National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 35 Research Studies DisplayedAustin N, Kristensen-Cabrera A, Sherman J
Analyzing the heterogeneity of labor and delivery units: a quantitative analysis of space and design.
This study evaluated the effect of space and design on labor and deliver (L&D) hospital units. A quantitative analysis was done to see if it made an impact on the risk of deliveries. The researchers recommend standardization of the space based on number of deliveries and cesarean sections.
AHRQ-funded; HS023506.
Citation: Austin N, Kristensen-Cabrera A, Sherman J .
Analyzing the heterogeneity of labor and delivery units: a quantitative analysis of space and design.
PLoS One 2018 Dec 26;13(12):e0209339. doi: 10.1371/journal.pone.0209339..
Keywords: Labor and Delivery, Pregnancy, Women
Kung SA, Saavedra-Avendano B, Velez EA
Capturing compassion: a survey of Mexican Catholics assessing abortion support by reason for abortion and degree of Catholicism.
No standard exists to measure religiosity in abortion studies. In this study, the investigators test whether religiosity was associated with support for abortion among Mexican Catholics and whether different measures of degree of Catholicism alter the relationship. The investigators found that the majority of Mexican Catholics supported abortion in some circumstances. The only measure of degree of Catholicism significantly associated with all the outcomes was belief that a person who helps someone who aborts can be a good Catholic.
AHRQ-funded; HS022981.
Citation: Kung SA, Saavedra-Avendano B, Velez EA .
Capturing compassion: a survey of Mexican Catholics assessing abortion support by reason for abortion and degree of Catholicism.
Contraception 2018 Dec;98(6):504-09. doi: 10.1016/j.contraception.2018.06.008..
Keywords: Racial and Ethnic Minorities, Pregnancy, Women
Danilack VA, Brousseau EC, Phipps MG
The effect of gestational weight gain on persistent increase in body mass index in adolescents: a longitudinal study.
Weight retention after pregnancy is a concern for adolescents who may be entering adulthood at unhealthy weights. In this article, the investigators studied associations between each of three measures: pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and post-pregnancy BMI in a longitudinal follow-up of an adolescent pregnancy study cohort. They concluded that teens experienced an increase in BMI from pre-pregnancy to within 4 years after their first delivery, and this increase was related to GWG.
AHRQ-funded; HS025013.
Citation: Danilack VA, Brousseau EC, Phipps MG .
The effect of gestational weight gain on persistent increase in body mass index in adolescents: a longitudinal study.
J Womens Health 2018 Dec;27(12):1456-58. doi: 10.1089/jwh.2017.6635..
Keywords: Children/Adolescents, Pregnancy, Obesity: Weight Management, Obesity, Women
Neal JL, Lowe NK, Caughey AB
Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women.
The aims of this study were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. The authors suggest that adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.
AHRQ-funded; HS024733.
Citation: Neal JL, Lowe NK, Caughey AB .
Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women.
Birth 2018 Dec;45(4):358-67. doi: 10.1111/birt.12358..
Keywords: Labor and Delivery, Pregnancy, Women
Neal JL, Lowe NK, Phillippi JC
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
The goals of this study were: Determine the proportions of women admitted to the hospital before or in active labor per the leading National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) guidelines; Compare associations of labor status at admission with oxytocin augmentation, cesarean birth, and adverse birth outcomes when using the different active labor diagnostic guidelines. Active labor diagnostic guidelines were applied retrospectively to cervical examination data. The authors conclude that many parous women with spontaneous labor onset are admitted to the hospital before active labor, and these women are more likely to receive oxytocin augmentation during labor and to have a cesarean birth. Implications for practice are discussed.
AHRQ-funded; HS024733.
Citation: Neal JL, Lowe NK, Phillippi JC .
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
Midwifery 2018 Dec;67:64-69. doi: 10.1016/j.midw.2018.09.007..
Keywords: Decision Making, Guidelines, Hospitalization, Labor and Delivery, Pregnancy, Women
Rice WS, Turan B, White K
Norms and stigma around unintended pregnancy in Alabama: associations with recent contraceptive use and dual method use among young women.
This study investigated the role of unintended pregnancy norms and stigma in contraceptive use among young women in Alabama. A total of 390 women aged 18-24 were surveyed from November 2014 to October 2015 at university and public health clinics. These women were considered at risk for unintended pregnancy and sexually transmitted diseases. Compared to nonusers, users of contraceptives were more likely to be White, nulliparous, from the university and had higher income. Disapproval of unintended pregnancy by close family and friends was associated with greater contraceptive use.
