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Whitfield B, Sierra G, Lerma K, Goyal V, Thaxton L, Kumar B, Gilbert A, White K. Abortion Return Rates and Wait Times Before and After Texas' Executive Order Banning Abortion During COVID-19. Am J Public Health 2024:e1-e11. [PMID: 39146519 DOI: 10.2105/ajph.2024.307747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Objectives. To assess the associations between the executive order that Texas governor Greg Abbott issued on March 22, 2020, postponing procedures deemed not immediately medically necessary, and patients' access to abortion care in Texas. Methods. We used 17 515 individual-level patient records from 13 Texas abortion facilities for matched periods in 2019 and 2020 to examine differences in return rates for abortion after completion of a state-mandated ultrasound and median wait times between ultrasound and abortion visits for those who returned. Results. Patients were less likely to return for an abortion if they had an ultrasound while the executive order was under effect (82.8%) than in the same period in 2019 (90.4%; adjusted odds ratio = 2.06; 95% confidence interval = 1.12, 3.81). Compared with patients at or before 10.0 weeks' gestation at ultrasound, patients at more than 10 weeks' gestation had higher odds of not returning for an abortion or, if they returned, experienced greater wait times between ultrasound and abortion visits. Conclusions. Texas' executive order prohibiting abortion during the COVID-19 pandemic disrupted patients' access to care and disproportionately affected patients who were past 10 weeks' gestation. (Am J Public Health. Published online ahead of print August 15, 2024:e1-e11. https://doi.org/10.2105/AJPH.2024.307747).
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Affiliation(s)
- Brooke Whitfield
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Gracia Sierra
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Klaira Lerma
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Vinita Goyal
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Lauren Thaxton
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Bhavik Kumar
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Allison Gilbert
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
| | - Kari White
- Brooke Whitfield, Gracia Sierra, Klaira Lerma, Vinita Goyal, and Kari White are with the Population Research Center, University of Texas at Austin. Lauren Thaxton is with Dell Medical School, University of Texas at Austin. Bhavik Kumar is with Planned Parenthood Gulf Coast, Houston, TX. Allison Gilbert is with Southwestern Women's Surgery Center, Dallas, TX
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McQuade M, Banwarth-Kuhn B, Trujillo V, Truehart A. "To Anyone Reading in the Future You Are Not Alone": How Patients Seeking Abortion in a Surge State Use Their Stories to Support Each Other. Am J Public Health 2024:e1-e5. [PMID: 39088788 DOI: 10.2105/ajph.2024.307772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
Amid growing restrictions on reproductive health care nationwide, understanding real-time contextualization of patient experience is critical. This qualitative approach uses inductive content analysis to examine 74 anonymous journal entries from 2020 to 2023 from patients accessing abortions in New Mexico. Prompted by a journal titled, "Tell your story, it may help someone else," entries described decision-making, highlighted autonomy, and built solidarity. This analysis explains how patients contextualized their abortion and offers insight to improving experiences for patients traveling for abortion care. (Am J Public Health. Published online ahead of print August 1, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307772).
