My current research interests encompass three main areas:
1) Abortion outside the formal healthcare setting
2) Unintended pregnancy
3) Contraceptive desires and access
Abortion outside the formal healthcare setting
In many parts of the world, abortion is highly restricted by laws and policies. Yet women still require access to abortion and find ways to self-source abortion medications and use them outside the formal healthcare setting. Focusing on Northern Ireland, Ireland, the United States, and Latin America, the overarching goals of my work in this area are to:
1) inform strategies to increase access to safe and supported at-home abortion in areas where abortion is unavailable or highly restricted
2) provide evidence that can shape the policy conversation.
- Aiken ARA, Digol I, Trussell J, & Gomperts R. Self-Reported Outcomes and Adverse Events Following Medical Abortion via Online Telemedicine: A Population-based Study in Ireland and Northern Ireland. BMJ 2017 Covered by The Associated Press, Reuters, The Washington Post, Sky News, The Guardian, The Irish Times, among others.
- Aiken ARA, Gomperts R & Trussell J. Experiences and Characteristics of Women Seeking and Completing At-home Medical Termination of Pregnancy Through Online Telemedicine in Ireland and Northern Ireland: A Population-based Analysis. British Journal of Obstetrics & Gynaecology 2016. Online Ahead of Print. Covered by TIME, Newsweek, The Guardian, The Irish Times, and BBC News, among others.
- Aiken ARA, Scott JG, Gomperts R, Trussell J, Worrell M, Aiken CE. Requests for abortion in Latin America related to concern about Zika virus exposure. New England Journal of Medicine. 2016 Jul 28;375(4):396-8. Covered by Reuters, The Associated Press, The New York Times, The Washington Post, NPR, and The Wall Street Journal, among others.
Unintended pregnancy has long been a major public health issue in the United States. The public discourse and policy conversation often focuses on unintended pregnancy solely as a negative and stigmatizing behavior, calling for women to adhere to a strict planning paradigm, where timing-based pregnancy intentions are essential and plans are made to follow through on those intentions. Yet for many women, their thoughts and feelings about pregnancy are not nearly so straightforward. For some women, the normative social ideals that dictate whether or not one is “ready to parent” are unattainable, for others, positive feelings about children clash with lack of economic resources. In short, the story of unintended pregnancy is often a lot more complex than it seems. The goal of this research is to bring women’s actual attitudes and experiences to the forefront of the policy conversation. In doing so, we suggest that is it not “unintended pregnancy” we should focus on preventing, but undesired pregnancy.
- Aiken ARA, Borrero S, Callegari LS, & Dehlendorf C. Rethinking the Pregnancy Planning Paradigm: Unintended Conceptions or Unrepresentative Concepts? This article was selected for recommendation by the Faculty of 1000 as being of special significance in its field.
- Aiken ARA, Westhoff C, Trussell J & Castaño, P. Comparison of a Timing-Based Measure of Unintended Pregnancy and the London Measure of Unplanned Pregnancy.
- Aiken ARA & Trussell J. Anticipated Emotional Impacts of Unintended Pregnancy: Differences by Relationship Context and Nativity.
- Aiken ARA. Happiness About Unintended Pregnancy and its Relationship to Contraceptive Desires Among a Predominantly Latina Cohort Perspectives on Sexual and Reproductive Health 2015:47(2);99-106
- Aiken ARA, Dillaway C & Mevs-Korff N. A Blessing I Can’t Afford: Factors Underlying the Paradox of Happiness About Unintended Pregnancy Social Science and Medicine 2015:132;149-155. This article was selected for recommendation by the Faculty of 1000 as being of special significance in its field.
- Aiken ARA & Potter JE. Are Latina Women Ambivalent About Pregnancies they are Trying to Prevent? Perspectives on Sexual and Reproductive Health 2013:45(4);196-203
Contraceptive desires and access
This aspect of my research investigates international, national, and state policies affecting access to contraception, abortion, and reproductive health services. As part of the Texas Policy Evaluation Project (Tx-PEP), I have been engaged in projects describing how legislative budget reductions in public funding for family planning in Texas affect the ability of clinics to provide services and the ability of women to obtain their desired methods of contraception.
