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Ludwigson A, Euser AG, Walsh C, Zahedi-Spung L, S Hirshberg J, French-Stewart L, Scott J, Reeves S, Putra M. Characteristics of Patients Undergoing Fetal Potassium Chloride Injection at a Single Center Over Time. J Womens Health (Larchmt) 2024. [PMID: 39190579 DOI: 10.1089/jwh.2024.0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
Changes in the U.S. laws, particularly the Dobbs decision in 2022, altered access to abortions. Fetal potassium chloride (KCl) injections can be used for second- and third-trimester abortions. This descriptive study aims to present the characteristics of patients who received KCl injections in a state with protective laws (Colorado), including pre- and post-Dobbs. Patients undergoing KCl injection at our institution between January 2014 and December 2023 were included. Records were reviewed for demographic data, parity, and procedure details. Distance traveled and area deprivation index (ADI) were determined based on residence data. Group differences pre- and post-Dobbs were analyzed using Chi-squared and Mann-Whitney U tests. Subanalyses were performed to compare in-state and out-of-state (OOS) patients. One hundred and nineteen patients were included: 56 pre-Dobbs and 63 post-Dobbs, representing a 6.4-fold increase in volume post-Dobbs. Patients were from 10 states of residence pre-Dobbs and 17 post-Dobbs. Median distance traveled significantly increased post-Dobbs, 29.8 versus 383.9 miles (p = 0.004). The maximum distance traveled was 855 miles pre-Dobbs and 1,201 miles post-Dobbs. ADI did not vary pre- or post-Dobbs. Singleton procedures increased post-Dobbs for all patients. There was no change in gestational duration at the time of procedure across any comparison. Procedure volume and distance traveled increased for both in-state and OOS patients with minimal change in patient characteristics pre- and post-Dobbs. Our data indicate an increased need for these procedures, even in a state with protective laws.
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Affiliation(s)
| | - Anna G Euser
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Caroline Walsh
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Leilah Zahedi-Spung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jonathan S Hirshberg
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lindsey French-Stewart
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Julie Scott
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shane Reeves
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Manesha Putra
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Kumari R, Chander S. Improving healthcare quality by unifying the American electronic medical report system: time for change. Egypt Heart J 2024; 76:32. [PMID: 38489094 PMCID: PMC10942963 DOI: 10.1186/s43044-024-00463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND In recent years, innovation in healthcare technology has significantly improved the efficiency of the healthcare system. Advancements have led to better patient care and more cost-effective services. The electronic medical record (EMR) system, in particular, has enhanced interoperability and collaboration across healthcare departments by facilitating the exchange and utilization of patient data. The COVID-19 pandemic further accelerated this trend, leading to a surge in telemedicine services, which rely on electronic communication to deliver healthcare remotely. MAIN BODY Integrating artificial intelligence (AI) and machine learning (ML) in healthcare have been instrumental in analyzing vast data sets, allowing for identifying patterns and trends that can improve care delivery and pinpoint potential issues. The proposal of a unified EMR system in the USA aims to capitalize on these technological advancements. Such a system would streamline the sharing of patient information among healthcare providers, improve the quality and efficiency of care, and minimize the likelihood of errors in patient treatment. CONCLUSION A unified electronic medical record system represents a promising avenue for enhancing interoperability within the US healthcare sector. By creating a more connected and accessible network of patient information, it sets the stage for a transformation in healthcare delivery. This change is imperative for maintaining the momentum of progress in healthcare technology and realizing the full potential of recent advancements in patient care and system efficiency.
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Affiliation(s)
- Roopa Kumari
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, 10029, USA
| | - Subhash Chander
- Department of Pathology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, 10029, USA.