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Affiliation(s)
- Miriam McQuade
- Miriam McQuade and Amber Truehart are with the Department of Obstetrics and Gynecology, Division of Complex Family Planning, University of New Mexico Medical Center, Albuquerque. Brenna Banwarth-Kuhn is with the School of Medicine, University of New Mexico, Albuquerque. Victoria Trujillo is with the Department of Obstetrics and Gynecology, University of New Mexico Medical Center
| | - Brenna Banwarth-Kuhn
- Miriam McQuade and Amber Truehart are with the Department of Obstetrics and Gynecology, Division of Complex Family Planning, University of New Mexico Medical Center, Albuquerque. Brenna Banwarth-Kuhn is with the School of Medicine, University of New Mexico, Albuquerque. Victoria Trujillo is with the Department of Obstetrics and Gynecology, University of New Mexico Medical Center
| | - Victoria Trujillo
- Miriam McQuade and Amber Truehart are with the Department of Obstetrics and Gynecology, Division of Complex Family Planning, University of New Mexico Medical Center, Albuquerque. Brenna Banwarth-Kuhn is with the School of Medicine, University of New Mexico, Albuquerque. Victoria Trujillo is with the Department of Obstetrics and Gynecology, University of New Mexico Medical Center
| | - Amber Truehart
- Miriam McQuade and Amber Truehart are with the Department of Obstetrics and Gynecology, Division of Complex Family Planning, University of New Mexico Medical Center, Albuquerque. Brenna Banwarth-Kuhn is with the School of Medicine, University of New Mexico, Albuquerque. Victoria Trujillo is with the Department of Obstetrics and Gynecology, University of New Mexico Medical Center
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Mackinnon Krems J, Grossman D, Ehrenreich K, Ralph L. Money and place: Quantifying the types of obstacles associated with seeking an abortion after 10 weeks' gestation, 2019-2020. Contraception 2024; 136:110476. [PMID: 38679274 DOI: 10.1016/j.contraception.2024.110476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Identify factors associated with presenting for abortion after 10 weeks' gestation in a large, geographically diverse sample. STUDY DESIGN From October 2019 to March 2020, we surveyed 1089 patients seeking abortion at seven U.S. facilities. We identified four domains of barriers: geographic, financial, logistical/personal, and legislative. Using multivariable logistic regression, we investigated the relationship between each domain and presenting for abortion after 10 weeks' gestation, overall and stratified by state policy landscape. RESULTS One-third of participants reported geographic (33.0%), financial (33.3%), and logistical/personal (31.4%) barriers; fewer (4.8%) reported legislative barriers. One-third (30.8%) traveled over 50 miles to the clinic. One-quarter (25.2%) presented after 10 weeks' gestation. In multivariable analyses, financial barriers (adjusted odds ratio [aOR] = 1.49, 95% confidence interval [CI] = 1.06-2.09), geographic barriers (aOR = 2.05, 95% CI = 1.44-2.90), and difficulty meeting basic expenses (aOR = 1.47, 95% CI = 1.15-1.89) were associated with presenting after 10 weeks' gestation across the seven clinics. Among participants accessing care at clinics in states with supportive abortion policies (n = 178), geographic barriers remained significantly associated with presenting after 10 weeks' gestation. CONCLUSIONS In a large, geographically diverse sample, financial and geographic barriers were associated with presenting after the threshold for medication abortion. In supportive states, the association with geographic barriers persisted. Cost and geographic barriers are increasing as more states restrict abortion post-Dobbs, highlighting the urgent need to expand financial and travel support. IMPLICATIONS People seeking abortion faced barriers before the Dobbs decision. Now, post-Dobbs, restrictions to abortion have only increased, making barriers to care even more threatening. Providing access to financial resources and transportation for people seeking abortion and expanding telehealth medication for abortion is now even more important.
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Affiliation(s)
- Jennifer Mackinnon Krems
- Joint Medical Program, University of California San Francisco and University of California Berkeley, San Francisco and Berkeley, CA, USA.
