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Affiliation(s)
- Carmel Shachar
- The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts
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52
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Murphy TF. Theorizing the Meaning of Health in Abortion Law. Am J Bioeth 2022; 22:77-79. [PMID: 35917431 DOI: 10.1080/15265161.2022.2089272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Rubin R. How Abortion Bans Could Affect Care for Miscarriage and Infertility. JAMA 2022; 328:318-320. [PMID: 35763283 DOI: 10.1001/jama.2022.11488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Cohen IG, Murray M, Gostin LO. The End of Roe v Wade and New Legal Frontiers on the Constitutional Right to Abortion. JAMA 2022; 328:325-326. [PMID: 35802387 DOI: 10.1001/jama.2022.12397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- I Glenn Cohen
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, Massachusetts
| | - Melissa Murray
- Birnbaum Women's Leadership Network, New York University, New York City
| | - Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
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55
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Affiliation(s)
- I Glenn Cohen
- Harvard Law School, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, Massachusetts
| | - Judith Daar
- Salmon P. Chase College of Law, Northern Kentucky University, Highland Heights
| | - Eli Y Adashi
- Department of Medical Science, Brown University, Providence, Rhode Island
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Affiliation(s)
- Rebecca B Reingold
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
| | - Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
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58
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Affiliation(s)
- Lisa H Harris
- From the Departments of Obstetrics and Gynecology and Women's and Gender Studies, University of Michigan, Ann Arbor
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Wilkinson B, Onwuzurike C, Bartz D. Restrictive State Abortion Bans - A Reproductive Injustice. N Engl J Med 2022; 386:1197-1199. [PMID: 35333482 DOI: 10.1056/nejmp2119364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Barbara Wilkinson
- From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School - both in Boston
| | - Chiamaka Onwuzurike
- From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School - both in Boston
| | - Deborah Bartz
- From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School - both in Boston
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Abstract
This cross-sectional study examines whether the passage of Texas Senate Bill 8 was associated with an increase in requests for self-managed medication abortion.
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Affiliation(s)
| | | | - James G. Scott
- Department of Statistics and Data Sciences, University of Texas at Austin
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62
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Affiliation(s)
- R Alta Charo
- From the University of Wisconsin Law School, Madison
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63
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Affiliation(s)
- Brian Callender
- Department of Medicine, MacLean Center for Clinical Medical Ethics, Stevanovich Institute on the Formation of Knowledge, University of Chicago, Chicago, IL 60637, USA.
| | - Margaret Carlyle
- Department of History and Sociology, Irving K Barber Faculty of Arts and Social Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Julie Chor
- Department of Obstetrics and Gynecology, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA
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Fleming V, Frith L, Ramsayer B. Tensions Between Ethics and the Law: Examination of a Legal Case by Two Midwives Invoking a Conscientious Objection to Abortion in Scotland. HEC Forum 2021; 33:189-213. [PMID: 31273516 PMCID: PMC8390396 DOI: 10.1007/s10730-019-09378-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK's Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4(1) of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: "Is Greater Glasgow and Clyde Health Board entitled to require the midwives to delegate, supervise and support staff in the treatment of patients undergoing termination of pregnancy?" The ethical issues concerning conscientious objection to abortion have been much debated although the academic literature is mainly concerned with the position of medical practitioners rather than what the World Health Organization terms "mid-level professionals" such as midwives. This paper examines the arguments put forward by the midwives to justify their refusal to carry out tasks they felt contravened their legal right to make a conscientious objection. We then consider professional codes, UK legislation and church legislation. While the former are given strong weighting the latter was been ignored in this case, although cases in other European countries have been prevented from escalating to such a high level by the intervention of prominent church figures. The paper concludes by stating that the question put to the courts remains as yet unanswered but offers some recommendations for future policy making and research.
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Affiliation(s)
- Valerie Fleming
- School of Nursing and Allied Health, Liverpool John Moores, University, 15-21 Webster St, Liverpool, L3 2ET, UK.
| | | | - Beate Ramsayer
- School of Nursing and Allied Health, Liverpool John Moores, University, 15-21 Webster St, Liverpool, L3 2ET, UK
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65
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Horn C. Abortion Rights after Artificial Wombs: Why Decriminalisation is Needed Ahead of Ectogenesis. Med Law Rev 2021; 29:80-105. [PMID: 34370037 DOI: 10.1093/medlaw/fwaa042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Significant scientific progress has been made toward artificial womb technology, which would allow part of human gestation to occur outside the body. Bioethical and legal scholars have argued that artificial wombs will challenge defences of abortion based in arguments for protecting bodily autonomy, for a pregnant person could have the foetus transferred to an artificial womb instead of being terminated. Drawing on examples from the common law jurisdictions of Canada, the USA, and the UK, I assess three ways scholars have argued abortion might be defended after ectogenesis (through redefining foetal viability, through a property right, and through a right to avoid genetic parenthood). I argue that while each of these proposals has strategic merit, each has significant legal and ethical limitations. Taking the normative position that abortion will remain a vital healthcare resource, I make the case for protecting abortion rights from a challenge posed by ectogenesis by focusing on decriminalisation.
