a list of 19 items. We estimated multivariable logistic regression models and controlled for respondents’ sociodemographic characteristics. Results: Overall, race and ethnicity, educational attainment, health insurance type, annual household income, partnership status, and US region were associated with low vaccine likelihood. The adjusted odds of reporting low likelihood were 1.83 (95% CI, 1.45-2.32) times greater among non-Hispanic Black than among non-Hispanic White participants. Among pregnant or postpartum participants, breastfeeding status was the strongest predictor (adjusted odds ratio = 2.77; 95% CI, 2.02-3.79). Conclusions: Vaccine hesitancy and concerns may exacerbate existing COVID-19 health disparities in racial and ethnic groups and highlight the need to target messaging to specific populations, including pregnant and breastfeeding women, because these populations are at high risk for COVID-19 complications.

Background The most widely used copper intrauterine device (IUD) in the world (the TCu380A), and the only product available in many countries, causes side effects and early removals for many users. These problems are exacerbated in nulliparous women, who have smaller uterine cavities compared to parous women. We compared first-year continuation rates and reasons/probabilities for early removal of the TCu380A versus a smaller Belgian copper IUD among nulliparous users. Methods This 12-month interim report is derived from a pre-planned interim analysis of a sub population and focused on key secondary comparative endpoints. In this participant-blinded trial at 16 centres in the USA, we randomised participants aged 17-40 in a 4:1 ratio to the NT380-Mini or the TCu380A. In the first year, participants had follow-up visits at 6-weeks and 3, 6, and 12-months, and a phone contact at 9 months; we documented continued use, expulsions, and reasons for removal. Among participants with successful IUD placement, we compared probabilities of IUD continuation and specific reasons for discontinuation using log-rank tests. This trial is registered with ClinicalTrials.gov number NCT03124160 and is closed to recruitment. Findings Between June 1, 2017, and February 25, 2019, we assigned 927 nulliparous women to either the NT380-Mini (n = 744) or the TCu380A (n = 183); the analysis population was 732 (NT380-Mini) and 176 (TCu380A).Participants using the NT380-Mini, compared to the TCu380A, had higher 12-month continuation rates (78.7% [95% CI: 72.9-84.5%] vs. 70.2% [95% CI: 59.7-80.7], p = 0.014), lower rates of removal for bleeding and/or pain (8.1% vs. 16.2%, p = 0.003) and lower IUD expulsion rates (4.8% vs. 8.9%, p = 0.023), respectively. Interpretation The NT380-Mini offers important benefits for a nulliparous population compared to the TCu380A in the first twelve months, when pivotal experiences typically occur. Higher continuation rates with the NT380-Mini may avert disruptions in contraceptive use and help users avoid unintended pregnancy. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Background: Despite the prevalence of abortion stigma in the United States, few studies have examined the relationship between stigma and psychological well-being postabortion among women who undergo abortion for fetal anomalies. Materials and Methods: We conducted a cross-sectional study of women who underwent second-trimester abortion for pregnancy complications to assess the association between abortion stigma and psychological outcomes. We asked women to retrospectively report self-judgment and perceived community condemnation at the time of their abortion and evaluated present-day grief, post-traumatic stress, and self-reported mental health. We recruited participants using Facebook, Craigslist, and other public online forums. We used multivariable linear regression to evaluate relationships between abortion stigma and psychological outcomes. In adjusted models, we controlled for covariates that were associated with the outcome at a level of p < 0.1. Results: Adjusted models, including 80 women, revealed that higher self-judgment at the time of abortion was significantly associated with increased postabortion grief (β = 2.5 and p = 0.02). Self-judgment was not associated with statistically significant differences in post-traumatic stress or mental health. There was no association between perceived community condemnation and psychological outcomes. Discussion: Abortion stigma may be associated with increased postabortion grief, but does not appear to be associated with differences in post-traumatic stress or mental health. Investigating how different preprocedure counseling methods can impact self-judgment might inform future interventions aimed at improving psychological outcomes postabortion. Implications for Practice and/or Policy: Abortion providers should consider that women who display signs of self-judgment may be at higher risk for increased grief after pregnancy termination for fetal anomalies or maternal complications.