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, USA
| | - Katherine Ehrenreich
- Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, USA
| | - Lauren Ralph
- Advancing New Standards in Reproductive Health, Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, CA, USA
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Papastefan ST, Bian Y, Singh M, Marriott WS, Ito JA, Fry J, Shaaban AF, Premkumar A. Neighborhood deprivation is not associated with abortion consideration or completion in patients with fetal myelomeningocele. Prenat Diagn 2024. [PMID: 38982329 DOI: 10.1002/pd.6633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/06/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate whether patient-level neighborhood deprivation index (NDI) was associated with termination of pregnancy consideration and completion in patients presenting with fetal myelomeningocele. METHODS This was a retrospective cohort analysis of patients with fetal myelomeningocele presenting to a fetal treatment center (FTC) in Illinois between 2018 and 2024. The exposure was NDI calculated from patient zip codes. The NDI was analyzed as both a dichotomous and ordinal exposure. The co-primary outcomes were abortion consideration prior to FTC consultation, ascertained by nurse intake, and abortion completion after consultation. Bivariate and log-binomial regression analyses were performed. Covariates were selected based on p < 0.10 on bivariate analyses. Otherwise, p < 0.05 indicated statistical significance. RESULTS A total of 157 participants were included. Evaluation of neighborhood deprivation as a dichotomous exposure revealed no association with abortion consideration or completion. AdditionallLy, no association was found on log binomial modeling after controlling for gestational age at presentation to the FTC and maternal race or ethnicity for abortion consideration (aRR 0.87, 95% CI 0.59-1.28) or completion (aRR 0.86, 95% CI 0.59-1.28). These results were similar when treating the NDI as an ordinal exposure. CONCLUSIONS Contrary to our hypothesis, NDI is not associated with abortion consideration or completion in patients with fetal myelomeningocele.
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Affiliation(s)
- Steven T Papastefan
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yuqi Bian
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Humanities and Bioethics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Manmeet Singh
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - William S Marriott
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Joyceline A Ito
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jessica Fry
- Neonatology and Palliative Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Aimen F Shaaban
- Division of Pediatric Surgery, The Chicago Institute for Fetal Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashish Premkumar
- Department of Obstetrics and Gynecology, Section of Maternal Fetal Medicine, Pritzker School of Medicine at the University of Chicago, Chicago, Illinois, USA
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Schueler K, Jacobs M, Averbach S, Marengo A, Mody SK. Understanding medication abortion ineligibility due to gestational age among a cohort of patients in Southern California. Contraception 2024; 133:110386. [PMID: 38307486 DOI: 10.1016/j.contraception.2024.110386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Medication abortion (MAB) is safe and effective up to 77 days gestation. Limited data are available on how often patients are ineligible for MAB due to advanced gestational age and how many of those ineligible go on to receive procedural abortion. STUDY DESIGN Retrospective analysis of electronic health records from Planned Parenthood of the Pacific Southwest (PPPSW) from January - December 2021. PPPSW has four procedural abortion sites and 15 MAB-only clinics that offered appointments only if last menstrual period-based GA was ≤70 days or unknown. Patients >70 days gestation by intake ultrasound at a MAB-only clinic were referred to a procedural center. RESULTS Of 11,684 patients presenting for MAB at MAB-only sites 2224 (19%) did not receive a MAB; 3.8% (N = 444) presented past 70 days gestation and were thus ineligible due to gestational age limits. Of those ineligible (N = 444), 234 (53%) measured between 71-77 days of gestation. Three quarters (75.7%) of those ineligible went on to receive a procedural abortion at PPPSW after a mean wait time of 10 days. In multivariable analysis, no demographic factors were associated with higher odds of receiving a procedural abortion. CONCLUSIONS Presenting for MAB past a gestational age limit was uncommon, supporting safety of no-test MAB protocols. A quarter of people ineligible for MAB due to gestational age did not receive a procedural abortion at PPPSW. If MAB were offered up to 77 days, half of patients who were denied MAB due to gestational age could have received MAB, expanding patient access. IMPLICATIONS Being ineligible for MAB due to advanced gestational age was uncommon. Increasing MAB gestational age limits from 70 days to 77 days could further improve abortion access.
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Affiliation(s)
- Kellie Schueler
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, CA, United States.