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Affiliation(s)
- Claire Horn
- Birkbeck School of Law, 14 Gower Street Bloomsbury, London, WC1E 6HE, UK
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66
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Gallo MF, Casterline JB, Chakraborty P, Norris A, Bessett D, Turner AN. Passage of abortion ban and women's accurate understanding of abortion legality. Am J Obstet Gynecol 2021; 225:63.e1-63.e8. [PMID: 33577763 DOI: 10.1016/j.ajog.2021.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/02/2021] [Accepted: 02/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Legislative and judicial procedures related to banning abortion after 6 weeks of gestation in Ohio occurred from November 2018 to July 2019. These activities could have increased the belief that abortion has become illegal even though the 6-week abortion ban has never been in effect to date. OBJECTIVE We sought to determine the prevalence and correlates of holding the belief that abortion is illegal in Ohio and to evaluate whether this belief increased over the time in which the 6-week abortion ban was introduced, passed twice, and then blocked in Ohio. STUDY DESIGN We analyzed data from the first wave of the Ohio Survey of Women, a population-based survey of adult, reproductive-aged Ohioan women conducted from October 2018 to June 2019. During each of the 8 survey months, a median of 240 women (range, 70-761) completed the survey, including the survey question "Based on what you know or have heard, is it legal to get an abortion in your state?" We used multivariable logistic regression to assess the prevalence and correlates of believing that abortion is illegal in the state of Ohio. In addition, we used multinomial logistic regression to evaluate whether this belief increased over the interval during which women completed the survey, which roughly corresponded to the interval marked by legislative and judicial activities surrounding the 6-week abortion ban. RESULTS Most of the 2359 participants understood that abortion is legal in the state of Ohio (64.0%) with the remainder believing it to be illegal (9.8%) or being unsure (26.2%). Correlates of believing abortion to be illegal included younger age, lower socioeconomic status, never married or married status, and Black, non-Hispanic race and ethnicity. Being unsure about legality did not change over time; however, the proportion of women who believed that abortion is illegal increased from the first month (4.5%) to the last month (15.9%) of the study period. Each additional study month was associated with a 17% increase in the odds of believing abortion to be illegal, in both unadjusted and adjusted models (odds ratio, 1.17; 95% confidence interval, 1.08-1.27). CONCLUSION Attempts to restrict abortion access could contribute to women mistakenly believing that abortion is illegal despite it being unsuccessful.
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Affiliation(s)
- Maria F Gallo
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH.
| | - John B Casterline
- Department of Sociology, College of Arts and Sciences, The Ohio State University, Columbus, OH
| | - Payal Chakraborty
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH
| | - Alison Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH
| | - Danielle Bessett
- Department of Sociology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH
| | - Abigail Norris Turner
- Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH
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67
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Macfarlane E, Stitely M, Paterson H. What does abortion law reform mean for primary care practitioners in New Zealand? N Z Med J 2021; 134:91-98. [PMID: 33927441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
New Zealand achieved a major sexual reproductive health and rights milestone when abortion ceased to be a crime. Introduction of the Abortion Legislation Act 2020 has significantly changed the way abortion care can be provided in New Zealand, with the potential to improve access, reduce inequities and transform the abortion experience for those people who choose to end their pregnancy. The primary care sector stands to be a key player in the provision of first-trimester abortion care. However, with issues relating to funding, training and access to medications yet to be resolved, the health sector is not yet ready to provide best-practice abortion care within the new legislative framework.
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Affiliation(s)
- Emma Macfarlane
- Lecturer, Department of Women's and Children's Health, Otago Medical School, University of Otago, Dunedin
| | - Michael Stitely
- Head of Department, Department of Women's and Children's Health, Otago Medical School, University of Otago, Dunedin
| | - Helen Paterson
- Senior Lecturer, Department of Women's and Children's Health, Otago Medical School, University of Otago, Dunedin
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68
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Tzaneva R, Todd-Gher J. Amnesty International's updated policy on abortion: A resource for medical providers. Int J Gynaecol Obstet 2021; 153:363-369. [PMID: 33523516 DOI: 10.1002/ijgo.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/25/2021] [Indexed: 11/07/2022]
Abstract
Treating abortion as a matter of reproductive autonomy is essential to promoting health, complying with medical ethics, and advancing human rights. When pregnant people can make autonomous decisions about their pregnancies, their health and human rights outcomes improve. Additionally, medical providers that support autonomous sexual and reproductive health decision-making can provide care in line with the highest ethical standards and promote pregnant individuals' human rights. This article highlights Amnesty International's updated institutional abortion policy which uses a reproductive autonomy frame to promote the full realization of human rights for all pregnant people. The policy relies on decades of evidence, the organization's learning from abortion research and advocacy around the world, and evolving human rights law and standards. While not specifically developed for a medical audience, Amnesty International's updated policy can be a useful resource for providers who seek to promote reproductive autonomy and achieve better health outcomes for their patients.
