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

Medication and procedural abortion uptake during a period of increasing abortion hostility

Hundreds of state-level abortion restrictions were implemented in the US between 2010 and 2020. Medication abortion was being widely adopted during this same period. Understanding the impact of health policies and political climate will improve the delivery of and access to reproductive healthcare in a period of rapid change. To measure the association between state abortion hostility and mifepristone and procedural abortion rates, we conducted a state-level repeated cross-sectional study using 2010-2020 employer-sponsored insurance claims data from Merative MarketScan. The exposure of interest was a 13-point state-level abortion hostility score based on the presence of policies which either reduce or protect access to abortion. Outcomes of interest were annual mifepristone and procedural abortion claims per 100,000 enrollees. We used a linear mixed model adjusting for urbanicity, age group, and year. We assessed whether temporal trends in abortion claims were modified by state abortion hostility by interacting year with two measurements of abortion hostility: baseline score in 2010 and change from baseline score. We found that median state-level mifepristone claims increased from 20 to 37 per 100,000 included enrollees; meanwhile, median procedural abortions claims decreased from 69 to 20 per 100. For mifepristone, every unit increase in a state's baseline abortion hostility score was associated with 7.5 (CI, -12 to -3.6) fewer mifepristone claims per 100,000 in 2010. For states with baseline hostility and change scores of zero, we did not observe a significant time trend over the 11 year study period. For every unit increase in baseline hostility, the time trend changed by 0.5 fewer claims (CI, -0.8 to -0.2) per 100,000 per year. States with higher baseline abortion hostility had fewer overall abortions, less uptake of mifepristone abortions, and slower decline in procedural abortions between 2010 and 2020. Changes in hostility from new restrictions during this time period did not significantly impact claims. Advocates for abortion access must simultaneously attend to individual abortion policies and the overall political climate. Updated research on the relationship between political climate and the evolving clinical landscape of abortion care is needed to inform this work.

Addressing challenges related to the professional practice of abortion post-Roe

The landmark Roe vs Wade Supreme Court decision in 1973 established a constitutional right to abortion. In June 2022, the Dobbs vs Jackson Women's Health Organization Supreme Court decision brought an end to the established professional practice of abortion throughout the United States. Rights-based reductionism and zealotry threaten the professional practice of abortion. Rights-based reductionism is generally the view that moral or ethical issues can be reduced exclusively to matters of rights. In relation to abortion, there are 2 opposing forms of rights-based reductionism, namely fetal rights reductionism, which emphasizes the rights for the fetus while disregarding the rights and autonomy of the pregnant patient, and pregnant patient rights reductionism, which supports unlimited abortion without regards for the fetus. The 2 positions are irreconcilable. This article provides historical examples of the destructive nature of zealotry, which is characterized by extreme devotion to one's beliefs and an intolerant stance to opposing viewpoints, and of the importance of enlightenment to limit zealotry. This article then explores the professional responsibility model as a clinically ethically sound approach to overcome the clashing forms of rights-based reductionism and zealotry and to address the professional practice of abortion. The professional responsibility model refers to the ethical and professional obligations that obstetricians and other healthcare providers have toward pregnant patients, fetuses, and the society at large. It provides a more balanced and nuanced approach to the abortion debate, avoiding the pitfalls of reductionism and zealotry, and allows both the rights of the woman and the obligations to pregnant and fetal patients to be considered alongside broader ethical, medical, and societal implications. Constructive and respectful dialogue is crucial in addressing diverse perspectives and finding common ground. Embracing the professional responsibility model enables professionals to manage abortion responsibly, thereby prioritizing patients' interests and navigating between absolutist viewpoints to find balanced ethical solutions.