| | - Marni Jacobs
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, CA, United States
| | - Sarah Averbach
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, CA, United States; Center on Gender Equity and Health, University of California, San Diego, CA, United States
| | - Antoinette Marengo
- Planned Parenthood of the Pacific Southwest, San Diego, CA, United States
| | - Sheila K Mody
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, CA, United States
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Sehgal NKR, Hswen Y, Cantor J, Upadhyay UD, Reis BY, Remmel C, Brownstein JS, Rader B. The impact of abortion bans on short-term housing needs. Public Health 2024; 228:200-205. [PMID: 38412759 DOI: 10.1016/j.puhe.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES State-level abortion bans in the United States have created a complex legal landscape that forces many prospective patients to travel long distances to access abortion care. The financial strain and logistical difficulties associated with travelling out of state for abortion care may present an insurmountable barrier to some individuals, especially to those with limited resources. Tracking the impact of these abortion bans on travel and housing is crucial for understanding abortion access and economic changes following the Dobbs U.S. Supreme Court decision. STUDY DESIGN This study used occupancy data from an average of 2,349,635 (standard deviation = 111,578) U.S. Airbnb listings each month from October 1st, 2020, through April 30th, 2023, to measure the impact of abortion bans on travel for abortion care and the resulting economic effects on regional economies. METHODS The study used a synthetic difference-in-differences design to compare monthly-level occupancy rate data from 1-bedroom entire-place Airbnb rentals within a 30-min driving distance of abortion clinics in states with and without abortion bans. RESULTS The study found a 1.4 percentage point decrease in occupancy rates of Airbnbs around abortion clinics in states where abortion bans were in effect, demonstrating reductions in Airbnb use in states with bans. In the 6-month period post Dobbs, this decrease translates to 16,548 fewer renters and a $1.87 million loss in revenue for 1-bedroom entire-place Airbnbs within a 30-min catchment area of abortion facilities in states with abortion restrictions. CONCLUSION This novel use of Airbnb data provides a unique perspective on measuring demand for abortion and healthcare services and demonstrates the value of this data stream as a tool for understanding economic impacts of health policies.
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Affiliation(s)
- N K R Sehgal
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA; Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Y Hswen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA; Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
| | - J Cantor
- RAND Corporation, Santa Monica, CA, USA
| | - U D Upadhyay
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, CA, USA
| | - B Y Reis
- Predictive Medicine Group, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - C Remmel
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA
| | - J S Brownstein
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - B Rader
- Harvard Medical School, Boston, MA, USA.
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Burdick KJ, Coughlin CG, D'Ambrosi GR, Monuteaux MC, Economy KE, Mannix RC, Lee LK. Abortion Restrictiveness and Infant Mortality: An Ecologic Study, 2014-2018. Am J Prev Med 2024; 66:418-426. [PMID: 37844712 DOI: 10.1016/j.amepre.2023.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION The U.S. has the highest infant mortality rate among peer countries. Restrictive abortion laws may contribute to poor infant health outcomes. This ecological study investigated the association between county-level infant mortality and state-level abortion access legislation in the U.S. from 2014 to 2018. METHODS A multivariable regression analysis with the outcome of county-level infant mortality rates, controlling for the primary exposure of state-level abortion laws, and county-level factors, county-level distance to an abortion facility, and state Medicaid expansion status was performed. Incidence rate ratios and 95% CIs were reported. Analyses were conducted in 2022-2023. RESULTS There were 113,397 infant deaths among 19,559,660 live births (infant mortality rate=5.79 deaths/1,000 live births; 95% CI=5.75, 5.82). Black infant mortality rate (10.69/1,000) was more than twice the White infant mortality rate (4.87/1,000). In the multivariable model, increased infant mortality rates were seen in states with ≥8 restrictive laws, with the most restrictive (11-12 laws) having a 16% increased infant mortality level (adjusted incidence rate ratios=1.162; 95% CI=1.103, 1.224). Increased infant mortality rates were associated with increased county-level Black race individuals (adjusted incidence rate ratios=1.031; 95% CI=1.026, 1.037), high school education (adjusted incidence rate ratios=1.018; 95% CI=1.008, 1.029), maternal smoking (adjusted incidence rate ratios=1.025; 95% CI=1.018, 1.033), and inadequate prenatal care (adjusted incidence rate ratios=1.045; 95% CI=1.036, 1.055). CONCLUSIONS State-level abortion law restrictiveness is associated with higher county-level infant mortality rates. The Supreme Court decision on Dobbs versus Jackson and changes in state laws limiting abortion may affect future infant mortality.