AHRQ-funded; HS013852.
Citation: Rice WS, Turan B, White K .
Norms and stigma around unintended pregnancy in Alabama: associations with recent contraceptive use and dual method use among young women.
Women Health 2018 Nov-Dec;58(10):1151-66. doi: 10.1080/03630242.2017.1414099.
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Keywords: Sexual Health, Pregnancy, Social Stigma, Women, Young Adults
Guo M, Quensell M, Chang A
Understanding of key obstetric quality terminology by Asian and Pacific Islander subgroups: implications for patient engagement and health equity.
In this study, women in Oahu, Hawai'i with a recent delivery were interviewed about their understanding of ten common obstetric terms. Health literacy was assessed by the rapid estimate of adult literacy in medicine (REALM). Multivariable models predicted total terms comprehended by demographic factors. The investigators found that participants were unfamiliar with common obstetrics terminology. Comprehension struggles were more common among populations with maternal health disparities, including Asian and Pacific Islander subgroups, and those with low health literacy.
AHRQ-funded; HS021903.
Citation: Guo M, Quensell M, Chang A .
Understanding of key obstetric quality terminology by Asian and Pacific Islander subgroups: implications for patient engagement and health equity.
Matern Child Health J 2018 Nov;22(11):1543-49. doi: 10.1007/s10995-018-2597-8..
Keywords: Health Literacy, Patient and Family Engagement, Pregnancy, Women
Masho SW, Rozario S, Walker D
Racial differences and the role of marital status in the association between intimate partner violence and unintended pregnancy.
This study examined the association between intimate partner violence (IPV) and unintended pregnancy across racial/ethnic and marital strata among U.S. women. Among other results, the investigators found that the odds of unintended pregnancy were increased for married non-Hispanic White women who reported IPV compared to their non-abused counterparts even after controlling for sociodemographic factors, health care access, and reproductive history.
AHRQ-funded; HS021504.
Citation: Masho SW, Rozario S, Walker D .
Racial differences and the role of marital status in the association between intimate partner violence and unintended pregnancy.
J Interpers Violence 2018 Oct;33(20):3162-85. doi: 10.1177/0886260516635317..
Keywords: Domestic Violence, Pregnancy, Racial and Ethnic Minorities, Social Determinants of Health
Sutherland S, Brunwasser SM
Sex differences in vulnerability to prenatal stress: a review of the recent literature.
This review evaluates the degree to which recent studies provide evidence that prenatal maternal stress (PNMS) has a varying effect on child health outcomes depending on the child's biological sex. “Stress” includes negative life events, psychological stress, and established stress biomarkers. A review of 50 peer-reviewed articles revealed that most found evidence of either sex-specific associations or significant PNMS (x) stress interactions for at least one outcome. Sex-dependent effects were strongest in the group of studies that evaluated child neural/nervous system development and temperament.
AHRQ-funded; HS022990.
Citation: Sutherland S, Brunwasser SM .
Sex differences in vulnerability to prenatal stress: a review of the recent literature.
Sex differences in vulnerability to prenatal stress: a review of the recent literature.
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Keywords: Children/Adolescents, Newborns/Infants, Outcomes, Pregnancy, Sex Factors, Stress
Nelson DB, Moniz MH, Davis MM
Population-level factors associated with maternal mortality in the United States, 1997-2012.
This study analyzed state-level maternal mortality for the years 1997-2012 using multilevel mixed-effects regression grouped by state, using publicly available data. The study concluded that, in addition to better case ascertainment of maternal deaths, adverse changes in chronic diseases, insufficient healthcare access, and social determinants of health represent identifiable risks for maternal mortality that merit prompt attention in population-directed interventions and health policies.
AHRQ-funded; HS025465.
Citation: Nelson DB, Moniz MH, Davis MM .
Population-level factors associated with maternal mortality in the United States, 1997-2012.
BMC Public Health 2018 Aug 13;18(1):1007. doi: 10.1186/s12889-018-5935-2..
Keywords: Health Services Research (HSR), Labor and Delivery, Mortality, Pregnancy, Social Determinants of Health
Phillippi JC, Doersam JK, Neal JL
Electronic informed consent to facilitate recruitment of pregnant women into research.