State of Confusion: Ohio's Restrictive Abortion Landscape and the Production of Uncertainty in Reproductive Health Care

This study examines an underexplored source of medical uncertainty: the political context of care. Since 2011, Ohio has passed over 16 abortion-restrictive laws. We know little about how this legislation affects reproductive health care outside of abortion clinics. Drawing on focus groups and interviews with genetic counselors and obstetrician-gynecologists, we examine how abortion legislation impacts their work. We find that interpretation and implementation of legislation is not straightforward and varies by institution and region of the state. An ever-changing legislative landscape combined with uneven implementation of restrictions into policy produces uncertainty in reproductive health care. We also found uncertainty about the legal consequences of abortion in restrictive contexts, with obstetrician-gynecologists reporting greater concerns given their proximity to care provision. We argue that uncertainty can result in stricter interpretations of regulations than necessitated by the law, thereby amplifying the impacts of an already restrictive context for abortion care.

People's knowledge of and attitudes toward abortion laws before and after the Dobbs v. Jackson decision

Although media response to the Dobbs v. Jackson Women's Health Organization decision was widespread in the United States, the extent to which people were aware of the Mississippi law leading to the decision, the Dobbs v. Jackson case, is unclear, as are the resulting effects of the decision on legal abortion. As such, we examined people's awareness of abortion legality prior to and after the Dobbs v. Jackson decision announcement, as well as the potential implications associated with the decision (i.e. overturning of Roe v. Wade). We also examined people's attitudes toward abortion legality, specifically focusing on 15 weeks' gestation to correspond with the Mississippi law that led to Dobbs v. Jackson. Data were collected across two studies at different times. In Study 1, a 15-minute survey was administered to IPSOS' KnowledgePanel (N = 1014) prior to the decision announcement. A shorter version of that survey was administered to a second sample using NORC's AmeriSpeak Omnibus panel (N = 1002). Nearly half of that sample (42.2%) completed the survey prior to the decision announcement. People were generally unaware of the Mississippi law, the Dobbs v. Jackson case, and implications associated with the decision (e.g. overturning Roe v. Wade). People generally endorsed abortion being legal at 15 weeks or later, but this varied by circumstance. We did not find meaningful effects of the decision announcement on people's knowledge and attitudes. Our findings suggest that the intense response to the decision from the media and people involved in the abortion movement may not represent the general public's reaction.

Social determinants among Black people during pregnancy following a short interpregnancy interval

BACKGROUND

Short interpregnancy interval has been shown to be a key contributor to infant mortality. Black pregnant people have a higher incidence of short interpregnancy interval than people of other races and ethnicities, as well as higher rates of infant mortality. Understanding the factors related to racial disparities in short interpregnancy interval and infant mortality are a public health priority.

OBJECTIVE

This study aimed to examine the relationship between social determinants of health and interpregnancy interval in Black pregnant people by comparing those with a short interpregnancy interval defined as <18 months with those with a referent interpregnancy interval defined as ≥18 months.

STUDY DESIGN

This was a nested case-control study from a prospective cohort analyzing social determinants of health in 576 postpartum patients at an urban medical center, 2011-2021. Sociodemographic, pregnancy, and maternal characteristic data were collected from participants' medical records. Structured interviews measured participants' health behaviors, physical environment, social support, health literacy, and structural drivers. Differences in social determinants of health among Black study participants were compared between those with a short interpregnancy interval (<18 months) and those with a referent interpregnancy interval (≥18 months). The odds ratios were calculated to assess the association between short interpregnancy interval and social determinants. Factors with significant differences between the short interpregnancy interval and referent interpregnancy interval groups in Black participants were compared with that of White groups for social context.

RESULTS

Black participants with a short interpregnancy interval were more likely to report financial support from the Special Supplemental Nutrition Program for Women, Infants, and Children (odds ratio, 2.4; 95% confidence interval, 1.2-5.1), negative feelings toward the pregnancy (odds ratio, 2.4; 95% confidence interval, 1.2-4.9), choosing not to breastfeed because they do not like it (odds ratio ,12.0; 95% confidence interval, 1.5-543.1), not receiving prenatal care as early as desired (odds ratio, 3.4; 95% confidence interval, 1.6-7.2) because of consid- eration of pregnancy termination (odds ratio, 5.2; 95% confidence interval, 1.2-30.5) and less likely to report low levels of social support (odds ratio, 0.3; 95% confidence interval, 0.1-0.8) than Black participants with a referent interpregnancy interval.