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Affiliation(s)
- Kendall J Burdick
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Catherine G Coughlin
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Gabrielle R D'Ambrosi
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Katherine E Economy
- Department of Obstetrics Gynecology & Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rebekah C Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
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Peart MS, Cartwright AF, Tadikonda A, Upadhyay UD, Tang JH, Morse JE, Stuart GS, Bryant AG. Potential demand for and access to medication abortion among North Carolina college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-8. [PMID: 38227925 DOI: 10.1080/07448481.2023.2299408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To estimate demand for medication abortion (MAB) among North Carolina (NC) college students and describe access to nearest clinics offering MAB to each campus. METHODS We calculated demand using 2019-2020 campus demographics and NC abortion statistics. We used a mystery client technique to gather MAB cost and appointment wait times at the closest clinics and calculated travel distances and times. RESULTS We estimated that 2,517 NC students seek MAB annually. Twenty-one clinics were closest to NC's 111 colleges and universities, including five in neighboring states. Mean cost was $450, with an average wait time of six days to appointment. The average round-trip travel distance was 58 miles and time to the nearest clinic was 84 min by car. CONCLUSIONS Many NC college students likely obtain MAB every year and face high costs, long wait times and distances to care, which has likely worsened after the overturning of Roe v. Wade.
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Affiliation(s)
- Mishka S Peart
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Alice F Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ananya Tadikonda
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California, USA
| | - Jennifer H Tang
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jessica E Morse
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Gretchen S Stuart
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Amy G Bryant
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Kibira SPS, Stillman M, Makumbi FE, Giorgio M, Nabukeera S, Nalwoga GK, Sully EA. Lived experiences and drivers of induced abortion among women in central Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002236. [PMID: 38055682 DOI: 10.1371/journal.pgph.0002236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/20/2023] [Indexed: 12/08/2023]
Abstract
Although unsafe abortions are preventable, they are one of the leading causes of maternal mortality and morbidity. Despite the serious potential health consequences, there is limited published information about drivers and challenges of obtaining abortions in restrictive settings such as Uganda. This limits efforts to improve programing for preventing unsafe abortion and providing comprehensive post abortion care. This study sought to understand the drivers and explain the lived abortion experiences among women from central Uganda, in an effort to promote greater access to safe reproductive healthcare services, and reduce unsafe abortions. This qualitative study included 40 purposely selected women who self-reported an abortion, living in Kampala and greater Rakai district, Uganda. They were part of a larger survey using respondent driven sampling, where seed participants were recruited from selected facilities offering post-abortion care, or through social referrals. Data were collected from May to September 2021 through in-depth interviews. Audio data were transcribed, managed using Atlas.ti 9, and analyzed thematically. The findings show that the underlying drivers stemmed from partners who were unsupportive, denied responsibility, or had raped/defiled women. Career and education decisions, stigma and fear to disappoint family also contributed. Women had feelings of confusion, neglect, betrayal, or shame after conception. Abortion and post-abortion experiences were mixed with physical and emotional pain including stigma, even when the conditions for safe abortion in the guidelines were satisfied. Although most women sought care from health facilities judged to provide safe and quality care, there was barely any counselling in these venues. Confidantes and health providers informed the choice of abortion methods, although the cost ultimately mattered most. The mental health of women whose partners are unsupportive or who conceive unintendedly need consideration. Abortion provided psychological relief from more complicated consequences of having an unplanned birth for women.
