Rethinking the Well Woman Visit: A Scoping Review to Identify Eight Priority Areas for Well Woman Care in the Era of the Affordable Care Act

Pascale, Alisa; Beal, Margaret W.; Fitzgerald, Tanya

doi:10.1016/j.whi.2015.11.003

Cited by 12 publications

(6 citation statements)

References 117 publications

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“…Two environments that have emerged as strong candidates are the justice and health care systems. While the health care contacts in prior studies encompassed a broad range of services, arguments have been made for assessment of IPV to be a priority at OB/GYN visits (Pascale et al, 2015), which may be especially relevant for pregnant women given the increased risk for IPH during pregnancy (Wallace et al, 2016). Shadigian and Bauer (2004) have argued that pregnancy-associated IPH is under-recognized and that all clinicians who care for pregnant women should screen for current and lifetime partner violence victimization, including experiences of physical, sexual, and emotional abuse.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Pregnancy-associated Intimate Partner Homicide

Kivisto

Mills

Elwood

2021

J Interpers Violence

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Pregnancy-associated femicide accounts for a mortality burden at least as high as any of the leading specific obstetric causes of maternal mortality, and intimate partners are the most common perpetrators of these homicides. This study examined pregnancy-associated and non-pregnancy-associated intimate partner homicide (IPH) victimization among racial/ethnic minority women relative to their non-minority counterparts using several sources of state-level data from 2003 through 2017. Data regarding partner homicide victimization came from the National Violent Death Reporting System, natality data were obtained from the Centers for Disease Control and Prevention’s National Center for Health Statistics, and relevant sociodemographic information was obtained from the U.S. Census Bureau. Findings indicated that pregnancy and racial/ethnic minority status were each associated with increased risk for partner homicide victimization. Although rates of non-pregnancy-associated IPH victimization were similar between Black and White women, significant differences emerged when limited to pregnancy-associated IPH such that Black women evidenced pregnancy-associated IPH rates more than threefold higher than that observed among White and Hispanic women. Relatedly, the largest intraracial discrepancies between pregnant and non-pregnant women emerged among Black women, who experienced pregnancy-associated IPH victimization at a rate 8.1 times greater than their non-pregnant peers. These findings indicate that the racial disparities in IPH victimization in the United States observed in prior research might be driven primarily by the pronounced differences among the pregnant subset of these populations.

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Section: Discussionmentioning

confidence: 99%

Racial Disparities in Pregnancy-associated Intimate Partner Homicide

Kivisto

Mills

Elwood

2021

J Interpers Violence

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“…This is unfortunate because screening for substance use as well as sexual risk behavior in reproductive health care settings affords an opportunity to improve young women’s health, in line with recommendations for screening, brief interventions, and referral for substance use treatment within ambulatory health care settings [22]. Leading gynecological providers therefore recommend such screening become an integral part of women’s health visits [23].…”

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confidence: 99%

Sexual risk behavior and substance use among young, diverse women seeking care at a reproductive health clinic

et al. 2019

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BackgroundTo describe sexual risk behavior, alcohol (and other substance) use, and perceived health promotion needs among young adult women seeking care from an urban reproductive health care clinic in the Northeastern United States, and to examine if these needs differ by race and ethnicity.MethodsWomen 18–29 years old presenting for a routine medical visit were invited to participate. Of 486 eligible women, 466 (96%) agreed to participate and completed a brief survey on a tablet computer. Most of the sample (53%) identified as non-Hispanic White. One-quarter (25%) identified as Hispanic/Latina. A smaller proportion of women identified as African American (19%).ResultsOne-third (31%) of women reported a history of sexually transmitted infection (STI), and women reported infrequent condom use with recent sexual partners. Regarding behavioral health needs, nearly three-quarters of women (72%) reported regular alcohol use, approximately one-third had used marijuana (37%) or tobacco (33%) in the last month, and 19% reported clinically significant depressive symptoms in the last two weeks. Women reported moderate-to-strong interest in receiving information about relationships and sexual health; however, the majority were not interested in information about their substance use. Hispanic and African-American women were more likely to report STI history despite reporting fewer sexual partners than non-Hispanic White women. Minority women also reported significantly less alcohol and cigarette use, but more water pipe tobacco use, and reported significantly greater interest in interventions to promote sexual health. Hispanic women also evidenced significantly elevated rates of depressive symptoms, with 26% of Hispanic women reporting a clinically significant level of depressive symptoms.ConclusionsReproductive health centers are opportune settings to address a broad range of healthcare needs, including sexual health, substance use, and mental health. These centers engage a diverse group of women, which is important given observed disparities in health outcomes based on race/ethnicity. Young women, particularly racial and ethnic minority women, report the most interest in services addressing sexual and relationship health.

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“…The LS and Stories revealed that even though women may understand the importance of prevention, they were often confused about recommendations related to seeking preventive health care (Theme #5). According to Pascale et al 20 in their review of the relevant content for the WWV: “At the same time that health plans are implementing the ACA-mandated coverage for annual WWVs without cost sharing, certain key components of the traditional WWV, such as the annual Pap smear for cervical cancer screening and the bimanual pelvic examination, are being challenged.” Pascale et al suggest that new recommendations have led to “headlines in the popular press and professional editorials, which question the need for any kind of preventive care at all” (p.136). However, they conclude that the “WWV remains a very important opportunity for prevention, health education, screening, and early detection” (p.135).…”

Section: Discussionmentioning

confidence: 99%

The Well-Woman Project: Listening to Women's Voices

et al. 2018

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Purpose: The U.S. Affordable Care Act (ACA) of 2010 included the Well-Woman Visit (WWV) as one of the preventive services, which must be covered without cost sharing. Despite concerted efforts to increase access to the WWV, data from the early years of the ACA demonstrated ongoing barriers, including insufficient consumer and provider awareness of the ACA's no cost-sharing provision for preventive services. As such, 2 years after full implementation of the ACA, the Well-Woman Project (WWP) used qualitative methods to learn about women's perceptions of the WWV and barriers that affect their ability to be healthy and seek well-woman care.Methods: Women's voices were captured by Listening Sessions in eight cities and through stories from women across the United States posted to a WWP Website, or reported over a WWP toll-free phone line. Thematic analysis of Listening Sessions and stories was conducted using Dedoose software.Results: In 2016, Listening Sessions (17) were held with 156 women; in addition, stories were collected from 102 women across the United States. Women are aware of the importance of preventive care, but report multiple barriers to seeking such care. However, they are able to articulate a variety of system and policy strategies that mitigate the complexity of navigating the health care system; help women prioritize their health and accessing health care; promote positive relationships with providers; empower women to advocate for themselves and others; promote positive mental health as well as access to safe environments, healthy food, and social support systems; decrease barriers related to lack of transportation and childcare; and support the provision of trauma informed care in the health care delivery system.Conclusion: To improve women's health status and reduce inequities, making the preventive well-care visit available without cost-sharing is necessary, but not a sufficient strategy.

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Rethinking the Well Woman Visit: A Scoping Review to Identify Eight Priority Areas for Well Woman Care in the Era of the Affordable Care Act

Cited by 12 publications

References 117 publications

Racial Disparities in Pregnancy-associated Intimate Partner Homicide

Racial Disparities in Pregnancy-associated Intimate Partner Homicide

Sexual risk behavior and substance use among young, diverse women seeking care at a reproductive health clinic

The Well-Woman Project: Listening to Women's Voices

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