CONCLUSION

Social determinants of health that differed between participants with a short interpregnancy interval and those with a referent interpregnancy interval were Special Supplemental Nutrition Program for Women, Infants, and Children support, feelings toward the pregnancy, social support, breastfeeding intent, and delayed prenatal care because of consideration of abortion. Previous studies examining infant mortality risk factors used White people as the referent group when analyzing social determinants. Our study focused specifically on understanding the lives of Black pregnant people so that future public health initiatives focused on social determinants may attenuate the racial disparity of infant mortality in the United States.

The association between reproductive rights and access to abortion services and mental health among US women

Background

This study examines whether living in US states with (1) restrictive reproductive rights and (2) restrictive abortion laws is associated with frequent mental health distress among women.

Methods

We operationalize reproductive rights using an overall state-level measure of reproductive rights as well as a state-level measure of restrictive abortion laws. We merged data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) with these state-level exposure variables and other state-level information. We used multilevel logistic regression to assess the relationship between these two measures and the likelihood of reporting 14 or more days of frequent mental health distress. We also tested whether associations differed across race, household income, education, and marital status.

Results

In the adjusted models, a standard deviation-unit increase in the reproductive rights score was significantly associated with decreased odds of reporting frequent mental health distress (OR = 0.95, 95% CI = 0.91, 0.99). Women in states with very hostile abortion restrictions had higher odds of frequent mental health distress. Associations between state-level abortion restrictions were larger among women 25-34 years old and women with a high school degree. For example, women aged 25-34 years residing in moderate (OR = 1.54, 95% CI = 1.14, 2.04), hostile (OR = 1.59, 95% CI = 1.15, 2.18), and very hostile (OR = 1.29, 95% CI = 1.02, 1.64) states were more likely to report frequent mental health distress than women living in states with less restrictive abortion policies.

Conclusion

We found the association between state-level restrictions on reproductive rights and abortion access and frequent mental health distress differed by age and socioeconomic status. These results suggest abortion rights restrictions may contribute to mental health inequities among women.

Perspectives on an early abortion ban in a restrictive US state: A qualitative exploration

OBJECTIVES

To gain a deeper understanding of perspectives on abortion and early abortion bans in a restrictive US state.

STUDY DESIGN

We conducted a qualitative study using semistructured Zoom interviews with residents of the US state Georgia's 6th Congressional District. Potential participants first completed a screening tool to recruit people who held "middle-of-the-spectrum" views on abortion based on two abortion questions on a 5-point Likert scale. The interviews focused on participants' thoughts and feelings on abortion and Georgia's early abortion ban. We transcribed, coded, and analyzed the interviews, and present a subset of themes.

RESULTS

We interviewed 28 people from March to May 2020. Participants often described holding complex views on abortion shaped by a range of lived experiences, values, and identities. They lamented the "black-and-white" nature of the national abortion discussion, which they felt oversimplified the issue and did not represent their views. Participants discussed the importance of experiences that allowed them to empathize with people who choose abortion, even when they personally felt they would make a different decision in a similar situation. Based on these experiences, many participants emphasized the importance of separating their own views on abortion from what needed to be regulated for others. However, participants often demonstrated a lack of understanding about the extent to which HB481 makes abortion inaccessible in Georgia.

CONCLUSIONS

Our results indicate that, even in states traditionally labeled as restrictive or hostile towards abortion, many people express an openness to understand others' experiences and hold complex and multifaceted views.

IMPLICATIONS

Our laws and policies at the state level profoundly affect the practice of medicine and access to care. Our study furthers our understanding of how a sample of people in a restrictive US state think and feel about abortion and early abortion bans. These results can be used to support educational efforts, policies, and communication practices that better reflect the complex views of the public.

