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Objectives: The objectives of this article are to present findings from recent qualitative research with patients in a combined perinatal substance use treatment program in Central Appalachia, and to describe and analyze participants' ambivalence about medicationassisted treatment for opioid use disorder (OUD), in the context of widespread societal stigma and judgement. Methods: We conducted research in a comprehensive outpatient perinatal substance use treatment program housed in a larger obstetric practice serving a large rural, Central Appalachian region. The program serves patients across the spectrum of substance use disorders but specifically offers medication-assisted treatment to perinatal patients with OUD. We purposively and opportunistically sampled patients receiving prescriptions for buprenorphine or buprenorphine-naloxone dual product, along with prenatal care and other services. Through participant-observation and semi-structured interviews, we gathered qualitative data from 27 participants, in a total of 31 interviews. We analyzed transcripts of interviews and fieldnotes using modified Grounded Theory. Results: Participants in a combined perinatal substance use treatment program value supportive, non-judgmental care but report ambivalence about medication, within structural and institutional contexts of criminalized, stigmatized substance use and close scrutiny of their pregnancies. Women are keenly aware of the social and public consequences for themselves and their parenting, if they begin or continue medication treatment for OUD. Conclusions: Substance use treatment providers should consider the social consequences of medication treatment, as well as the clinical benefits, when presenting treatment options and recommendations to patients. Patient-centered care must include an understanding of larger social and structural contexts.

Nearly half of all women in the United States will have at least one abortion during their lifetime, and many will encounter economic, logistical, and/or social obstacles while attempting to undergo the procedure. The purpose of this project was to examine the abortion-seeking experiences of a volunteer sample of Oregon women, to identify key barriers and the strategies women employed to overcome them. Using a mixed-methods approach combining survey and interview data with participant observation, we found that low-income women experienced structural and economic barriers to abortion even though abortion is covered by the state Medicaid program in Oregon. Social support helped women overcome obstacles, and a lack of support was itself experienced as an obstacle. Women of lower socioeconomic status also encountered more barriers and had a more difficult time overcoming them. Our findings indicate the need for improved advocacy to reduce structural delay, and to improve access to social support and other resources needed for timely abortion care.

Purpose Tracking changes in care utilization of medication for opioid use disorder (MOUD) services before, during, and after COVID‐19‐associated changes in policy and service delivery in a mixed rural and micropolitan setting. Methods Using a retrospective, open‐cohort design, we examined visit data of MOUD patients at a family medicine clinic across three identified periods: pre‐COVID, COVID transition, and COVID. Outcome measures include the number and type of visits (in‐person or telehealth), the number of new patients entering treatment, and the number of urine drug screens performed. Distance from patient residence to clinic was calculated to assess access to care in rural areas. Goodness‐of‐Fit Chi‐Square tests and ANOVAs were used to identify differences between time periods. Findings Total MOUD visits increased during COVID (436 pre vs. 581 post, p < 0.001), while overall new patient visits remained constant (33 pre vs. 29 post, p = 0.755). The clinic's overall catchment area increased in size, with new patients coming primarily from rural areas. Length of time between urine drug screens increased (21.1 days pre vs. 43.5 days post, p < 0.001). Conclusions The patterns of MOUD care utilization during this period demonstrate the effectiveness of telehealth in this area. Policy changes allowing for MOUD to be delivered via telehealth, waiving the need for in‐person initiation of MOUD, and increased Medicaid compensation for MOUD may play a valuable role in improving access to MOUD during the COVID‐19 pandemic and beyond.