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Affiliation(s)
- Rada Tzaneva
- Amnesty International, International Secretariat, London, UK
| | - Jaime Todd-Gher
- International Reproductive and Sexual Health Law Program, Faculty of Law, University of Toronto, Toronto, ON, Canada
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Higgins JA, Schmuhl NB, Wautlet CK, Rice LW. The Importance of Physician Concern and Expertise in Increasing Abortion Health Care Access in Local Contexts. Am J Public Health 2021; 111:33-36. [PMID: 33090878 PMCID: PMC7750602 DOI: 10.2105/ajph.2020.305997] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Jenny A Higgins
- All authors are with the Department of Obstetrics and Gynecology, University of Wisconsin-Madison. Jenny A. Higgins is also with the Department of Gender and Women's Studies, University of Wisconsin-Madison
| | - Nicholas B Schmuhl
- All authors are with the Department of Obstetrics and Gynecology, University of Wisconsin-Madison. Jenny A. Higgins is also with the Department of Gender and Women's Studies, University of Wisconsin-Madison
| | - Cynthie K Wautlet
- All authors are with the Department of Obstetrics and Gynecology, University of Wisconsin-Madison. Jenny A. Higgins is also with the Department of Gender and Women's Studies, University of Wisconsin-Madison
| | - Laurel W Rice
- All authors are with the Department of Obstetrics and Gynecology, University of Wisconsin-Madison. Jenny A. Higgins is also with the Department of Gender and Women's Studies, University of Wisconsin-Madison
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70
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Affiliation(s)
- Janet M Turan
- Janet M. Turan and Henna Budhwani are with the Department of Health Care Organization and Policy, University of Alabama at Birmingham, School of Public Health
| | - Henna Budhwani
- Janet M. Turan and Henna Budhwani are with the Department of Health Care Organization and Policy, University of Alabama at Birmingham, School of Public Health
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71
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Abstract
Fetal "heartbeat" bills have become the anti-abortion legislative measure of choice in the US war on sexual and reproductive health and rights (SRHR). In 2019, Georgia House Bill 481 (HB 481) passed by a narrow margin banning abortions upon detection of embryonic cardiac activity, as early as six weeks gestation. The purpose of this study was to distinguish and characterise the arguments and tactics used by legislators and community members in support of Georgia's early abortion ban. Our data included testimony and debate from House Health and Human Services and the Senate Science and Technology Committees; data were transcribed verbatim and coded in MAXQDA 18 using a constant comparison method. Major themes included: the use of the "heartbeat" as an indicator of life and therefore personhood; an attempt to create a new class of persons - fetuses in utero - entitled to legal protection; and arguments to expand state protections for fetuses as a matter of state sovereignty and rights. Arguments were furthered through appropriation by misrepresenting medical science and co-opting the legal successes of progressive movements. Our analysis provides an initial understanding of evolving early abortion ban strategy and its tactics for challenging established legal standards and precedent. As the battle over SRHR wages on, opponents of abortion bans should attempt to understand, deconstruct, and analyse anti-abortion messaging to effectively combat it. These data may inform their tactical strategies to advance sexual and reproductive health, rights, and justice both in the US context and beyond.
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Affiliation(s)
- Dabney P. Evans
- Associate Professor, Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA, USA; Center for Reproductive Health Research in the Southeast (RISE) at Emory University, Atlanta, GA, USA
| | - Subasri Narasimhan
- Postdoctoral Research Fellow, Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA, USA; Center for Reproductive Health Research in the Southeast (RISE) at Emory University, Atlanta, GA, USA
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Abstract
The Trump Administration's Protecting Life in Global Health Assistance (PLGHA) significantly expands the "Global Gag Rule" - and, in so doing, weakens the global governance of abortion. By chilling debate, reducing transparency, ghettoising sexual and reproductive health and rights work, and interfering with research, PLGHA makes an already bad context demonstrably worse. Individual women suffer the most, as PLGHA inhibits ongoing efforts to reduce abortion-related morbidity and mortality.
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Affiliation(s)
- Terry McGovern
- Chair, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marta Schaaf
- Independent Research Consultant, New York, NY, USA
| | | | - Emily Maistrellis
- Senior Program Officer, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kathryn Gibb
- MPH Candidate, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sara E Casey
- Assistant Professor, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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73
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Affiliation(s)
- Silvia De Zordo
- Ramón y Cajal Researcher and ERC Stg PI, Department of Anthropology, University of Barcelona, Barcelona, Spain
| | - Joanna Mishtal
- Professor, Department of Anthropology, University of Central Florida, Orlando, FL, USA
| | - Giulia Zanini
- Post-doctoral Researcher, Department of Anthropology, University of Barcelona, Barcelona, Spain
| | - Caitlin Gerdts
- President for Research, Ibis Reproductive Health, Oakland, CA, USA
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74
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Assifi AR, Kang M, Sullivan EA, Dawson AJ. Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence. PLoS One 2020; 15:e0242015. [PMID: 33166365 PMCID: PMC7652292 DOI: 10.1371/journal.pone.0242015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022] Open
Abstract
Limited research in high-income countries (HICs) examines adolescent abortion care-seeking pathways. This review aims to examine the pathways and experiences of adolescents when seeking abortion care, and service delivery processes in provision of such care. We undertook a systematic search of the literature to identify relevant studies in HICs (2000–2020). A directed content analysis of qualitative and quantitative studies was conducted. Findings were organised to one or more of three domains of an a priori conceptual framework: context, components of abortion care and access pathway. Thirty-five studies were included. Themes classified to the Context domain included adolescent-specific and restrictive abortion legislation, mostly focused on the United States. Components of abortion care themes included confidentiality, comprehensive care, and abortion procedure. Access pathway themes included delays to access, abortion procedure information, decision-making, clinic operation and environments, and financial and transportation barriers. This review highlights issues affecting access to abortion that are particularly salient for adolescents, including additional legal barriers and challenges receiving care due to their age. Opportunities to enhance abortion access include removing legal barriers, provision of comprehensive care, enhancing the quality of information, and harnessing innovative delivery approaches offered by medical abortion.