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Axelson SM, Steiner RJ, Jones RK. Characteristics of U.S. Abortion Patients Who Obtained Care Out of State Prior to the Overturning of Roe v. Wade. Womens Health Issues 2024; 34:142-147. [PMID: 38102056 DOI: 10.1016/j.whi.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023]
Abstract
CONTEXT In light of the Dobbs v. Jackson Women's Health Organization decision overturning Roe v. Wade, the number of people who need to travel out of state for abortion is increasing as several states impose abortion bans. Better understanding the characteristics of patients who obtained out-of-state abortions before the decision can provide a reference point for future research and inform efforts to improve abortion access. METHODS We used data from the 2014 Abortion Patient Survey, administered by the Guttmacher Institute, to examine the prevalence and characteristics of patients obtaining nonhospital abortions outside of their state of residence. We examined bivariate and multivariable associations between selected characteristics and obtaining an abortion out of state. RESULTS Six percent of abortion patients traveled out of state for care. Among patients who obtained their abortion out of state, more than half (56.9%) were non-Hispanic (NH) white, 26.6% were non-Hispanic Black, and 10.2% were Hispanic. Two-fifths (43.9%) resided in the South, one-third (34.3%) resided in the Midwest, 15% resided in the Northeast, and 7% resided in the West. More than one-third (38.2%) had family incomes below 100% of the federal poverty level (FPL), and two-thirds (67.7%) paid out of pocket; only 3% used Medicaid. Profiles of out-of-state abortion patients differed from in-state abortion patients by all characteristics except age. In adjusted analyses, NH Black (adjusted odds ratio [AOR]: 0.76; 95% confidence interval [CI]: 0.61-0.96), NH Asian, South Asian, and Asian Pacific Islander (AOR: 0.37; 95% CI: 0.20-0.67), and Hispanic (AOR: 0.46; 95% CI: 0.33-0.64) patients had lower odds of traveling out of state compared with their NH white counterparts. Compared with those paying for their abortion with private insurance, those who paid out of pocket had higher odds of traveling out of state (AOR: 1.75; 95% CI: 1.29-2.37) and those paying with Medicaid had lower odds (AOR: 0.27; 95% CI: 0.15-0.47). CONCLUSION Given the observed differences by race/ethnicity and method of payment for abortion, people of color and those without resources to pay out of pocket may especially benefit from efforts to support access to abortion care via interstate travel as an increasing number of states ban abortion.
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Affiliation(s)
- Sarah M Axelson
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
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White K, Arey W, Whitfield B, Dane'el A, Dixon L, Potter JE, Ogburn T, Beasley AD. Abortion patients' decision making about where to obtain out-of-state care following Texas' 2021 abortion ban. Health Serv Res 2024; 59:e14226. [PMID: 37700552 PMCID: PMC10771901 DOI: 10.1111/1475-6773.14226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE To assess pregnant Texans' decisions about where to obtain out-of-state abortion care following the September 2021 implementation of Senate Bill 8 (SB8), which prohibited abortions after detectable embryonic cardiac activity. DATA SOURCE In-depth telephone interviews with Texas residents ≥15 years of age who obtained out-of-state abortion care after SB8's implementation. STUDY DESIGN This qualitative study explored participants' experiences identifying and contacting abortion facilities and their concerns and considerations about traveling out of state. We used inductive and deductive codes in our thematic analysis describing people's decisions about where to obtain care and how they evaluated available options. DATA COLLECTION Texas residents self-referred to the study from flyers we provided to abortion facilities in Arkansas, Colorado, Kansas, Louisiana, Mississippi, New Mexico, and Oklahoma. We also enrolled participants from a concurrent online survey of Texans seeking abortion care. PRINCIPAL FINDINGS Participants (n = 65) frequently obtained referral lists for out-of-state locations from health-care providers, and a few received referrals to specific facilities; however, referrals rarely included the information people needed to decide where to obtain care. More than half of the participants prioritized getting the soonest appointment and often contacted multiple locations and traveled further to do so; others who could not travel further typically waited longer for an appointment. Although the participants rarely cited state abortion restrictions or cost of care as their main reason for choosing a location, they often made sacrifices to lessen the logistical and economic hardships that state restrictions and out-of-state travel costs created. Informative abortion facility websites and compassionate scheduling staff solidified some participants' facility choice. CONCLUSIONS Pregnant Texans made difficult trade-offs and experienced travel-related burdens to obtain out-of-state abortion care. As abortion bans prohibit more people from obtaining in-state care, efforts to strengthen patient navigation are needed to reduce care-seeking burdens as this will support people's reproductive autonomy.