This study examined the use of electronic informed consent to increase the participation of racially and geographically diverse pregnant women in prospective research. They evaluated the feasibility and utility of e-consent in the first year of a multiyear clinical trial involving pregnant women. Out of 86 women screened, 71 were eligible, 65 agreed to review the e-consent form, and 61 completed the process. Even those women who reported low health literacy were able to complete the form and may expedite enrollment of a representative sample.
AHRQ-funded; HS024733.
Citation: Phillippi JC, Doersam JK, Neal JL .
Electronic informed consent to facilitate recruitment of pregnant women into research.
J Obstet Gynecol Neonatal Nurs 2018 Jul;47(4):529-34. doi: 10.1016/j.jogn.2018.04.134.
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Keywords: Women, Pregnancy, Health Literacy
Connor KA, Duran G, Faiz-Nassar M
Feasibility of implementing group well baby/well woman dyad care at federally qualified health centers.
The aim of this qualitative study was to assess stakeholder perspectives on the feasibility of implementing Centering Parenting (CP) in federally qualified health centers (FQHCs) in Baltimore. The investigators concluded that perceptions regarding facilitators and barriers to CP implementation in FQHCs were similar to existing group well-child care literature; however the benefit of emphasis on maternal wellness was a unique finding. The investigators suggested that a maternal wellness integration might make CP a particularly desirable model for implementation at FQHCs, but potential systems barriers must be addressed.
AHRQ-funded; HS017596.
Citation: Connor KA, Duran G, Faiz-Nassar M .
Feasibility of implementing group well baby/well woman dyad care at federally qualified health centers.
Acad Pediatr 2018 Jul;18(5):510-15. doi: 10.1016/j.acap.2017.09.011..
Keywords: Caregiving, Children/Adolescents, Education: Patient and Caregiver, Health Promotion, Healthcare Delivery, Maternal Care, Newborns/Infants, Pregnancy, Women
Hedderson MM, Brown SD, Ehrlich SF
A tailored letter based on electronic health record data improves gestational weight gain among women with gestational diabetes mellitus: the Gestational Diabetes' Effects on Moms (GEM) cluster-randomized controlled trial.
The purpose of this study was to evaluate whether a tailored letter improved gestational weight gain (GWG) and whether GWG mediated a multicomponent intervention's effect on postpartum weight retention among women with gestational diabetes mellitus (GDM). The authors concluded that a tailored electronic health record-based letter improved GWG, which mediated the effect of a multicomponent intervention in reducing postpartum weight retention.
AHRQ-funded; HS019367.
Citation: Hedderson MM, Brown SD, Ehrlich SF .
A tailored letter based on electronic health record data improves gestational weight gain among women with gestational diabetes mellitus: the Gestational Diabetes' Effects on Moms (GEM) cluster-randomized controlled trial.
Diabetes Care 2018 Jul;41(7):1370-77. doi: 10.2337/dc17-1133..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Lifestyle Changes, Patient-Centered Outcomes Research, Pregnancy, Women
Xu X, Lee HC, Lin H
Hospital variation in cost of childbirth and contributing factors: a cross-sectional study.
The purpose of this study was to examine hospital variation in cost of childbirth hospitalizations and identify factors that contribute to the variation. The study concluded that cost of childbirth hospitalizations varied widely among hospitals in California. Institutional characteristics significantly contributed to this variation. Higher-cost hospitals did not have better outcomes, suggesting potential opportunities to enhance value in care.
AHRQ-funded; HS023801.
Citation: Xu X, Lee HC, Lin H .
Hospital variation in cost of childbirth and contributing factors: a cross-sectional study.
BJOG 2018 Jun;125(7):829-39. doi: 10.1111/1471-0528.15007..
Keywords: Healthcare Costs, Health Services Research (HSR), Hospitals, Labor and Delivery, Pregnancy
White VanGompel E, Main EK, Tancredi D
Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study.
The authors estimated the association between individual provider attitudes towards birth and their low-risk primary cesarean rate. Through surveys of California providers of intrapartum care in 2013, they found that provider attitudinal differences are associated with nulliparous, term, singleton, vertex cesarean rates. Those meeting the HP2020 goal hold attitudes more favorable towards vaginal birth, suggesting a modifiable target for quality improvement initiatives to decrease low risk primary cesareans.
AHRQ-funded; HS022236.
Citation: White VanGompel E, Main EK, Tancredi D .
Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study.
