Virginia Apgar and colleagues wrote “Evaluation of the Newborn Infant—Second Report” in 1958. This article explained that Apgar’s system for evaluating infants’ condition after birth accurately predicted the health of infants. Apgar had developed the scoring system in 1953 to provide a simple method for determining if an infant needed medical attention after birth. The research team, working at Columbia University College of Physicians and Surgeons in New York City, New York, studied the Apgar scores of over 15,000 infants from Sloane Hospital for Women in New York City, New York, over a period of five years. In “Evaluation of the Newborn Infant—Second Report,” Apgar and colleagues established that Apgar scores correlated with infants’ health directly after birth and indicated when medical personnel should treat the infant.

On 1 July 1976, the US Supreme Court decided in the case Planned Parenthood v. Danforth that provisions of a Missouri law regulating abortion care were unconstitutional. That law, House Bill 1211, restricted abortion care by requiring written consent for each abortion procedure from the pregnant woman as written consent of the woman’s husband if she was married, or the written consent of her parents if she was unmarried and younger than eighteen. House Bill 1211 also required that physicians make efforts to preserve the lives of aborted fetuses. Following the passage of House Bill 1211 in 1974, two physicians and Planned Parenthood of Central Missouri challenged the law. Following the decisions by several lower courts, the US Supreme Court ruled on the case. The US Supreme Court struck down parts of a law that violated the US Constitution and the prior court case Roe v. Wade, and in doing so, they expanded access to abortion care in the US.

In the 1989 case Webster v. Reproductive Health Services, the
US Supreme Court upheld the constitutionality of a Missouri law regulating abortion care. The
Missouri law prohibited the use of public facilities, employees, or
funds to provide abortion counseling or services. The law also placed restrictions on physicians who provided
abortions. A group of physicians affected by the law challenged the
constitutionality of certain sections of it. The US federal district
court that first heard the case ruled many of the challenged sections of
the law unconstitutional. The Missouri attorney general then appealed
the case to an US federal appeals court and eventually to the US Supreme
Court in Washington, D.C. In a five to four decision, the US Supreme
Court overturned the decisions of the lower federal courts, ruling that
it was constitutional to prohibit public funds, facilities, and
employees from providing abortion care. In doing so, the Supreme
Court upheld a state law that limited women’s access to abortions
and established a precedent that states could apply restrictions to
abortion care.

In 1952 Virginia Apgar, a physician at the Sloane Women’s Hospital in New York City, New York, created the Apgar score as a method of evaluating newborn infants’ health to determine if they required medical intervention. The score included five separate categories, including heart rate, breathing rate, reaction to stimuli, muscle activity, and color. An infant received a score from zero to two in each category, and those scores added up to the infant’s total score out of ten. An infant with a score of ten was healthy, and those with low scores required medical attention at birth. Apgar originally used the score to determine how infants responded to the pain-relieving drugs given to pregnant women during labor. But it also served to determine when the infant required medical assistance, especially oxygen resuscitation. As of 2016, nearly every hospital in the world uses an updated Apgar score to evaluate the health of newborn infants. The Apgar score has allowed for medical personnel to evaluate an infant directly after birth on an objective scale to determine whether that infant could benefit from possibly life-saving medical intervention.

In the 2016 case Whole Woman's Health v. Hellerstedt, the US Supreme Court ruled unconstitutional the Texas requirements that abortion providers have admitting privileges at local hospitals and that abortion facilities meet ambulatory surgical center standards. Whole Woman’s Health represented abortion care providers in Texas and brought the case against the commissioner for the Texas Department of State Health Services, John Hellerstedt. In a five to three decision, the US Supreme Court ruled that the requirements of the challenged law, Texas House Bill 2, had forced the majority of abortion care facilities to close. With fewer available facilities, women faced undue burdens of travel time and cost when seeking abortions, restricting their access abortion care. In previous US Supreme Court cases Roe v. Wade (1973) and Planned Parenthood v. Casey (1992), the Court ruled that placing undue burdens on women seeking abortion care was unconstitutional. Upholding those decisions in Whole Woman's Health v. Hellerstedt, the US Supreme Court struck down Texas House Bill 2 and protected women’s access to abortion care.

