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Cartwright AF, Bell SO, Upadhyay UD. Separating Procedure-related Fears From Future Fertility Concerns Among a Cohort Seeking Abortion Information Online. Womens Health Issues 2024; 34:45-50. [PMID: 37479629 PMCID: PMC10796831 DOI: 10.1016/j.whi.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION The general public and abortion patients in the United States have misinformation about the risks of infertility associated with abortion, which may influence abortion care-seeking. METHODS The Google Ads Abortion Access Study was a national study of people considering abortion and searching online for information. Participants completed baseline and follow-up surveys, providing free text responses to questions about barriers and facilitators to abortion. We conducted an exploratory analysis of the free text responses related to fertility and used thematic analysis to identify concerns raised about links between abortion and future fertility. RESULTS Of 864 participants who provided free text responses in the follow-up survey, 32 specifically mentioned fertility. Few expressed fear that complications from the abortion procedure would somehow lead to infertility; rather, most discussed complex and overlapping thoughts about how abortion factored into their reproductive life plans. These included age-related concerns, missing out on their "chance" to have a child, fear of being punished by God with infertility for having an abortion, and conflicting emotions if they had previously been told they were subfecund or infertile. CONCLUSION Although previous research has focused on misinformation about the link between abortion and infertility, participants in this study rarely mentioned it as a concern. Researchers and practitioners should be attuned to the distinctions people make between infertility occurring as a result of abortion and other fears they might have about not achieving their future reproductive aspirations, ask questions, and provide counseling accordingly.
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Affiliation(s)
- 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; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Suzanne O Bell
- Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, Oakland, California
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2
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French V, Steinauer J. Sexual and reproductive health teaching in undergraduate medical education: A narrative review. Int J Gynaecol Obstet 2023; 163:23-30. [PMID: 36951645 DOI: 10.1002/ijgo.14759] [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: 06/14/2022] [Revised: 02/25/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE Contraception use, undesired pregnancy, and abortion care are common medical experiences that most physicians will encounter for their patients. Future physicians should therefore have some formal education on these topics. In this narrative review, we focused on how medical education approaches these sometimes polarizing yet fundamental topics. METHODS We assessed the published literature on sexual and reproductive health education in undergraduate medical education from 2000 to 2021, screening 868 articles and including 52 articles. We included articles that discussed contraception, emergency contraception, pregnancy options counseling, abortion, and ethics related to sexual and reproductive health. RESULTS Included studies came from 14 countries and described both preclinical and clinical education. Studies assessed medical student knowledge, the effectiveness of educational interventions and medical school faculty perspectives on sexual and reproductive health curricula. Medical educators have employed a variety of approaches to teach sexual and reproductive health including simulation, objective structured clinical examinations, team-based learning, narrative medicine, online modules, and flipped classrooms. CONCLUSION Students generally received sexual and reproductive health education favorably, demonstrating increased knowledge and comfort with these topics after an education session. Studies also identified curricular gaps and deficiencies in student knowledge, which may indicate a need for improved and consistent medical school education on contraception and abortion.
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Affiliation(s)
- Valerie French
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas, USA
| | - Jody Steinauer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
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Wang S, Su F, Ye L, Jing Y. Disinformation: A Bibliometric Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16849. [PMID: 36554727 PMCID: PMC9779732 DOI: 10.3390/ijerph192416849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This paper aimed to provide a systematic review of relevant articles from the perspectives of literature distribution, research hotspots, and existing results to obtain the frontier directions in the field of disinformation. METHODS We analyzed disinformation publications published between 2002 and 2021 using bibliometric methods based on the Web of Science. There were 5666 papers analyzed using Derwent Data Analyzer (DDA). RESULTS The result shows that the USA was the most influential country in this area, while Ecker and Lewandowsky from the University of Western Australia published the largest volumes of papers. Keywords such as "social media", "COVID-19", and "vaccination" have gained immense popularity recently. CONCLUSIONS We summarized four themes that are of the biggest concern to scholars: group heterogeneity of misinformation in memory, disinformation mechanism in social media, public health related to COVID-19, and application of big data technology in the infodemic. The future agenda of disinformation is summarized from three aspects: the mechanism of disinformation, social media users, and the application of algorithms. This work can be a meaningful resource for researchers' study in the area of disinformation.