BMC Pregnancy Childbirth 2018 May 29;18(1):184. doi: 10.1186/s12884-018-1756-7.
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Keywords: Provider: Health Personnel, Labor and Delivery, Pregnancy, Practice Patterns
Glazer KB, Eliot MN, Danilack VA
Residential green space and birth outcomes in a coastal setting.
The objective of this study was to evaluate associations between green and blue space and birth outcomes in a coastal area of the northeastern US. Findings from this study did not support the hypothesis that residential green space was associated with reduced risk of preterm birth or higher birthweight after adjustment for individual and contextual socioeconomic factors, but variation in results with incremental adjustment raised questions about the optimal degree of control for confounding by markers of SES. The investigators found that living near a freshwater body was associated with higher birthweight.
AHRQ-funded; HS025013.
Citation: Glazer KB, Eliot MN, Danilack VA .
Residential green space and birth outcomes in a coastal setting.
Environ Res 2018 May;163:97-107. doi: 10.1016/j.envres.2018.01.006..
Keywords: Pregnancy, Newborns/Infants, Outcomes, Adverse Events, Women
Lyndon A, Malana J, Hedi LC
Thematic analysis of women's perspectives on the meaning of safety during hospital-based birth.
This study used an interdisciplinary team of five investigators to examine women’s birth experiences in the perspective of patient safety. Five investigators in the fields of nursing, medicine, product design, and journalism analyzed transcripts to see how women felt about their physical or emotional safety during birth, and to identify opportunities for improvement in care. Teams that were well-organized promoted feelings of safety as well as human connection.
AHRQ-funded; HS023506.
Citation: Lyndon A, Malana J, Hedi LC .
Thematic analysis of women's perspectives on the meaning of safety during hospital-based birth.
J Obstet Gynecol Neonatal Nurs 2018 May;47(3):324-32. doi: 10.1016/j.jogn.2018.02.008..
Keywords: Labor and Delivery, Pregnancy, Women, Patient Safety, Patient Experience
Liu CH, Phan J, Yasui M
Prenatal life events, maternal employment, and postpartum depression across a diverse population in New York City.
This study examined racial and ethnic disparities in three postpartum depression (PPDF) symptoms and identified specific predictors. Women from the New York City area completed the 2009-2011 Pregnancy Risk Assessment Monitoring System survey. White women were more likely to have PPD than African American women. Employment was also associated with PPD for white women.
AHRQ-funded; HS023007.
Citation: Liu CH, Phan J, Yasui M .
Prenatal life events, maternal employment, and postpartum depression across a diverse population in New York City.
Community Ment Health J 2018 May;54(4):410-19. doi: 10.1007/s10597-017-0171-2..
Keywords: Depression, Disparities, Pregnancy, Racial and Ethnic Minorities, Women
Wynn A, Ramogola-Masire D, Gaolebale P
Prevalence and treatment outcomes of routine Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis testing during antenatal care, Gaborone, Botswana.
AHRQ-funded; HS000046.
Citation: Wynn A, Ramogola-Masire D, Gaolebale P .
Prevalence and treatment outcomes of routine Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis testing during antenatal care, Gaborone, Botswana.
Sex Transm Infect 2018 May;94(3):230-35. doi: 10.1136/sextrans-2017-053134..
Keywords: Antibiotics, Human Immunodeficiency Virus (HIV), Infectious Diseases, Pregnancy, Women
Hefele JG, Santos P, Ritter G
Risk factors for shoulder dystocia: the impact of mother's race and ethnicity.
The purpose of this observational study was to examine shoulder dystocia risk factors by race and ethnicity using a 19,236 sample of pregnant women who presented for labor and delivery. Results found that, for White non-Hispanic mothers, the strongest risk factors were delivering past 40 weeks' gestation and use of epidural anesthesia during delivery. Among Black non-Hispanic mothers, the risk factors with the greatest impact were use of epidural and having gestational diabetes and controlling the condition with insulin. Additionally, among Hispanic mothers, having Spanish as the primary language increased shoulder dystocia likelihood compared to those who did not cite it as their primary language. This study provides evidence that risk factors for a labor and delivery condition can vary significantly across racial and ethnic subgroups.
AHRQ-funded; HS019608.
Citation: Hefele JG, Santos P, Ritter G .
Risk factors for shoulder dystocia: the impact of mother's race and ethnicity.