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Affiliation(s)
- Kari White
- Steve Hicks School of Social WorkUniversity of Texas at AustinAustinTexasUSA
| | - Whitney Arey
- Population Research CenterUniversity of Texas at AustinAustinTexasUSA
| | - Brooke Whitfield
- Department of SociologyUniversity of Texas at AustinAustinTexasUSA
| | | | - Laura Dixon
- Population Research CenterUniversity of Texas at AustinAustinTexasUSA
| | - Joseph E. Potter
- Population Research CenterUniversity of Texas at AustinAustinTexasUSA
| | - Tony Ogburn
- Department of Obstetrics and GynecologyUniversity of Texas Rio Grande ValleyEdinburgTexasUSA
| | - Anitra D. Beasley
- Department of Obstetrics and GynecologyBaylor College of MedicineHoustonTexasUSA
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Kortsmit K, Nguyen AT, Mandel MG, Hollier LM, Ramer S, Rodenhizer J, Whiteman MK. Abortion Surveillance - United States, 2021. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2023; 72:1-29. [PMID: 37992038 PMCID: PMC10684357 DOI: 10.15585/mmwr.ss7209a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Problem/Condition CDC conducts abortion surveillance to document the number and characteristics of women obtaining legal induced abortions and number of abortion-related deaths in the United States. Period Covered 2021. Description of System Each year, CDC requests abortion data from the central health agencies for the 50 states, the District of Columbia, and New York City. For 2021, a total of 48 reporting areas voluntarily provided aggregate abortion data to CDC. Of these, 47 reporting areas provided data each year during 2012-2021. Census and natality data were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births), respectively. Abortion-related deaths from 2020 were assessed as part of CDC's Pregnancy Mortality Surveillance System (PMSS). Results A total of 625,978 abortions for 2021 were reported to CDC from 48 reporting areas. Among 47 reporting areas with data each year during 2012-2021, in 2021, a total of 622,108 abortions were reported, the abortion rate was 11.6 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 204 abortions per 1,000 live births. From 2020 to 2021, the total number of abortions increased 5% (from 592,939 total abortions), the abortion rate increased 5% (from 11.1 abortions per 1,000 women aged 15-44 years), and the abortion ratio increased 4% (from 197 abortions per 1,000 live births). From 2012 to 2021, the total number of reported abortions decreased 8% (from 673,634), the abortion rate decreased 11% (from 13.1 abortions per 1,000 women aged 15-44 years), and the abortion ratio decreased 1% (from 207 abortions per 1,000 live births).In 2021, women in their 20s accounted for more than half of abortions (57.0%). Women aged 20-24 and 25-29 years accounted for the highest percentages of abortions (28.3% and 28.7%, respectively) and had the highest abortion rates (19.7 and 19.4 abortions per 1,000 women aged 20-24 and 25-29 years, respectively). By contrast, adolescents aged <15 years and women aged ≥40 years accounted for the lowest percentages of abortions (0.2% and 3.6%, respectively) and had the lowest abortion rates (0.4 and 2.5 abortions per 1,000 women aged <15 and ≥40 years, respectively). However, abortion ratios were highest among adolescents (aged ≤19 years) and lowest among women aged 30-39 years.From 2020 to 2021, abortion rates increased among women aged 20-39 years, decreased among adolescents aged 15-19 years, and did not change among adolescents aged <15 years and women aged ≥40 years. Abortion rates decreased from 2012 to 2021 among all age groups, except women aged 30-34 years for whom it increased. The decrease in the abortion rate from 2012 to 2021 was highest among adolescents compared with any other age group. From 2020 to 2021, abortion ratios increased