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Affiliation(s)
| | | | - Fredrick E Makumbi
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Sarah Nabukeera
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Koenig LR, Becker A, Ko J, Upadhyay UD. The Role of Telehealth in Promoting Equitable Abortion Access in the United States: Spatial Analysis. JMIR Public Health Surveill 2023; 9:e45671. [PMID: 37934583 PMCID: PMC10664017 DOI: 10.2196/45671] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/05/2023] [Accepted: 09/26/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Even preceding the Supreme Court's 2022 Dobbs v. Jackson Women's Health Organization decision, patients in the United States faced exceptional barriers to reach abortion providers. Abortion restrictions disproportionately limited abortion access among people of color, young people, and those living on low incomes. Presently, clinics in states where abortion remains legal are experiencing an influx of out-of-state patients and wait times for in-person appointments are increasing. Direct-to-patient telehealth for abortion care has expanded since its introduction in the United States in 2020. However, the role of this telehealth model in addressing geographic barriers to and inequities in abortion access remains unclear. OBJECTIVE We sought to examine the amount of travel that patients averted by using telehealth for abortion care, and the role of telehealth in mitigating inequities in abortion access by race or ethnicity, age, pregnancy duration, socioeconomic status, rural residence, and distance to a facility. METHODS We used geospatial analyses and data from patients in the California Home Abortion by Telehealth Study, residing in 31 states and Washington DC, who obtained telehealth abortion care at 1 of 3 virtual abortion clinics. We used patients' residential ZIP code data and data from US abortion facility locations to document the round-trip driving distance in miles, driving time, and public transit time to the nearest abortion facility that patients averted by using telehealth abortion services from April 2021 to January 2022, before the Dobbs decision. We used binomial regression to assess whether patients reported that telehealth was more likely to make it possible to access a timely abortion among patients of color, those experiencing food insecurity, younger patients, those with longer pregnancy durations, rural patients, and those residing further from their closest abortion facility. RESULTS The 6027 patients averted a median of 10 (IQR 5-26) miles and 25 (IQR 14-46) minutes of round-trip driving, and 1 hour 25 minutes (IQR 46 minutes to 2 hours 30 minutes) of round-trip public transit time. Among a subsample of 1586 patients surveyed, 43% (n=683) reported that telehealth made it possible to obtain timely abortion care. Telehealth was most likely to make it possible to have a timely abortion for younger patients (prevalence ratio [PR] 1.4, 95% CI 1.2-1.6) for patients younger than 25 years of age compared to those 35 years of age or older), rural patients (PR 1.4, 95% CI 1.2-1.6), those experiencing food insecurity (PR 1.3, 95% CI 1.1-1.4), and those who averted over 100 miles of driving to their closest abortion facility (PR 1.6, 95% CI 1.3-1.9). CONCLUSIONS These findings support the role of telehealth in reducing abortion-related travel barriers in states where abortion remains legal, especially among patient populations who already face structural barriers to abortion care. Restrictions on telehealth abortion threaten health equity.
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Affiliation(s)
- Leah R Koenig
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
- Center for Gender and Health Justice, University of California Global Health Institute, Oakland, CA, United States
| | - Andréa Becker
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer Ko
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
- Center for Gender and Health Justice, University of California Global Health Institute, Oakland, CA, United States
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
- Center for Gender and Health Justice, University of California Global Health Institute, Oakland, CA, United States
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Riley T, Godfrey EM, Angelini E, Zia Y, Cook K, Balkus JE. Demand for medication abortion among public university students in Washington. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-5. [PMID: 37561697 DOI: 10.1080/07448481.2023.2245481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023]
Abstract
Provision of medication abortion in student health centers is safe and effective, but no public universities in Washington state provide such services. We estimate demand for medication abortion and describe barriers to care among students at four-year public universities in Washington. Using publicly available data, we estimated that students at the 11 Washington public universities obtained between 549 and 932 medication abortions annually. Students must travel an average of 16 miles (range:1-78) or 73 minutes via public transit (range:22-284) round trip to the nearest abortion-providing facility. Average wait time for the first available appointment was 10 days (range:4-14), and average cost was $711. Public universities can play an integral role in expanding abortion access post-Dobbs by providing medication abortion, effectively reducing barriers to care for students. The state legislature can pass legislation requiring universities to provide medication abortion, similar to what other states also protective of abortion rights have done.