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Affiliation(s)
- Anisa R. Assifi
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | - Melissa Kang
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Elizabeth A. Sullivan
- Office of the PVC Health and Medicine, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Angela J. Dawson
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
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75
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Abstract
IMPORTANCE Although abortion is common in the United States, patients face substantial barriers to obtaining an abortion. Recently enacted abortion restrictions pose such barriers. OBJECTIVES To assess the association between a state legislative climate that is highly restrictive toward abortion provision and the abortion rate and to evaluate whether distance to a facility providing abortion care mediates the association between legislative climate and the abortion rate. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined county-of-residence abortion rates from all states that publicly provided them and used data on abortion restrictions, facility locations, and county demographic characteristics for the years 2000 to 2014. The association between legislative climate and abortion rates was evaluated using propensity score-weighted, linear regression difference-in-difference analysis. All models included state and year fixed effects and standard errors adjusted for state-level clustering. EXPOSURES Highly restrictive legislative climate, defined as having at least 3 of 4 types of abortion restrictions; distance to a high-volume facility providing abortion care (ie, performing ≥395 abortions per year) in miles. MAIN OUTCOMES AND MEASURES County-level abortion rate, defined as abortions per 1000 women per year. RESULTS Abortion rate data were obtained from 1178 counties in 18 states for a median of 12.5 years (range, 5-14). The median abortion rate was 2.89 per 1000 women (interquartile range, 1.71-4.46 per 1000 women). A highly restrictive legislative climate, when compared with a less restrictive one, was associated with 0.48 fewer abortions per 1000 women (95% CI, -0.92 to -0.04 abortions per 1000 women; P = .03). Adjusted for distance to a facility providing abortion care, a highly restrictive legislative climate was associated with 0.44 fewer abortions per 1000 women (95% CI, -0.85 to -0.03; P = .04). Each mile to a facility was associated with 0.02 fewer abortions per 1000 women (95% CI, -0.03 to -0.01 abortions per 1000 women; P = .003). Legislative climate was not significantly associated with distance to a facility providing abortion care (change in distance associated with highly restrictive climate, -2.73 [95% CI, -6.02 to 0.57] miles; P = .10). CONCLUSIONS AND RELEVANCE This study provides evidence that a state legislative climate that is highly restrictive toward abortion provision is associated with a lower abortion rate. The cumulative effect of restrictive policies may pose a barrier to abortion access.
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Affiliation(s)
- Benjamin P. Brown
- Division of General Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence
| | - Luciana E. Hebert
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle
| | - Melissa Gilliam
- Departments of Obstetrics and Gynecology and Pediatrics, University of Chicago, Illinois
| | - Robert Kaestner
- Harris School of Public Policy, University of Chicago, Illinois
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76
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Fuleihan C. American College of Obstetricians and Gynecologists v. United States Food & Drug Administration: Restricted Access to Medical Abortion Threatens Reproductive Rights during the COVID-19 Pandemic. Am J Law Med 2020; 46:507-517. [PMID: 33413017 DOI: 10.1177/0098858820975536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Affiliation(s)
| | - John M Benson
- From the Harvard T.H. Chan School of Public Health, Boston
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78
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Moore AM, Blades N, Ortiz J, Whitehead H, Villarreal C. What does informal access to misoprostol in Colombia look like? A mystery client methodology in Bogotá and the Coffee Axis. BMJ Sex Reprod Health 2020; 46:294-300. [PMID: 32624479 PMCID: PMC7569367 DOI: 10.1136/bmjsrh-2019-200572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION In 2006, abortion was decriminalised in Colombia under certain circumstances. Yet, women avail themselves of ways to terminate pregnancy outside of the formal health system. This study explored how drug sellers engage with women who attempt to purchase misoprostol from them. METHODS A mapping exercise was undertaken to list small-chain and independent drug stores in two regions in Colombia. A sample (n=558) of drug stores was selected from this list and visited by mystery clients between November and December 2017. Mystery clients sought to obtain a medication to bring back a delayed period, and described the experience, the information obtained and the medications proffered in exit interviews. RESULTS Misoprostol was offered for purchase in 15% of the visits; in half of visits, only information about misoprostol was shared, while no information about misoprostol was provided on the remaining visits. Over half of sellers who refused to sell any medication provided referrals, most commonly to an abortion provider. Among visits which included discussion of misoprostol, two out of five sellers provided dosage instructions with most recommending the minimum adequate dosage. Mystery clients received little information on the physical effects to expect with the use of misoprostol and possible complications. CONCLUSIONS As misoprostol is being obtained from some drug sellers without a prescription, capacitating this cadre with at least a minimum of standardised information on dosage, routes of administration and expected effects and outcomes have the potential to improve reproductive health outcomes for women who choose to terminate pregnancies this way in Colombia.