for women aged 15-24 years, decreased among adolescents aged <15 years and women aged ≥35 years and did not change for women aged 25-34 years. From 2012 to 2021, abortion ratios increased among women aged 15-29 years and decreased among adolescents aged <15 years and women aged ≥30 years. The decrease in abortion ratio from 2012 to 2021 was highest among women aged ≥40 years compared with any other age group.In 2021, the majority (80.8%) of abortions were performed at ≤9 weeks' gestation, and nearly all (93.5%) were performed at ≤13 weeks' gestation. During 2012-2021, the percentage of abortions performed at >13 weeks' gestation remained ≤8.7%. In 2021, the highest percentage of abortions were performed by early medication abortion at ≤9 weeks' gestation (53.0%), followed by surgical abortion at ≤13 weeks' gestation (37.6%), surgical abortion at >13 weeks' gestation (6.4%), and medication abortion at >9 weeks' gestation (3.0%); all other methods were uncommon (<0.1%). Among those that were eligible (≤9 weeks' gestation), 66.6% of abortions were early medication abortions. In 2020, the most recent year for which PMSS data were reviewed for pregnancy-related deaths; six women died as a result of complications from legal induced abortion. Interpretation Among the 47 areas that reported data continuously during 2012-2021, overall decreases were observed during 2012-2021 in the total number, rate, and ratio of reported abortions; however, from 2020 to 2021, increases were observed across all measures. Public Health Action Abortion surveillance can be used to help evaluate programs aimed at promoting equitable access to patient-centered quality contraceptive services in the United States to reduce unintended pregnancies.
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Alterio M, Von Davies R, Tobias M, Koehl A, Tang JH, Kopp D. A Geospatial Analysis of Abortion Access in the United States After the Reversal of Roe v Wade. Obstet Gynecol 2023; 142:1077-1085. [PMID: 37499266 DOI: 10.1097/aog.0000000000005329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To investigate current abortion access in the United States based on geographic location and to forecast access according to the landscape of abortion care in the year after the Dobbs v Jackson Women's Health Organization decision. METHODS Addresses of abortion-providing clinics were identified using web-based directories from Planned Parenthood, the National Abortion Foundation, Abortion Finder, and Power to Decide. Using geographic coordinates and the OpenStreetMap road network, Valhalla's Isochrone application programming interface was used to calculate the areas within a 30-, 60-, and 90-minute driving distance from these clinics. The population of reproductive-aged women (15-49 years) in the tracts inside or outside the accessible areas was determined using the U.S. Census American Community Survey for 2020. Review of legislative and judicial actions for 2023 determined at-risk states. Clinic locations and laws are accurate as of June 2, 2023. RESULTS The addresses of 750 abortion facilities were geocoded. Currently, 41.4% (30.8 million) of women do not have access to an abortion clinic within a 30-minute drive, and 29.3% and 23.6% do not have access within a 60-minute and 90-minute drive, respectively. When accounting for the combined population with no access, severely limited access, and at-risk of losing access, 53.5% of women do not have access within a 30-minute drive, and 45.6% and 43.0% do not have access within a 60-minute and 90-minute drive, respectively. DISCUSSION Two of every five American women do not have access to an abortion facility within a 30-minute drive, and one in four lack access within a 90-minute drive. These proportions could significantly increase if access is restricted further with state bans proposed in 2023.
