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Heger JA, Young BJ, Richards LR, Carrasquillo O, Kenya S. Abortion education: What are future physicians learning in medical school? Contraception 2024; 130:110293. [PMID: 37729958 DOI: 10.1016/j.contraception.2023.110293] [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: 05/26/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES The last nationwide evaluation of abortion education in undergraduate medical schools was conducted by Espey et al. more than 15 years ago. To better understand what medical schools are teaching medical students about abortion care, we conducted a brief assessment of abortion education and training at U.S. medical schools. STUDY DESIGN In April 2019, the study team emailed a three-item survey to the obstetrics and gynecology clerkship directors at Association of American Medical Colleges-accredited U.S. allopathic medical schools (n = 143). The multiple-choice survey assessed the availability and type of reproductive health education students had during their preclinical and clinical experiences. RESULTS Ninety-one (64%) medical schools responded. Fifty-four (59%) schools reported abortion education as part of their preclinical curriculum, with 26 (29%) dedicating at least one lecture to abortion education. Sixty-seven (74%) institutions provided a clinical abortion experience for students, with 24 (26%) indicating students had to arrange participation on their own. Nine programs (10%) reported offering no formal abortion education. CONCLUSIONS While the availability of abortion education has increased since the last nationwide survey in 2005, discrepancies in the education offered persist, and many medical students remain without access to this training. IMPLICATIONS Although abortion plays an essential role in women's health services, discrepancies in training opportunities limit abortion education in U.S. medical schools. Gaps in the education of medical students may have downstream effects on the availability of doctors who are trained in providing medically-safe abortions.
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Affiliation(s)
- Julie A Heger
- Deptartment of Emergency Medicine, University of California, Orange, CA, United States
| | - BreAnne J Young
- Deptartment of General Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lindsay R Richards
- Deptartment of General Medicine, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Olveen Carrasquillo
- Deptartment of General Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sonjia Kenya
- Deptartment of General Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
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Millar E. Abortion stigma, abortion exceptionalism, and medical curricula. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:261-276. [PMID: 36916481 DOI: 10.1080/14461242.2023.2184272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
ABSTRACTWhile it is well established that medical student learning about abortion is inadequate and lacks systemisation, there is little research on why this might be the case. This exploratory study draws on a survey sent to 438 medical educators at Australia's 21 accredited medical schools through March-May 2021. Forty-eight educators responded to the survey. In this article, I examine their responses alongside policy and research on medical education to consider how curricula are determined. I conceptualise abortion exceptionalism - the singling out of abortion from other areas of medicine on the grounds that it is special, different, or more complex or risky than is empirically justified - as a mode of 'stigma-in-action', arguing that medical curricula are powerful sites for its reproduction and undoing.
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Affiliation(s)
- Erica Millar
- Department of Social Inquiry, School of Humanities & Social Sciences, La Trobe University, Bundoora, Australia
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Barcelona V, Horton RL, Rivlin K, Harkins S, Green C, Robinson K, Aubey JJ, Holman A, Goffman D, Haley S, Topaz M. The Power of Language in Hospital Care for Pregnant and Birthing People: A Vision for Change. Obstet Gynecol 2023; 142:795-803. [PMID: 37678895 PMCID: PMC10510792 DOI: 10.1097/aog.0000000000005333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 09/09/2023]
Abstract
Language is commonly defined as the principal method of human communication made up of words and conveyed by writing, speech, or nonverbal expression. In the context of clinical care, language has power and meaning and reflects priorities, beliefs, values, and culture. Stigmatizing language can communicate unintended meanings that perpetuate socially constructed power dynamics and result in bias. This bias may harm pregnant and birthing people by centering positions of power and privilege and by reflecting cultural priorities in the United States, including judgments of demographic and reproductive health characteristics. This commentary builds on relationship-centered care and reproductive justice frameworks to analyze the role and use of language in pregnancy and birth care in the United States, particularly regarding people with marginalized identities. We describe the use of language in written documentation, verbal communication, and behaviors associated with caring for pregnant people. We also present recommendations for change, including alternative language at the individual, clinician, hospital, health systems, and policy levels. We define birth as the emergence of a new individual from the body of its parent, no matter what intervention or pathology may be involved. Thus, we propose a cultural shift in hospital-based care for birthing people that centers the birthing person and reconceptualizes all births as physiologic events, approached with a spirit of care, partnership, and support.