Estimation of Multiyear Consequences for Abortion Access in Georgia Under a Law Limiting Abortion to Early Pregnancy

Importance

Following the US Supreme Court ruling in Dobbs v Jackson Women's Health Organization, Georgia's law limiting abortion to early pregnancy, House Bill 481 (HB481), was allowed to go into effect in July 2022.

Objectives

To estimate anticipated multiyear effects of HB481, which prohibits abortions after detection of embryonic cardiac activity, on abortion incidence in Georgia, and to examine inequities by race, age, and socioeconomic status.

Design, Setting, and Participants

This repeated cross-sectional analysis used abortion surveillance data from January 1, 2007, to December 31, 2017, to estimate future effects of HB481 on abortion care in Georgia, with a focus on the 2 most recent years of data (2016 and 2017). Abortion surveillance data were obtained from the 2007-2017 Georgia Department of Public Health's Induced Termination of Pregnancy files. Linear regression was used to estimate trends in abortions provided at less than 6 weeks' gestation and at 6 weeks' gestation or later in Georgia, and χ2 analyses were used to compare group differences by race, age, and educational attainment. Data were analyzed from July 26 to September 22, 2022.

Exposures

HB481, Georgia's law limiting abortion to early pregnancy.

Main Outcome and Measures

Weeks' gestation at abortion (<6 vs ≥6 weeks).

Results

From January 1, 2007, to December 31, 2017, there were 360 972 reported abortions in Georgia, with an annual mean (SD) of 32 816 (1812) abortions. Estimates from 2016 to 2017 suggest that 3854 abortions in Georgia (11.6%) would likely meet eligibility requirements for abortion care under HB481. Fewer abortions obtained by Black patients (1943 [9.6%] vs 1280 [16.2%] for White patients), patients younger than 20 years (261 [9.1%] vs 168 [15.0%] for those 40 years and older), and patients with fewer years of education (392 [9.2%] with less than a high school diploma and 1065 [9.6%] with a high school diploma vs 2395 [13.5%] for those with some college) would likely meet eligibility requirements under HB481.

Conclusions and Relevance

These findings suggest that Georgia's law limiting abortion to early pregnancy (HB481) would eliminate access to abortion for nearly 90% of patients in Georgia, and disproportionately harm patients who are Black, younger, and in lower socioeconomic status groups.

Association Between Rates of Down Syndrome Diagnosis in States With vs Without 20-Week Abortion Bans From 2011 to 2018

IMPORTANCE

Many states enacted 20-week abortion bans from 2011 to 2018. Such bans affect individuals who receive diagnoses of fetal anomalies and aneuploidy in the second trimester, preventing pregnant individuals from having the choice of whether or not to continue the pregnancy.

OBJECTIVES

To examine the trends of neonatal Down syndrome rates and assess the association between enactment of 20-week abortion bans and rates of Down syndrome diagnosis.

DESIGN, SETTING, AND PARTICIPANTS

This population-based, historical cohort study used National Vital Statistics System data on 31 157 506 births in the US from 2011 to 2018. Statistical analysis was performed from May 2021 to February 2023.

EXPOSURE

States were categorized as those with or without a 20-week abortion ban enacted during the study period.

MAIN OUTCOMES AND MEASURES

Demographic characteristics between the ban and no-ban states were compared using χ2 tests and 2-sample t tests. Multivariable logistic regression evaluated the adjusted odds of Down syndrome among births in states that enacted 20-week abortion bans after the abortion ban enactment, adjusting for state, year of birth, maternal race and ethnicity, age, educational level, insurance, and number of prenatal visits.