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Affiliation(s)
- Shixiong Wang
- Library, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Fangfang Su
- College of Economics and Management, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Lu Ye
- College of Economics and Management, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Yuan Jing
- Library, Zhejiang Sci-Tech University, Hangzhou 310018, China
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Madzia J, Kudrimoti M, Turner AN, Bessett D, Gallo MF. Ohio survey data assessing perceptions of abortion safety. Contraception 2021; 110:86-92. [PMID: 34971612 DOI: 10.1016/j.contraception.2021.11.008] [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: 04/05/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Juliana Madzia
- University of Cincinnati Dept. of Sociology, 301 Clifton Ct, Cincinnati, OH 45219, USA.
| | - Meghana Kudrimoti
- The Ohio State University College of Medicine, 370 W 9(th) Ave, Columbus, OH 43210, USA
| | - Abigail Norris Turner
- The Ohio State University College of Public Health, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH 43210, USA
| | - Danielle Bessett
- University of Cincinnati Dept. of Sociology, 301 Clifton Ct, Cincinnati, OH 45219, USA
| | - Maria F Gallo
- The Ohio State University College of Public Health, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH 43210, USA
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Patev AJ, Hood KB. Towards a better understanding of abortion misinformation in the USA: a review of the literature. CULTURE, HEALTH & SEXUALITY 2021; 23:285-300. [PMID: 32202213 DOI: 10.1080/13691058.2019.1706001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
Roughly 20% of women in the USA will seek an abortion during their lifetimes. As abortion is a medical procedure, individuals seeking abortion services must have access to accurate medical information. Inaccurate information about abortion, known as abortion misinformation, adversely affects knowledge about abortion, and may impair informed decision-making. Abortion misinformation has received limited attention in psychological and health research. This review summarises current findings on abortion misinformation from studies of adults in the USA, examines which forms of misinformation are most common, and assesses prominent sources of abortion misinformation. A narrative, integrative approach was adopted focussing on nine articles. Findings suggest that first, inaccurate beliefs about abortion exist among many samples of US adults, including inaccurate connections between abortion and breast cancer, infertility and negative mental health outcomes. Second, abortion misinformation comes from a variety of informational sources, which may render efforts to prevent it challenging. Summarising and extending knowledge of abortion misinformation may be useful first steps to better understanding this phenomenon and may ultimately aid in reduction of abortion misinformation among individuals living in the USA.
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Affiliation(s)
- Alison J Patev
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kristina B Hood
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Liu YQ, Yu Y, Bai JB, Chen XL. Development and psychometric properties of the maternal health needs scale in Chinese maternal women. Midwifery 2020; 81:102588. [DOI: 10.1016/j.midw.2019.102588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/04/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
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Herold S, Sisson G. Hangers, Potions, and Pills: Abortion Procedures on American Television, 2008 to 2018. Womens Health Issues 2019; 29:499-505. [PMID: 31331660 DOI: 10.1016/j.whi.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Television portrayals of medical procedures may contribute to patient anxieties and cultural myths. We explored how television depicts abortion procedures, focusing on what these portrayals communicate about abortion access and safety. METHODS Researchers identified all abortion procedure plotlines on American television from 2008 to 2018 through Internet searches. We viewed plotlines and coded for type of abortion, health outcome, and whether the abortion occurred on or off screen. We used inductive content analysis to identify themes. FINDINGS We identified 96 television plotlines between 2008 and 2018 in which a character obtains or discloses an abortion. Of these, 39 plotlines (40%) depict some aspect of the abortion procedure. Twenty-three of the 39 abortion portrayals (59%) depict a surgical abortion procedure, of which about one-half were legal abortions and one-half were illegal. Only 7 of the 39 procedure plotlines (18%) portray medication abortions. Five of these plotlines depict illegal abortions; only two depict legal abortions. Four plotlines depict attempted abortions by supernatural means or ingestion of a toxic liquid. CONCLUSION The majority of abortions on television are surgical, contrasting with the reality of abortion practice in which one-third of U.S. abortions are by medication. Portrayals of surgical abortion often reinforce the misperception that abortion is a surgical intervention requiring hospitalization. The few portrayals of medication abortion also perpetuate inaccuracies, including that it is easily accessible, uncommon, and dangerous. Portrayals of illegal abortions are overrepresented. This misinformation may seed unnecessary fear for patients before an abortion, and may create confusion among the public about abortion access and safety.