Virginia Apgar worked as an obstetrical anesthesiologist, administering drugs that reduce women’s pain during childbirth, in the US in the mid-twentieth century. In 1953, Apgar created a scoring system using five easily assessable measurements, including heart rate and breathing rate, to evaluate whether or not infants would benefit from medical attention immediately after birth. Apgar’s system showed that infants who were previously set aside as too sick to survive, despite low Apgar scores, could recover with immediate medical attention. Additionally, Apgar researched the effects of anesthesia used during childbirth and advocated for the prevention and management of birth defects. Apgar’s work led to a decrease in infant mortality rates in the mid-twentieth century, and into the twenty-first century, hospitals around the world still used the Apgar score at one and five minutes after birth.

Routine cervical cancer screening has significantly decreased the mortality rate of cervical cancer. Today, cervical cancer predominantly affects those who are rarely or never screened. Government programs are in place to provide cervical cancer screening at little to no cost, yet screening rates remain suboptimal.

This project evaluated an evidence-based intervention to increase cervical cancer screening among underserved women in a federally qualified health center (FQHC). Female patients ages 21 to 65 years without history of hysterectomy (n=1,710) were sent reminders to their phones through the electronic health record (EHR). The message included educational material about the screening process and an announcement regarding government aid for free or reduced cost screening.

The number of patients who made an appointment after receiving the message was assessed two months later. In total, 156 responses were collected, and 28 patients made an appointment for screening. The most frequently observed category of Ethnicity was Hispanic/Latina (n = 24, 86%). The most frequently observed category of Insurance was Title X (n = 13, 46%). The observations for Age had an average of 41.04 (SD = 9.93). Using an EHR communication function to send motivational reminders has shown some promise for increasing cervical cancer screening, thereby reducing cervical cancer mortality among the underserved.

Women in recovery from substance use disorders (SUD) face significant barriers to achieving reproductive well-being (RWB) and disproportionately experience unintended pregnancy. Unintended pregnancy can have serious consequences in this population. Equity-informed approaches promote the integration of reproductive health care (RHC) with recovery programs to improve both access to and quality of RHC. Arizona’s largest SUD recovery program, Crossroads, Inc. recently opened an on-site, integrated primary clinic offering RHC. A one-month pilot demonstration of One Key Question (OKQ), a pregnancy desire screening tool, was implemented with fidelity at Crossroads to identify clients with RHC needs and offer care.

IRB exempt status was obtained through Arizona State University. All female-bodied clients aged 18-49 were screened following routine admission assessments. The Institute for Healthcare Improvement Triple Aim model based on Self-Determination Theory and Motivational Interviewing was used to prioritize client autonomy. The client experience of care was measured using an adapted Interpersonal Quality of Family Planning scale. The magnitude of needs and desires were summarized with descriptive statistics. Sixty-three clients were screened with OKQ. Needs were identified in 97% of clients. Of those clients, 98% accepted referrals. Ninety percent of items measuring the client experience of care were rated as “excellent.” OKQ provided an efficient structure for person-centered screening and referral conversations to integrate RHC in a large SUD recovery program with excellent care experiences reported by clients.

Stress of transitioning to parenthood, hormonal fluctuations as well as physical changes, and complications during postpartum could be addressed at the routine postpartum follow-up visit to avoid long-term adverse effects. While emphasis on preconception and prenatal care has increased nationwide, attendance at this important visit is on the decline. The purpose of this project was to investigate how enhanced prenatal education and concurrent scheduling of a well-baby visit at four weeks, instead of the traditional six weeks, could increase adherence to recommended follow-up care at a federally qualified health clinic in the Southwestern United States.

The Theory of Reasoned Action guided the intervention while Rosswurum and Larrabee’s evidence-based practice model was used to develop the project. The pre-existing weekly prenatal education program was enhanced with information regarding the importance of a four-week postpartum follow-up visit. Front desk schedulers were educated to offer same day appointments for the postpartum care visit and one-month well-baby appointment. Data collection took place for three months after implementation of the project and was compared to adherence rates during the three months prior to the intervention. Providers and scheduling staff members participated in a short post-intervention interview. Prenatal education and convenience of concurrent scheduling increased the percentage of adherence to follow-up visits over a three-month period. Providers and clinic staff recommend continuing with the process changes to increase patient’s access to family centered care.