RESULTS

The cohort consisted of 31 157 506 births (mean [SD] maternal age, 28.4 [5.9] years) in the United States, of whom 15 951 neonates (0.05%) received a diagnosis of Down syndrome at birth. A total of 17 states enacted 20-week abortion bans during the study period, and 33 states did not enact bans. In both states with and states without bans, the birth prevalence of neonatal Down syndrome increased over time; in states with bans, rates increased from 48.0 to 58.4 per 100 000 births; in states without bans, rates increased from 47.4 to 53.3 per 100 000 births. In multivariable logistic regression assessing the interaction of time and presence of a 20-week abortion ban, the odds of Down syndrome were higher in states that enacted 20-week abortion bans after enactment of the law compared with the years prior to enactment of the ban (adjusted odds ratio, 1.22; 95% CI, 1.11-1.35).

CONCLUSIONS AND RELEVANCE

In the US from 2011 to 2018, neonatal Down syndrome diagnoses increased more in states that enacted 20-week abortion bans compared with states that did not enact bans. Because these abortion bans were enacted throughout the study period and are known to inhibit choice in patient decision-making, it is possible that the difference in the rates of diagnosis is associated with these policies.

Racial disparities in pregnancy options counseling and referral in the US South

OBJECTIVE

The objective of this study is to examine racial variation in receipt of counseling and referral for pregnancy options (abortion, adoption, and parenting) following pregnancy confirmation. Equitable offering of such information is a professional and ethical obligation and an opportunity to prevent racial disparities in maternal and child health.

DATA SOURCE

Primary data from patients at southern United States publicly funded family planning clinics, October 2018-June 2019.

STUDY DESIGN

Patients at 14 clinics completed a survey about their experiences with pregnancy options counseling and referral following a positive pregnancy test. The primary predictor variable was patients' self-reported racial identity. Outcomes included discussion of pregnancy options, referral for those options, and for support services.

DATA COLLECTION

Data from eligible patients with non-missing information for key variables (n = 313) were analyzed using descriptive statistics, χ² tests, and multivariable logistic regression.

PRINCIPAL FINDINGS

Patients were largely Black (58%), uninsured (64%), and 18-29 years of age (80%). Intention to continue pregnancy and receipt of prenatal care referral did not differ significantly among Black as compared to non-Black patients. However, Black patients had a higher likelihood of wanting an abortion or adoption referral and not receiving one (abortion: marginal effect [ME] = 7.68%, p = 0.037; adjusted ME [aME] = 9.02%, p = 0.015; adoption: ME = 7.06%, p = 0.031; aME = 8.42%, p = 0.011). Black patients intending to end their pregnancies had a lower probability of receiving an abortion referral than non-Black patients (ME = -22.37%, p = 0.004; aME = -19.69%, p = 0.023). In the fully adjusted model, Black patients also had a higher probability of wanting access to care resources (including transportation, childcare, and financial support) and not receiving them (aME = 5.38%, p = 0.019).

CONCLUSIONS

Clinical interactions surrounding pregnancy confirmation provide critical opportunities to discuss options, coordinate care, and mitigate risk, yet are susceptible to systemic bias. These findings add to limited evidence around pregnancy counseling and referral disparities. Ongoing assessment of pregnancy counseling and referral disparities can provide insight into organizational strengths or the potential to increase structural equity.

The Zika virus: an opportunity to revisit reproductive health needs and disparities

First isolated in 1947, the Zika virus was initially connected only to limited or sporadic human infections. In late 2015, the temporal clustering of a Zika outbreak and microcephaly in newborn babies from northeastern Brazil, and the identification of a causal link between the two, led to the characterization of the congenital Zika syndrome. In the wake of the epidemic, several countries from Latin America advised women to postpone pregnancies for periods ranging from six months to two years. These recommendations initiated critical conversations about the challenges of implementing them in societies with limited access to contraception, widespread socioeconomic inequalities, and high rates of unplanned and adolescent pregnancies. The messaging targeted exclusively women, despite a high prevalence of imbalances in the relationship power, and addressed all women as a group, failing to recognize that the decision to postpone pregnancies will impact different women in different ways, depending on their age at the time. Finally, in several countries affected by the Zika epidemic, due to restrictive reproductive policies, legally terminating a pregnancy is no longer an option even at the earliest time when brain malformations as part of the congenital Zika syndrome can be detected by ultrasonography. The virus continued to circulate after 2016 in several countries. Climate change models predict an expansion of the geographical area where local Zika transmission may occur, indicating that the interface between the virus, teratogenesis, and reproductive rights is a topic of considerable interest for medicine, social sciences, and public health for years to come.