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Affiliation(s)
- Stephanie Herold
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, California.
| | - Gretchen Sisson
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, California
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Donnelly KZ, Elwyn G, Theiler R, Thompson R. Promoting or Undermining Quality Decision Making? A Qualitative Content Analysis of Patient Decision Aids Comparing Surgical and Medication Abortion. Womens Health Issues 2019; 29:414-423. [PMID: 31266679 DOI: 10.1016/j.whi.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/09/2019] [Accepted: 05/24/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To understand, describe, and compare the content of patient decision aids on surgical and medication abortion, including 1) attributes used to describe each method, 2) approaches to clarify patients' values, 3) language used to describe each method, and 4) language used to frame women's decision-making role. STUDY DESIGN We analyzed 49 decision aids identified through a previous systematic review and environmental scan. We used summative content analysis for objectives 1 and 2 and directed content analysis for objectives 3 and 4. RESULTS We identified 37 method attributes. Overall, the attributes privileged medical over practical and emotional information. One decision aid included an explicit values clarification approach, and others included implicit approaches, which varied in length, information consistency, and organization. We identified four themes-information consistency, subjective claims, emotive or ambiguous descriptions, and medication abortion as not a real abortion-related to the methods' descriptions. We identified three themes-agency in choice, unclear emphasis on women's preferences, and endorsement of clinic services-related to women's decision-making role. Of the nine tools that listed factors influencing women's decision making, patient preferences was often listed last. CONCLUSIONS Early abortion method decision aids presented a broad range of information and typically framed the method choice as the woman's. However, their emphasis on medical attributes, use of inconsistent information, and, at times, biased presentation of methods may undermine quality decision making. We recommend adapting an existing decision aid or designing a novel tool based on the content and language that women find most acceptable.
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Affiliation(s)
- Kyla Z Donnelly
- The Dartmouth Centers for Health and Aging, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Regan Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Rachel Thompson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Littman L. Correction: Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS One 2019; 14:e0214157. [PMID: 30889220 PMCID: PMC6424391 DOI: 10.1371/journal.pone.0214157] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kimport K, Doty C. Interpreting the Truth: How People Make Sense of New Information about Abortion. Womens Health Issues 2019; 29:182-187. [PMID: 30826134 DOI: 10.1016/j.whi.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 12/19/2018] [Accepted: 01/18/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In July 2015, the antiabortion Center for Medical Progress released a covertly filmed video of a Planned Parenthood official discussing the dispensation of postabortion remains for research, a practice the general public was not familiar with. Research shows that people use preexisting frameworks (such as support for or opposition to abortion rights) to make sense of new information. We examine the presence and use of abortion-related movement heuristics, language, and framing in the lay public's engagement with this video and their response to it. METHODS Using modified grounded theory, we analyzed user comments on five online news articles about the video, drawn from sources representing different segments of the spectrum of support for abortion rights, to serve as a proxy for the public conversation. RESULTS Commenters used language and framing consistent with the abortion rights and antiabortion social movements to debate basic information about this practice (i.e., the language of "fetal tissue" vs "baby parts" and whether the abortion provider profited from the exchange). Discussion of the abortion provider's casual demeanor, however, did not always use movement language and association consistently, with some commenters demonstrating inconsistency between their support for abortion and response to the video. CONCLUSIONS Online commenters largely used language consistent with the contemporary abortion movements' ideological frames in their engagement about the video. The presence of this language suggests that people may draw on existing frameworks about abortion when they engage with abortion-related information, which could have implications for efforts to address abortion misinformation.
