Association of Texas Senate Bill 8 With Requests for Self-managed Medication Abortion

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.

Tensions Between Ethics and the Law: Examination of a Legal Case by Two Midwives Invoking a Conscientious Objection to Abortion in Scotland

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.

Abortion Rights after Artificial Wombs: Why Decriminalisation is Needed Ahead of Ectogenesis

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.

Passage of abortion ban and women's accurate understanding of abortion legality

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.

What does abortion law reform mean for primary care practitioners in New Zealand?

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.

Amnesty International's updated policy on abortion: A resource for medical providers

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.

A narrative analysis of anti-abortion testimony and legislative debate related to Georgia's fetal "heartbeat" abortion ban

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.

From bad to worse: global governance of abortion and the Global Gag Rule

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.

Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence

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.

Association of Highly Restrictive State Abortion Policies With Abortion Rates, 2000-2014

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.

What does informal access to misoprostol in Colombia look like? A mystery client methodology in Bogotá and the Coffee Axis

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.

Time for Better Access to High-Quality Abortion Data in the United States

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.

Re: AB (Termination of Pregnancy) [2019] EWCA CIV 1215: 'Wishes and Feelings' Under the Mental Capacity Act 2005

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.