Making a third-trimester abortion referral: Learning from patients

OBJECTIVES

Research on abortion referral practices has focused on referral to first-trimester abortion care. Research has not examined whether and how these recommendations apply to referrals for abortion later in pregnancy.

METHODS

We conducted a secondary analysis of semi-structured interviews with thirty third-trimester abortion patients of their experiences of referral from prenatal and/or pre-third-trimester abortion care. We used thematic coding to identify referral-related actions participants desired or wished providers would avoid.

RESULTS

Participants reported needs in referral for information that third-trimester abortion was a possibility and about third-trimester providers and funding resources. Several also reported a need for emotional support from the prenatal or abortion care provider who denied them abortion care.

CONCLUSIONS

Many factors important for first-trimester abortion referral are important in third-trimester abortion referral, but the specifics of third-trimester care (namely the paucity of clinics, need for travel, and possibility of strong emotional attachment to the pregnancy) require additional practice actions.

PRACTICE IMPLICATIONS

Providers can support their patients in need of third-trimester abortion care by proactively providing: information that third-trimester abortion is available; information on third-trimester providers and funding support (e.g., an abortion referral hotline); and clear, non-judgmental emotional support.

The Interest in Permanent Contraception Peaked Following the Leaked Supreme Court Majority Opinion of Roe vs. Wade: A Cross-Sectional Google Trends Analysis

Introduction With the leaked Supreme Court draft regarding Roe vs. Wade, substantial public reactions followed as the horizon of abortion laws within the United States of America have been changing. We sought to compare internet searches for vasectomy and tubal ligation seven days following the leaked draft on May 2, 2022. Methods We used public data provided by Google Trends to investigate the interest and geographic distribution of searches for the two forms of permanent contraception: Vasectomy and tubal ligation. We calculated the mean Search Volume Index (SVI) of these terms. Data analysis was performed with Microsoft Excel Version 16.60 (Redmond, USA), and comparisons between groups were performed using paired t-tests. Results The term 'vasectomy' saw a 121% increase (p=0.0063), and 'tubal ligation' had a 70% (p=0.029) increase compared to the week prior. 49/50 states had increased search inquiries for each term. However, the North and Southwestern regions of the U.S. had increased relative surge for vasectomy and the Midwest region for tubal ligation procedures, respectively. South Dakota and Idaho, with trigger laws that banned abortion immediately following the overturn of Roe vs. Wade, had the greatest surge in SVI for tubal ligation and vasectomy, respectively. Conclusion Our study indicates that with the potential overturn of Roe vs. Wade, there was a significantly increased interest in these two forms of permanent contraception. Future studies should investigate specific concerns and questions patients may have when it comes to the different options of contraception.

Abortion Knowledge Among Advanced Practice Clinicians in Colorado

INTRODUCTION

Our objective was to quantify abortion law and care knowledge among Colorado advanced practice clinicians.

METHODS

We conducted a stratified random survey of advanced practice clinicians, oversampling women's health and rural clinicians. We assessed sample characteristics, positions on abortion legality, and knowledge of abortion law and care. Mean knowledge scores were compared by sample characteristics. Survey responses were compared by provision of pregnancy options counseling and positions on abortion legality. Linear regression models were used to examine knowledge scores.