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Affiliation(s)
- Katrina Kimport
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, California.
| | - Colin Doty
- Bachelor's Degree for Professionals Program, California Lutheran University, Thousand Oaks, California
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Upadhyay UD, Johns NE, Barron R, Cartwright AF, Tapé C, Mierjeski A, McGregor AJ. Abortion-related emergency department visits in the United States: An analysis of a national emergency department sample. BMC Med 2018; 16:88. [PMID: 29898742 PMCID: PMC6000974 DOI: 10.1186/s12916-018-1072-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/10/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Media depictions and laws passed in state legislatures regulating abortion suggest abortion-related medical emergencies are common. An accurate understanding of abortion-related emergencies is important for informing policy and practice. We assessed the incidence of abortion-related emergency department (ED) visits in the United States (U.S.). METHODS We used a retrospective observational study design using 2009-2013 data from the Nationwide Emergency Department Sample, a nationally representative sample of U.S. ED visits from 947 to 964 hospitals across the U.S. per year. All ED visits among women of reproductive age (15-49) were included. We categorized ED visits by abortion relatedness and treatments received, and assessed whether the visit was for a major incident (defined as requiring blood transfusion, surgery, or overnight inpatient stay). We estimated the proportion of visits that were abortion-related and described the characteristics of patients making these visits, the diagnoses and subsequent treatments received by these patients, the sociodemographic and hospital characteristics associated with the incidents and observation care only (defined as receiving no treatments), and the rate of major incidents for all abortion patients in the U.S. RESULTS Among all ED visits by women aged 15-49 (189,480,685), 0.01% (n = 27,941) were abortion-related. Of these visits, 51% (95% confidence interval, 95% CI 49.3-51.9%) of the women received observation care only. A total of 20% (95% CI 19.3-21.3%) of abortion-related ED visits were for major incidents. One-fifth (22%, 95% CI 20.9-23.0%) of abortion-related visits resulted in admission to the same hospital for abortion-related reasons. Of the visits, 1.4% (n = 390, 95% CI 1.1-1.7%) were potentially due to attempts at self-induced abortion. In multivariable models, women using Medicaid (adjusted odds ratio, AOR 1.28, 95% CI 1.08-1.52) and women with a comorbid condition (AORs 2.47-4.63) had higher odds of having a major incident than women using private insurance and those without comorbid conditions. During the study period, 0.11% of all abortions in the U.S. resulted in major incidents as seen in EDs. CONCLUSIONS Abortion-related ED visits comprise a small proportion of women's ED visits. Many abortion-related ED visits may not be indicated or could have been managed at a less costly level of care. Given the low rate of major incidents, perceptions that abortion is unsafe are not based on evidence.
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Affiliation(s)
- Ushma D Upadhyay
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, California, 94612, USA.
| | - Nicole E Johns
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, California, 94612, USA
| | - Rebecca Barron
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Alice F Cartwright
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, California, 94612, USA
| | - Chantal Tapé
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Alyssa Mierjeski
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Alyson J McGregor
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
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Kamali S, Ahmadian L, Khajouei R, Bahaadinbeigy K. Health information needs of pregnant women: information sources, motives and barriers. Health Info Libr J 2017; 35:24-37. [PMID: 29131537 DOI: 10.1111/hir.12200] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 09/24/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pregnant women should be provided with relevant and useful information to manage this specific period of their lives. Assessing information needs of this group is a prerequisite for providing this information. OBJECTIVE The aim of this study was to assess the information needs of pregnant women during their pregnancy and childbirth. METHODS This descriptive study was conducted on the pregnant women who attended antenatal clinics and obstetricians/gynaecologists' offices in Kerman, Iran, in 2015. Data were collected using a self-administered, valid and reliable questionnaire. A total of 400 women participated in the study. FINDINGS Most pregnant women needed information about care of the foetus (n = 344, 86%), physical and psychological complications after delivery (n = 333, 83%), development and growth of the foetus (n = 330, 82.5%), pregnancy nutrition (n = 327, 82%) and special tests during pregnancy (n = 326, 81.5%). They mostly (n = 195, 49%) looked for information when they were suffering from a disease or pregnancy complications. CONCLUSIONS As pregnant women need extensive information to be able to take care of themselves and their babies, their information needs should be identified and taken into consideration when planning educational programmes for this group of women.