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Affiliation(s)
- Maeve Alterio
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington; DataLab: Data Science and Informatics, University of California, Davis, Davis, California; and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Smith MH, Broscoe M, Chakraborty P, Hill J, Hood R, McGowan M, Bessett D, Norris AH. COVID-19 and abortion in the Ohio River Valley: A case study of Kentucky, Ohio, and West Virginia. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:178-191. [PMID: 37571959 DOI: 10.1363/psrh.12244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
INTRODUCTION During early stages of COVID-19 in the United States, government representatives in Kentucky, Ohio, and West Virginia restricted or threatened to restrict abortion care under elective surgery bans. We examined how abortion utilization changed in these states. METHODOLOGY We examined COVID-19 abortion-related state policies implemented in March and April 2020 using publicly available sources. We analyzed data on abortions by method and gestation and experiences of facility staff, using a survey of 14 facilities. We assessed abortions that took place in February-June 2020 and February-June 2021. RESULTS In February-June 2020 the monthly average abortion count was 1916; 863 (45%) were medication abortions and 229 (12%) were ≥14 weeks gestation. Of 1959 abortions performed across all three states in April 2020, 1319 (67%) were medication abortions and 231 (12%) were ≥14 weeks gestation. The shift toward medication abortion that took place in April 2020 was not observed in April 2021. Although the total abortion count in the three-state region remained steady, West Virginia had the greatest decline in total abortions, Ohio experienced a shift from instrumentation to medication abortions, and Kentucky saw little change. Staff reported increased stress from concerns over health and safety and increased scrutiny by the state and anti-abortion protesters. DISCUSSION Although abortion provision continued in this region, policy changes restricting abortion in Ohio and West Virginia resulted in a decrease in first trimester instrumentation abortions, an overall shift toward medication abortion care, and an increase in stress among facility staff during the early phase of COVID-19.
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Affiliation(s)
- Mikaela H Smith
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, USA
| | - Molly Broscoe
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jessie Hill
- Case Western Reserve University School of Law, Cleveland, Ohio, USA
| | - Robert Hood
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michelle McGowan
- Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Department of Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, Ohio, USA
| | - Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alison H Norris
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, USA
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Moseson H, Smith MH, Chakraborty P, Gyuras HJ, Foster A, Bessett D, Wilkinson TA, Norris AH. Abortion-Related Laws and Concurrent Patterns in Abortion Incidence in Indiana, 2010-2019. Am J Public Health 2023; 113:429-437. [PMID: 36795983 PMCID: PMC10003501 DOI: 10.2105/ajph.2022.307196] [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] [Accepted: 12/02/2022] [Indexed: 02/18/2023]
Abstract
Objectives. To analyze abortion incidence in Indiana concurrent with changes in abortion-related laws. Methods. Using publicly available data, we created a timeline of abortion-related laws in Indiana, calculated abortion rates by geography, and described changes in abortion occurrence coincident with changes in abortion-related laws between 2010 and 2019. Results. Between 2010 and 2019, Indiana's legislature passed 14 abortion-restricting laws, and 4 of 10 abortion-providing clinics closed. The Indiana abortion rate decreased from 7.8 abortions per 1000 women aged 15 to 44 years in 2010 to 5.9 in 2019. At all time points, the abortion rate was 58% to 71% of the Midwestern rate and 48% to 55% of the national rate. By 2019, nearly 1 in 3 (29%) Indiana residents who obtained abortion care did so outside the state. Conclusions. Access to abortion in Indiana over the past decade was low, required increases in interstate travel to obtain care, and co-occurred with the passage of numerous abortion restrictions. Public Health Implications. These findings preview unequal abortion access and increases in interstate travel as state-level restrictions and bans go into effect across the country. (Am J Public Health. 2023;113(4):429-437. https://doi.org/10.2105/AJPH.2022.307196).