RESULTS

A total of 513 participants completed the survey; the response rate was 21%. Abortion law knowledge questions (mean score, 1.7/7.0) ranged from 12% (physician-only law) to 45% (parental consent law) correct. For five of seven questions, "I don't know" was the most frequently chosen response. Abortion care knowledge questions (mean score, 2.8/8.0) ranged from 19% (abortion prevalence) to 60% (no elevated risk of breast cancer) correct. For four of eight questions, "I don't know" was the most frequently chosen response. Practicing in all other areas (e.g., family practice) was associated with lower abortion law and care knowledge than practicing in women's health. Providing options counseling was positively associated with abortion knowledge (law, β = 0.44; 95% confidence interval [CI], 0.10-0.78; care, β = 0.52; 95% CI, 0.08-0.95). Compared with participants who believe abortion should be legal in all circumstances, those who believe abortion should be illegal in all circumstances had similar abortion law knowledge (β = -0.03; 95% CI, -0.65 to 0.59), but lower abortion care knowledge (β = -1.85; 95% CI, -2.34 to -1.36).

CONCLUSIONS

Abortion knowledge is low among Colorado advanced practice clinicians and education is needed.

Undue burdens created by the Texas Abortion Law for vulnerable pregnant women

The new Texas abortion law requires the physician to determine whether a fetal heartbeat is present and prohibits abortion after a heartbeat has been documented. An exception is allowed when a "medical emergency necessitated the abortion." These and other provisions of the statute are to be enforced through "civil actions" brought by private citizens. This article identifies 3 populations of vulnerable women who will experience undue burdens created by the Texas abortion law. We begin with an account of the concept of undue burden in the jurisprudence of abortion, as expressed in the 1992 US Supreme Court case, Planned Parenthood v. Casey of Southeastern Pennsylvania. We then provide an evidence-based account of the predictable, undue burdens for 3 populations of vulnerable women: pregnant women with decreased freedom of movement; pregnant minors; and pregnant women with major mental disorders and cognitive disabilities. The Texas law creates an undue burden on these 3 populations of vulnerable women by reducing or even eliminating access to abortion services outside of Texas. The Texas law also creates an undue burden by preventably increasing the risks of morbidity, including loss of fertility, and mortality for these 3 populations of vulnerable women. For these women, it is indisputable that the Texas law will create undue burdens and is therefore not compatible with the jurisprudence of abortion as set forth in Planned Parenthood v. Casey because a "significant number of women will likely be prevented from obtaining an abortion." Federal courts should therefore strike down this law.

Selecting an Abortion Clinic: The Role of Social Myths and Risk Perception in Seeking Abortion Care

Recent shifts in the abortion provision landscape have generated increased concern about how people find abortion care as regulations make abortion less accessible and clinics close. Few studies examine the reasons that people select particular facilities in such constrained contexts. Drawing from interviews with 41 Ohio residents, we find that people's clinic selections are influenced by the risks they associate with abortion care. Participants' strategies for selecting an abortion clinic included: drawing on previous experience with clinics, consulting others online, discerning reputation through name recognition and clinic type, and considering location, especially perceptions about place (privacy, legality, safety). We argue that social myths inform the risks people anticipate when seeking health care facilities, shaping care seeking in ways that are both abortion-specific and more general. These findings can also inform research in other health care contexts where patients increasingly find their options constrained by rising costs, consolidation, and facility closure.

Ohio survey data assessing perceptions of abortion safety

OBJECTIVE

Despite overwhelming data supporting the safety of abortion care in the U.S., public perceptions of abortion safety vary widely. While evidence suggests that the public overestimates abortion risk, few studies have analyzed why people think abortion is safe or unsafe.

STUDY DESIGN

Using data from the Ohio Survey of Women, a representative survey of women aged 18-44 years with a residential address in Ohio, we examined responses to two questions about abortion safety perceptions: the first asked respondents to rate abortion safety in Ohio, and the second asked respondents why they chose this rating of abortion safety. We analyzed these responses with inductive and deductive approaches.