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Affiliation(s)
- Ann M Moore
- Division of Research, Guttmacher Institute, New York, New York, USA
| | - Nakeisha Blades
- Division of Research, Guttmacher Institute, New York, New York, USA
| | | | - Hannah Whitehead
- Division of Research, Guttmacher Institute, New York, New York, USA
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79
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Ahrens KA, Hutcheon JA. Time for Better Access to High-Quality Abortion Data in the United States. Am J Epidemiol 2020; 189:640-647. [PMID: 32219373 DOI: 10.1093/aje/kwaa048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 01/03/2023] Open
Abstract
Despite considerable lay attention on the regulation and legislation of abortion in the United States, important gaps remain in our understanding of its incidence and health and social consequences since its legalization in 1973. Many of these gaps in knowledge can be attributed to a lack of access to high-quality, individual-level abortion data over the past 46 years. Herein, we review the strengths and limitations of different, currently available methods for enumerating abortions in the United States and discuss how lack of access to high-quality data limits our surveillance and research activities of not only abortion but other important reproductive and perinatal health outcomes. We conclude by discussing some potential opportunities for improved access to high-quality abortion data in the United States.
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Bessa MMM, Unigarro Ramirez FD, Dias E Almeida KR, da Cruz ÍS, Rolim Neto ML. Rape, child and abortion: From ideologization to rights violation in Brazil. J Gynecol Obstet Hum Reprod 2020; 50:101923. [PMID: 32980564 DOI: 10.1016/j.jogoh.2020.101923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Maria Misrelma Moura Bessa
- Center for Studies and Research in Public Health - NUEPESC - Centro Universitário Paraíso, Juazeiro do Norte, Ceará, Brazil
| | | | | | - Ítalo Silva da Cruz
- Faculty of Medicine of Juazeiro do Norte - FMJ/Estácio, Juazeiro do Norte, Ceará, Brazil
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81
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82
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Affiliation(s)
- Michelle L McGowan
- From the Ethics Center, Cincinnati Children's Hospital Medical Center (M.L.M.), and the Departments of Pediatrics (M.L.M.), Women's, Gender, and Sexuality Studies (M.L.M.), and Sociology (D.B.), University of Cincinnati, Cincinnati, and the College of Public Health and the College of Medicine, Ohio State University, Columbus (A.H.N.)
| | - Alison H Norris
- From the Ethics Center, Cincinnati Children's Hospital Medical Center (M.L.M.), and the Departments of Pediatrics (M.L.M.), Women's, Gender, and Sexuality Studies (M.L.M.), and Sociology (D.B.), University of Cincinnati, Cincinnati, and the College of Public Health and the College of Medicine, Ohio State University, Columbus (A.H.N.)
| | - Danielle Bessett
- From the Ethics Center, Cincinnati Children's Hospital Medical Center (M.L.M.), and the Departments of Pediatrics (M.L.M.), Women's, Gender, and Sexuality Studies (M.L.M.), and Sociology (D.B.), University of Cincinnati, Cincinnati, and the College of Public Health and the College of Medicine, Ohio State University, Columbus (A.H.N.)
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83
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Cherkassky L. Re: AB (Termination of Pregnancy) [2019] EWCA CIV 1215: 'Wishes and Feelings' Under the Mental Capacity Act 2005. Med Law Rev 2020; 28:605-614. [PMID: 32542344 DOI: 10.1093/medlaw/fwaa009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In Re: AB (Termination of Pregnancy), the Court of Appeal was asked to consider an assumption made about the future living arrangements of a pregnant patient, and the weight to be ascribed to her wishes and feelings when she had no real understanding of her predicament. This commentary explores the importance of taking into account the perspective of the patient, even if suffering from a mental disorder, and it will analyse the existing common law to show that the weaker the ability of the patient to form her own wishes and feelings, the more appropriate it would be to rely on the remaining evidence.
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Affiliation(s)
- Lisa Cherkassky
- Law School, University of Derby, Agard Street, Derby DE1 1DZ, UK
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84
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Abstract
The United States is facing a national crisis related to increasing rates of maternal morbidity and mortality. Over the past few years, significant focus has been turned to initiatives that aim to address maternal morbidity and mortality rates. In parallel, the United States has seen a significant increase in restrictive abortion access state laws. The link between abortion restrictions and worsening maternal outcomes has been proposed. This review article outlines the national crisis of maternal morbidity and mortality, the potential role of limiting abortion access in this crisis, and the significant racial, socioeconomic, and geographical disparities that exist.
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Affiliation(s)
- Nisha Verma
- Clinical Fellow, Division of Family Planning, Emory University, United States.
| | - Scott A Shainker
- Director, New England Center for Placenta Disorders, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Assistant Professor, Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, United States.