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Affiliation(s)
- Heidi Moseson
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Mikaela H Smith
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Payal Chakraborty
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Hillary J Gyuras
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Abigail Foster
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Danielle Bessett
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Tracey A Wilkinson
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
| | - Alison H Norris
- Heidi Moseson is with Ibis Reproductive Health, Oakland, CA. Mikaela H. Smith, Hillary J. Gyuras, Abigail Foster, and Alison H. Norris are with the Ohio Policy Evaluation Network, Ohio State University, Columbus. Danielle Bessett is with the Ohio Policy Evaluation Network, University of Cincinnati, Cincinnati. Payal Chakraborty is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Tracey A. Wilkinson is with the Indiana University School of Medicine, Indianapolis
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Scoglio AAJ, Nayak SS. Alignment of state-level policies and public attitudes towards abortion legality and government restrictions on abortion in the United States. Soc Sci Med 2023; 320:115724. [PMID: 36709689 DOI: 10.1016/j.socscimed.2023.115724] [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: 10/12/2022] [Revised: 12/20/2022] [Accepted: 01/24/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Contextual factors can shape public opinion towards abortion. We investigated the association between the state-level abortion legislative climate and individual attitudes towards abortion legality and government restrictions of abortion access in the United States. METHODS Data come from the 2020 Cooperative Congressional Election Study (n = 61,000). Using multivariable logistic regression with generalized estimating equations, we explored whether state-level abortion policy climates (based on the Guttmacher Institute's 2020 rating of state abortion policies) were associated with individual attitudes (1) towards abortion legality, and (2) towards government restriction of abortion access, controlling for individual socio-demographic factors. RESULTS Eighty-eight percent of participants supported the legality of abortion in some or all circumstances. Conversely, 30% of the sample opposed all federal government restrictions on abortion. More than 60% of the sample lived in highly abortion-restrictive states. Participants living in states with a more supportive abortion legislative climate were more likely to support the legality of abortion in some or all circumstances (AOR = 1.07, (95% CI 1.05, 1.09). Participants in states with more supportive abortion policies were more likely to oppose federal governmental restrictions (AOR = 1.03, 95% CI 1.02, 1.04). Low religiosity, higher educational attainment, and politically liberal views were associated with increased support for abortion legality and increased opposition to government restrictions on abortion. CONCLUSIONS State-level abortion policy contexts were positively associated with public attitudes towards abortion. While attitudes towards abortion legality are favorable across the country; there is also strong support at least one type of government restriction on abortion access. Results highlight a disconnect between multifaceted public attitudes towards abortion and polarized state contexts, suggesting that policymaking on abortion represents a higher level of polarization than exists at the individual level. Policymakers and legislators should more carefully consider the desires of the public when designing abortion legislation.
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Affiliation(s)
- Arielle A J Scoglio
- Department of Natural and Applied Sciences, Bentley University, Waltham, MA, USA; Epidemiology Department, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Sameera S Nayak
- Department of Sociology, Anthropology, and Public Health, University of Maryland Baltimore County, Baltimore, MD, USA
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Bardhi O, Rizk PE. The Future of Medical Abortion Care: an Internal Medicine Obligation. J Gen Intern Med 2022; 37:4268-4269. [PMID: 36175756 PMCID: PMC9708975 DOI: 10.1007/s11606-022-07798-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/07/2022] [Indexed: 01/04/2023]
Abstract
Abortion care is an essential part of women's reproductive health. Due to increasing state restrictions on abortion care and the United States Supreme Court decision to overturn the landmark case of Roe v. Wade, it is becoming ever more important to increase medical abortion access for all women. Internal Medicine (IM) physicians are able to provide reproductive healthcare including medical abortions. As women in over 20 states are at risk of not having any access to abortion, it is our obligation as IM physicians to provide this care and help curb the effects of these restrictive laws and therefore train the next generation of internists to continue doing so.
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Affiliation(s)
- Olgert Bardhi
- Internal Medicine Residency Program, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
| | - Patrick E Rizk
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Jones RK, Kirstein M, Philbin J. Abortion incidence and service availability in the United States, 2020. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:128-141. [PMID: 36404279 PMCID: PMC10099841 DOI: 10.1363/psrh.12215] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND This study provides a baseline assessment of abortion incidence and service delivery prior to Roe v. Wade being overturned. METHODS We collected information from all facilities known to have provided abortion services in the United States in 2019 and 2020. We examined abortion incidence by state, region and nationally and combined data on number of abortions with population data to estimate abortion rates. We also examined the number of abortion clinics, trends in medication abortion and service disruptions and changes in abortion protocols that occurred during the COVID-19 pandemic. We compare these findings to those of our prior Abortion Provider Census, which collected information for 2017. RESULTS We documented 930,160 abortions in 2020, an 8% increase from 2017. Between 2017 and 2020, abortion incidence increased in all four regions of the country and in a majority of states. The total number of clinics providing abortion care remained stable nationally but increased in the Midwest and the West and declined in the Northeast and South. There were 492,210 medication abortions in 2020, a 45% increase from 2017. A substantial minority of clinics adjusted protocols in response to COVID, most commonly adopting remote pre- and post-abortion counseling. DISCUSSION This study did not address factors behind the increase in abortion. However, this report demonstrates that the need for abortion care was growing just prior to the overturning Roe v. Wade, and the impact of this decision will be even more far-reaching than previously expected.