RESULTS

There were 2,529 responses, of which 1,368 (54%) provided a response to the open-ended question about abortion safety. From this subset, 529 gave open-ended responses indicating that they perceive abortion as safe, with 47% attributing this perception to the procedure being performed by a professional in a regulated environment. In contrast, 370 gave open-ended responses indicating that they perceive abortion as unsafe; the most common explanations referred to health risks (19%) and that safety depends on pre-existing health conditions (19%).

CONCLUSION

Many participants perceived abortion as safe because it is performed by professionals in a clinical environment or because of personal experiences with abortion. Those perceiving a lack of safety provided more varied responses, including that abortion was dangerous due to a detrimental effect on mental health or protesters at abortion clinics.

Differences in abortion-related knowledge among women involved in the criminal legal system in three US cities

OBJECTIVE

We examined if abortion-related knowledge among women with criminal legal system involvement differed in three U.S. cities in states with varying abortion policies.

STUDY DESIGN

Respondents were self-identified women with criminal legal system involvement. Data come from a cross-sectional baseline survey of 381 women in three U.S. cities: Oakland, California, Kansas City, Kansas/Missouri, and Birmingham, Alabama. The primary outcome, high abortion-related knowledge, was based on a 10-item scale dichotomized into low vs high abortion-related knowledge. We used descriptive statistics, bivariable associations, and logistic regression to assess the association between high abortion-related knowledge, city of residence, and other possible related factors.

RESULTS

Respondents in Kansas City, KS/MO and Birmingham, AL had lower odds of high abortion-related knowledge compared to respondents in Oakland, CA (OR: 0.19, 95% CI: 0.10-0.38 and OR: 0.17, 95% CI: 0.11-0.28, respectively). In adjusted analysis, the association remained after controlling for race/ethnicity, insurance status, and community supervision past year.

CONCLUSIONS

Findings underscore the need for communicating clear and accurate information about abortion care, especially in states where laws and ongoing political challenges make it difficult to access both reliable information and services.

IMPLICATIONS

Efforts to disseminate accurate information regarding abortion care, particularly among marginalized people, should utilize multiple venues in addition to traditional healthcare information sources. Reproductive justice advocates should connect with jails and probation offices to reach people with criminal legal system involvement and foster increased knowledge of reproductive rights and services.

Attitudes of US adults toward using telemedicine to prescribe medication abortion during COVID-19: A mixed methods study

OBJECTIVES

We explored public opinion about using telemedicine to provide medication abortion during the COVID-19 pandemic in 2020. We also investigated the associations between socio-demographic characteristics and support for using telemedicine in this context and explored factors that influenced respondents' attitudes on the topic.

STUDY DESIGN

In a nationally representative, web-based survey of US adults (n = 711), we asked open- and closed-ended questions about using telemedicine to prescribe medication abortion during COVID-19. We used multinomial logistic regression to assess the relationship between socio-demographic characteristics, endorsement of abortion labels, and political affiliation and support for telemedicine in this circumstance. Then, we conducted content and thematic analyses with the open-ended data to explore what influenced respondents' opinions.

RESULTS

Overall, 332 (44%) of respondents supported using telemedicine for medication abortion during the pandemic; 237 (35%) opposed and 138 (21%) were unsure. Respondents who identified as prochoice were more likely to support using telemedicine for abortion during the pandemic than those who identified as prolife were to oppose it in this context (RRR 2.95; 95% CI 1.31-6.64). Via our content and thematic analysis, we identified that concerns about safety, the legitimacy of telemedicine, and the belief that abortion should occur as early in the pregnancy as possible influenced respondents' beliefs about using telemedicine for medication abortion.

CONCLUSIONS

More respondents supported using telemedicine for medication abortion during COVID-19 than opposed it. Among respondents who expressed support, most thought that medication abortion was safe and that telemedicine was equivalent to the in-person provision of care.

IMPLICATIONS

There appears to be support among US adults for the provision of medication abortion via telemedicine during COVID-19. Policymakers may consider public sentiment as well as clinical evidence when considering legislation about abortion.