Abstract
Objectives
This study uses the abortion visit as an opportunity to identify women lacking well-woman
care (WWC) and explores factors influencing their ability to obtain WWC after implementation
of the Affordable Care Act.
Methods
We conducted semistructured interviews with low-income women presenting for induced
abortion who lacked a well-woman visit in more than 12 months or a regular health
care provider. Dimensions explored included 1) pre-abortion experiences seeking WWC,
2) postabortion plans for obtaining WWC, and 3) perceived barriers and facilitators
to obtaining WWC. Interviews were transcribed and analyzed using ATLAS.ti.
Results
Thirty-four women completed interviews; three-quarters were insured. Women described
interacting psychosocial, interpersonal, and structural barriers hindering WWC use.
Psychosocial barriers included negative health care experiences, low self-efficacy,
and not prioritizing personal health. Women's caregiver roles were the primary interpersonal
barrier. Most prominently, structural challenges, including insurance insecurity,
disruptions in patient–provider relationships, and logistical issues, were significant
barriers. Perceived facilitators included online insurance procurement, care integration,
and social support.
Conclusions
Despite most being insured, participants encountered WWC barriers after implementation
of the Affordable Care Act. Further work is needed to identify and engage women lacking
preventive reproductive health care.
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Biography
Julie Chor, MD, MPH, is an Assistant Professor of Obstetrics and Gynecology at the University of Chicago. Her research focuses on the use of lay health workers in reproductive health care, reproductive health disparities, and reproductive ethics.
Biography
Sarah Garcia-Ricketts, BA, is a medical student at The University of Chicago's Pritzker School of Medicine. Her research interests are reproductive justice and LGBTQ health.
Biography
Danielle Young, MPH, is a Research Specialist, in the Section of Family Planning and Contraceptive Research at the University of Chicago. Her research interests include maternal and child health, reproductive health, and health disparities.
Biography
Luciana E. Hebert, PhD, is a Research Specialist in the Section of Family Planning and Contraceptive Research at the University of Chicago. Her research interests include gender, family planning, and adolescent health.
Biography
Lee A. Hasselbacher, JD, is Policy Coordinator with the Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at The University of Chicago. Her research interests are sexual and reproductive health law and policy.
Biography
Melissa L. Gilliam, MD, MPH, is a Professor of Obstetrics and Gynecology and Pediatrics at the University of Chicago. Her research focuses on the adolescent sexual and reproductive health, reproductive justice, and positive youth development.
Article info
Publication history
Published online: May 07, 2018
Accepted:
March 30,
2018
Received in revised form:
March 6,
2018
Received:
December 20,
2017
Footnotes
Funding for this study was provided by The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Award number K23HD084753.
Identification
Copyright
© 2018 Jacobs Institute of Women's Health. Published by Elsevier Inc.