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Affiliation(s)
| | | | - Jesse Philbin
- Research DivisionGuttmacher InstituteNew YorkNew YorkUSA
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Kortsmit K, Nguyen AT, Mandel MG, Clark E, Hollier LM, Rodenhizer J, Whiteman MK. Abortion Surveillance - United States, 2020. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2022; 71:1-27. [PMID: 36417304 PMCID: PMC9707346 DOI: 10.15585/mmwr.ss7110a1] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Problem/Condition CDC conducts abortion surveillance to document the number and characteristics of women obtaining legal induced abortions and number of abortion-related deaths in the United States. Period Covered 2020. Description of System Each year, CDC requests abortion data from the central health agencies for the 50 states, the District of Columbia, and New York City. For 2020, a total of 49 reporting areas voluntarily provided aggregate abortion data to CDC. Of these, 48 reporting areas provided data each year during 2011-2020. Census and natality data were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births), respectively. Abortion-related deaths from 2019 were assessed as part of CDC's Pregnancy Mortality Surveillance System (PMSS). Results A total of 620,327 abortions for 2020 were reported to CDC from 49 reporting areas. Among 48 reporting areas with data each year during 2011-2020, in 2020, a total of 615,911 abortions were reported, the abortion rate was 11.2 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 198 abortions per 1,000 live births. From 2019 to 2020, the total number of abortions decreased 2% (from 625,346 total abortions), the abortion rate decreased 2% (from 11.4 abortions per 1,000 women aged 15-44 years), and the abortion ratio increased 2% (from 195 abortions per 1,000 live births). From 2011 to 2020, the total number of reported abortions decreased 15% (from 727,554), the abortion rate decreased 18% (from 13.7 abortions per 1,000 women aged 15-44 years), and the abortion ratio decreased 9% (from 217 abortions per 1,000 live births).In 2020, women in their 20s accounted for more than half of abortions (57.2%). Women aged 20-24 and 25-29 years accounted for the highest percentages of abortions (27.9% and 29.3%, respectively) and had the highest abortion rates (19.2 and 19.0 abortions per 1,000 women aged 20-24 and 25-29 years, respectively). By contrast, adolescents aged <15 years and women aged ≥40 years accounted for the lowest percentages of abortions (0.2% and 3.7%, respectively) and had the lowest abortion rates (0.4 and 2.6 abortions per 1,000 women aged <15 and ≥40 years, respectively). However, abortion ratios were highest among adolescents (aged ≤19 years) and lowest among women aged 25-39 years.Abortion rates decreased from 2011 to 2020 among all age groups. The decrease in abortion rate was highest among adolescents compared with any other age group. From 2019 to 2020, abortion rates decreased or did not change for all age groups. Abortion ratios decreased from 2011 to 2020 for all age groups, except adolescents aged 15-19 years and women aged 25-29 years for whom abortion ratios increased. The decrease in abortion ratio was highest among women aged ≥40 years compared with any other age group. From 2019 to 2020, abortion ratios decreased for adolescents aged <15 years and women aged ≥35 and increased for women 15-34 years.In 2020, 80.9% of abortions were performed at ≤9 weeks' gestation, and nearly all (93.1%) were performed at ≤13 weeks' gestation. During 2011-2020, the percentage of abortions performed at >13 weeks' gestation remained consistently low (≤9.2%). In 2020, the highest percentage of abortions were performed by early medical abortion at ≤9 weeks' gestation (51.0%), followed by surgical abortion at ≤13 weeks' gestation (40.0%), surgical abortion at >13 weeks' gestation (6.7%), and medical abortion at >9 weeks' gestation (2.4%); all other methods were uncommon (<0.1%). Among those that were eligible (≤9 weeks' gestation), 63.9% of abortions were early medical abortions. In 2019, the most recent year for which PMSS data were reviewed for pregnancy-related deaths, four women died as a result of complications from legal induced abortion. Interpretation Among the 48 areas that reported data continuously during 2011-2020, overall decreases were observed during 2011-2020 in the total number, rate, and ratio of reported abortions. From 2019 to 2020, decreases also were observed in the total number and rate of reported abortions; however, a 2% increase was observed in the total abortion ratio. Public Health Action Abortion surveillance can be used to help evaluate programs aimed at promoting equitable access to patient-centered quality contraceptive services in the United States to reduce unintended pregnancies.