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Affiliation(s)
- Taylor Riley
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Emily M Godfrey
- Departments of Family Medicine and Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Erin Angelini
- Department of Applied Mathematics, College of Arts and Sciences, University of Washington, Seattle, Washington, USA
| | - Yasaman Zia
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Kels Cook
- Department of Geography, University of Washington, Seattle, Washington, USA
| | - Jennifer E Balkus
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
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12
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Kumsa FA, Prasad R, Shaban-Nejad A. Medication abortion via digital health in the United States: a systematic scoping review. NPJ Digit Med 2023; 6:128. [PMID: 37438435 PMCID: PMC10338479 DOI: 10.1038/s41746-023-00871-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023] Open
Abstract
Digital health, including telemedicine, has increased access to abortion care. The convenience, flexibility of appointment times, and ensured privacy to abortion users may make abortion services via telemedicine preferable. This scoping review systematically mapped studies conducted on abortion services via telemedicine, including their effectiveness and acceptability for abortion users and providers. All published papers included abortion services via telemedicine in the United States were considered. Articles were searched in PubMed, CINAHL, and Google Scholar databases in September 2022. The findings were synthesized narratively, and the PRISMA-ScR guidelines were used to report this study. Out of 757 retrieved articles, 33 articles were selected based on the inclusion criteria. These studies were published between 2011 and 2022, with 24 published in the last 3 years. The study found that telemedicine increased access to abortion care in the United States, especially for people in remote areas or those worried about stigma from in-person visits. The effectiveness of abortion services via telemedicine was comparable to in-clinic visits, with 6% or fewer abortions requiring surgical intervention. Both care providers and abortion seekers expressed positive perceptions of telemedicine-based abortion services. However, abortion users reported mixed emotions, with some preferring in-person visits. The most common reasons for choosing telemedicine included the distance to the abortion clinic, convenience, privacy, cost, flexibility of appointment times, and state laws imposing waiting periods or restrictive policies. Telemedicine offered a preferable option for abortion seekers and providers. The feasibility of accessing abortion services via telemedicine in low-resource settings needs further investigation.
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Affiliation(s)
- Fekede Asefa Kumsa
- The University of Tennessee Health Science Center (UTHSC) - Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, Memphis, TN, 38103, USA.
| | - Rameshwari Prasad
- The University of Tennessee Health Science Center (UTHSC) - Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, Memphis, TN, 38103, USA
| | - Arash Shaban-Nejad
- The University of Tennessee Health Science Center (UTHSC) - Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, Memphis, TN, 38103, USA.
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13
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Smith SR. Abortion and Reproductive Freedom: Constitutional and Practical Issues. Clin Obstet Gynecol 2023; 66:312-322. [PMID: 37130376 DOI: 10.1097/grf.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
In Dobbs v. Jackson Women's Health, the Supreme Court reversed constitutional protection for abortion. The law will affect the practice of medicine and patients. Practitioners should understand the decision. Protection for reproductive liberties has a checkered history. Much of the constitutional controversy is over the basis for reproductive rights, "substantive due process," the proposition that substantive rights arise from a procedural guarantee in the fourteenth amendment. The change in constitutional protection for abortion will play out differently among the states. Physicians should be prepared to assist patients with new rules and to participate in the public discussion of reproductive liberties.