Introduction: Structural inequities may impact the relationship between COVID-19 and access to contraception. Methods: In July 2020 and January 2021, we used social media to survey 2 samples of women of reproductive age who had not been surgically sterilized and were not currently pregnant about their experiences seeking contraception. We explore whether experiences differed for people experiencing social and/or economic disadvantage due to COVID-19, using multivariable logistic regression to control for age, education and income. Results: In July 2020, 51.5% of respondents who sought contraception (total N = 3064) reported barriers to care compared to 55.3% in January 2021 (total N = 2276). A larger percent (14% in July 2020 and 22% in Jan 2021) reported not using their preferred method of contraception due to COVID-19. Individuals experiencing income loss (OR = 1.61, 95% CI 1.27-2.04 early in the COVID-19 pandemic and OR = 1.58, 1.21-2.06 mid COVID-19 pandemic) and hunger (OR = 1.73, 1.24-2.40 early and OR = 2.02, 1.55-2.64 mid-COVID-19 pandemic) were more likely to report they would be using a different method if not for COVID-19, compared to respondents without income loss or hunger. Conclusions: COVID-19 has complicated access to contraception, especially for disadvantaged populations. Implications: Effort s are needed to ensure access to contraception despite the COVID-19 epidemic, especially for disadvantaged populations. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

Objectives: To evaluate the effect of race, socioeconomic status (SES), and parity on providers’ response to patients requesting “early” IUD removal.

OBJECTIVE:The aim of the study was to examine whether miscarriage treatment-related morbidities and adverse events vary across facility types. METHODS:A retrospective cohort study compared miscarriage treatment-related morbidities and adverse events across hospitals, ambulatory surgery centers (ASCs), and office-based settings. Data on women who had miscarriage treatment between 2011 and 2014 and were continuously enrolled in their insurance plan for at least 1 year before and at least 6 weeks after treatment were obtained from a large national private insurance claims database. The main outcome was miscarriage treatment-related morbidities and adverse events occurring within 6 weeks of miscarriage treatment. Secondary outcomes were major events and infections. RESULTS:A total of 97,374 miscarriage treatments met inclusion criteria. Most (75%) were provided in hospitals, 10% ASCs, and 15% office-based settings. A total of 9.3% had miscarriage treatment-related events, 1.0% major events, and 1.5% infections. In adjusted analyses, there were fewer events in ASCs (6.5%) than office-based settings (9.4%) and hospitals (9.6%), but no significant difference between office-based settings and hospitals. There were no significant differences in major events between ASCs (0.7%) and office-based settings (0.8%), but more in hospitals (1.1%) than ASCs and office-based settings. There were fewer infections in ASCs (0.9%) than office-based settings (1.2%) and more in hospitals (1.6%) than ASCs and office-based settings. In analyses stratified by miscarriage treatment type, the difference between ASCs and office-based settings was no longer significant for miscarriages treated with procedures. CONCLUSIONS:Although there seem to be slightly more events in hospitals than ASCs or office-based settings, findings do not support limiting miscarriage treatment to particular settings.

OBJECTIVES/GOALS: Despite its critical importance in reproductive health, access to abortion care continues to be impeded by laws grounded in religious, political, or other ideologies. We will characterize abortion attitudes among US men who live in areas with restrictive abortion laws using qualitative methods. METHODS/STUDY POPULATION: We will use a semi-structured interview guide to elicit men’s attitudes about abortion, characterized within moral, legal, religious, political, and other domains. Inclusion criteria include English-speaking cisgender men, ages 18 to 65 who live in states with the most restrictive abortion laws as defined by the Guttmacher Institute. We will recruit participants through Facebook ads and interviews will continue until theoretic sufficiency. Using an inductive thematic analysis approach, transcripts will be coded for emergent themes by two researchers independently in QRS NVivo 12.0, with concurrent refinement of themes as interviews are completed. RESULTS/ANTICIPATED RESULTS: We will elucidate emergent themes regarding men’s abortion attitudes which could include how men think of abortion as a medical, moral, or personal reality, why they do or do not support abortion provision, among many other possibilities. We anticipate that researchers can use the data obtained from this study to begin to build a conceptual framework of abortion attitudes among US men who lives in restrictive states. DISCUSSION/SIGNIFICANCE OF IMPACT: This study will fill an important gap in the literature by qualitatively characterizing abortion attitudes among a population that has political influence on abortion access. Results can inform policy and advocacy campaigns aimed at shifting public abortion attitudes towards increased acceptance.