In the final issue of 2020, Perspectives offers six research articles that examine topics ranging from abortion access and care to the link between parent connectedness and sexual health among transgender and gender‐diverse youth. However, the issue kicks off with a triad of commentaries that examine several critical areas of maternal health and equity: the importance of addressing the COVID‐related, structural and institutional barriers that impede Black women's access to community‐based doulas; the dearth of research to guide the development of effective and culturally appropriate mobile health applications to promote Black women's sexual and reproductive health; and, finally, the disturbing and widespread practice of forcibly separating incarcerated women from their newborns for nonmedical reasons immediately after delivery. These three issues—lack of access to community‐based doulas, the need for tailored mobile health technologies and infant removal following birth—call for immediate attention from public health researchers and policymakers, and focused efforts to address them can help mitigate some of the maternal and infant health disparities and unjust infant removal policies currently affecting populations of color in the United States.

•While the COVID‐19 pandemic has had profound and widely reported effects on the U.S. health care system, its impact on abortion clinics has not been well documented. In a unique rapid‐response project, Sarah C.M. Roberts, Rosalyn Schroeder and Carole Joffe surveyed representatives of 103 independent abortion clinics in the spring of 2020 to explore how the facilities were being affected by—and were navigating—the pandemic and associated restrictions (page TK). More than a quarter of clinics had had to cancel or postpone medication or procedural abortions, and more than half had canceled or postponed gynecologic or other nonabortion services. Some facilities—including a third of those in the South—had had to close temporarily. Respondents also described a variety of other disruptions, ranging from the emotional toll on staff to increased expenses and declining revenue. In future crises of this sort, the authors write, public health efforts should consider taking steps “to ensure the sustainability of independent abortion clinics and the well‐being of their workforce.”

•A major contributor to the growing distance women must travel to reach an abortion provider has been the enactment of state‐level abortion restrictions, which have led to facility closures and, in turn, reduced access to abortion. To clarify the interplay between abortion access and the abortion rate, Benjamin P. Brown and colleagues conducted two analyses—a series of linear regression models and an instrumental variable analysis—using linked data on provider locations and county‐level abortion data from 18 states over the period 2000–2014 (page TK). In both analyses, the greater the distance between the center of a county and the nearest abortion provider, the lower the county's abortion rate. The researchers conclude that policies resulting in facility closures have the potential to harm patients who are unable to access safe and legal abortion care because of the increased travel distances required.

•U.S. teaching hospitals play a crucial role in abortion care, both as providers of such care and as training grounds for physicians who wish to provide abortions. However, abortion provision in these facilities may be hindered by staff who are not committed to providing such care. To examine the nature and prevalence of interprofessional opposition, Ariana H. Bennett et al. conducted a nationwide survey of residency and site directors at 169 obstetrics‐gynecology training programs, as well as in‐depth interviews with 18 program directors, in 2014–2017 (page TK). Among respondents who reported that they or their colleagues had wanted or needed to provide abortions in the previous year, seven in 10 faced opposition from hospital staff—most commonly nurses and anesthesiologists. The authors recommend that interventions prioritize patient care and address the hospital restrictions and staff opposition that commonly interfere with the provision of abortion services.

•Although community health centers (CHCs) provide a growing share of contraceptive services, little is known about how clinicians in these centers counsel patients about contraceptive methods, including IUDs. To explore this topic, M. Antonia Biggs and colleagues interviewed 20 clinicians from San Francisco Bay Area CHCs regarding their IUD counseling with young people (page TK). While some providers viewed counseling as an opportunity to empower their patients to make contraceptive decisions without pressure, they also described a tension between guiding young people toward higher‐efficacy methods and respecting their choices. Many clinicians tried to dissuade women from removals within a year of placement, or downplayed the side effects they experienced—practices that could be considered coercive. According to the authors, “more training is needed to ensure that providers employ patient‐centered counseling approaches, including honoring patient requests for removals.”

•Engaging in unprotected sex and having many partners are often termed “risky behaviors,” but little is known about whether adolescents who engage in risky nonsexual behaviors—from not wearing a seat belt to using narcotics—differ from their peers in their use of contraceptives. To examine this issue among female adolescents, Mónica L. Caudillo and colleagues performed latent class analyses, separately by race and ethnicity, using data from the 2011–2015 National Youth Risk Behavior Surveys (page TK). Compared with their less risk‐prone peers, White youth in the “high substance use and violence” group were less likely to use condoms (alone or with prescription contraceptives) rather than no method, and more likely to use withdrawal or no method than condoms alone. However, they also favored prescription methods over condoms, suggesting that they had taken steps to mitigate risk. Few associations were seen among Black and Hispanic adolescents, perhaps indicating that external factors, rather than risk‐taking tendencies, were key determinants of their contraceptive use.

•Although parent connectedness has been shown to play an important role in adolescents’ sexual and reproductive health, it has not been examined in a population‐based sample of transgender and gender‐diverse youth—a group that may be at elevated risk for negative sexual health outcomes. To address this gap in the literature, Camille Brown and colleagues performed a secondary analysis of data from nearly 2,200 ninth‐ and 11th‐grade participants of the 2016 Minnesota Student Survey (page TK). Employing multivariate logistic regression models to examine parent connectedness and eight sexual health indicators, the researchers found results similar to those among general adolescent populations: Higher levels of connectedness were associated with not having had sex, fewer risky sexual behaviors and more health‐promoting behaviors, regardless of sex assigned at birth. The authors call for the development of tools that can help health care and community service providers better assist transgender and gender‐diverse youth.