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Affiliation(s)
- Sudabeh Kamali
- Health Information Sciences Department, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Ahmadian
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Donnelly KZ, Elwyn G, Thompson R. Quantity over quality-Findings from a systematic review and environmental scan of patient decision aids on early abortion methods. Health Expect 2017; 21:316-326. [PMID: 28881071 PMCID: PMC5750699 DOI: 10.1111/hex.12617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2017] [Indexed: 12/25/2022] Open
Abstract
Background The availability and effectiveness of decision aids (DAs) on early abortion methods remain unknown, despite their potential for supporting women's decision making. Objective To describe the availability, impact and quality of DAs on surgical and medical early abortion methods for women seeking induced abortion. Search strategy For the systematic review, we searched MEDLINE, Cochrane Library, CINAHL, EMBASE and PsycINFO. For the environmental scan, we searched Google and App Stores and consulted key informants. Inclusion criteria For the systematic review, we included studies evaluating an early abortion method DA (any format and language) vs a comparison group on women's decision making. DAs must have met the Stacey et al (2014). Cochrane review definition of DAs. For the environmental scan, we included English DAs developed for the US context. Data extraction and synthesis We extracted study and DA characteristics, assessed study quality using the Effective Practice and Organization of Care risk of bias tool and assessed DA quality using International Patient Decision Aid Standards (IPDAS). Results The systematic review identified one study, which found that the DA group had higher knowledge and felt more informed. The evaluated DA met few IPDAS criteria. In contrast, the environmental scan identified 49 DAs created by non‐specialists. On average, these met 28% of IPDAS criteria for Content, 22% for Development and 0% for Effectiveness. Conclusions Research evaluating DAs on early abortion methods is lacking, and although many tools are accessible, they demonstrate suboptimal quality. Efforts to revise existing or develop new DAs, support patients to identify high‐quality DAs and facilitate non‐specialist developers' adoption of best practices for DA development are needed.
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Affiliation(s)
- Kyla Z Donnelly
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Rachel Thompson
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
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Sisson G, Herold S, Woodruff K. "The stakes are so high": interviews with progressive journalists reporting on abortion. Contraception 2017; 96:395-400. [PMID: 28844876 DOI: 10.1016/j.contraception.2017.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 08/10/2017] [Accepted: 08/16/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Because news frames can influence public and policy agendas, proponents of abortion access should be concerned with how this issue is covered in the news. While previous research has examined the content of news on abortion, this analysis explores the process of newsmaking on abortion, examining how journalists understand their role in and experience of covering abortion. STUDY DESIGN We recruited journalists with experience reporting on abortion through listservs for progressive and feminist reporters. Thirty-one participants, with experiences at 75 diverse media outlets, completed in-depth, open-ended interviews. We used grounded theory to code interview transcripts in Dedoose to identity emergent themes. RESULTS Journalists described many challenges that applied to reporting generally, but that they perceived to be more difficult around abortion: grappling with the meaning of "neutrality" on this issue, finding new angles for articles, and handling editors with varying knowledge of abortion. Over one-third (n=13) of participants mentioned feeling that the stakes were higher around abortion: this urgency and polarization left journalists frustrated by efforts to find new sources or angles on abortion stories. Finally, over 80% (n=28) of participants reported experiencing anti-abortion harassment as a result of their abortion work. CONCLUSIONS The difficulties journalists described when reporting on abortion were often rooted in abortion stigma and the political polarization around the issue. This pattern was true even for reporters who worked to counter abortion stigma through their reporting. IMPLICATIONS Advocates interested in accurate, destigmatizing news frames might work pro-actively to educate editors and increase reporters' access to providers, patients, and advocates.