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McCarty CA, Hutto SL, Shaw AK. "It's important to foster open discussion about the topic": development, implementation, and evaluation of an ethics of abortion independent learning module for second year medical students. Reprod Health 2023; 20:145. [PMID: 37749632 PMCID: PMC10521547 DOI: 10.1186/s12978-023-01686-w] [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: 04/19/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Despite the frequency of abortions, one-third of medical schools in the US and Canada did not include coverage of that topic, according to a survey conducted in 2002-2005. The purpose of this project was to develop, implement, and evaluate a module for second year medical students related to the ethics of abortion. METHODS The module was designed as Independent Learning Time (ILT). The stated purpose was for students to consider some of the recent debate in the ethics literature related to conscientious objection and abortion and how personal views may influence future practice. The ILT included readings and Power Points to view. Students were asked to write a one-page reflection on one of three writing prompts. RESULTS The most commonly selected writing prompt in three classes was on personal values in relation to abortion (56.5%), followed by information about nearest provider of reproductive services to rural preceptor site (34.7%), followed by conscientious objection (23.3%). We received many positive comments about the ILT, including: "First, I would like to acknowledge my gratitude for this assignment and its subject. I believe it is very important that future physicians learn the entirety of women's reproductive health care, including abortion and contraception, but unfortunately this is not always the case in medical training". CONCLUSIONS There has been an extremely positive response to the ILT. With the exception of the prompt specific to our regional campus mission that includes rural preceptorships during the preclinical years, this module could be implementable at other medical schools.
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Affiliation(s)
- Catherine A McCarty
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, 1035 University Drive, Duluth, MN, 55812, USA.
| | - Sarah L Hutto
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Aubie K Shaw
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
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Rivlin K, Kissling A, Sackeim MG. "They were there because they were pregnant. Which is a really apolitical thing"-Medical student discussions of politics in abortion care in the United States. Contraception 2023; 120:109922. [PMID: 36535416 DOI: 10.1016/j.contraception.2022.109922] [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: 06/21/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES State abortion policies can vary widely. Geographic location and political climate could influence a medical student's abortion education experience. We compared how medical students training in one permissive and one restrictive state discussed politics in abortion care. STUDY DESIGN From 2018 to 2019, we interviewed US medical students during their Obstetrics and Gynecology rotation from two Midwestern academic centers with differing state abortion policies-one in Ohio (restrictive) and one in Illinois (permissive). In-depth interviews occurred following an abortion shadowing experience and included questions about politics in abortion care. We sorted data using flexible coding, with index codes around "politics," followed by specific analytic coding. We compared codes by medical school using NVIVO software. RESULTS We interviewed 28 students (50% in Ohio). Students in Ohio discussed specific barriers to patient care and how politics infringed upon the quality of medical care, describing abortion as stigmatized care. Students in Illinois described abortion as high-quality medical care, delivered without the infringement of restrictive laws. Students at both schools described their medical school climates as supportive to abortion, yet in Ohio, students described exposure to more diverse abortion views than Illinois students. Ohio students also described engaging in abortion advocacy work, while Illinois students felt more politically disconnected. CONCLUSIONS Even as clinical training opportunities decline, restrictive states may hold unique advocacy opportunities. Educators should tailor abortion curricula to address state level differences, as disparities in abortion access and student learning opportunities widen. IMPLICATIONS Students training in permissive states see abortion as routine health care, occurring without political interference. Students in restrictive states see abortion as hindered by politics and stigmatized, which may encourage advocacy. Educators should tailor curricula to address state level differences as disparities in abortion access and student learning opportunities widen.