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Rader B, Upadhyay UD, Sehgal NKR, Reis BY, Brownstein JS, Hswen Y. Estimated Travel Time and Spatial Access to Abortion Facilities in the US Before and After the Dobbs v Jackson Women's Health Decision. JAMA 2022; 328:2041-2047. [PMID: 36318194 PMCID: PMC9627517 DOI: 10.1001/jama.2022.20424] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
IMPORTANCE Abortion facility closures resulted in a substantial decrease in access to abortion care in the US. OBJECTIVES To investigate the changes in travel time to the nearest abortion facility after the Dobbs v Jackson Women's Health Organization (referred to hereafter as Dobbs) US Supreme Court decision. DESIGN, SETTING, AND PARTICIPANTS Repeated cross-sectional spatial analysis of travel time from each census tract in the contiguous US (n = 82 993) to the nearest abortion facility (n = 1134) listed in the Advancing New Standards in Reproductive Health database. Census tract boundaries and demographics were defined by the 2020 American Community Survey. The spatial analysis compared access during the pre-Dobbs period (January-December 2021) with the post-Dobbs period (September 2022) for the estimated 63 718 431 females aged 15 to 44 years (reproductive age for this analysis) in the US (excluding Alaska and Hawaii). EXPOSURES The Dobbs ruling and subsequent state laws restricting abortion procedures. The pre-Dobbs period measured abortion access to all facilities providing abortions in 2021. Post-Dobbs abortion access was measured by simulating the closure of all facilities in the 15 states with existing total or 6-week abortion bans in effect as of September 30, 2022. MAIN OUTCOMES AND MEASURES Median and mean changes in surface travel time (eg, car, public transportation) to an abortion facility in the post-Dobbs period compared with the pre-Dobbs period and the total percentage of females of reproductive age living more than 60 minutes from abortion facilities during the pre- and post-Dobbs periods. RESULTS Of 1134 abortion facilities in the US (at least 1 in every state; 8 in Alaska and Hawaii excluded), 749 were considered active during the pre-Dobbs period and 671 were considered active during a simulated post-Dobbs period. Median (IQR) and mean (SD) travel times to pre-Dobbs abortion facilities were estimated to be 10.9 (4.3-32.4) and 27.8 (42.0) minutes. Travel time to abortion facilities in the post-Dobbs period significantly increased (paired sample t test P <.001) to an estimated median (IQR) of 17.0 (4.9-124.5) minutes and a mean (SD) of and 100.4 (161.5) minutes. In the post-Dobbs period, an estimated 33.3% (sensitivity interval, 32.3%-34.8%) of females of reproductive age lived in a census tract more than 60 minutes from an abortion facility compared with 14.6.% (sensitivity interval, 13.0%-16.9%) of females of reproductive age in the pre-Dobbs period. CONCLUSIONS AND RELEVANCE In this repeated cross-sectional spatial analysis, estimated travel time to abortion facilities in the US was significantly greater in the post-Dobbs period after accounting for the closure of abortion facilities in states with total or 6-week abortion bans compared with the pre-Dobbs period, during which all facilities providing abortions in 2021 were considered active.
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Affiliation(s)
- Benjamin Rader
- Computational Epidemiology Lab, Boston Children’s Hospital, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Ushma D. Upadhyay
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Neil K. R. Sehgal
- Computational Epidemiology Lab, Boston Children’s Hospital, Boston, Massachusetts
- Institute for Applied Computational Science, Harvard University, Cambridge, Massachusetts
| | - Ben Y. Reis
- Predictive Medicine Group, Boston Children’s Hospital Computational Health Informatics Program, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John S. Brownstein
- Computational Epidemiology Lab, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Yulin Hswen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Bakar Computational Health Sciences Institute, University of California, San Francisco
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Upadhyay UD. Barriers Push People into Seeking Abortion Care Later in Pregnancy. Am J Public Health 2022; 112:1280-1281. [PMID: 35969829 PMCID: PMC9382185 DOI: 10.2105/ajph.2022.306992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Ushma D Upadhyay
- Ushma D. Upadhyay is a professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, as well as core faculty of the Advancing New Standards in Reproductive Health Program, at the University of California, San Francisco. She is also co-director of the University of California Global Health Institute's Center for Gender and Health Justice
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Adynski GI, Bravo L, Harris M, Adynski HR, Zaragoza S, Ikharo E, Harris LK, Lackey C. Global implications of Dobbs vs. Jackson Women's health Organization for Nurses as a historically gendered profession. Int J Nurs Stud 2022; 135:104342. [DOI: 10.1016/j.ijnurstu.2022.104342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/02/2022] [Indexed: 10/31/2022]
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