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Do 72-Hour Waiting Periods and Two-Visit Requirements for Abortion Affect Women's Certainty? A Prospective Cohort Study. Womens Health Issues 2017; 27:400-406. [DOI: 10.1016/j.whi.2017.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/08/2017] [Accepted: 02/10/2017] [Indexed: 11/19/2022]
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Kirkman M, Apicella C, Graham J, Hickey M, Hopper JL, Keogh L, Winship I, Fisher J. Meanings of abortion in context: accounts of abortion in the lives of women diagnosed with breast cancer. BMC Womens Health 2017; 17:26. [PMID: 28381301 PMCID: PMC5382471 DOI: 10.1186/s12905-017-0383-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 03/30/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A breast cancer diagnosis and an abortion can each be pivotal moments in a woman's life. Research on abortion and breast cancer deals predominantly with women diagnosed during pregnancy who might be advised to have an abortion. The other-discredited but persistent-association is that abortions cause breast cancer. The aim here was to understand some of the ways in which women themselves might experience the convergence of abortion and breast cancer. METHODS Among 50 women recruited from the Australian Breast Cancer Family Study and interviewed in depth about what it meant to have a breast cancer diagnosis before the age of 41, five spontaneously told of having or contemplating an abortion. The transcripts of these five women were analysed to identify what abortion meant in the context of breast cancer, studying each woman's account as an individual "case" and interpreting it within narrative theory. RESULTS It was evident that each woman understood abortion as playing a different role in her life. One reported an abortion that she did not link to her cancer, the second was relieved not to have to abort a mid-treatment pregnancy, the third represented abortion as saving her life by making her cancer identifiable, the fourth grieved an abortion that had enabled her to begin chemotherapy, and the fifth believed that her cancer was caused by an earlier abortion. CONCLUSIONS The women's accounts illustrate the different meanings of abortion in women's lives, with concomitant need for diverse support, advice, and information.
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Affiliation(s)
- Maggie Kirkman
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Carmel Apicella
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jillian Graham
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
| | - Martha Hickey
- School of Medicine, The University of Melbourne, Melbourne, Australia
| | - John L. Hopper
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ingrid Winship
- School of Medicine, The University of Melbourne, Melbourne, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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17
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Sisson G, Rowland B. "I was close to death!": abortion and medical risk on American television, 2005-2016. Contraception 2017; 96:25-29. [PMID: 28365166 DOI: 10.1016/j.contraception.2017.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the portrayal of complications and long-term health consequences associated with abortion on television, recognizing the impact that fictional stories can have on public beliefs about abortion's safety. STUDY DESIGN Using a systematic online search, we identified all instances of abortion on US television from 2005 to 2016. We qualitatively coded these plotlines to identify any occurrences of complications, interventions or long-term health consequences associated with abortion care, with 95% intercoder reliability. We calculated the frequencies and rates of these occurrences in Microsoft Excel. RESULTS Our search identified 80 abortion plot lines. A percentage of 37.5 of characters who obtained an abortion experienced complications, interventions and/or negative health consequences. This rate contrasts with the 2.1% of real patients who experience complications or require intervention as a result of their abortions. Most onscreen complications were major events (e.g., hemorrhage), as opposed to real women, whose complications are mostly minor. Major medical interventions (e.g., hysterectomy) were similarly overportrayed, while the most commonly used interventions for real patients (e.g., medication) were not depicted at all. Finally, 22.5% of characters faced a long-term adverse health consequence, including mental illness, infertility or death. The onscreen abortion mortality rate was 5%, about 7000 times the actual mortality rate. CONCLUSIONS Overall, television dramatically exaggerates the risk associated with abortion procedures, overportraying medical complications - particularly major and life-threatening complications - and long-term adverse health consequences. This pattern of misrepresentation may be partially attributable to the occurrence of stories about illegal abortions or abortions taking place outside of modern medical contexts. IMPLICATIONS Onscreen abortion portrayals may contribute to inaccurate beliefs about abortion's risk that are common among the public, broadly, and abortion patients, specifically. Abortion advocates and providers will be more equipped to respond misinformation if they understand how and to what extent our popular culture portrays abortion as unsafe.