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Affiliation(s)
- Katherine Rivlin
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH, United States.
| | - Alexandra Kissling
- Department of Sociology, Ohio State University, Columbus, OH, United States
| | - Maryl G Sackeim
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
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Heuser CC, Sagaser KG, Christensen EA, Johnson CT, Lappen JR, Horvath S. Society for Maternal-Fetal Medicine Special Statement: A critical examination of abortion terminology as it relates to access and quality of care. Am J Obstet Gynecol 2023; 228:B2-B7. [PMID: 36563832 DOI: 10.1016/j.ajog.2022.12.302] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Legal, institutional, and payer policies regulating reproductive health care lack a shared language with medicine, resulting in great confusion and consternation. This paper critically examines the implications and ramifications of unclear language related to abortion care. Using a case-based approach, we highlight the ways in which language and terminology may affect the quality and accessibility of care. We also address repercussions for providers and patients within their team, institutional, state, and payer landscapes. In particular, we explore the stigmatization of abortion as both a word and a process, the role of caregivers as gatekeepers, the implications of viability as a limit for access, and the hierarchy of deservedness and value. Recognizing the role of language in these discussions is critical to building systems that honor the complexities of patient-centered reproductive decision-making, ensure access to comprehensive reproductive health care including abortion, and center patient autonomy. Healthcare providers are uniquely positioned to facilitate institutional, state, and national landscapes in which pregnant patients are supported in their autonomy and provided with just and equitable reproductive health care.
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Rice WS, Narasimhan S, Newton-Levinson A, Pringle J, Redd SK, Evans DP. "Post- Roe" Abortion Policy Context Heightens the Imperative for Multilevel, Comprehensive, Integrated Health Education. HEALTH EDUCATION & BEHAVIOR 2022; 49:913-918. [PMID: 36172995 PMCID: PMC9574421 DOI: 10.1177/10901981221125399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The exceptionalism of abortion in public health education, due to social stigma,
politicization, and lack of training, contributes to misinformation, policies
unjustified by rigorous science, lack of access to person-centered health care,
and systemic pregnancy-related inequities. Now that abortion access has vanished
for large portions of the United States, following the Supreme Court decision in
Dobbs v. Jackson Women’s Health Organization
(JWHO), health educators must work to eliminate
abortion-related silos, destigmatize abortion education, and bring comprehensive
sexual and reproductive health information and evidence to the many audiences
that will require it. We discuss consequences of abortion exceptionalism in
health education for the public, health care providers, pregnant people, and
health professionals in training—and opportunities to better and more accessibly
provide sexual and reproductive health education to these audiences.
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Ward KM. Dirty Work and Intimacy: Creating an Abortion Worker. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:512-525. [PMID: 34018439 DOI: 10.1177/00221465211016440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Abortion work has changed in the decades since Roe v. Wade, and concerns over efficiency and cost reduction have resulted in increased specialization and compartmentalization of duties among health workers. This study examines the current state of surgical abortion at a clinic in southern California. Drawing on 18 months of ethnographic fieldwork at an abortion clinic, I use theories of dirty work and intimate work to examine how abortion work is organized and allocated among staff. I find that work in the clinic is best understood as existing on two intersecting spectrums of intimacy and dirtiness. Whereas existing research on abortion workers has primarily focused on doctors and nurses, this study includes medical assistants and compares experiences across different occupations. I conclude that frequency, intensity, and purpose of intimate work and dirty work coalesce to create distinct types of abortion workers.
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Connor J, Madhavan S, Mokashi M, Amanuel H, Johnson NR, Pace LE, Bartz D. Health risks and outcomes that disproportionately affect women during the Covid-19 pandemic: A review. Soc Sci Med 2020; 266:113364. [PMID: 32950924 PMCID: PMC7487147 DOI: 10.1016/j.socscimed.2020.113364] [Citation(s) in RCA: 264] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Covid-19 pandemic is straining healthcare systems in the US and globally, which has wide-reaching implications for health. Women experience unique health risks and outcomes influenced by their gender, and this narrative review aims to outline how these differences are exacerbated in the Covid-19 pandemic. OBSERVATIONS It has been well described that men suffer from greater morbidity and mortality once infected with SARS-CoV-2. This review analyzed the health, economic, and social systems that result in gender-based differences in the areas healthcare workforce, reproductive health, drug development, gender-based violence, and mental health during the Covid-19 pandemic. The increased risk of certain negative health outcomes and reduced healthcare access experienced by many women are typically exacerbated during pandemics. We assess data from previous disease outbreaks coupled with literature from the Covid-19 pandemic to examine the impact of gender on women's SARS-CoV-2 exposure and disease risks and overall health status during the Covid-19 pandemic. CONCLUSIONS Gender differences in health risks and implications are likely to be expanded during the Covid-19 pandemic. Efforts to foster equity in health, social, and economic systems during and in the aftermath of Covid-19 may mitigate the inequitable risks posed by pandemics and other times of healthcare stress.