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85
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Abstract
This paper develops the concept of 'abortion exile' to understand the situation of women who are forced to travel for abortion services because the procedure is outlawed, stigmatized, unaffordable or otherwise inaccessible in their place of residence. A number of legislative, economic, and moral mechanisms conspire to deny women abortion rights at home such that they must journey within and across national borders in pursuit of needed abortion care. While anthropologists have examined the movement of women and men in search of fertility care that is unavailable at home, attention to the situation of women forced to relocate to terminate an untenable pregnancy is surprisingly scarce. Taking Mexico's fractured abortion landscape as an ethnographic starting place, this paper examines the experiences of women made to venture to the capital for legal abortion services because the procedure is criminalised and difficult to access elsewhere in the country. The concept of 'abortion exile' can helpfully explain the forced movement, political status and subjective experiences of women in different world regions where abortion rights are limited, absent, or under threat, and for whom reproductive citizenship remains elusive.
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Affiliation(s)
- Elyse Ona Singer
- Department of Anthropology, University of Oklahoma, Norman, OK, USA
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87
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McGovern T. US Global Gag Rule increases unsafe abortion. Lancet 2020; 396:24-25. [PMID: 32622389 DOI: 10.1016/s0140-6736(20)30921-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/04/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Terry McGovern
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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88
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Jones RK, Lindberg L, Witwer E. COVID-19 Abortion Bans and Their Implications for Public Health. Perspect Sex Reprod Health 2020; 52:65-68. [PMID: 32408393 PMCID: PMC7272883 DOI: 10.1363/psrh.12139] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 05/10/2023]
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89
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Fleming V, Maxwell C, Ramsayer B. Accommodating conscientious objection in the midwifery workforce: a ratio-data analysis of midwives, birth and late abortions in 18 European countries in 2016. Hum Resour Health 2020; 18:42. [PMID: 32513175 PMCID: PMC7278127 DOI: 10.1186/s12960-020-00482-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In recent years, the role of a midwife has expanded to include the provision of abortion-related care. The laws on abortion in many European countries allow for those who hold a conscientious objection to participating to refrain from such participation. However, some writers have expressed concerns that this may have a detrimental effect on the workforce and limit women's access to the service. METHOD The aim of this study was to provide a picture of the potential exposure midwives in Europe have to late abortions, an important factor in the integration of accommodation of conscientious objection to abortion by midwives into workload planning. We collected data from Ministries of Health or government statistical departments in 32 European countries on numbers of births, abortions, late abortions and midwives in 2016. We conducted a ratio-data analysis in those countries that met the inclusion criteria. RESULTS Eighteen of the 32 countries provided full data; thus, our calculations are based on a total of 4 036 633 live births, 49 834 late abortions and a total of 132 071 midwives. The calculated ratios of live births to midwife, abortions to midwife and late abortions to midwife illustrate the wide variations between countries in relation to ratios of midwives to live births (15.22-53.99) and late abortions (0.17-1.47) CONCLUSIONS: This study provides the first comprehensive insight to ratios relating to birth and abortion, especially late abortion services, with regard to the midwifery workforce. It is essential to improve the reporting of abortion data and access to it within Europe to support evidence-informed decisions on optimising the contribution of the midwifery workforce especially within highly contentious fields such as abortion services. The study's findings suggest that there should be neither be any difficulty for those who are responsible for workload allocation nor compromises to a women's right to abortion services.
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Affiliation(s)
- Valerie Fleming
- Faculty of Health, Liverpool John Moores University, 16-19 Webster St, Liverpool, L3 2ET UK
| | - Clare Maxwell
- Faculty of Health, Liverpool John Moores University, 16-19 Webster St, Liverpool, L3 2ET UK
| | - Beate Ramsayer
- Faculty of Health, Liverpool John Moores University, 16-19 Webster St, Liverpool, L3 2ET UK
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90
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Abstract
It is frequently claimed that artificial wombs (AWs) could alleviate the burdens placed exclusively on women in reproduction. In this article, I demonstrate how AWs used for the partial gestation of preterm neonates could introduce new choices for women by changing perceptions of tolerable risks in gestation. In light of advancing medical technology, it is necessary to consider whether the current legal framework in England and Wales would support increased choice for women about alternative forms of gestation. I examine the ill-defined offence of 'unlawfully procuring miscarriage' in the Offences Against the Person Act 1861 and demonstrate that different conclusions about the legal significance of ending a pregnancy are evident, depending on the analytical lens adopted in interpreting ambiguities. Furthermore, I demonstrate that the defences available to pregnancy termination under the Abortion Act 1967 are too narrow to support choices about alternative forms of gestation, even if they become physically and medically possible. Therefore, we should decriminalise termination of pregnancy, or, if it is assumed that gestation is the business of the criminal law, specific reforms to the legal framework are necessary. The offence of unlawfully procuring miscarriage is too uncertain and broad, and the defences available are too restrictive.