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18
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Berglas NF, Gould H, Turok DK, Sanders JN, Perrucci AC, Roberts SCM. State-Mandated (Mis)Information and Women's Endorsement of Common Abortion Myths. Womens Health Issues 2017; 27:129-135. [PMID: 28131389 DOI: 10.1016/j.whi.2016.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The extent that state-mandated informed consent scripts affect women's knowledge about abortion is unknown. We examine women's endorsement of common abortion myths before and after receiving state-mandated information that included accurate and inaccurate statements about abortion. METHODS In Utah, women presenting for an abortion information visit completed baseline surveys (n = 494) and follow-up interviews 3 weeks later (n = 309). Women answered five items about abortion risks, indicating which of two statements was closer to the truth (as established by prior research) or responding "don't know." We developed a continuous myth endorsement scale (range, 0-1) and, using multivariable regression models, examined predictors of myth endorsement at baseline and change in myth endorsement from baseline to follow-up. RESULTS At baseline, many women reported not knowing about abortion risks (range, 36%-70% across myths). Women who were younger, non-White, and had previously given birth but not had a prior abortion reported higher myth endorsement at baseline. Overall, myth endorsement decreased after the information visit (0.37-0.31; p < .001). However, endorsement of the myth that was included in the state script-describing inaccurate risks of depression and anxiety-increased at follow-up (0.47-0.52; p < .05). CONCLUSIONS Lack of knowledge about the effects of abortion is common. Knowledge of information that was accurately presented or not referenced in state-mandated scripts increased. In contrast, inaccurate information was associated with decreases in women's knowledge about abortion, violating accepted principles of informed consent. State policies that require or result in the provision of inaccurate information should be reconsidered.
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Affiliation(s)
- Nancy F Berglas
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, California.
| | - Heather Gould
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, California
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Alissa C Perrucci
- Women's Options Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, California
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19
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Ralph LJ, Foster DG, Kimport K, Turok D, Roberts SCM. Measuring decisional certainty among women seeking abortion. Contraception 2016; 95:269-278. [PMID: 27745910 DOI: 10.1016/j.contraception.2016.09.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Evaluating decisional certainty is an important component of medical care, including preabortion care. However, minimal research has examined how to measure certainty with reliability and validity among women seeking abortion. We examine whether the Decisional Conflict Scale (DCS), a measure widely used in other health specialties and considered the gold standard for measuring this construct, and the Taft-Baker Scale (TBS), a measure developed by abortion counselors, are valid and reliable for use with women seeking abortion and predict the decision to continue the pregnancy. METHODS Eligible women at four family planning facilities in Utah completed baseline demographic surveys and scales before their abortion information visit and follow-up interviews 3 weeks later. For each scale, we calculated mean scores and explored factors associated with high uncertainty. We evaluated internal reliability using Cronbach's alpha and assessed predictive validity by examining whether higher scale scores, indicative of decisional uncertainty or conflict, were associated with still being pregnant at follow-up. RESULTS Five hundred women completed baseline surveys; two-thirds (63%) completed follow-up, at which time 11% were still pregnant. Mean scores on the DCS (15.5/100) and TBS (12.4/100) indicated low uncertainty, with acceptable reliability (α=.93 and .72, respectively). Higher scores on each scale were significantly and positively associated with still being pregnant at follow-up in both unadjusted and adjusted analyses. CONCLUSION The DCS and TBS demonstrate acceptable reliability and validity among women seeking abortion care. Comparing scores on the DCS in this population to other studies of decision making suggests that the level of uncertainty in abortion decision making is comparable to or lower than other health decisions. IMPLICATIONS The high levels of decisional certainty found in this study challenge the narrative that abortion decision making is exceptional compared to other healthcare decisions and requires additional protection such as laws mandating waiting periods, counseling and ultrasound viewing.
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Affiliation(s)
- Lauren J Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
| | - Katrina Kimport
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
| | - David Turok
- University of Utah, Department of Obstetrics and Gynecology, 50 N Medical Dr, Salt Lake City, UT 84132, USA.
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA.