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Affiliation(s)
- Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Antoinette T. Nguyen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Michele G. Mandel
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Elizabeth Clark
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Lisa M. Hollier
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Jessica Rodenhizer
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Maura K. Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Corpuz JS, Simmonds K. Empowering the Nurse Practitioner With the Reproductive Justice Framework. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chakraborty P, Murawsky S, Smith MH, McGowan ML, Norris AH, Bessett D. How Ohio's proposed abortion bans would impact travel distance to access abortion care. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:54-63. [PMID: 35442569 PMCID: PMC9324164 DOI: 10.1363/psrh.12191] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 05/30/2023]
Abstract
CONTEXT Since March 2021, the Ohio legislature has been actively considering laws that would ban abortion if the United States Supreme Court overturns the Roe v. Wade decision that legalized abortion nationally in 1973. METHODS We used a national database of publicly advertised abortion facilities to calculate driving distances for Ohioans before and after the activation of proposed abortion bans. Using a legal analysis of abortion laws following the overturn of Roe, we determined which states surrounding Ohio would continue providing abortion care. We calculated distances from each Ohio county centroid to the nearest open abortion facility in three scenarios: (1) as of February 2022, (2) the best-case post-Roe scenario (two of the five surrounding states continue to offer abortion care), and (3) worst-case post-Roe scenario (no surrounding states continue to offer abortion care). We calculated population-weighted distances using county-level data about women aged 15-44 years from the 2019 American Community Survey. RESULTS In February 2022, all Ohio county centroids were at most 99 miles from an abortion facility (median = 50 miles). The best-case post-Roe scenario shows 62 of Ohio's 88 counties to be 115-279 miles away from the nearest facility (median = 146). The worst-case shows 85 counties to be 191-339 miles away from the nearest facility (median = 264). The current average population-weighted driving distance from county centroid to the nearest facility is 26 miles; the post-Roe scenarios would increase this to 157 miles (best-case) or 269 miles (worst-case). CONCLUSIONS Ohio's proposed abortion bans would substantially increase travel distances to abortion care, impacting over 2.2 million reproductive-aged Ohioans.
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Affiliation(s)
- Payal Chakraborty
- Division of Epidemiology, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | - Stef Murawsky
- Department of Sociology, College of Arts and SciencesUniversity of CincinnatiCincinnatiOhioUSA
| | - Mikaela H. Smith
- Division of Epidemiology, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | - Michelle L. McGowan
- Ethics CenterCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of Pediatrics, College of MedicineUniversity of CincinnatiCincinnatiOhioUSA
- Department of Women's, Gender & Sexuality Studies, College of Arts and SciencesUniversity of CincinnatiCincinnatiOhioUSA
| | - Alison H. Norris
- Division of Epidemiology, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
- Division of Infectious Diseases, College of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Danielle Bessett
- Department of Sociology, College of Arts and SciencesUniversity of CincinnatiCincinnatiOhioUSA
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