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Affiliation(s)
- Elizabeth Chloe Romanis
- Department of Law, Centre for Social Ethics and Policy, School of Social Sciences, University of Manchester, Manchester, UK
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91
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Löwy I, Dias Villela Corrêa MC. The "Abortion Pill" Misoprostol in Brazil: Women's Empowerment in a Conservative and Repressive Political Environment. Am J Public Health 2020; 110:677-684. [PMID: 32191521 PMCID: PMC7144453 DOI: 10.2105/ajph.2019.305562] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2019] [Indexed: 11/04/2022]
Abstract
In the aftermath of the introduction of severe restrictions on abortion in several US states, some activists have argued that providing widespread access to an abortive drug, misoprostol, will transform an induced abortion into a fully private act and therefore will empower women. In Brazil, where abortion is criminalized, the majority of women who wish to terminate an unwanted pregnancy already use the illegal, but easily accessible, misoprostol. We examine the history of misoprostol as an abortifacient in Brazil from the late 1980s until today and the professional debates on the teratogenicity of this drug. The effects of a given pharmaceutical compound, we argue, are always articulated, elicited, and informed within dense networks of sociocultural, economic, legal, and political settings. In a conservative and repressive environment, the use of misoprostol for self-induced abortions, even when supported by formal or informal solidarity networks, is far from being a satisfactory solution to the curbing of women's reproductive rights.
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Affiliation(s)
- Ilana Löwy
- Ilana Löwy is with the Centre de Recherche Médicine, Science, Santé et Societé- CERMES 3 (Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, École des hautes études en sciences sociales, Paris V), Paris, France. Marilena Cordeiro Dias Villela Corrêa is with the Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marilena Cordeiro Dias Villela Corrêa
- Ilana Löwy is with the Centre de Recherche Médicine, Science, Santé et Societé- CERMES 3 (Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, École des hautes études en sciences sociales, Paris V), Paris, France. Marilena Cordeiro Dias Villela Corrêa is with the Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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92
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Affiliation(s)
- Luchuo Engelbert Bain
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux Population Health Research Center, Team IDLIC, UMR 1219, Bordeaux, France
- Global South Health Research and Services, Liedestraat 9, 1316HE, Almere, the Netherlands
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93
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Blackwell S, Louis JM, Norton ME, Lappen JR, Pettker CM, Kaimal A, Landy U, Edelman A, Teal S, Landis R. Reproductive services for women at high risk for maternal mortality: a report of the workshop of the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, the Fellowship in Family Planning, and the Society of Family Planning. Am J Obstet Gynecol 2020; 222:B2-B18. [PMID: 32252942 DOI: 10.1016/j.ajog.2019.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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94
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Affiliation(s)
- Lisa H Harris
- From the Department of Obstetrics and Gynecology and the Department of Women's Studies, University of Michigan, Ann Arbor (L.H.H.); and the Department of Obstetrics, Gynecology, and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), and the Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco (D.G.)
| | - Daniel Grossman
- From the Department of Obstetrics and Gynecology and the Department of Women's Studies, University of Michigan, Ann Arbor (L.H.H.); and the Department of Obstetrics, Gynecology, and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), and the Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco (D.G.)
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95
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Cohen AB. In the September 2019 Issue of the Quarterly. Milbank Q 2020; 97:627-630. [PMID: 31512294 DOI: 10.1111/1468-0009.12415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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96
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Abstract
The detention of immigrants inside US borders is not a new phenomenon. However, a dramatic shift has occurred in both the number and treatment of immigrants in detention.We examine recent changes in immigration policies that have systematized the mistreatment of children and pregnant immigrants, including a ban on abortion for unaccompanied minors in immigration detention, the neglect and mistreatment of pregnant immigrants in detention, and the separation and prolonged detention of parents and children in unsafe facilities.We employ the reproductive justice framework to demonstrate how these policies violate all 3 primary values of reproductive justice: the right to have children, the right not to have children, and the right to parent children in safe and secure environments. We argue that, when analyzed through the lens of reproductive justice, these policies can be seen as manifestations of a single targeted strategy to control the reproductive autonomy of migrants as a tool of immigration enforcement. We conclude with a call to action to the public health community.
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Affiliation(s)
- Ariella J Messing
- Ariella J. Messing and Joanne D. Rosen are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Ariella J. Messing is also with the Berman Institute of Bioethics, Johns Hopkins University, Baltimore. Rachel E. Fabi is with the Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, NY
| | - Rachel E Fabi
- Ariella J. Messing and Joanne D. Rosen are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Ariella J. Messing is also with the Berman Institute of Bioethics, Johns Hopkins University, Baltimore. Rachel E. Fabi is with the Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, NY
| | - Joanne D Rosen
- Ariella J. Messing and Joanne D. Rosen are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Ariella J. Messing is also with the Berman Institute of Bioethics, Johns Hopkins University, Baltimore. Rachel E. Fabi is with the Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, NY
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97
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Coleman‐Minahan K, Jean Stevenson A, Obront E, Hays S. Adolescents Obtaining Abortion Without Parental Consent: Their Reasons and Experiences of Social Support. Perspect Sex Reprod Health 2020; 52:15-22. [PMID: 32115875 PMCID: PMC7155056 DOI: 10.1363/psrh.12132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 05/10/2023]
Abstract
CONTEXT Most states require adolescents younger than 18 to involve a parent prior to obtaining an abortion, yet little is known about adolescents' reasons for choosing abortion or the social support received by those who seek judicial bypass of parental consent for abortion. METHODS In-depth interviews were conducted with 20 individuals aged 16-19 who sought judicial bypass in Texas between 2015 and 2016 to explore why they chose to get an abortion, who they involved in their decision and what their experiences of social support were. Data were analyzed thematically using stigma and social support theories. RESULTS Participants researched their pregnancy options and involved others in their decisions. They chose abortion because parenting would limit their futures, and they believed they could not provide a child with all of her or his needs. Anticipated stigma motivated participants to keep their decision private, although they desired emotional and material support. Not all male partners agreed with adolescents' decisions to seek an abortion, and agreement by some males did not guarantee emotional or material support; some young women described their partners' giving them the "freedom" to make the decision as avoiding responsibility. After a disclosure of their abortion decision, some participants experienced enacted stigma, including shame and emotional abuse. CONCLUSIONS Abortion stigma influences adolescents' disclosure of their abortion decisions and limits their social support. Fears of disclosing their pregnancies and abortion decisions are justified, and policymakers should consider how laws requiring parental notification may harm adolescents. Further research is needed on adolescents' experiences with abortion stigma.
