Patterns in Women's Unmet Sexual and Reproductive Healthcare Needs Over the Life Course

ABSTRACT Unmet sexual and reproductive healthcare (SRH) needs are a significant problem in the United States and are associated with a broad spectrum of negative sexual and reproductive health outcomes. Consequently, it is essential to understand the factors associated with unmet SRH needs and the characteristics of women who are most vulnerable to unmet SRH needs. Existing research has been limited in two ways. First, quantitative research on unmet SRH needs is often constrained by a lack of available information on women who do not receive care, by virtue of their absence from care. Second, the paucity of robust, longitudinal data has prohibited researchers’ ability to specify how SRH experiences (and unmet needs) are connected throughout women’s lives. The objective of this project is to elucidate the connection between unmet SRH needs over time and to identify the factors associated with and disparities in levels of unmet SRH needs over time. To do so, this project will leverage an innovative mixed-methods dataset from the Person to Person (P2P) Health Interview study, a large omnibus health study, including: (1) new in-depth interviews with reproductive-aged women in the P2P sample (N=40), (2) linked electronic health records (EHR) of women in the P2P sample (N=1,462), and (3) associated P2P survey data. To achieve the overall objective, the proposed project addresses two specific aims. Aim 1: Identify women’s perceptions of unmet SRH needs across their lives and the conditions that contribute to those unmet needs using in-depth interviews guided by participant’s EHR. These interviews will elicit women’s narratives of their experiences with SRH over time and contextualize SRH events in their EHR with information about their social circumstances and the connections between each experience and subsequent SRH utilization decisions. Furthermore, these interviews will identify instances of unmet need and utilization not included in the EHR. Aim 2: Classify patterns in SRH usage over time using sequence analysis to compare (2a) factors and resources associated with unmet SRH needs and (2b) sociodemographic disparities in patterns of SRH utilization. I will evaluate the elements in each pattern against standards of preventative and acute care and women’s accounts of their unmet needs (gathered in Aim 1) to assess the level of unmet need. I will use multinomial logistic regression to examine the association between (a) measures of predisposing factors and enabling resources (healthcare access, racism, trust in doctors, and social support), (b) sociodemographic characteristics and patterns of SRH utilization with differing levels of unmet SRH need. Results from this study will generate valuable information that can be used to develop targeted interventions to reduce unmet SRH needs, eliminate racial and socioeconomic disparities in SRH utilization, and improve sexual and reproductive health outcomes over women’s lives.