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Affiliation(s)
| | | | | | | | - Natasha R Johnson
- Harvard Medical School, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Lydia E Pace
- Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Deborah Bartz
- Harvard Medical School, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA, USA
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Rivlin K, Sedlander E, Cepin A. "It Allows You to Challenge Your Beliefs": Examining Medical Students' Reactions to First Trimester Abortion. Womens Health Issues 2020; 30:353-358. [PMID: 32669243 DOI: 10.1016/j.whi.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/08/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Abortion is a common medical procedure, integral to women's health, and a core educational topic for medical students. Medical schools often rely on brief clinical exposure to abortion during the obstetrics and gynecology clerkship to provide this learning. Abortion is also a highly politicized and stigmatized procedure. Given this potential conflict, we examine medical student reactions to their observation of abortion care. STUDY DESIGN Medical students in their second and third years at an academic medical center who observed in a first trimester abortion clinic completed open-ended, written questionnaires. Questionnaires explored student reactions to participating in the abortion clinic. We used applied thematic analysis to code and qualitatively analyze 78 questionnaires. RESULTS We identified the following five themes: (1) students found participating in abortion care deeply worthwhile, (2) some were challenged by their reactions, particularly when reactions conflicted with prior beliefs, (3) some demonstrated empathy for the patient, but (4) some expressed judgment of both the patient and the abortion provider, and (5) students reported a desire for curricular change around abortion education, requesting more time for reflection, and some felt that their abortion observation might better prepare them to serve future patients. CONCLUSIONS Observing in an abortion clinic is a valued experience that allows students to challenge their existing beliefs and may build empathy. Educators should provide students with adequate time for preparation and reflection around this topic and address areas of misunderstanding that may perpetuate abortion stigma. These findings may inform medical student curriculum changes around abortion.
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Affiliation(s)
- Katherine Rivlin
- Department of Obstetrics and Gynecology, Columbia University Irving Medicine Center, New York, New York.
| | - Erica Sedlander
- Milken Institute School of Public Health, Department of Prevention and Community Health, The George Washington University, Washington, District of Columbia
| | - Ana Cepin
- Department of Obstetrics and Gynecology, Columbia University Irving Medicine Center, New York, New York
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Dianat S, Silverstein IA, Holt K, Steinauer J, Dehlendorf C. Breaking the silence in the primary care office: patients' attitudes toward discussing abortion during contraceptive counseling. Contracept X 2020; 2:100029. [PMID: 32671336 PMCID: PMC7338626 DOI: 10.1016/j.conx.2020.100029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 05/23/2020] [Accepted: 06/07/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives Abortions are common health experiences in the United States, yet they are siloed from mainstream health care. To provide guidance on how clinicians could break down these silos, normalize conversations about abortion, and potentially improve patient experience and contraceptive decision-making, we sought to understand patient attitudes regarding discussing abortion during contraceptive counseling. Study design In 2018, we completed in-depth semi-structured interviews with reproductive-aged women recruited from primary care clinics of two politically disparate regions within California. We elicited acceptability, preferences, and implications of clinicians mentioning abortion during contraceptive counseling. Using directed content analysis, we coded transcripts for inductive and deductive themes. Results We achieved thematic saturation after 49 interviews. Interviewees were diverse in reproductive history, race/ethnicity, religiosity, and abortion attitudes. Participants with diverse attitudes about abortion reported that having abortion mentioned during contraceptive counseling was generally viewed as acceptable, and even helpful, when delivered in a non-directive manner focused on information provision. For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making. Careful attention to a non-judgmental communication style is critical to safeguard against potential contraceptive coercion. Conclusions Discussing abortion during contraceptive counseling was acceptable among this diverse population, and our findings suggest ways to best structure such counseling. Coupled with research on clinician perspectives, our findings can inform development of patient-centered contraceptive counseling approaches that integrate abortion in an attempt to facilitate patient care and reduce stigma. Implications Mentioning abortion during contraceptive counseling can be acceptable, and even helpful, to patients when delivered in a non-directive manner focused on information provision, even among patients who believed abortion should be illegal in all or most cases. For some patients, mentioning abortion may reduce abortion stigma and help contraceptive decision-making.