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20
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Sisson G, Kimport K. After After Tiller: the impact of a documentary film on understandings of third-trimester abortion. CULTURE, HEALTH & SEXUALITY 2015; 18:695-709. [PMID: 26670628 DOI: 10.1080/13691058.2015.1112431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Onscreen pseudo-experiences have been shown to influence public perceptions of contested social issues. However, research has not considered whether such experiences have limits in their influence and/or vary in their impact. Using the case of third-trimester abortion, an issue subject to high amounts of misinformation, low public support and low occurrence in the general population, we investigate how the pseudo-experience of viewing After Tiller, a documentary film showing stories of third-trimester abortion, providers and patients, might serve as a counterpoint to misinformation and myth. We interviewed 49 viewers to assess how viewing the film interacted with viewers' previously held understandings of later abortion. Participants reported that viewing made them feel more knowledgeable about later-abortion patients and providers and increased their support for legal third-trimester abortion access, suggesting the efficacy of this pseudo-experience in changing belief. Nonetheless, respondents' belief systems were not entirely remade and the effects of the film varied, particularly in regards to gatekeeping around the procedure and the reasons why women seek later abortion. Findings show the potential of onscreen pseudo-experiences as a means for social change, but also reveal their limits and varying impacts.
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Affiliation(s)
- Gretchen Sisson
- a Advancing New Standards in Reproductive Health , University of California , San Francisco , USA
| | - Katrina Kimport
- a Advancing New Standards in Reproductive Health , University of California , San Francisco , USA
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21
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Donnelly KZ, Thompson R. Medical versus surgical methods of early abortion: protocol for a systematic review and environmental scan of patient decision aids. BMJ Open 2015; 5:e007966. [PMID: 26173718 PMCID: PMC4513513 DOI: 10.1136/bmjopen-2015-007966] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Currently, we lack understanding of the content, quality and impact of patient decision aids to support decision-making between medical and surgical methods of early abortion. We plan to undertake a systematic review of peer-reviewed literature to identify, appraise and describe the impact of early abortion method decision aids evaluated quantitatively (Part I), and an environmental scan to identify and appraise other early abortion method decision aids developed in the US (Part II). METHODS AND ANALYSIS For the systematic review, we will search PubMed, Cochrane Library, CINAHL, EMBASE and PsycINFO databases for articles describing experimental and observational studies evaluating the impact of an early abortion method decision aid on women's decision-making processes and outcomes. For the environmental scan, we will identify decision aids by supplementing the systematic review search with Internet-based searches and key informant consultation. The primary reviewer will assess all studies and decision aids for eligibility, and a second reviewer will also assess a subset of these. Both reviewers will independently assess risk of bias in the studies and abstract data using a piloted form. Finally, both reviewers will assess decision aid quality using the International Patient Decision Aid Standards criteria, ease of readability using Flesch/Flesch-Kincaid tests, and informational content using directed content analysis. ETHICS AND DISSEMINATION As this study does not involve human subjects, ethical approval will not be sought. We aim to disseminate the findings in a scientific journal, via academic and/or professional conferences and among the broader community to contribute knowledge about current early abortion method decision-making support. TRIAL REGISTRATION NUMBER This protocol is registered in the International Prospective Register of Systematic Reviews (CRD42015016717).
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Affiliation(s)
- Kyla Z Donnelly
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Rachel Thompson
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
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22
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Bessett D, Gerdts C, Littman LL, Kavanaugh ML, Norris A. Does state-level context matter for individuals' knowledge about abortion, legality and health? Challenging the 'red states v. blue states' hypothesis. CULTURE, HEALTH & SEXUALITY 2015; 17:733-746. [PMID: 25622191 DOI: 10.1080/13691058.2014.994230] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Recently, the hypothesis that state-level political context influences individuals' cultural values--the 'red states v. blue states' hypothesis--has been invoked to explain the hyper-polarisation of politics in the USA. To test this hypothesis, we examined individuals' knowledge about abortion in relation to the political context of their current state of residence. Drawing from an internet-survey of 586 reproductive-age individuals in the USA, we assessed two types of abortion knowledge: health-related and legality. We found that state-level conservatism does not modify the existing relationships between individual predictors and each of the two types of abortion knowledge. Hence, our findings do not support the 'red states' versus 'blue states' hypothesis. Additionally, we find that knowledge about abortion's health effects in the USA is low: 7% of our sample thought abortion before 12 weeks gestation was illegal.
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Affiliation(s)
- Danielle Bessett
- a Department of Sociology , University of Cincinnati , Cincinnati , USA
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