J Racial Ethn Health Disparities 2018 Apr;5(2):333-41. doi: 10.1007/s40615-017-0374-9..
Keywords: Adverse Events, Labor and Delivery, Injuries and Wounds, Newborns/Infants, Pregnancy, Risk
McArdle J, Sorensen A, Fowler CI
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
The purpose of this study using TeamSTEPPS was to assess the implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. Results suggested that successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The Safety Program for Perinatal Care strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.
AHRQ-funded; 2902010000241.
Citation: McArdle J, Sorensen A, Fowler CI .
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
J Obstet Gynecol Neonatal Nurs 2018 Mar;47(2):191-201. doi: 10.1016/j.jogn.2017.11.014.
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Keywords: Labor and Delivery, Newborns/Infants, Pregnancy, Adverse Events, TeamSTEPPS, Injuries and Wounds, Care Management, Education: Continuing Medical Education, Training, Tools & Toolkits, Patient Safety, Nursing, Communication, Quality of Care
Brousseau EC, Danilack V, Cai F
Emergency department visits for postpartum complications.
The investigators performed a retrospective analysis of all postpartum visits to the emergency department (ED) at a tertiary care women's hospital over 6 months and described characteristics of the population and clinical details of the ED visit, specifically the presenting complaint, delivery type, final diagnosis, and admission rate. They found that women presenting to the ED postpartum period had a wide variety of medical issues but 78% were not admitted.
AHRQ-funded; HS025013.
Citation: Brousseau EC, Danilack V, Cai F .
Emergency department visits for postpartum complications.
J Womens Health 2018 Mar;27(3):253-57. doi: 10.1089/jwh.2016.6309..
Keywords: Adverse Events, Emergency Department, Maternal Care, Pregnancy, Women
Sun B, Perkins NJ, Cole SR
AHRQ Author: Mitchell EM
Inverse-probability-weighted estimation for monotone and nonmonotone missing data.
The goal of this study was to examine the issue of missing data in epidemiologic research by estimating the association of maternal smoking behavior with spontaneous abortion. Three data sets with induced missing values from the Collaborative Perinatal Project are provided in the article as examples of prototypical epidemiologic studies with missing data. The article also describes a proposed approach to modeling nonmonotone missing-data mechanisms under missingness at random that can be used in constructing the weights in inverse probability weighting complete-case estimation.
AHRQ-authored.
Citation: Sun B, Perkins NJ, Cole SR .
Inverse-probability-weighted estimation for monotone and nonmonotone missing data.
Am J Epidemiol 2018 Mar;187(3):585-91. doi: 10.1093/aje/kwx350..
Keywords: Data, Health Services Research (HSR), Pregnancy, Research Methodologies
Dickens LT, Naylor RN
Clinical management of women with monogenic diabetes during pregnancy.
This study discusses clinical management of women with monogenic diabetes during pregnancy. Monogenic diabetes is rare and only accounts for 1-2% of all diabetes cases so it is frequently misdiagnoses as one of the other diabetes types. Diabetes treatment is different for this type of diabetes, and if untreated can cause fetal mutations. However, if treated there can be transplacental transfer of the medication (sulfonylurea). The study authors recommend large prospective studies be conducted to better define the need and timing of initiation of insulin treatment.
AHRQ-funded; HS023007.
Citation: Dickens LT, Naylor RN .
Clinical management of women with monogenic diabetes during pregnancy.
Curr Diab Rep 2018 Feb 15;18(3):12. doi: 10.1007/s11892-018-0982-8..
Keywords: Care Management, Chronic Conditions, Diabetes, Maternal Care, Pregnancy, Women
Saavedra-Avendano B, Schiavon R, Sanhueza P
Who presents past the gestational age limit for first trimester abortion in the public sector in Mexico City?
This study identified socio-demographic factors associated with presenting for abortion services past the gestational age (GA) limit (12 weeks), and thus not receiving services, in Mexico City's public sector first trimester abortion program. Adult women had significantly lower odds than adolescents of presenting past the limit. There was an educational gradient across all age groups.
AHRQ-funded; HS022981.
Citation: Saavedra-Avendano B, Schiavon R, Sanhueza P .
Who presents past the gestational age limit for first trimester abortion in the public sector in Mexico City?
PLoS One 2018 Feb 7;13(2):e0192547. doi: 10.1371/journal.pone.0192547.
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Keywords: Education, Pregnancy, Social Determinants of Health, Women