- Potter JE, Hopkins K, Aiken ARA, Hubert C, Stevenson A, White K & Grossman D. Unmet Demand for Highly Effective Postpartum Contraception in Texas. Contraception 2014:90(5);488-495
- White K, Hopkins K, Aiken ARA, Stevenson A, Hubert C, Grossman D, Potter JE. The Impact of Reproductive Health Legislation on Family Planning Clinic Services in Texas. American Journal of Public Health 2015:105(5);851-8
The postpartum and post-abortion periods offer opportunities for women to access the healthcare system and providers to engage in shared contraceptive decision-making. Yet these key times are often overlooked in research aiming to improve access to contraception and reduce unintended pregnancy. In collaboration with domestic and international colleagues, I have examined system-level barriers affecting postpartum access to highly effective long-acting reversible methods of contraception via Medicaid in the U.S. and via the National Health Service (NHS) in the UK, and evaluated programs to improve access.
- Goyal V, Canfield C, Aiken ARA, Dermish A & Potter J. Post-Abortion Contraceptive Use and Continuation when Long-Acting Reversible Contraception is Free. Obstetrics & Gynecology 2017.Online Ahead of Print.
- Aiken ARA, Lohr P, Aiken CE, Forsyth T & Trussell J. Contraceptive Method Preferences and Provision After Termination of Pregnancy: a Population-based Analysis of Women Obtaining Care with the British Pregnancy Advisory Service. British Journal of Obstetrics & Gynaecology 2016 Forthcoming.
- Aiken ARA, Creinin M, Kaunitz, A, Nelson, A, & Trussell J. Global Fee Prohibits Postpartum Provision of the Most Effective Reversible Contraceptives. Contraception 2014:90(5);466-467
- Aiken ARA, Aiken CEM, Trussell J, & Guthrie KA. Immediate Postpartum Provision of Highly Effective Reversible Contraception in the UK. Commentary in British Journal of Obstetrics and Gynaecology 2015:122(8);1050-1
Evidence-Based Obstetric Practice
I also work with a number of clinical collaborators interested in informing good obstetric practices. Clinical guidelines and practice norms for managing prolonged labor due to fetal malposition vary widely by country. In the U.S, Cesarean section is the default mode of management. In the U.K, obstetric instruments including forceps and ventouse are available as alternatives to Cesarean section. In collaboration with clinical colleagues in the U.K., this aspect of my research compares maternal and neonatal outcomes for complex deliveries conducted using obstetric instruments versus Cesarean section and examines the factors influencing success. Findings support not only the safety of instrumental delivery, but also several benefits for maternal health over Cesarean delivery.
- Aiken CEM, Aiken ARA, Brockelsby JC & Scott JG. Factors Influencing the Likelihood of Instrumental Delivery Success. Obstetrics & Gynecology 2014:123(4);796-803. This article was chosen for The Green Journal’s Journal Club and named one of the top five articles in labor management of 2014.
- Aiken ARA, Aiken CEM, Brockelsby JC, Alberry, M & Scott JG. Management of Fetal Malposition in the Second Stage of Labor: A Propensity Score Analysis. American Journal of Obstetrics and Gynecology 2015:212(3);355.e1–355.e7
- Aiken CEM, Aiken ARA & Prentice A. Influence of the Duration of the Second Stage of Labor on the Likelihood of Obstetric Anal Sphincter Injury. Birth 2015:42(1);86-93
- Aiken CEM, Aiken ARA, Cole JC, Brockelsby JC & Bamber JH. Maternal and Fetal Outcomes Following Unplanned Conversion to General Anesthetic at Elective Cesarean Section. Journal of Perinatology 2015. Forthcoming