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98
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Gonzalez F, Quast T, Venanzi A. Factors associated with the timing of abortions. Health Econ 2020; 29:223-233. [PMID: 31793124 DOI: 10.1002/hec.3981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 08/09/2019] [Accepted: 11/02/2019] [Indexed: 06/10/2023]
Abstract
The timing of an abortion (often measured as gestational age) can have important effects on the woman's physical health and on the cost of the procedure. To the authors' knowledge, there has been only one national analysis of the factors associated with the gestational age at abortion, but it employed data from over 20 years ago. The state-specific studies that have explored abortion timing have typically examined the effects of a specific change in abortion regulations. In this study, we employ annual, state-level data covering the 1991-2014 period that measure the frequency of abortions by gestational age. We regress these measures of abortion utilization on policy, economic, demographic, and health care infrastructure characteristics. The estimates indicate that the introduction of state restrictions on Medicaid funding of abortions is associated with a 13% increase in the rate of abortions after the first trimester. We do not find a statistically significant association between parental involvement laws and the rate or percentage of post-first-trimester abortions.
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Affiliation(s)
- Fidel Gonzalez
- Department of Economics and International Business, College of Business Administration, Sam Houston State University, Huntsville, Texas
| | - Troy Quast
- College of Public Health, University of South Florida, Tampa, Florida
| | - Alex Venanzi
- College of Public Health, University of South Florida, Tampa, Florida
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99
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Abstract
Objectives Mifepristone was approved for use in medical abortion by Health Canada in 2015. Approval was accompanied by regulations that prohibited pharmacist dispensing of the medication. Reproductive health advocates in Canada recognized this regulation would limit access to medical abortion and successfully worked to have this regulation removed in 2017. The purpose of this study was to assess the leadership involved in changing these regulations so that the success may be replicated by other groups advocating for health policy change. Methods This study involved a mixed methods instrumental design in the context of British Columbia, Canada. Our data collection included: a) interviews with seven key individuals, representing the organizations that worked in concert for change to Canadian mifepristone regulations, and b) document analysis of press articles, correspondence, briefing notes, and meeting minutes. We conducted a thematic analysis of transcripts of audio-recorded interviews. We identified strengths and weaknesses of the team dynamic using the Develop Coalitions, Achieve Results and Systems Transformation domains of the LEADS Framework. Results Our analysis of participant interviews indicates that autonomy, shared values, and clarity in communication were integral to the success of the group’s work. Analysis using the LEADS Framework showed that individuals possessed many of the capabilities identified as being necessary for successful health policy leadership. A lack of post-project assessment was identified as a possible limitation and could be incorporated in future work to strengthen dynamics especially when a desired outcome is not achieved. Document analysis provided a clear time-line of the work completed and suggested that strong communication between team members was another key to success. Conclusions The results of our analysis of the interviews and documents provide valuable insight into the workings of a successful group committed to a common goal. The existing collegial and trusting relationships between key stakeholders allowed for interdisciplinary collaboration, rapid mobilization, and identification of issues that facilitated successful Canadian global-first deregulation of mifepristone dispensing.
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Affiliation(s)
- Brigid Dineley
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- * E-mail:
| | - Sarah Munro
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), Vancouver, Canada
| | - Wendy V. Norman
- Department of Family Practice, University of British Columbia, Vancouver, Canada
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, England
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100
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Uterhark E. International Law and the Legalization of Abortion in Northern Ireland. J Law Health 2020; 34:155-189. [PMID: 33449459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
On July 24, 2019, the Parliament of the United Kingdom passed an act that included an amendment requiring Northern Ireland to implement recommendations from the Committee on the Elimination on Discrimination Against Women. The amendment required Northern Ireland to repeal the 1861 abortion act and requires the decriminalization of abortion. The law went into effect on October 22, 2019, since the Northern Ireland power-sharing government (Stormont) did not reconvene before October 21, 2019. Since the law did go into effect, it gave women the right to obtain abortions under the CEDAW recommendations; however, when the Northern Irish government (Stormont) reconvenes, it can recriminalize abortion. They made this attempt when Stormont under DUP leadership reconvened briefly on January 11, 2020 before the official Brexit the next day. This Note argues that abortion should be legal in Northern Ireland regardless of whether the new legislation from British Parliament ever went into effect or gets overturned by the Stormont legislature because of several treaties and domestic decisions from the Supreme Court in Belfast and the new regulations made in accordance with the amendment need to meet the standards of the CEDAW recommendations.
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