—The Editors

在2020年的最后一期中，《观点》提供六篇研究文章，研究主题从堕胎获得和护理到跨性别者和性别多样化青年之间的父母亲联系与性健康之间的联系。然而，这个问题开始于三条评论，从三个方面来审查孕产妇保健和公平的几个关键领域：解决阻碍黑人妇女获得基于社区的导尿管的与COVID相关的，结构性和体制性障碍的重要性；缺乏研究来指导开发有效和符合文化要求的移动医疗应用程序，以促进黑人妇女的性健康和生殖健康；最后，令人不安的普遍做法是在分娩后立即出于非医学原因将被监禁的妇女与新生儿分开。

•虽然COVID-19大流行对美国卫生保健系统产生了深远且广泛报道的影响，但对流产诊所的影响尚未得到充分记录。在一个独特的快速响应项目中，Sarah CM Roberts，Rosalyn Schroeder和Carole Joffe于2020年春季对103个独立堕胎诊所的代表进行了调查，以探讨设施如何受到大流行性疾病及相关限制的影响，并在其中进行导航（第TK）。超过四分之一的诊所不得不取消或推迟药物治疗或程序性流产，一半以上的诊所取消或推迟了妇科或其他不堕胎服务。有些设施（包括南部的三分之一）不得不暂时关闭。受访者还描述了其他各种干扰，从员工的情感损失到支出增加和收入下降。作者写道，在未来的此类危机中，公共卫生工作应考虑采取步骤“以确保独立堕胎诊所的可持续性及其员工的福祉。”

•国家级堕胎限制措施的颁布，是导致妇女必须走更多路才能到达堕胎提供者的一个主要因素，这导致了设施的关闭，进而减少了堕胎的机会。为了阐明堕胎机会与堕胎率之间的相互影响，Benjamin P. Brown及其同事进行了两项分析（一系列线性回归模型和工具变量分析），使用提供者所在地的链接数据和来自18个州的县级堕胎数据2000-2014年（TK页）。在这两项分析中，县中心与最近的堕胎提供者之间的距离越大，县的堕胎率越低。

•美国教学医院在堕胎护理中扮演着至关重要的角色，既是此类护理的提供者，又是希望提供堕胎的医师的培训基地。但是，不致力于提供此类护理的工作人员可能会妨碍在这些设施中提供堕胎服务。为了考察职业间反对派的性质和普遍程度，Ariana H. Bennett等人。在2014–2017年，对169项妇产科培训计划的住院医师和现场主任进行了全国性调查，并对18名计划主任进行了深入访谈（TK页）。在报告称他们或他们的同事在去年曾希望或需要提供堕胎的受访者中，十分之七的人遭到了医院工作人员的反对，其中大多数是护士和麻醉师。

•尽管社区卫生中心（CHC）提供越来越多的避孕服务，但这些中心的临床医生如何就避孕方法（包括宫内节育器）向患者提供咨询服务的情况鲜为人知。为了探讨这个话题，安东尼娅·比格斯（M. Antonia Biggs）及其同事采访了旧金山湾区社区卫生中心的20名临床医生，介绍了他们与年轻人进行的宫内节育器咨询（TK页）。虽然一些提供者将咨询视为机会，使他们的患者能够在没有压力的情况下做出避孕决定，但他们还描述了在引导年轻人采用更有效的方法与尊重他们的选择之间的紧张关系。许多临床医生试图劝说女性在安置后一年内撤离，或轻描淡写她们经历的副作用，这种做法被认为是强制性的。根据作者的说法，

•从事不受保护的性行为并有很多伴侣，通常被称为“危险行为”，但对于是否从事危险的非性行为的青少年知之甚少从不系安全带到使用麻醉品的行为与同龄人在使用避孕药具方面有所不同。为了研究女性青少年的这一问题，MónicaL. Caudillo及其同事使用2011-2015年全国青年风险行为调查（第TK页）的数据，按种族和种族分别进行了潜在的阶级分析。与他们的风险较低的同龄人相比，“高滥用和暴力”组中的白人青年使用安全套（单独使用或与处方避孕药一起使用）的可能性较小，而不是不使用任何方法，而使用避孕套或不使用任何方法的可能性均高于安全套单独。但是，他们也更喜欢使用避孕套而不是避孕套，这表明他们已采取措施降低风险。黑人和西班牙裔青少年之间的关联很少，这可能表明外部因素，

•尽管已证明父母之间的联系在青少年的性健康和生殖健康中起着重要作用，但尚未在基于人群的变性者和性别多样化的青年样本中进行检验，因为该群体中性交阴性的风险较高健康状况。为了解决文献中的这一空白，Camille Brown及其同事对2016年明尼苏达州学生调查（第TK页）的近2,200名9年级和11年级参与者的数据进行了二次分析。研究人员使用多元logistic回归模型检查父母的亲密关系和八个性健康指标，发现结果与一般青少年人群的结果相似：较高的亲密关系与没有性行为，较少的危险性行为和促进健康的行为有关，无论出生时分配性别。作者呼吁开发能够帮助医疗保健和社区服务提供者更好地帮助变性者和性别多样化青年的工具。

—编辑