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Affiliation(s)
- Shokoufeh Dianat
- University of California, San Francisco, Departments of Family & Community Medicine and Obstetrics, Gynecology & Reproductive Sciences. Address: 1001 Potrero Ave, Ward 22, San Francisco, CA 94110
| | - Ilana A Silverstein
- University of California, San Francisco, Department of Family & Community Medicine, 1001 Potrero Ave, Ward 22, San Francisco, CA 94110
| | - Kelsey Holt
- University of California, San Francisco, Department of Family & Community Medicine, 1001 Potrero Ave, Ward 22, San Francisco, CA 94110
| | - Jody Steinauer
- University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, 1001 Potrero Ave, Ward 6D, San Francisco, CA 94110
| | - Christine Dehlendorf
- University of California, San Francisco, Departments of Family & Community Medicine, Obstetrics, Gynecology & Reproductive Sciences, and Epidemiology & Biostatistics, 1001 Potrero Ave, Ward 22, San Francisco, CA 94110
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Bayefsky MJ, Bartz D, Watson KL. Abortion during the Covid-19 Pandemic - Ensuring Access to an Essential Health Service. N Engl J Med 2020; 382:e47. [PMID: 32272002 DOI: 10.1056/nejmp2008006] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michelle J Bayefsky
- From Harvard Medical School (M.J.B., D.B.) and the Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital (D.B.) - both in Boston; and the Departments of Medical Social Sciences, Medical Education, and Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago (K.L.W.)
| | - Deborah Bartz
- From Harvard Medical School (M.J.B., D.B.) and the Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital (D.B.) - both in Boston; and the Departments of Medical Social Sciences, Medical Education, and Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago (K.L.W.)
| | - Katie L Watson
- From Harvard Medical School (M.J.B., D.B.) and the Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital (D.B.) - both in Boston; and the Departments of Medical Social Sciences, Medical Education, and Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago (K.L.W.)
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Autorino T, Mattioli F, Mencarini L. The impact of gynecologists' conscientious objection on abortion access. SOCIAL SCIENCE RESEARCH 2020; 87:102403. [PMID: 32279862 DOI: 10.1016/j.ssresearch.2020.102403] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/04/2019] [Accepted: 01/16/2020] [Indexed: 06/11/2023]
Abstract
Although abortion in Italy is free of charge and legal in a broad set of circumstances, 71% of gynecologists are registered as conscientious objectors, i.e. they are exempted from performing abortions for reasons of religious or moral beliefs. To assess whether this practice limits abortion access, we analyze aggregate regional data on abortion and a dataset of over one million clinical records of single interventions performed between 2002 and 2016. Results, from both cross-regional panel data and microdata analysis, suggest that conscientious objection hampers abortion access at the local level, being a significant driver of a woman's decision of having an abortion out of the region of residence and leading to longer waiting times to have one. Conscientious objection appears to have a stronger impact on women living in lower-income regions or experiencing other forms of economic disadvantage.
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Affiliation(s)
- Tommaso Autorino
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Via Sarfatti 25, 20136 Milan, Italy
| | - Francesco Mattioli
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Via Sarfatti 25, 20136 Milan, Italy
| | - Letizia Mencarini
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Via Sarfatti 25, 20136 Milan, Italy.
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